Dentistry Question

An Empirical Investigation of Healthcare Service Quality an Patient Satisfaction: A Study on the Private Dental Clinics in Jeddah A research project for the partial fulfillment of the requirments for the degree of Excutive Master of Business Adminstration By: Abdulwahed Mohammad Alghamdi Supervised by Professor Asif Salam FACULTY OF ECONOMICS AND ADMINSTRATION KING ABDULAZIZ UNIVERSITY 2023/2024 1445 1 Table of Contents: Abstract:………………………………………………………………………………………………… 5 Chapter I:………………………………………………………………………………………………. 6 Introduction:………………………………………………………………………………………….. 6 Background information: ………………………………………………………………………………………. 6 Problem Statement ………………………………………………………………………………………………… 8 Significance of the Research ………………………………………………………………………………….. 8 Scope of the Research ……………………………………………………………………………………………. 9 Research Question: ……………………………………………………………………………………………… 10 Chapter II: …………………………………………………………………………………………… 11 Literature Review: ……………………………………………………………………………….. 11 Hypothesses: ……………………………………………………………………………………………………….. 24 Chapter III: …………………………………………………………………………………………. 27 Methodology: ……………………………………………………………………………………….. 27 Research Design ………………………………………………………………………………………………….. 27 Sampling …………………………………………………………………………………………………………….. 27 Measurement of Scales and Data Collection …………………………………………………………. 27 Common Method Bias …………………………………………………………………………………………. 28 Analytical Procedure …………………………………………………………………………………………… 28 Chapter IV: ………………………………………………………………………………………….. 30 2 Analysis and Findings: …………………………………………………………………………. 30 DVSS (Dental Visit Satisfaction Scale) ……………………………………………………………………. 31 SERVQUAL (Service Quality Questionnaire)…………………………………………………………… 36 Chapter V: …………………………………………………………………………………………… 39 Discussion and Conclusions: …………………………………………………………………. 39 Chapter VI: ………………………………………………………………………………………….. 43 Theoretical Implications ………………………………………………………………………………………. 43 Managerial Implications: …………………………………………………………………………………….. 49 Future Research: …………………………………………………………………………………………………. 51 References: …………………………………………………………………………………………… 52 Appendices …………………………………………………………………………………………… 61 Service Quality Questionnaire ………………………………………………………………………………… 67 Dental Visit Satisfaction Scale ………………………………………………………………………………… 71 3 Tables and Figures: Table 3. Demographic Characteristics of Study Participants …………………………………………… 61 Table 4. Patients’ Ratings on Information-Communication Following Dental Consultation .. 62 Table 5. Information-Communication Satisfaction Based on Dental Visits ………………………. 62 Table 6. Patients’ Perceptions of Understanding – Acceptance by Dentists ……………………….. 63 Table 7. Patients’ Perceptions of Dentists’ Technical Competence. ………………………………….. 63 Table 8. Correlation between different dimensions of DVSS ………………………………………….. 63 Table 1. Summary of Statistical Tests for DVSS Dimensions by Demographic Variables ….. 64 Table 2. Paired Samples Statistics for SERVQUAL Dimensions …………………………………….. 64 Table 9. Correlation Coefficients Between Expectations and Perceptions in SERVQUAL Dimensions ……………………………………………………………………………………………………………… 65 Table 10. Paired Samples t-Test Results for SERVQUAL Dimensions ……………………………. 65 4 Abstract: Objective: This evaluation examines service quality and patient satisfaction for private dental clinics in Jeddah, Saudi Arabia utilizing the SERVQUAL model and the Dental Visit Satisfaction Scale (DVSS) to offer a comprehensive assessment of such factors within a culturally sensitive environment. Design/methodology/approach: A cross-sectional survey was conducted, gathering data from 296 patients across private dental clinics in Jeddah. Based on the established instruments SERVQUAL and DVSS, we have evaluated patient perception of service quality and patient satisfaction. We have focused on the dimensions of tangibility, reliability, responsiveness, assurance, empathy, and communication effectiveness. The statistical analysis incorporated correlation analysis, regression, and paired sample tests to explore service quality dimensions and dental patient satisfaction in detail. Findings: The study found a dire discrepancy between patients’ expectations and perceptions concerning the physical environment and operational efficiency. Nevertheless, patients expressed the highest levels of satisfaction with the assurance and sympathy dimensions. The study implies that patient satisfaction is high where there is proper communication and paying attention to the patient’s needs. Therefore, there is need for clinics to enhance this to improve the patient’s needs. Research limitations and implications: The study focused on private dental clinics within Jeddah, which may undermine the representativeness of results regarding other regions or healthcare settings. Further studies in the long-term perspective and qualitative methods would help to achieve a more profound understanding of the patient experience. Practical implications: The findings reinforce the significance of building up the environmental features and quality of communication at the dental office to be in step with the 5 expectations of patients. Targeted patient relations and an increase in efficiency across the board could result in higher customer satisfaction and engagement. Originality/value: Using a combined SERVQUAL and DVSS approach within a non-Western setting, the research provides an insight into those dimensions that are critical concerning quality of service and satisfaction in the dental care sphere. The study shows the role of cultural dimensions of service quality and patient satisfaction and offers useful guidelines on the matter for healthcare providers in similar cultural settings. Keywords: Service Quality, Patient Satisfaction, SERVQUAL Model, Dental Visit Satisfaction Scale (DVSS), Private Dental Clinics, Cultural Sensitivity, Communication Effectiveness, Operational Efficiency, Patient Expectations, Cross-Sectional Survey Chapter I: Introduction: Background information: Healthcare and dental services, in particular, hinge not only on service quality but also on patient satisfaction. This determines the success of the treatment process, patient outcomes, and patient satisfaction. The research also indicated that quality service surpasses 75% of the patients’ consideration as a critical element that determines which dental clinic to choose (Luo et al., 2018). This is only to emphasize the fact that service quality is a central concept in the choice-making process of patients and their compliance with prescribed treatment plans. Healthcare service quality is a multidimensional concept that can be broken down into reliability, responsiveness, assurance, empathy, and tangible aspects that affect a patient’s satisfaction directly (Jain & Gupta, 2004; Parasuraman et al., 1988). In the discipline of dentistry, these factors play the most important part as the dentist has the actual physical contact with the patients during the treatments that are often accompanied by discomfort and anxiety. 6 The reason for the excellent services rendered in every aspect of the hospital is not only to retain patients but also to improve the quality of treatment and a baseline of security in dental care. The history of healthcare service quality is marked by numerous significant milestones that have revolutionized atient care practices. SERVQUAL model which is one of the key approaches developed in the late eighties of the twentieth century by (Parasuraman et al., 1988) that uses dimensions such as tangibility, reliability, responsiveness, assurance, and empathy. The framework has given a chance to other healthcare services to follow and even improve in the field of service quality measurement and quality improvement. At the same time, the Satisfaction Scale for the Dental Visit (DVSS) was also created as an instrument to evaluate patient satisfaction in dental care facilities. DVSS works on the efficiency, competency, and communication level of the dental staff and patient comfort and satisfaction after the procedure (Corah et al., 1984). This scale furnishes critical information on the very patient-oriented dimensions of dental service quality which make up the supplementary dimensions suggested by SERVQUAL. However, these schemes are still not being adopted easily in different cultures, especially in non-Western regions like Saudi Arabia. Many studies use SERVQUAL for overall quality of service measurement, but they do not research SERVQUAL dimensions about this kind of service. Such matter is of immense significance, particularly in those regions where cultural distinctions affect greatly the patients’ expectations and experiences (Al Fraihi & Latif, 2016). In contrast, there is a research gap regarding the studies that simultaneously use SERVQUAL and DVSS to make a complex view of the quality of dental services. This is particularly true for areas like Jeddah, where exposure to cultural aspects of patient satisfaction can result in more successful healthcare practices, totally adapted to the different individuals. Utilizing both scales as a complement can enable researchers to provide grounded data for the general and specific aspects of dental care service that patients appreciate most. 7 Problem Statement The SERVQUAL model is a worldwide model for assessing services in healthcare equally; but there are some problems in the dental sector in Jeddah, Saudi Arabia, which has its characteristics that are not dealt with by this model currently. Therefore, so far, most of the studies did not involve the way how these frameworks are adopted in new cultural contexts, particularly, in the Middle East where patients’ beliefs and expectations can widely differ from those of the Western world (Al Fraihi & Latif, 2016). However, while it is an inclusive approach to quality of service measurement, it does not hold all the details of the dental patient experience, which is especially important, bearing in mind the frenzy-inductions typical of going to dentists. The DVSS gives a more precise picture of patient notes which are focused on dental care rather than the satisfaction of the visit itself by assessing the aspects of communication, empathy, and technical competence, which are the most important in a dental set (Corah et al., 1984). Though this is a foreseeable notion, focusing on DVSS alongside the other dimensions of SERVQUAL is still not adequately studied, particularly regarding the cultural context of Saudi customers. This mysterious gap in information paralyzes the development of practical strategies based on cultural sensitivity and a client-centered, human approach to quality improvement. the purpose of this study is to fill in the existing gaps by using both SERVQUAL and DVSS which are used to measure satisfaction with the quality of the service in private dental clinics located in Jeddah. As a result, our study objective is to contribute in-depth knowledge of the service quality dimensions and dental patient satisfaction from a particular cultural background. The results are envisioned to be able to guide the process of creating efficient guidelines for the patients’ care, thus improving the care quality and promoting better outcomes for the patient community. Significance of the Research This research is significant as it addresses a critical aspect of healthcare delivery: service quality and patient satisfaction in the context of the culture that is Jeddah, Saudi Arabia. 8 The application of both the SERVQUAL model and the Dental Visit Satisfaction Scale (DVSS) not only examines their usefulness in the non-Western setting but also improves our knowledge of the cultural influences on patient expectations and perceptions. The results are expected to have a substantial contribution to the existing knowledge base by providing evidence on the service quality dimensions that have the highest impact on patient satisfaction in dental clinics in the Middle East. Practically, this research will be very helpful to policymakers and healthcare administrators in identifying the specific areas of improvement concerning dental service delivery. It expands the scope of established service quality models into a new geographical and cultural area to address the issue of adaptability and limitations of these models. The anticipated outcomes could be instrumental in the development of patient management strategies, to meet the specific needs and expectations of patients in Jeddah, and eventually lead to better patient outcomes and clinic reputation. Scope of the Research This research aims to evaluate the quality of service and the level of patient satisfaction in private dental clinics in Jeddah, Saudi Arabia. . It is delimited to this city and conceived around the application of the SERVQUAL and DVSS models to measure service quality. Spatially, the study will focus on the data collection to present a current situation without longitudinal analysis. The main goal of this research is to examine the dimensions of the SERVQUAL model and patient satisfaction gauged by DVSS. It will not extend to the broader issues of the dental care delivery system and its comparison with non-dental healthcare services. Also, it will not cover the economic effects on service quality and patient satisfaction. This research will follow these principles for clarity and focus on its goals and outcomes. This study utilizes a quantitative research approach to investigate the service quality dimensions and patient satisfaction at private dental clinics in Jeddah, Saudi Arabia. SERVQUAL model together with the DVSS are incorporated and structured questionnaires are 9 used to gather data from patients after their dental appointment. The choice of these instruments is based on the proven reliability and validity in measuring quality of service, and patients’ satisfaction in various healthcare settings. Information will be collected via a survey in cross-sectional design that will be given out to a group of patients from some private dental clinics in Jeddah. Correlation analysis, and regression analysis is used. These approaches will facilitate a comprehensive assessment of the service quality attributes and satisfaction outcomes as well as consider confounders such as demographic factors. Research Question: How does the perception of service quality mong patients attending private dental offices in Jeddah compare to their expectations? And how does this affect their satisfaction? 10 Chapter II: Literature Review: Definition of Service Quality and Patient Satisfaction Dental service quality involves the extent to which dental services surpass or match the patient’s needs and expectations. As per (Faeni, 2023) it can be seen as a multidimensional entity consisting of elements like dependability, reliability, prompt service, kindness, empathy, and assurance of return. Reliability means that the services are delivered consistently and accurately. At the same time, assurance consists of the behavior and attitude of a dental professional, such as fair play, transparency, courtesy, and confidence (Yasin et al., 2023). A study by (Moteki, 2021) indicated that tangibles comprise of buildings, hardware, and the external style of the dental clinic. Patients are physically and emotionally vulnerable when they visit the dentist, so to keep them comfortable empathy should be used by staff (Sitaraman et al., 2020). Empathy is any balanced attitude of attentiveness, caring, and understanding toward patients. Responsiveness is the characteristics of dental staff that attract them to the patient’s needs and concerns. However, patient satisfaction is the overall experience of the patient with dental care, which means that there has to be an evaluation of the services as well. Theoretical Perspectives and Models Several theoretical perspectives and models have been developed to understand and measure service quality and patient satisfaction in dentistry. Among different models, the SERQUAL model, created by Parasuraman and their colleagues (1988) (Parasuraman et al., 1988), is the most popular. SERVQUAL identifies five dimensions of service quality: scholarship, consistency, reassurance, feel-good factor, and sensitiveness. This line of thinking has been widely adopted in the sector of health sector, too, for example the field of dentistry in 11 the provision of better and improved service quality (Aboubakr & Bayoumy, 2022). The SERVPERF model employs another approach where existing manifestations of service quality will be used for evaluation instead of the SERVQUAL model that discerns users’ expectations and perceptions (Jain & Gupta, 2004). The SERVQUAL model offers a structured framework for evaluating service quality by comparing patients’ perceptions of service delivery with their expectations. It helps dental clinics to identify and focus on areas of strength and weakness in improving service delivery. So, some rationalization of interventions is put in place to enhance the quality of service (Wu et al., 2024a). For instance, dentistry clinics can assess the patient’s perception of the clinics’ reliability. The reliability can be measured by asking the patients if they get the service whenever they need it and if they are satisfied with the result of the treatment if they had one in the clinic. Once the clinics can identify any gaps in providing the services, they can consult with the staff to help formulate strategies to improve the process. In addition to the SERVQUAL and SERVPERF models, other theoretical perspectives and frameworks are also relevant to understanding service quality and patient satisfaction in dentistry. So, patient-centered care means that the viewpoint of the patient is one of the highest things, when we look at preferences and values and integration and coordination (Sitaraman et al., 2020). The model developed by patient-centered care means that the patient-oriented outlook should be considered. This concept demonstrates that empathy and communication form the basis for building constructive relationships among patients and dental caregivers to enhance patient care experiences and satisfaction (Mills et al., 2014). Measurement of Service Quality Overview of Tools and Scales 1. SERVQUAL: The model SERVQUAL has been recognized as a reliable means of service quality assessment that spans numerous industrial sectors- – for instance, 12 healthcare and dentistry (Aboubakr & Bayoumy, 2022). SERVQUAL identifies five dimensions of service quality: reliability, authenticity, the provision of concrete/visible evidence, empathy, and responsiveness to the consumers´ demands. Patients’ viewpoints affect service delivery against their expectations, and this shows the areas where there are problems or need to be upgraded. 2. SERVPERF: SERVPERF is another model separated from SERVQUAL and emphasizes performance-based assessment of service quality rather than comparing expectations with reality (Jain & Gupta, 2004). This model evaluates care recipients’ experiences with a service delivered without fully taking into account the client’s expectations. 3. Dental Patient Satisfaction Questionnaire: This is a questionnaire that best describes the patients’ satisfaction with dental care, including the quality of treatment, communication with staff of the dental clinic, waiting time, and overall experience (Lin & Yin, 2020). 4. Dental Visit Satisfaction Scale (DVSS): The DVSS stands for the Dental Visits Satisfaction Scale, which is a validated measure developed to gauge a patient’s experience at both the assessment and care visit. The report not only rates the dental visit by considering the cleanliness of the clinic and the friendliness of the staff but also communication (Corah et al., 1984). 5. Patient Feedback Surveys: Dental practice providers and clinics commonly seek client input through patient satisfaction questionnaires to measure patient experience and the level of provided services (Akbar et al., 2020). For instance, when the surveys are administered at the clinic, they can be in person, online or via mailed questionnaires, and they can be modified to suit the tastes and preferences of the patient. 13 Measurement of Patient Satisfaction Overview of Tools and Scales 1. Dental Visit Satisfaction Scale (DVSS): The DVSS is a patented surgical instrument, the use of which is supported by well-established scientific data. This instrument has been proven as an eligible tool to assess patient satisfaction with individual dental visits. It screens lots of components in the dental office life, such as the cleanliness of the clinic, the friendliness of workers, and the effectiveness of communication. It also covers the quality of care (Siripipatthanakul, 2021). The DVSS often consists of multiple items in which patients are required to choose on a Likert scale, and then fill in specific details through continuous writing. 2. Patient Satisfaction Questionnaire: Often, this questionnaire is a tool used to measure how satisfied patients are with the treatment they receive at the healthcare facility, and it is also used at dental clinics. It usually includes outcomes concerning a patient’s perception of general satisfaction with how dental care is provided, the level of treatment received, the care provided, and access to dental services, among others (Lin & Yin, 2022). Through the questionnaire of patient satisfaction, qualitative comments from the patient’s open questions are capable of being collected too. 3. Patient Feedback Surveys: Among dental clinics, the patient satisfaction surveys given on the use of feedback surveys to assess the patient’s responses are highly used. These surveys could be done face to face, online, or via mail questionnaires and the content could be adjusted to the requirements and inclinations of the clinic. A feedback survey for patients prospectively usually has Likert-scale items and open-ended questions in order to capture patients’ viewpoints as much as possible (Aldossary et al., 2023). 14 4. Post-Appointment Surveys: Providing patient surveys after appointments and sending them out as a feedback service is what some dental clinics do to gather immediate feedback right after the patient’s dental visit (Pamungkas et al., 2022). The questionnaires may either be administered online or in person but are usually designed to get feedback from the patients concerning the aspects of their dental care experience they are satisfied with, including the length of the wait before treatment, communicating well with staff and the best treatment they received. Evaluation of Different Approaches There are several approaches to measuring patient satisfaction in dental care, each with its strengths and limitations. One way is spreading measuring devices, including DVSS and various patient satisfaction questionnaires. Such assessment tools would provide a system of measurement to rate patient satisfaction reports that can facilitate comparisons of patients by clinic and population groups (Afrashtehfar et al., 2020). Alternatively, generic instruments may undermine peculiar practices of patient satisfaction among individual clinics and conditions. Another approach is the use of qualitative methods, such as focus groups and interviews, to gather in-depth insights into patients’ experiences and perceptions of dental care. With qualitative methods, researchers can study patients’ understanding of their lives better and highlight the issues that they can fix (Luo et al., 2018). Although qualitative methods can be very time and resource-consuming, their results can be of high quality and relevant to make for better decision-making. A third approach is the use of patient feedback mechanisms, such as suggestion boxes and online feedback forms, to gather real-time feedback from patients (Gray et al., 2021). This process includes patients responding to their experiences instantly right after their dental visits. Because of this, clinics will be able to address immediate concerns or issues. Yet, a medium sort of like that may miss the natural range of patient experiences and may be influenced by specific thoughts. 15 Factors Influencing Service Quality and Patient Satisfaction in Dentistry Healthcare Provider Factors Healthcare providers play a crucial role in shaping patients’ experiences and perceptions of dental care. Service quality and patient satisfaction will be subject to impact by all areas of communication skills, technical competence, and interpersonal relationships (Shie et al., 2022). Consequently, the nature of communication between patients and their dental professionals is essential. According to (Aboubakr & Bayoumy, 2022) it is critical when it comes to the development of trust, to enhance the relationships between patients and healthcare providers, and to make sure that patients understand the possible treatment options as well as their treatment plans. The actual skill level of healthcare providers, such as their clinical skills and competence, will make a difference in the level of treatment quality and results offered, hence shaping patients’ thinking about the care they receive (Imanipour et al., 2022; Pueyo-Garrigues et al., 2022). Furthermore, the providers’ manners and behaviors, compassion and bedside manner are those factors that influence patients’ comfort and guarantee their appraisal of the oral care they receive, leading to their excellent overall satisfaction with dental services. Facility Factors Facility factors, such as the cleanliness, organization, and ambiance of the dental clinic, also play a significant role in shaping patients’ experiences and perceptions of care. A clean and adequately maintained clinic quite clearly implies professionalism, seriousness and patient reassurance and improves the patients’ service level (Davies, 2022; Stuart, 2022). They might perceive the dental experience to be improved. On top of it, waiting time, appointment scheduling, and patient’s preference for accessing services at a dental clinic are considerations necessary for patient satisfaction and convenience (Aldossary et al., 2023). Efficient clinic 16 operations, processes that flow smoothly, and waiting rooms that are minimized make the experience of a patient positive as well as the satisfaction of one’s dental care. Patient Factors Patients’ expectations, preferences, and individual characteristics also influence their perceptions of service quality and satisfaction with dental care. Patients’ perceptions and expectations concerning the quality of dental work, professional and friendly relations with staff, as well as the overall medical hotline are fundamental to their satisfaction with treatment (Rao et al., 2024; Szabó et al., 2023). It is essential always to meet and possibly even surpass patients’ expectations; consequently, this could lead to patient satisfaction and, thus, building long-term patient loyalty (AlOmari & A Hamid, 2022; Mohd-Any et al., 2022). Moreover, the patient’s choice of controversial treatment approaches, the precious amenities, and the way of communication affect the level at which they are happy with dental services (Moore, 2022). Knowledge of patients’ strategies and adjustment of care to match their unique preferences and beliefs will make the patients feel happy and satisfied. Empirical Studies Empirical research on service quality and patient satisfaction in dentistry provides valuable insights into the factors influencing patient experiences and perceptions of care. Through the use of multiple measuring instruments and procedures, the researchers deseeds the natural features of the service quality and patient’s satisfaction in several fields also to get the grip on how to deal with the dental care delivery better (Lin & Yin, 2022; Zanzeh et al., 2023). This section reviews key findings from empirical studies in dentistry, highlighting the use of different measurement tools and their implications for enhancing service quality and patient satisfaction. 17 (Gutierrez-Marín & López-Soto, 2022) conducted a study to assess patient satisfaction with dental services at the School of Dentistry, University of Costa Rica. Employing the Patient Satisfaction Questionnaire, the researchers have a sworn statement that the services provided are highly appreciated and satisfactory by the patients. The study indicates the significance of high-quality dental care as well as a patient-centric approach to education and practices in dentistry. The positive dental service experiences, as reported by patients, contribute to overall satisfaction with the services as well as build trust in the dental professionals. The creation of a user-friendly website would aim to streamline the process of booking appointments by providing an easy-to-navigate platform (Akbar et al., 2020) conducted a systematic review examining the relationship between service quality and patient satisfaction in medical (dental) tourism. The investigation revealed that service quality was indeed the key factor that led patients to choose a particular healthcare facility above others. The research group was able to ascertain factors like reliability, assuredness, thinkable, and empathy as the critical dimensions through which patients experience dental tourism destinations using the SERVQUAL model. Offering patients dental services of high quality and meeting their expectations is an essential part of keeping the patients safe while helping cater to their satisfaction with care (Parvaie & Osmani, 2022) investigated patients’ knowledge and satisfaction with health protocols during dental treatment for COVID-19. By means of the Dental Visit Satisfaction Scale (DVSS), the researchers discovered that assimilation to health protocols is directly linked with patients’ levels of satisfaction with dental services. Recipients of the care appreciate institutions’ approaches to the maintenance of safety standards and well-being even during the challenging period. This adds to the feeling of credibility and qualitative service (Lin & Yin, 2022) explored the impacts of service quality, brand image, and perceived value on patients’ loyalty to private dental clinics in China. Via the Patient Satisfaction 18 Questionnaire, which the researchers revealed as the most crucial factor for patients’ loyalty development, the researchers attested that service quality perceived by patients had a vital role. Patient satisfaction is a powerful connection between service quality, brand image and value. Dental care at high standards can impact patients’ decision to remain patient Implications for Practice Practical Implications for Improving Service Quality and Patient Satisfaction 1. Enhance Communication Skills: Patient communication that leads to trust and rapport are among the essential elements of adequate health care services. Heighten emphasizes communication, which should be transparent and humane with patients, explaining treatment and procedures in the form of simple sentences (Kwame & Petrucka, 2021). 2. Focus on Technical Competence: Fundamental professionalism is an integral factor in providing dental care at a sophisticated level. A dentist practitioner should always be the first to take part in CPD (continuing professional development) to keep up with the recent developments in dental care as well as to improve their clinical skills (GutierrezMarín & López-Soto, 2022). Providing funding for practitioner training and certification programs can mean the difference between a practitioner lacking confidence and competence and providing patients with subpar results and a skilled practitioner with satisfactory outcomes (Kuczawski et al., 2024). 3. Maintain a Clean and Welcoming Clinic Environment: For patients, the ambiance of the dental clinic that reflects the quality of care provided becomes pivotal (Sarapultseva et al., 2022). Dental Practitioners should be patient-friendly while they ensure that their clinic remains clean and organized and offers comfort with lovely décor, seating, and lighting. Norms of sanitation and order be regulated as well as the 19 periodic re-stipulation of maintaining hygienic standards and safety (Jaber-Chehayeb, 2023). 4. Minimize Waiting Times: Patients may get annoyed and may even become furious due to the long lines. A responsible dentist should make it a priority to minimize patients’ expected wait time by practicing several ways of scheduling, streamlining the offices and establishing patient flow protocols (Fun et al., 2022). Communicating well with patients about the arrangements of their appointments and any possible delays to avoid patients waiting too long and creating stress in them is also essential (Matulis & McCoy, 2021). 5. Adhere to Health Protocols: Particularly important in the era concomitant with the pandemic of COVID-19. Facilitating patient safety and comfort is thus subject to the health protocols implementation. Dentists must stick to the high standards of infection control, so they should use well sterilized instruments, PPE should be used, and also social distancing should be in place (Martin et al., 2020). Inducing well-coordinated communication with patients about the safety protocols applied and risk mitigation assists in boosting the practicality and confidence of patients. Suggestions for Dental Practitioners to Enhance Patient Experience 1. Personalize Patient Care: There is a patient that is unique for everyone that needs to realize things in light of an individual’s personal favor, fear and expectations (Stewart et al., 2024). The community of dental practitioners should adopt a patient-centered approach to treatment planning and modes of communication that are specific to each patient (Lee et al., 2023). This individualizes the communication and creates a foundation of trust, which is reinforced with patients’ name recognition, acknowledgment of concerns and a human touch. 20 2. Empower Patients through Education: Orientation of patients with regard to dental health and preventive care, as well as treatment options, can culminate in patients’ knowledgeable participation in the decision-making process about dental care (Little et al., 2017). One of the responsibilities of dental practitioners is to teach people oral hygiene practices. This should involve information on the significance of regular dental visits, as well as the advantages of different therapeutic procedures (Janto et al., 2022). Education is the key to promoting self-care; therefore, providing educational materials, which could come in the form of pamphlets or videos, helps to reinforce key concepts, as well as encourage the participation of the patients (Jaarsma et al., 2023). 3. Provide a Positive Chairside Experience: The active part of the chair is very important in determining the patient’s attitude and impression of dental care (Mersel & Carles, 2022). Providers of dental health should endeavor to instill a feeling of disquiet and tranquility in their patients during the surgical procedure, including amenities such as soothing music, best as distraction techniques, or relaxation techniques (Schroeder, 2023). A simple touch, constant checking of patients’ statuses, detailed explanation of the procedure progress, and quick caring for the patient’s well-being can build a higher level of comfort and satisfaction (Wulandari et al., 2023). 4. Seek Feedback and Continuous Improvement: By continuously asking for patient feedback on how they experience treatment and perceived satisfaction with care, practitioners in dentistry should strive to ensure that the patients are delighted with the services they provide (Knight et al., 2024; Pogorzelska et al., 2023). To acquire the evaluation of patients receiving the service, you can use feedback surveys, suggestion boxes, or online review platforms, which are the appropriate tools to find out the possible areas for improvement (Kharchenko, 2023). Dental practitioners must use this 21 feedback by finding the chances in the service continuity and patient challenges, and improve the system to address the patient concerns accordingly and that too continually. Global Perspectives on Service Quality in Dentistry Several studies of the quantitative statistics from different areas prove helpful in the global dental clinics’ service quality perceptions. According to (Afrashtehfar et al., 2020) service quality affects patient satisfaction in medical (dental). The research findings demonstrate the function of service quality for patient loyalty. The emphasis is on care so that those who are ill and their companions may have pleasant experiences and return to the institution. Similarly, the study by Lin and Yin (2022) finds the effects of service quality, brand image, and perceived value on patient loyalty to private dental clinics in China. The study ascertained that the service quality perceived by patients is involved in improving patients’ loyalty through the mediation of patient satisfaction, hence emphasizing that dental settings are evidence that the role of service quality in retaining patients and winning their loyalty should not be neglected. (Parvaie & Osmani, 2022) examined patients’ knowledge and contentment with the health protocols during dental treatment for COVID-19. Their research findings again highlight the importance of responding to patients’ questions and ensuring the protocols of COVID-19 are adhered to. It increases the patients’ experience of satisfaction and trust in such corresponding services under challenging times. Furthermore, (Gutierrez-Marín & LópezSoto, 2022) assessed patient satisfaction with dental services at the School of Dentistry, University of Costa Rica. The researcher found a high satisfaction level among the patients concerning dental services, which points to the necessity of good quality medical delivery and patient-centered approaches to dental education and practice. Service Quality in Dentistry: Saudi Arabian Context 22 Quantitative research specific to service quality in Saudi Arabian dental clinics offers insights into the region’s unique healthcare delivery dynamics. Aboubakr and Bayoumy (2022) assessed educational service quality among dental and nursing students in Egypt and Saudi Arabia. They, however, observed a more significant portion of students agreeing with the statement relating the quality of the educational service to country and sector. While not medical practice-related, the present study shows that the quality of services is not only a healthcare concern but also plays a significant role in any field of work, including dentistry, regardless of geographical location (Aboubakr & Bayoumy, 2022). Furthermore, Akbar et al. (2020) investigated the relationship between service quality and patient satisfaction in medical (dental) tourism, which may also have implications for dental clinics in Saudi Arabia catering to international patients. The factors that affect patient satisfaction and retention can be considered to enhance the overall quality of services offered in dental clinics in Saudi Arabia; this will ensure that both local and international patients are satisfied, making this a good experience for the patients (Akbar et al., 2020). However, there is a scarcity of specific quantitative research focusing solely on service quality in Saudi Arabian dental clinics. This area should be further explored in future studies as they need to study patients’ perspectives, satisfaction, and loyalty to dental care in Saudi Arabia (Akbar et al., 2020). This region can benefit from the conduct of in-depth research that is customized to the healthcare system in Saudi Arabia. Policymakers, healthcare providers, and dentists in the region can gain valuable information that will enable them to improve service quality, increase patient satisfaction, and build long-term patient relations (Lin & Yin, 2022). Saudi Arabia is imperative to derive the similarities and differences in perceptions and experiences relating to service quality. 23 Hypothesses: H1: There is a positive correlation between service quality factors, including reliability, assurance, tangibles, empathy, and responsiveness, and patients’ satisfaction with dental services in private dental offices in Jeddah. Research in service quality, especially in healthcare settings, has consistently revealed that the dimensions of the SERVQUAL model including reliability, assurance, tangibles, empathy, and responsiveness significantly affect patient satisfaction (Parasuraman et al., 1988). The research on dental care, such as that done by (Alshareef et al., 2020; Lin & Yin, 2022), shows that these factors are very significant in the formation of the patient’s experience and satisfaction. As an example, assurance, which means the knowledge and courtesy of providers and their skills to convey trust and confidence, is especially important in healthcare where the stake in personal well-being is high (Aboubakr & Bayoumy, 2022). The empirical evidence demonstrates that improving the physical aspects of the service environment has a direct impact on the quality of care being perceived, resulting in higher patient satisfaction, according to (Gray et al., 2021). Thus, the positive relationships proposed in this hypothesis are strongly supported by literature, implying that patient satisfaction in private dental clinics in Jeddah would likely be enhanced through these changes. H2: There is a positive correlation between information communication by the dentist, patient acceptance and understanding by the dentist, and the technical competence of the dentist. Communication effectiveness in healthcare has been a subject of much research and the clear and compassionate information exchange between healthcare providers and patients can significantly influence patient outcomes (AA et al., 2016; Corah et al., 1984). Technical competence, no doubt, is a fundamental expectation in healthcare but the value is enhanced 24 when it is accompanied by effective communication and understanding of patients. Research, for example, by (Emanuel & Emanuel, 1992) highlights the importance of understanding patient needs and clearly explaining care plans as part of patient-centered care models. Furthermore, the literature highlights that the patients’ perception of how technically competent their healthcare providers are can impact their level of trust and satisfaction (Martin et al., 2020). Hence, the idea of a correlation between these variables can be supported by the direct impact of these aspects on patient satisfaction. H3: The patients’ expectation and perception of service quality is affected by the delivary of the healthcare services. The gap reflects the difference between patients’ expectations and their subsequent experience of the service. This is the essence of the SERVQUAL approach. The gap analysis helps in the areas of service delivery that need improvement (Parasuraman et al., 1988). Studies demonstrate that when healthcare services provide the care that patients want, the satisfaction level is typically higher (Al Fraihi & Latif, 2016). The delivery of healthcare services including timeliness, attention depending on personal care, and physical environment, directly influences patient perception and can either bridge or enlarge the expectation-perception gap. Therefore, the hypothesis brings in the theoretical framework which is a vital area for quality improvement in the healthcare settings which includes dental services as well in Jeddah. To study these hypothysses, the study utilizes a quantitative research approach to investigate the service quality dimensions and patient satisfaction at private dental clinics in Jeddah, Saudi Arabia. SERVQUAL model together with the DVSS are incorporated and structured questionnaires are used to gather data from patients after their dental appointment. 25 The choice of these instruments is based on the proven reliability and validity in measuring quality of service, and patients’ satisfaction in various healthcare settings. Information will be collected via a survey in cross-sectional design that will be given out to a group of patients from some private dental clinics in Jeddah. Correlation analysis, and regression analysis is used. These approaches will facilitate a comprehensive assessment of the service quality attributes and satisfaction outcomes as well as consider confounders such as demographic factors. 26 Chapter III: Methodology: Research Design The study will systematically describe the current state of patient expectations, perceptions, and satisfaction levels regarding dental service quality and will also compare these factors across different patient demographics, such as age, gender, and prior experience with dental services, to identify patterns or significant differences to answer the question of exploring the relationship between the perception, expectation, and satisfaction of service quality among the population of interest in a cross-sectional design. Sampling Based on the research design, a sample of 300 patients was required. DVSS and SERVQUAL questionnaires were electronically distributed to a representative sample attending four private dental offices in Jeddah. Convenient sampling was done, and all the patients attending the offices during the month of March 2024 were included after they consented to answer DVSS and SERVQUAL questionnaires. Measurement of Scales and Data Collection A SERVQUAL model was applied to determine the quality of services based on the gap between the customers’ expectations and perceptions. The questionnaire was validated and used broadly in the literature (Parasuraman et al., 1988). It consists of 22 indicators that measure five aspects: Attributes: the level of physical resources, tools, and appearance; Reliability: the consistency and accuracy of service delivery; Responsiveness: the readiness and timeliness of service provision; Assurance: the level of competence, courtesy, and security; Empathy: the level of care and personalization. We used a scale of 1 (strongly disagree) to 5 (strongly agree) for both expectations and perception. The difference between the two scores was the gap score, which showed the level of satisfaction/dissatisfaction with the service. The 27 quality of service score was derived by subtracting the ratings that patients gave to paired statements of perception and expectation from each other, following the formula: SERVQUAL score = SQ = P − E on which SQ is overall service quality, P is performance perception, and E is service quality expectations. The disparity score represented the difference between anticipated and viewed standards of outpatient services. The amount of positive gap scores showed that the services were either more than expectations, thus achieving high perceptions. A low gap score implied that the facilities and services were not satisfactory and that there were poor sentiments. A zero gap score indicated that the criterion was met and the outpatient service quality was satisfactory. The total gap scores for each dimension were obtained by summating the individual gap scores for each comparative statement. The DVSS is also an instrument that has been validated to assess patient satisfaction in a variety of dental settings. Encompassing 10 questions on three domains, namely information-communication, understandingacceptance, and technical competency (Corah et al., 1984). For every question, there was a scale from 1 (strongly disagree) to 5 (strongly agree). Common Method Bias Common Method Bias (CMB) refers to the variance attributed to the measurement method rather than the constructs the measures represent (Podsakoff et al., 2023). In this study, potential CMB was addressed by ensuring anonymity and confidentiality, reducing social desirability and demand characteristics. Additionally, using different scales (DVSS and SERVQUAL) helps mitigate CMB by diversifying measurement methods. Analytical Procedure Statistical analysis was done by applying different tests using SPSS software. The descriptive analysis of the data involved calculating the continuous variables’ mean and standard deviation values, as well as the categorical variables’ frequency and percentage distributions. Descriptive statistics presented the foundation of the data distribution and its central tendencies. Accordingly, independent samples t-tests were used to compare the means 28 of different groups, especially to find out the possible variations among the views related to demographic variables such as gender and education. This test was precious in understanding the contrast in views based on binary demographic variables like gender. In addition, ANOVA (Analysis of Variance) was used to determine the difference in satisfaction scores across different demographic categories. The two-way ANOVA was applied to study the differences between categories in more than two groups, such as educational levels and age categories. Additionally, correlation analysis was carried out to find the linkages between the quality dimensions of the SERVQUAL and DVSS scales. 29 Chapter IV: Analysis and Findings: In the current study, the demographic characteristics of the 296 participants were assessed. The age distribution indicated that the largest group of participants was aged between 25-30 years (30.74%), followed by those in the 31-36 years bracket (26.35%). Participants aged 18-24 years accounted for 19.26% of the sample, and those aged 49 and above represented 10.47%. Fewer participants fell within the 37-42 (7.43%) and 43-48 (5.74%) year ranges. Regarding gender distribution, males were slightly more prevalent (53.04%) compared to females (46.96%). With a slight male predominance, any gender-related findings should be interpreted with caution, as they may not fully represent the female perspective. However, the near-equal distribution allows for a comparative analysis of gender-specific trends. The majority of participants were Saudi nationals (90.88%), with a minority being non-Saudis (9.12%). The high percentage of Saudi nationals could mean that the study’s results are strongly reflective of Saudi cultural norms, values, and behaviors, which may not be generalizable to other populations. Singles constituted a greater portion of the sample (54.05%) as opposed to married individuals (45.95%). The fact that singles outnumber married individuals will not influence the study’s outcomes, the reason fo this is that the research does not touch on lifestyle, social relationships, or economic factors. Educational attainment varied among participants; the majority held a bachelor’s degree (58.78%), while a substantial minority had obtained a master’s degree (23.65%). Those with a high school education made up 13.51% of the sample, followed by individuals with a doctorate or Ph.D. (3.38%). Intermediate school education was least represented at 0.68%. The predominance of participants with higher education degrees suggests that the findings may be skewed towards the attitudes and behaviors of the educated class. Table: 1 30 DVSS (Dental Visit Satisfaction Scale) For the statement “After talking with the dentist, I know what the condition of my mouth is,” in the information-communication domain, most patients (57.8%) indicated strong agreement. This suggests that most patients feel confident in the knowledge imparted by their dentist and could imply that dentists are effectively communicating the essential aspects of oral health to their patients. Similarly, for the statement “After talking with the dentist, I have a good idea of what changes to expect in my dental health in the next few months,” 43.6% of patients strongly agreed, with 25.3% agreeing, suggesting a general positive reception of information communicated by dentists and that that dentists are successfully setting realistic expectations for their patients. This is crucial for patient compliance and satisfaction. However, a small percentage of participants expressed uncertainty or disagreement, with 14.9% remaining neutral and 4.1% disagreeing regarding their understanding of their oral health condition. Despite the overall positive reception regarding understanding of oral health condition indicates that there is room for improvement. The statement “The dentist told me all I wanted to know about my dental problem(s)” saw 46.6% of patients strongly agreeing, indicative of a high level of satisfaction with the information provided by their dentist. Yet, this item also noted a combined 11.1% of participants disagreeing with the statement, pointing to an area for potential improvement in patient communication. Table 2. Table 3. In response to understanding the condition of their mouth, a considerable majority (57.8%) expressed strong agreement (5 out of 5), indicating a high level of clarity postconsultation and effective communication by the dentists. This suggests that most dentists are successfully conveying important health information to their patients. Conversely, a small minority expressed disagreement (4%) or neutrality (14.9%). This highlights a gap in communication and could be due to various factors such as the complexity of the dental issues, 31 patient comprehension levels, or the communication methods used by the dentists. Expectations about future dental health changes were well communicated, with 43.6% of patients strongly agreeing they had a good idea of what to expect, while 25.3% agreed, cumulatively indicating that nearly 69% of patients felt adequately informed about future changes to their dental health. This implies that dentists are not only addressing current issues but also educating patients on future oral health maintenance. When it came to receiving comprehensive information about dental problems, nearly half of the respondents (46.6%) indicated they strongly agreed that the dentist told them all they wished to know. Adding those who agreed (21.6%) It appears that most patients leave consultations feeling satisfied with the information provided. This is indicative of a high level of patient satisfaction regarding dentist communication. Nevertheless, approximately 11.1% did not feel fully informed, this represent an opportunity for dentists to improve their communication strategies. This could involve spending more time with patients, using visual aids, or providing written materials to supplement verbal communication. Table 3. A significant proportion of patients felt positively, with 46.3% strongly agreeing and 27.4% agreeing, indicating that a majority of patients (73.7%) felt their dentists were attuned to their needs. Concerning empathy regarding potential pain, 36.8% of patients strongly felt that their dentist was aware of their distress about pain, and an additional 30.7% agreed, totaling 67.5% who felt their concerns were recognized. It can be inferred from this is that empathy is an important factor in patient satisfaction. Dentists who show understanding towards their patients’ distress about pain may contribute to a more comforting and trustful healthcare environment. The highest level of satisfaction was reported in terms of personal acceptance, where a remarkable 55.1% of patients strongly felt accepted by their dentist as a person, complemented by 28.7% who agreed. This demonstrates a strong sense of personal care and acceptance, with a combined 83.8% of patients affirming this sentiment. The high percentages 32 of patients feeling that their dentists are attuned to their needs (73.7%) and the strong sense of personal acceptance (83.8%) suggest that a good patient-dentist relationship is prevalent. This could lead to better patient compliance, satisfaction, and potentially better oral health outcomes. Table 3. In the technical competence domain, a large proportion of patients (49.3%) strongly agreed that their dentist was thorough in conducting the dental procedure, with another 24.7% in agreement, summing to a substantial 73.9% expressing a positive viewpoint on the thoroughness of their dentist’s work which suggests that technical competence is highly valued and well-received. This indicates that dentists who are meticulous and detailed in their work are likely to be appreciated by their patients. In contrast, a notable 37.2% of patients strongly disagreed with the notion that the dentist was too rough, with a further 23.0% disagreeing, which together represent 60.2% of the sample, indicating a preference for a gentler approach. However, it is also notable that 18.6% did feel the dentist was too rough. This suggests that patient experiences vary, and there may be a need for dentists to adjust their approach based on individual patient sensitivity and expectations. Dentists may need to consider patient feedback more closely to tailor their approach to each individual’s comfort level. Satisfaction with the dental work performed was also rated highly, with 37.2% strongly satisfied and 33.8% satisfied, making a cumulative 70.9% of patients content with the work of their dentist. These figures imply a high overall satisfaction rate among the respondents regarding their dental procedures and reflect positively on the dental services provided. This level of satisfaction is likely to contribute to patient loyalty and positive word-of-mouth for the dental practice. Table 5. Information-Communication and Understanding-Acceptance (r = .761, p < .001), The strong correlations suggest that the quality of information and communication provided by the dentist is closely linked to patients’ understanding and acceptance of their dental conditions and 33 treatments. This implies that effective communication may not only help patients understand their health better but also lead to greater acceptance of the treatment plan. Information-Communication and Technical Competence (r = .669, p < .001), this strong coorelation suggests that the way information is communicated can influence patients’ perceptions of the dentist’s technical skills. Good communication may enhance patients’ trust in the dentist’s competence. Additionally, understanding-Acceptance and Technical Competence (r = .711, p < .001) strong correlation suggest that perceptions of quality in one dimension are likely to be associated with perceptions of quality in another, reflecting a cohesive patient experience of service quality. The overall high correlation values indicate that patients tend to have a holistic experience where good communication, understanding, acceptance, and technical competence are all interrelated. Improving one aspect could positively affect the others. The effective communication is a key factor that is strongly associated with patients’ understanding, acceptance, and perceptions of technical competence, all of which contribute to a cohesive and satisfactory patient experience. Table 6. Further analysis utilizing independent samples t-tests indicated a significant gender differences in the domains of Information Communication (t(294) = 3.722, p < .001) and Understanding-Acceptance (t(294) = 3.548, p < .001), suggesting that male and female patients have different experiences or expectations when it comes to the communication and understanding they receive from their dentist. This could be due to a variety of social, psychological, or cultural factors that influence how information is processed and accepted by different genders. Also, a significant mean difference was observed for Technical Competence (t(294) = 3.459, p = .001), highlighting a potential disparity in perceptions of technical quality between genders. This might indicate that men and women evaluate the technical skills of their dentists differently. This could reflect differing priorities or criteria used by each gender to 34 assess technical quality. For marital status data, independent samples t-tests revealed no significant differences in the Information-Communication domain between single and married patients (t(294) = .005, p = .996), nor in Understanding-Acceptance (t(294) = 1.329, p = .185). This suggests that marital status does not affect how patients perceive the quality of communication and understanding from their dentist. However, there was a significant difference in the Technical Competence domain (t(294) = 4.135, p < .001), indicating that marital status may influence perceptions of technical aspects of dental car and implies that single and married individuals may have different perspectives on the technical aspects of dental care, possibly influenced by differing life experiences or responsibilities. Table 7. An ANOVA was conducted on educational level, significant effects were found across all three dimensions of patient satisfaction: Information-Communication (F(3, 292) = 10.232, p < .001), This suggests that patients with different educational backgrounds may have varying expectations or preferences for how information is communicated by their dentist. Patients with higher education levels might expect more detailed explanations or may be better equipped to understand complex information. The significant result in the Understanding-Acceptance domain (F(3, 292) = 5.311, p = .001), implies that educational level influence how patients perceive and accept the information provided about their dental health. This could affect their satisfaction with the service and their willingness to follow through with treatment recommendations. The significant effect found for Technical Competence (F(3, 292) = 5.355, p = .001) indicates that a patient’s educational background may affect how they judge the technical quality of the dental care they receive. Higher educated patients might have higher standards or be more critical in their assessment of technical competence. Table 7. 35 SERVQUAL (Service Quality Questionnaire) The paired sample statistics for the SERVQUAL survey revealed differences in patient expectations and perceptions across all five dimensions of service quality. For tangibility, there was a noticeable difference between the expectation (M = 4.26, SD = 0.64) and perception (M = 3.74, SD = 0.88). This suggests that patients expect a high level of physical facilities, equipment, and appearance of personnel (tangibility), but their actual experiences do not meet these expectations. This gap suggests that improvements in the physical aspects of the healthcare environment could enhance patient satisfaction. Reliability also showed a significant gap, with expectation (M = 4.65, SD = 0.58) outstripping perception (M = 3.97, SD = 0.80). This indicates a need for healthcare providers to be more consistent in delivering services and to manage patient expectations more effectively. Responsiveness expectations (M = 4.54, SD = 0.66) were notably higher than perceptions (M = 3.84, SD = 0.93). This indicate that patients anticipate prompt service and willingness to help from healthcare providers, but perceive less responsiveness than expected. This suggests that staff could be trained to be more attentive and responsive to patient needs. Assurance had a reverse pattern, with perceptions (M = 4.01, SD = 0.84) exceeding expectations (M = 3.47, SD = 0.49). Interestingly, perceptions of assurance, which involves competence, courtesy, credibility, and security, exceed expectations. This could indicate that once patients interact with healthcare providers, they find the competence and courtesy levels to be satisfactory. Empathy exhibited a marked difference between expectations (M = 4.49, SD = 0.63) and perceptions (M = 3.80, SD = 0.91). This means that patients have high expectations for personalized care and empathy, but perceive a lower level of empathetic behavior than expected. This highlights the importance of personalized care in patient satisfaction and the potential for healthcare providers to improve in this area. Table 8. The correlation analysis of the paired samples indicated significant relationships between expectations and perceptions within each SERVQUAL dimension. Tangibility showed 36 a moderate correlation (r = .527, p < .001). The physical aspects of the service, such as facilities and equipment, moderately influence patient perceptions. As patients expect more tangible quality, they tend to perceive it as well, suggesting that investments in the physical environment could positively impact patient satisfaction. As for the reliability (r = .544, p < .001), a slightly stronger correlation in reliability indicates that consistent and dependable service is crucial to patients. Enhancing reliability could lead to a significant improvement in how patients perceive the overall quality of care. For the responsiveness dimension (r = .497, p < .001), The willingness and promptness of staff to provide service play a moderate role in shaping patient perceptions. Quick and attentive responses to patient needs are likely to elevate their perception of service quality. For the assurance correlation is (r = .506, p < .001), which indicate that the knowledge and courtesy of employees and their ability to convey trust and confidence are moderately correlated with patient perceptions. This suggests that training staff to be more reassuring could enhance patient trust and perception of service quality. Lastly, the empathy correlation is (r = .503, p < .001), which shows that care and individual attention provided by the service provider have a moderate impact on patient perceptions. Personalized care that meets patient expectations can significantly improve their perception of service quality. These correlations indicate that improvements in service quality dimensions that align with patient expectations can lead to enhanced patient perceptions of the service provided. It also suggests that healthcare providers should focus on understanding and managing patient expectations to improve their perceived service quality. Table 9. The paired samples t-tests conducted on the SERVQUAL data demonstrated significant differences between expected and perceived service quality. The tangibility dimension showed a significant mean difference (MD = 0.52, SD = 0.77, t(295) = 11.59, p < .001), indicating a service gap which indicated that patients expect a high level of physical facilities, equipment, and appearance of personnel (tangibility), but their actual experiences do not meet these 37 expectations. This gap suggests that improvements in the physical aspects of the healthcare environment could enhance patient satisfaction. Reliability (MD = 0.68, SD = 0.69, t(295) = 16.96, p < .001), This significant gap between the high reliability patients expect and what they perceive indicates a need for healthcare providers to be more consistent in delivering services and to manage patient expectations more effectively. The responsiveness shows a significant gap also (MD = 0.70, SD = 0.83, t(295) = 14.55, p < .001), which means patients anticipate prompt service and willingness to help from healthcare providers, but perceive less responsiveness than expected. This suggests that staff could be trained to be more attentive and responsive to patient needs. For the empathy, paired sample t-test shows a significant gap as well (MD = 0.69, SD = 0.80, t(295) = 14.80, p < .001), which indicates that patients have high expectations for personalized care and empathy, but perceive a lower level of empathetic behavior than expected. This highlights the importance of personalized care in patient satisfaction and the potential for healthcare providers to improve in this area. Interestingly, assurance showed a negative mean difference (MD = -0.54, SD = 0.72, t(295) = -12.80, p < .001), where perceptions exceeded expectations, an uncommon finding that may reflect an overestimation in the service delivery of this dimension. This could indicate that once patients interact with healthcare providers, they find the competence and courtesy levels to be satisfactory. Overall, the data suggests that while patients generally receive satisfactory assurance from their healthcare providers, there are significant gaps in tangibility, reliability, responsiveness, and empathy that need to be addressed to meet patient expectations and improve overall service quality. Table 10. 38 Chapter V: Discussion and Conclusions: This study utilized the SERVQUAL and Dental Visit Satisfaction Scale (DVSS) instruments to evaluate service quality and patient satisfaction in private dental clinics, components critical to shaping patient loyalty and clinical outcomes. In the context of dental healthcare, which is inherently personal and invasive, these measures are essential, they do not only assess patient perceptions and expectations but also directly influence their trust and comfort levels with the dental care provided. Understanding these dynamics is crucial for reducing treatment-related anxiety, enhancing patient experience, and ultimately fostering a reliable patient-practitioner relationship that encourages regular dental visits and comprehensive dental health care management. The SERVQUAL analysis revealed a notable gap between expectations and perceptions in the tangibility dimension, with expectations averaging at 4.26 and perceptions at 3.74 on a 5-point scale. This significant disparity indicates that while patients expect high-quality physical environments, the actual conditions often fall short (MD = 0.52, SD = 0.77, t(295) = 11.59, p < .001). Conversely, the assurance dimension demonstrated a rare case where perceptions (M = 4.01) exceeded expectations (M = 3.47), suggesting that clinics may be effectively communicating their reliability and safety, thus alleviating patient concerns (MD = -0.54, SD = 0.72, t(295) = -12.80, p < .001). The DVSS findings paint a more positive picture regarding informational clarity. The majority of respondents (57.8%) strongly agreed that they understood the condition of their mouths post-consultation, and 43.6% were clear about the expected changes in their dental health. However, gaps in patient communication are highlighted by 11.1% of participants who felt they were not adequately informed about their dental problems, suggesting an area ripe for 39 improvement. While most patients are satisfied, dentists could benefit from targeted communication strategies to ensure that all patients leave with a thorough understanding of their oral health. This could involve personalized discussions, visual aids, or follow-up information sessions.. Demographically, the data reveals that younger patients (ages 18-36) displayed higher satisfaction, which might be attributed to less complex dental needs or more aligned expectations with service realities. Educational attainment also influenced perceptions; patients with higher education levels scrutinized services more intensely, expecting higher standards (F(3, 292) = 10.232, p < .001 for Information-Communication). Regarding the impact of gender on DVSS scores, a study on sweedish pupulation found that there was no significant difference with respect to gender (Hakeberg et al., 2000). This is different from our findings which could be explained by the different cultural background between sweedish and saudi pupulations. Table correlations underscore the interconnectedness of service quality dimensions. Information-Communication and Understanding-Acceptance shared a strong correlation (r = .761, p < .001), indicating that clear communication likely enhances patient understanding and acceptance of the care provided. Similarly, correlations between Information-Communication and Technical Competence (r = .669, p < .001) suggest that informative interactions can elevate perceptions of technical proficiency. The findings echo the results reported by Alshareef et al. (2020), who documented high satisfaction levels within university dental clinics, particularly in terms of the interpersonal elements of dental service delivery, such as dentist-patient interactions and the comprehensiveness of the information provided. This resonance suggests a general satisfaction when dental services are rendered in settings that are closely monitored and where educational standards are rigorously applied, perhaps due to the systematic approach and the ongoing educational feedback that typifies academic environments (Alshareef et al., 2020). However, 40 this study departs from findings in broader healthcare research, such as those presented by Subait et al. (2016), who identified pronounced demographic influences on patient satisfaction across different medical fields (AA et al., 2016). Unlike these broader contexts, our results suggest that the direct and intimate nature of dental care interactions may moderate the impact of such demographic variables, possibly due to the personalized approach taken in dental treatments. This specificity in dental care underscores the importance of focusing on service quality dimensions that directly impact patient perceptions, such as tangibility and responsiveness. Further alignment is found with the research by Al Fraihi & Latif (2016), which also highlighted significant service quality gaps in the same dimensions we found tangibility and responsiveness (Al Fraihi & Latif, 2016). These gaps affect patients’ first impressions and overall patient comfort, which are key factors for patient retention and satisfaction. The recurrence of the same deficiencies in different studies underlines the necessity of changes to dental clinic procedures and administration for better patient service. Besides, the DVSS and SERVQUAL analysis gives us a better understanding of the patient’s expectations and their feelings about the service provided. For instance, although most patients report that the communication about treatment is clear, there is a group of patients who find the information provided is not enough. This contrast reveals that although the patients experience high overall satisfaction, they need more targeted and patient-specific communication strategies that address the specific concerns and higher anxiety levels of the patients about dental care. As far as shared decision-making, the aspect that has been less studied in general dentistry than in the overall medical context, the results indicate that greater engagement in decision-making leads to more satisfaction. This is backed up by Emanuel and Emanuel (1992), who argued that shared decision-making improves the quality of care and patient satisfaction by letting patients actively participate in their health maintenance (Emanuel & Emanuel, 1992). Such an approach not only clarifies treatment procedures but also makes patients self-confident, which 41 may result in better treatment adherence and a good outcome. In contrast with other health studies, where Riley et al. (2014) look at shared decision-making in a wider healthcare context, our study demonstrates the particular significance of this strategy in dental care, where the personal and often invasive nature of the treatments can significantly affect the patient’s anxiety and satisfaction (Riley et al., 2014). Furthermore, demographic variables like age and educational level contribute differently to dental satisfaction than those in other healthcare services. Younger and more educated patients in dental settings tend to have higher expectations and, consequently, report lower satisfaction when these are not met, reflecting a discrepancy that the rapid advancements in dental treatment options and patient awareness may amplify. To conclude, this research has not only unveiled the significant position of quality of dental service with patients’ expectations and perceptions but also has demonstrated SERVQUAL and DVSS measures. Some of these main findings are that patients, overall, have their expectations met in terms of assurance and empathy, but there are large gaps around tangibility and responsiveness. To fill these gaps, a facility should be renovated, communication protocols should be improved, and staff members should be made empathetic so that patient satisfaction is improve 42 Chapter VI: Theoretical Implications The SERVQUAL model used in our research is by its general acceptance in different service sectors including healthcare, to measure service quality dimensions. The identified major gaps in tangibility, reliability, responsiveness, and empathy in dental settings support the validity of this model which was originally designed to evaluate service quality based on discrepancies between consumer expectations and perceptions (Parasuraman et al., 1988). Although in comparison to other industries, the application of SERVQUAL in dentistry must consider the highly personal and trust-based nature of dental services, which may not be as pronounced in other service sectors (Dopeykar et al., 2018). This necessitates a careful consideration of the tool’s dimensions and potential modifications to better suit the dental context. Additionally, the importance of tangible elements such as the clinic environment and modern equipment may be more influential in patients’ perceptions of quality in dentistry than in less personal service industries (Wu et al., 2024b). First, the model may not account for cultural differences in service expectations and perceptions, which can be particularly relevant in diverse populations. Second, some dimensions of SERVQUAL may not be as relevant or comprehensive for dentistry as they are for other industries. For example, the ‘empathy’ dimension might need to be more emphasized in healthcare settings than in non-healthcare service industries (Dopeykar et al., 2018). These limitations suggest that while SERVQUAL can provide valuable insights into patient satisfaction and service quality in dental care, it should be used with an understanding of its constraints and possibly in conjunction with other methods to obtain a more comprehensive evaluation such as DVSS that is used in our study. 43 On the other hand, the SERVQUAL is designed to capture consumer expectations and perceptions of service quality across various service industries, including healthcare. In the context of dentistry, the theoretical implications of using SERVQUAL are multifaceted: First, gap analysis is based on the premise that service quality is measured by the gap between customer expectations and their perceptions of the actual service received. In dentistry, this can help identify specific areas where dental services do not meet patient expectations, allowing for targeted improvements (Riaz & Sughra, 2021). Second, the five dimensions of SERVQUAL—tangibles, reliability, responsiveness, assurance, and empathy—are particularly relevant to dentistry. These dimensions can be theoretically linked to patient satisfaction and the likelihood of patients returning for future dental care, which is critical for dental practices operating in competitive environments (Rocha et al., 2017). Third, it helps in providing patientcentric approach care by focusing on patient perceptions. SERVQUAL aligns with the modern healthcare paradigm that emphasizes patient-centered care. This approach recognizes the importance of patient feedback in evaluating the quality of care and the overall patient experience (Jonkisz et al., 2022). Forth, The use of SERVQUAL enables dental practices to benchmark their service quality against other providers or industry standards. This can theoretically drive continuous quality improvement and help practices to differentiate themselves in the marketplace (Goetz et al., 2014). Fifth, theoretically, the application of SERVQUAL in dentistry can lead to a better understanding of patient needs and expectations, fostering a culture of quality improvement and patient satisfaction. This can translate into practical strategies for enhancing the patient experience and building patient loyalty (Santosa & Azam, 2019). Sixth, understanding the service quality perceptions through SERVQUAL can also provide insights into consumer behavior, such as the factors that influence the choice of a dental provider, the value placed on different aspects of service, and the willingness to pay for high-quality dental care. 44 The SERVQUAL analysis in the presented study offered valuable insights into patient satisfaction regarding dental services. In the tangibility dimension, the gap between expectations (M = 4.26) and perceptions (M = 3.74) in the tangibility dimension suggests that patients have high expectations for the physical aspects of healthcare facilities, which are not being met. The mean difference (MD) of 0.52, with a standard deviation (SD) of 0.77 and a highly significant t-value (t(295) = 11.59, p < .001), indicates a substantial discrepancy that is not due to chance. This finding implies that there is a critical need for dental clinics to invest in and improve the physical environment of their facilities. Enhancing the tangibility aspects of dental service could lead to increased patient satisfaction and could also be a differentiating factor in a competitive market. In contrast, the assurance dimension showed that perceptions (M = 4.01) exceeded expectations (M = 3.47), with patients feeling more assured than they anticipated. The negative MD of -0.54, SD of 0.72, and a significant negative t-value (t(295) = -12.80, p < .001) reflect that clinics are effectively communicating their competence and safety, surpassing patient expectations. The clinics seem to be succeeding in conveying trustworthiness and safety, which are intangible yet critical components of service quality. This could lead to a stronger patient-provider relationship, fostering loyalty and potentially leading to positive word-of-mouth referrals. In summary, while the physical environment needs improvement, the effective communication of reliability and safety is a strong point for these clinics. These insights could guide dental healthcare providers in prioritizing resource allocation and strategic planning to enhance overall service quality. Improving tangible elements and maintaining strong assurance communication can work synergistically to elevate patient satisfaction and trust in dental services. The SERVQUAL survey’s paired sample statistics provided a comprehensive look at the discrepancies between patient expectations and perceptions across the five dimensions of 45 service quality. In tangibility dimension, patients expected higher tangibility (M = 4.26) than they perceived (M = 3.74), indicating dissatisfaction with the physical aspects of healthcare services. This suggests a need for dental clinics to improve their physical environment, equipment, and appearance of personnel to meet patient expectations. Investments in tangibility could lead to enhanced patient satisfaction and loyalty. In reliability, a significant gap exists between the expected (M = 4.65) and perceived (M = 3.97) reliability of services. Reliability is crucial for patient trust. The gap indicates a need for consistent and dependable dental services. Addressing this could improve patient outcomes and service credibility. In responsiveness, patients’ expectations for responsiveness (M = 4.54) were not met by their perceptions (M = 3.84). Dental healthcare providers should focus on improving the willingness and readiness of employees to assist patients. Quick and effective responses to patient needs can significantly boost perceived service quality. In assurance, interestingly, perceptions of assurance (M = 4.01) exceeded expectations (M = 3.47). This indicates that clinics are effectively communicating their competence and the safety of their services, which is reassuring to patients. Maintaining and enhancing this communication can further strengthen patient trust. For the empathy, there is a notable difference between the expected (M = 4.49) and perceived (M = 3.80) levels of empathy. Empathy is a key component of patient care. The data suggests a need for more personalized and caring interactions between dental healthcare providers and patients. Improving empathy can lead to better patient-provider relationships and increased satisfaction. In conclusion, the SERVQUAL survey highlights critical areas where healthcare services can be improved to meet patient expectations. Assurance stands out as a potential area of strength, but it also warrants further investigation to understand why perceptions exceed expectations. While assurance is a strong point, tangibility, reliability, responsiveness, and empathy need attention. Addressing these gaps can lead to higher patient satisfaction, better dental health 46 outcomes, and a competitive edge in the dental healthcare market. The survey’s findings can guide strategic improvements in service delivery and patient care practices. The results of the correlation analysis within the SERVQUAL model, shows a moderate positive correlation in tangibility (r = .527, p < .001) which indicates that as patients’ expectations regarding the physical aspects of service (like facilities and equipment) increase, their perceptions of these aspects also tend to be more positive. This suggests that improving the physical environment could not only meet but potentially exceed patient expectations, thereby enhancing their overall perception of service quality. For the reliability, another moderate positive correlation (r = .544, p < .001) suggests a similar relationship for reliability, which involves consistency and dependability of the service. Ensuring reliable service delivery is likely to improve patients’ perceptions of the service, leading to increased satisfaction and trust in the dental healthcare provider. For the responsiveness (r = .497, p < .001), the positive correlation here implies that patients’ perceptions of how quickly and effectively their needs are met will improve as their expectations of responsiveness increase. Dental healthcare providers should focus on improving their speed and efficiency in addressing patient needs, which can significantly enhance perceived service quality. In the assurance dimension (r = .506, p < .001), this shows that higher expectations of staff’s knowledge, courtesy, and ability to convey trust and confidence are associated with better patient perceptions. Training staff to communicate effectively and confidently can lead to higher patient satisfaction and perceived service quality. In the empathy dimension, a moderate positive correlation (r = .503, p < .001) indicates that as expectations for empathetic, caring, and personalized service increase, so do patients’ perceptions. Providing personalized care and attention can greatly improve patients’ service experience and satisfaction. In summary, the correlations indicate that there is a significant relationship between patient expectations and their perceptions of service quality across all SERVQUAL dimensions. This underscores the importance of managing patient 47 expectations and aligning service delivery with these expectations to improve service quality perception. Private dental clinics can use these insights to prioritize areas for improvement and to develop strategies that enhance patient experiences and outcomes. Our results are similar to the findings of the studies of (Aboubakr & Bayoumy, 2022), who also used the SERVQUAL model in the context of dental education. The studies verify SERVQUAL applicability in a healthcare setting and call for the model’s continuous modification to reflect specific service features of modern dental practice. Moreover, our findings reveal the crucial role of communication which is a core factor of patient satisfaction according to theoretical frameworks that value the quality of interaction between patients and healthcare providers. Effective communication is the key not only to ensuring patient understanding but also to improving patient satisfaction (AA et al., 2016). This is in line with (Gray et al., 2021) who stated that the quality of patient-practitioner interactions is the major determinant of patient choices and satisfaction in dental services. The positive link between clear communication and patient satisfaction as our study shows implies that dental professionals should pay more attention to their communication skills as a strategic way to improve the results. Furthermore, (Sitaraman et al., 2020) emphasize on the SERVQUAL dimension of empathy which implies that empathizing and addressing the patients’ anxiety can remarkably improve their experience which is consistent with our research. In addition, our research shows that patient-oriented care, as explained by (Emanuel & Emanuel, 1992), can be a big factor in improving patient satisfaction. This theory proposes a collaborative approach that includes patients’ preferences and the dentist’s responsiveness to them, which agrees with the results of our research where patients reported higher satisfaction when they felt that their needs and concerns were being taken into consideration by their dentists. These theoretical implications underline the need to modify the models of service quality like SERVQUAL to suit the context of dental healthcare, where both technical 48 competence and relational factors play a key role. They also highlight the need for dental education and ongoing professional development to include modules on effective communication and empathy that are in line with the modern healthcare approach that is oriented toward the patient. Managerial Implications: To effectively address the identified gaps in dental service quality, specific strategic actions are recommended: A set of specific strategic actions are suggested for the purpose of filling in the quality of dental services: Enhance Physical Environment: Invest in remodeling the clinic to make it more beautiful and relaxing so that patients feel the physical space is conducive to them. This also includes redesigning the waiting areas to provide comfort seats and take cleanliness and hygiene issues into account. Improve Communication Strategies: Develop a full communication training course for all dental personnel. This training should emphasize the development of empathy and informationgiving skills, hence enhancing the efficiency of the treatment. Dentist could benefit from targeted communication strategies to ensure that all patients leave with a thorough understanding of their oral health. This could involve personalized discussions, visual aids, or follow-up information sessions. Optimize Administrative Processes: Revamp the scheduling systems to reduce wait times and improve patient care flow efficiency. The installation of effective scheduling software and training of the front office staff would be the most important elements in improving operational responsiveness. Personalize Patient Interactions: Tailor treatment plans according to each patient’s case, taking into account their medical history, individual needs and preferences, and previous 49 experience with the service. These interactions not only improve the quality of life for the patients but also create a bond of trust between the doctors and the patients. Therefore, dental clinics can increase patient satisfaction rates and regular visit frequency through the focus on the areas mentioned above; these are very important for long-term dental health. Hence, the improvements necessitate target investments in both physical infrastructure and human resources but yield huge returns in the form of patient loyalty and the clinic’s goodwill. The main limitation of this study is its cross-sectional design and the use of convenience sampling, both of which could limit the generalization of the findings. Future studies should consider the implementation of longitudinal studies to observe changes over time and apply a more diverse sample to guarantee the applicability of the results to a wider audience. Moreover, adopting qualitative research methods like patient interviews or focus groups could give a better understanding of personal experience and provide a more accurate quality of service for dental care practices. The difference between patients’ expectations and the way they perceive the quality of dental service suggests the areas to focus on for improvement. Through better communication, improved clinic physical settings and tailored treatment, dental clinics are capable of considerably improving patient experience. Perpetual enhancements in such areas are crucial for the development of trust that, in turn, encourages regular dental visits. These visits are the backbone of community oral health. Not only will these changes enhance the patient experience but also the effectiveness and popularity of dental care providers, which in turn will result in better health outcomes and more retention of patients. 50 Future Research: Future studies should consider the implementation of longitudinal studies to observe changes over time and apply a more diverse sample to guarantee the applicability of the results to a wider audience. Moreover, adopting qualitative research methods like patient interviews or focus groups could give a better understanding of personal experience and provide a more accurate quality of service for dental care practices. Future studies should be more demographically diverse and use a long-term approach to explore the topic in-depth and attend to emerging dental needs. 51 References: References AA, S., Ali, A., O, A., M, A., S, A., Alsalem, M., A, A., W, A., & El-Metwally, A. (2016). 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