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INFECCION DE VIAS URINARIAS, SITIO NO ESPECIFICADO

2.3.1 Conceptu al isation and o perational isation of custo mer

satisfaction

Customer satisfaction has been defined (Lovelock et al ., 1998) as \\a consumer's post-purchase eval uation of the overall service experience ... a n affective state o r feeling reaction i n which the consumer's needs, desires and expectations ... have been met or exceeded" (p. 1 16).

Customer satisfaction encompasses a number of related cognitive and affective elements o n the part of the customer i nc l u d i n g expectations, confirmation/ disconfirmation of expectations, needs, regret, dissonance, performance evaluation, perceived quality, value judgement, attribution of outcomes, mood and emotions such as anger or delight as well as equity (Uljander & Mattsson, 2002; Oliver, 1997; Olsen & Johnson, 2003; Szymanski & Henard, 2001). Indeed, satisfaction may be influenced by so many factors, including the referent's age, general level of life satisfaction and the number of purchase choices available, not to m ention the cost of the service to the customer, that Peterson's and Wilson's (1992) comment, "operationally, customer satisfaction is a complex and elusive phenomenon" (p.68), would seem to be something of an understatement.

Customer satisfaction is commonly conceptualised in the marketing and �ervices literature as an outcome of the comparison customers make between their prepurchase expectations of the service performance and postpurchase perceptions of that performance. This conceptualisation is known as the disconfirmation of expectations paradigm (Cardolo, 1965; Churchill & Suprenant, 1982; Oliver, 1980) . Vi's (1990) review showed that there is substantial empirical evidence supporting the role of disconfirmation of expectations in the formation of satisfaction/dissatisfaction. Further studies (e.g. Danaher & Haddrell, 1996) have continued to provide support. Meta-

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analysis of satisfaction studies showed that, along with equity, disconfirmation had the strongest correlation with satisfaction on average (Szymanski & Henard, 2001 ) . The importance of disconfirmation to the satisfaction process should lead managers to focus on i mproving disconfirmation levels, avoid situations where they overpromise and under-deliver (Parasura man, Zeithaml, & Berry, 1985) and match their service delivery to customer expectations (Gutek, Groth, & Cherry, 2002). Given the inherent intangibility of services, the quality of a service resides in the customer perceptions of the quality of the service performance (Buzzell & Gale, 1987). Within the service experience, the operation of the disconfirmation paradigm leads to customer satisfaction or dissatisfaction with a range of service encounters, which over time crystallises into perceived service quality (Patterson & Johnson, 1993).

Figure 2.3 (next page) demonstrates the disconfirmation and word-of-mouth process. If perceived performance fails to meet expectations, a negative disconfirmation occurs and the customer is dissatisfied or disappointed. If performance exceeds the customer's expectations, a positive disconfirmation occurs and the customer is strongly satisfied or delighted (Oliver, 1980) . Dissatisfaction/disappointment may produce negative WOM, while strong satisfaction/delight may produce positive WOM . Confirmation of expectations occurs when customers find that the service provided meets their expectations. This produces in the mind of the customer a "neutral" state, which has been referred to as mere satisfaction (Patterson, 1993). In terms of services best practice, mere satisfaction is not enough, since "marginally satisfied customers are at risk of being lured away by a competitor's offering" (Lovelock et al., 1998, pp. 1 16-1 17) . Positive disconfirmation is therefore fa r more important because it produces not just mere satisfaCtion but strong satisfaction or delight.

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- I I I I I I I I I I I I I I , Decision not to purchase WORD OF MOUTH DISCOMMENDAnON NEGATIVE - 52 -

Customer previous uperience Customer wants/needs

Marlcetlng/Publicity Image of service organisation

Decision to purchase

D

EXPECTA nONS

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EXPERIENCE OF SERVICE

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PERCEPnONS OF SERVICE PERFORMANCE

DISCONFIRMAnON CONFIRMA nON

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I I I I I I I I I I I 015- MERE 1 _ _ _ _ _ _ _ APPOINTMENT SA TISFACTION WORD-OF-MOUTH RECOMMENDAnON POSlnVE I DISCONFIRMAnON I I I I

D

I I I I I I I I I I DELIGHT

Figure 2.3. Customer disconfirmation of expectations a. word-of­ mouth cycle (based on Patterson, 1993)

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Service firms need to delight customers, since it is only delighted customers who develop the sort of loyalty behaviours firms need for long-term customer commitment (Hallowell, 1996; White & Schneider, 2000) . In one study, for instance, "completely satisfied" customers were more likely to be loyal than "merely satisfied" customers (Jones & Sasser, 1995, cited in Stauss & Neuhaus, 1997, p. 237). More importantly for ELCs, it is delighted clients who are more likely to spread positive WOM for the organisation (Lovelock et al., 1998). A key indicator for ELCs of their performance, therefore, would be the extent to which clients are delighted with specific aspects of the ELC's service.

There is, however, one apparent weakness of the disconfirmation of expectations paradigm. This relates to a logical i nconsistency (Spreng, MacKenzie, & Olshavsky, 1996), namely, that if a customer expects poor performance and then receives poor performance, in theory, the customer is satisfied. In reality, however, it must be asked how likely it is for a customer to engage and pay for a service, in the expectation that the service performance will be poor. Only in contexts where no other choice is available, such as public/government services, is such a scenario probable, which may account for reported levels of unusually high satisfaction with such services (Lovelock et al., 1998). In a competitive service industry such as TESOL, however, this is unlikely.

2.3.2 Client satisfaction and English language centre performance Service organisations may choose a number of methods for measuring their performance. Financial measures of performance, for instance, such as Return on Investment have been used in such comparative studies (Denison, 1990; Kotter & Heskett, 1992; Siehl & Martin, 1990). An additional approach for ELCs might be to measure client English language proficiency gain since this is the principal raison d'etre of ELCs. This would mean ensuring that clients were tested at the commencement and conclusion of their language course, using the same standardised test. However, such a measure would present a limited

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view of the entire service provision, since it does not take into account other components of the ELC experience such as the homestay, milieu, facilities or activities programme.

Services researchers have also used customer satisfaction as an indicator of performance. Since satisfying customers is a primary obligation on companies, all company activities, poliCies, and programmes should be assessed in terms of how well they meet this obligation (Peterson & Wilson, 1992). There is more than adequate evidence in the literature of performance as either a direct or an indirect driver of satisfaction (Bolton & Drew, 1991; Churchill & Suprenant, 1982; Oliver, 1980, 1981, 1993, 1997; Spreng et al., 1996; Tse & Wilton, 1988; Wirtz & Bateson, 1999; Vi, 1990). The effectiveness of service operations is viewed in the services literature largely as a function of customer satisfaction with the service process (Gronroos, 1990; Peterson & Wilson, 1992; Wilson, 2002) because assessment of the quality of a service organisation's output is entirely in the mind of the customer, regardless of any objective effiCiency measures or "expert" opinion (Bowen & Ford, 2002). Measures of customer perceptions of service process outputs or service levels are, moreover, considered to represent good practice in terms of service performance measure ment (Voss, Johnston, Fitzgerald, & Sylvestro, 1990) . It seems, therefore, that customer satisfaction has substantial support as at least one key i ndicator of service performance. However, there are some speCific client satisfaction issues where ELCs are concerned, and these are discussed in the next section.

2.3.3 English language centre client satisfaction and service evaluation

ELC client satisfaction is dependent on the value judgement the client makes of the quality of the various aspects of the ELC service. But how well are ELC clients able to judge the service performance of an ELC? With respect to higher education, Barnett (1992) commented: "Clients of a professional service are not necessarily the best judges of the service they receive ... " (p. 17).

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Barnett's point was that students may lack the knowledge, experience and maturity to be able to judge whether particular methodologies, content or courses of action represent a competent choice on the part of the educational service provider. Also, students have less-defined cognitive structures and are more outward focused than other, mature, groups of consumers, meaning that inward focused factors such as affect, expectations and disconfirmation may be less instrumental i n terms of their satisfaction assessments (Szymanski & Henard, 2001).

Second language students in particular may have difficulties accurately evaluating the teaching-learning component of an ELC's service. Their cultural backgrounds may lead them to have a totally different perception from their teachers of what is an effective methodology and what is not. Teachers in ELCs, for example, commonly encounter Asian clients who are used to a language teaching-learning style based on outdated gra mmar/translation ideology, and who reject the active-communicative methodology now considered best practice in Western TESOL circles. Such clients can become troublesome and even disruptive if they perceive that the ELC's methodology conflicts with their preconceived notions of best practice. Unless clients can be shown that the ELC's methodology is actually going to be effective, they may register dissatisfaction with this part of the service.

ELC clients may also have unrealistic expectations of what they can achieve in terms of language and study success within a specific period of time and the realities of both the service performance and their own performance may cause severe disappoi ntment and dissatisfaction. Although some clients may retrospectively adjust their expectations of the service performance to fit in with their actual perceptions (Patterson, Romm, & Hill, 1994), this may not always be the case. The success of a language course, furthermore, depends on a complex interplay of factors, not least of which is the client's own aptitude to learn a language and willingness to expend the required levels of effort

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needed for success. Outcomes of language instruction may not be immediate and it may take many months before a client is aware of having made progress.

ELC client satisfaction may also be determined by clients' status as "novice consumers" or "expert consumers" of the service. Whereas novices do not know what to do or how to perform i n terms of their role in the service provision, expert consumers do. Novices need to be taught a "service

so that they can develop the sort of confidence that will lead to effective utilization of what the service has to offer and thus, perhaps, to satisfaction with the service (Bateson, 2002). High customer familiarity with the service process is linked to higher levels of customer satisfaction (SOderlund, 2002). Although most E LC clients will have had prior experience of language instruction, many will not have attended a commercial language school, nor will they be familiar with particular instructional approaches in the New Zealand ESOL context. Their transformation from novices to experts may therefore be linked to the length of their stay in an ELC - the longer they attend, the more "expert" they become. Length of time in the ELC could therefore be linked to satisfaction levels.

A further issue for ELCs relates to diversity of their clientele. There is increasing evidence in the literature that different national a nd cultural groups, for instance, may respond differently to service provision and express different levels of satisfaction (e.g. Espinoza, 1999; Johnson, Herrmann, & Gustafsson, 2002; Maruca, 2000; Mattila, 1999; Snow, Bartel, & Cullen, 1996; Triplett, Yau, & Neal, 1994; Ueltshchy & Krampf, 2001). Language barriers and associated factors oblige ethnic consumers to rely more on WOM, as previously discussed, but also to develop more long-term relationships with service providers (Pires & Stanton, 2000) . Client personal characteristics may also elicit diverse client responses. Research in a retail services context (Homburg & Giering, 2001) has shown that while age, income and variety seeking were important moderators

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of client satisfaction and loyalty, gender and levels of client i nvolvement in the service were not. Such issues underline the i mportance of ELC manager awareness of the make up of ELC clientele and the key marketing function of WOM among potential clients.

Given these issues, ELCs may manage client expectations of the service (Lovelock et al., 1998), that is, view customer expectations as a strategic issue (Schneider & Bowen, 1995) and take steps to shape or influence customer expectations with a view to creating a positive perception of eventual service performance . Conventionally, service organisations manage customer expectations by delivering what they promise or even overdelivering, thus creating positive disconfirmation and delight. Complex, professional services such as TESOL may need to go further, devoting resources to educating new clients about the nature of the service - i ncluding, for instance, teaching methodology - and, specifically, about what the client can realistically achieve within a given period of time. Although the teaching-learning component is the core of the service, other factors such as the attitudes and service orientation of the ELC staff, the nature of the homestay experience, emotional and physical comfort levels, and a number of tangibles such as decor, facilities, or location may be equally or even more important in terms of creating client satisfaction.

2.3.4 The measurement of customer I client satisfaction

• Measurement issues

There are pitfalls in the traditional satisfaction analysis i nvolving "direct" measures of satisfaction, for instance, the generation of a list of key service features, the rating of these features in terms of i mportance and an evaluation by the customer of the service i n terms of the features (Oliver, 1997) . Problems i nclude: the fact that practical constraints mean that not all features could possibly be included; ambiguity over the actual meaning of the term "importance" and its conceptualisation by individual respondents; and the fact

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that such surveys often do not actually measure satisfaction but other concepts such as like/dislike, service quality or likelihood of repeat business.

An issue commonly reported in the literature is that find ings from customer satisfaction surveys tend to be skewed towards the positive with up to 80% or of customers commonly reporting that they are satisfied or very satisfied (Danaher & Haddrell, 1996; Peterson & Wilson, 1992; Stauss & Neuhaus, 1997) with a particular service or product. In spite of this very positive result, a number of studies have shown (Stauss & Neuhaus, 1997) that such professed satisfaction is no guarantee of customer loyalty and that measures of customer satisfaction may not provide a reliable indicator of future customer behaviour. In one study of customers who switched brands, for instance, 90% were found to have been satisfied or very satisfied with the brand they switched from

(Reichheld & Aspinall, 1994).

Peterson and Wilson ( 1992) argued that the wel l - known skewness phenomenon either meant that there was indeed a high level of general customer satisfaction with goods and services, or that the satisfaction measure was a function of a number of factors in the process, the respondents or the methodology used. Although the former explanation cannot be dismissed out of hand, common sense would tend to suggest that the explanation is rather more complex. While discarding a "ceiling effect" in the measurement scales and response rate bias (for example, satisfied customers are more likely to respond to satisfaction surveys), Peterson and Wilson (199 2) cited a number of empirical studies which suggested that satisfaction measures were subject to influence and potential contamination by methodological factors such as:

• Data collection mode bias: The level of satisfaction expressed may depend on the type of data collection procedure used.

• The question form: The use of a positive form of words (i.e. "satisfied") may

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• The question context: Asking a general question before a specific question may result in a more satisfied response for the latter.

• Measurement timing: Customer satisfaction appears to be highest

immediately after purchase but declines over time.

• Response styles: Personal characteristics may dispose respondents to suspend critical judgement and evaluate to an over-positive extent.

• Mood: Responses may be related to respondent mood at the time of the survey, particularly if respondents have not thought about the topic until asked a specific question.

The operationalisation of these factors in terms of the client satisfaction survey used in this study is discussed in Section 3.6. 1 .

• The choice of a satisfaction scale

Although single item measures of customer satisfaction have been in use, such scales do not capture the complexity of the various dimensions of satisfaction, nor are they sound in terms of establishing reliability (Danaher & Haddrell, 1996). Evidence weighs in favour of multi-item scales to capture satisfaction data, particularly in terms of their increased reliability a nd convergent and discriminant validity (Yi, 1990) . For these reasons, much of the customer satisfaction research has moved to multi-item scales which are a ble to capture responses to key components of the particular service.

A survey of the satisfaction literature identified three broad categories of customer satisfaction scale in use by researchers (Danaher & Haddrell, 1996):

• performance scales, e.g. poor, fair, good and excellent

• disconfirmation scales, e.g. worse than expected to better than expected

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Of these three, the disconfirmation model has enjoyed increasing support in the literature (e.g . Danaher & Haddrell, 1996; Erevelles & Leavitt, 1992; Parasuraman et al., 1988; Vi, 1990) since, as discussed in Section 2.3 . 1 , it embraces one of the key elements of the satisfaction response, namely expectations, and addresses the complexity of the satisfaction concept as a psychological process (Oliver, 1997), involving the dichotomy between what clients expect of a service and what they actually perceives they have got. When subjected to quantitative analYSiS, comparison with expectations has a higher correlation with customer retention than either quality or satisfaction measures. Also, the use of a disconfirmation scale can reduce asymmetry in the measure of perceived service, which skews results towards the top end of the satisfaction scale (Devlin, Oong, & Brown, 1993; Rust, Zahorik, & Keiningham,

1994).

Patterson et al. (1998) likewise found that the concept of expectation was an important reference point for the development of customer satisfaction among overseas students in Australian universities and that "the disconfirmation of expectations paradigm explains (dis)satisfaction at least on individual dimensions" (p. 154).

Danaher and Haddrell (1996) demonstrated the disconfirmation scale to be superior to either the satisfaction or the performance scale in terms of reliability and convergent, discriminant, and face validity. The disconfirmation scale also corrected the skewness commonly experienced with other forms of satisfaction scale and was also found to have greater managerial value, because it provided a more consistent picture of customer satisfaction with individual elements of the service.

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2.3.5 Comparative English language centre satisfaction studies

The general lack of empirical research into ELC management issues has already been reported. This lack extends to surveys of client satisfaction with ELC