With the rapid development of the companion animal market in China, and especially in the cities, more pet owners are focusing their attention on the quality of veterinary services. There has been limited study of veterinary care in China and little is known about the provision of veterinary services or the attitudes of pet owners. Consequently, this study set out to evaluate companion animal owners' perceptions of veterinary service quality in Beijing using primary research techniques.
China is the largest veterinary market in Asia and has been characterized by a rapid growth in the number of pets to over 200 million. This increase of 500% between 1999 and 2007 is the result of a rapid rise in personal disposable incomes (Liu, 2007) and recognizes the growing importance to Chinese pet owners of the human–animal bond. By 2015 the number of pets is estimated to reach 500 million. Accordingly, the companion animal market has risen in value from 10 million Yuan in 2004 to approximately 100 million Yuan in 2009 (Petmsn, 2009). The top five cities with regard to pet numbers are Beijing followed by Shanghai, Guangzhou, Chongqing and Wuhan (Li 2005).
Quality is a vital issue in the provision of services such as veterinary care (Lovelock and Wirtz, 2011). The unique characteristics of services, especially as applied to companion animals on behalf of their owners, create special problems for the veterinary practice. This paper makes use of Importance–Performance Analysis (IPA), a widely used method of assessing customer service quality, to develop prescriptions for enhancing customers' experience of using veterinary care services.
Measuring service quality
The provision of any service provides challenges to managers and those actually delivering the service (Palmer, 2008). Services exhibit the properties of intangibility (cannot be directly examined before delivery); inseparability (of consumption and production); variability (especially in labour intensive personal services provided in a one-to-one situation); and perishability (inability to store services coupled with fluctuating patterns of demand). A further characteristic is the inability of clients to own a service.
Because of the absence of tangible elements, measuring service quality can lead to difficulties as it is not always clear what dimensions of service are important to clients in their evaluation process (Palmer, 2008). In the case of veterinary services, clients may well attach great importance to the quality of the service provided by the veterinarian as distinct from the variety of services offered. It is, furthermore, likely to be different to the normal service experience due to the client's emotional connection with their animal (Brockman et al, 2008;Dobson, 2008).
Palmer (2008) takes the view that given the complex nature of service quality, it is not surprising that there have been various methods proposed for measuring it. One approach for assessing quality is the critical incident method. The methodological approach is to ask respondents to think of situations where the service, or any part of the service process including the outcome of that process, clearly deviated from the normal whether favourably or unfavourably. The respondent is asked to describe what happened and what made the incident critical. The results give management rich material indicating problems and strengths and action to be taken (Grönroos, 2007). A second approach is to ask clients to rate the performance of a service. Woodcock and Barleggs (2005) developed a questionnaire for measuring satisfaction with UK veterinary services using 72 satisfaction items based on a five category Likert scale. However, this approach does not in itself indicate the importance to a consumer of individual items of quality.
A more complex method is to focus on differences between expectations and perceptions as proposed initially by Parasuraman et al (1988) which led to the development of the widely used quantitative technique for measuring service quality known as SERQUAL. Unfortunately, expectations and perceptions do not readily translate into management action. A fourth approach is to use IPA which compares the importance of elements of a service with the performance of each of these elements to the consumer.
Method
IPA was chosen for this study as it is a relatively simple means of systematically evaluating the attributes of the product or service offering in terms of their importance to the customer and the perceived performance of the service provider. It was popularized by Martilla and James (1977) and recent applications have been in the context of the management of multi-purpose stadiums (Hock et al, 2010), e-business decision making in small and medium-sized enterprises (Magal et al, 2009), and the mobile telecommunications industry (Pezeshki et al, 2009). IPA normally comprises three stages: identification of the attributes; collection of importance and performance data; and analysis of that data.
According to Breivik and Supphellen (2003) there are ten techniques that may be employed in stage one to identify the relevant attributes of the service for analysis. These techniques include repertory grid analysis, visual techniques, and indirect questioning. However, in this survey the attributes were identified via direct elicitation, the best approach overall (Alpert, 1971), combined with a review of the literature.
Stage two requires the collection of numerical importance and performance data. This normally involves the design of a questionnaire comprising rating scales. The questionnaire relating to Chinese veterinary services was based on a five point Importance scale where 1 equalled ‘Not Important’ and 5 equalled ‘Extremely Important’, and a five point Performance scale where 1 equalled ‘Poor’ and 5 equalled ‘Excellent’. A draft questionnaire utilizing the principles of IPA was devised and discussed with a veterinarian at the pet hospital of China Agricultural University. Additional information was gathered on the provision of companion animal veterinary services and comments were made about the questionnaire which led to revisions being made to both the questions and the layout. The technique assumes that performance should be relative to the importance that clients attach to each attribute. Palmer (2008) explains that high performance of a relatively important aspect of the service could indicate that management is ‘exceeding expectations’. Conversely, poor performance for an important item indicates a priority area for management action.
A convenience sampling approach was taken to the main survey as it is fast, low cost and gained the basic information effectively. Malhotra and Birks (2003) define convenience sampling as ‘a non-probability sampling technique that attempts to obtain a sample of convenient elements. The selection of sampling units is left primarily to the interviewer.’ Ten communities in Beijing were selected with the intention of conducting 30 personal interviews with pet owners in each one. Interviewing was carried out by year 2 undergraduate students on a joint Harper Adams University College – Beijing Agricultural College degree programme during February 2010. A total of 260 successful interviews were conducted.
Veterinary service provision in China
A series of problems have been identified by researchers investigating Chinese companion animal veterinary practices including failure to keep up with the growth in the number of pets, irregular charging and inappropriate methods of treatment (Xi, 2005). Many pet owners do not have the income to satisfactorily care for their pets and find the cost of pet care to be expensive. Liu (2007) gives a selection of prices (£1 sterling = 10 Yuan) from a Beijing pet hospital including dealing with trauma (100–350 Yuan), subcutaneous intramuscular injection (20 Yuan), intravenous injection (50 Yuan), oviarectomy surgery (150–300 Yuan), castration (150–280 Yuan) and claw cutting (20 Yuan). Li (2009) found that a small proportion of people spent 1000 Yuan per month on their pets, with most spending around 300 Yuan and only a small number spending less than 100 Yuan. Many pet owners were afraid of their pet becoming ill as it might be more expensive to cure than humans.
Mark-ups were high with a drug costing 6 Yuan from the supplier being sold at 160 Yuan in a pet hospital, while a can of oxygen wholesaling at 35 Yuan was sold for 60 Yuan. The price of pet medication is not a part of the Chinese government's responsibilities so there are no regulatory measures. Certain pet hospitals were found not to have been properly registered for tax and irregularities were noted with receipts and invoicing procedures (Bjsilp, 2010). Li (2009) found that using human medicines on pets was a common occurrence as there were not enough veterinary medicines available. Many pet hospitals have their own dispensary which customers are not allowed to enter and so do not know what drugs are being used on their pets. Prices for standard procedures varied considerably such as the price for a tooth extraction being between 50 and 200 Yuan.
Some veterinarians were found to have little academic training in small animal work (Xi, 2005) while others exaggerated the pet's illness in order to maximize their charges. Again, the lack of a clear government standard was noted as leading to the variable quality of veterinary services. Many pet hospitals were believed to focus on profits rather than the health of the pets (Xi, 2005). Given these indications there is reason to believe that serious gaps in veterinary service provision exist. The research conducted thus attempts to discover if this is actually the case and to identify which aspects of service quality require most attention by veterinary practice managers.
Results
The mean Importance–Performance scores of all respondents in the veterinary service study are displayed in Table 1.
| Variable | Importance | Performance | |
|---|---|---|---|
| 1 | Experience of vet | 4.5923 | 3.5000 |
| 2 | Attitude of veterinarian towards client | 4.2192 | 3.5269 |
| 3 | Taking care of patient | 4.4077 | 3.3846 |
| 4 | Detailed explanation of treatment | 4.1846 | 3.1308 |
| 5 | Cost evaluated before treatment | 3.8192 | 2.8269 |
| 6 | Complaint system | 3.4038 | 2.6462 |
| 7 | Operating hours | 3.5385 | 3.3231 |
| 8 | Holiday operating | 3.8154 | 3.3385 |
| 9 | Reservation system | 3.6308 | 3.1500 |
| 10 | Complete medical facilities | 4.3423 | 3.4000 |
| 11 | Advanced medical facilities | 4.1769 | 3.2385 |
| 12 | Large facility | 3.4577 | 3.1115 |
| 13 | Clean environment | 4.1231 | 3.2808 |
| 14 | Resting area for pet owners | 3.4615 | 2.9077 |
| 15 | Parking | 3.4346 | 2.8038 |
| 16 | Reasonable cost | 4.1308 | 2.7077 |
| 17 | Near home | 4.0038 | 3.2538 |
Stage three of the IPA requires the data to be used as coordinates and plotted in a graph to permit systematic evaluation of the data. The graph has four quadrants each of which has a generic strategy label developed from the Importance and Performance axis. The Chinese veterinary service data are plotted in two graphs comprising Figures 1 and 2.
Discussion
Figure 1 is what may be termed an ‘absolute’ view of the data as the axes are based on the full five point scale. This view suggests that the veterinarians should just ‘keep up the good work’ for those attributes located in the top right hand quadrant and concentrate attention on those located in the top left hand quadrant. Figure 2 is best thought of as a ‘relative’ view of the data as the axes have been adjusted such that the cross-hairs run through the centre of the data points. This view allows management further insight into the attributes that they should focus their attention on in order to further improve the service offering. It is worth noting that in all cases the performance score attributed to veterinary practices in Beijing was less than the importance score suggesting significant potential for providing improved service quality.
Quadrant A — ‘concentrate quality improvements here’
Two key areas for management action were highlighted. With an importance score of 4.2192 and a performance score of 3.5269 the attitude of the veterinarian towards the client needs attention by Beijing veterinarians. The need to assure reasonable costs of providing veterinary services is indicated by an importance score of 4.1308 and a performance score of 2.7077, the second lowest of all 17 attributes.
Quadrant B — ‘keep up the good work’
With regards to those service attributes where veterinarians need to keep up the good work the ‘experience of the vet’ gained the highest importance score of 4.5923. However, a corresponding performance score of 3.5000 suggests that respondents have some concerns about the experience of Chinese veterinarians. Other attributes in this quadrant include taking care of the patient, detailed explanation of treatment, complete medical facilities, advanced medical facilities, clean environment and near home.
Quadrant C — ‘low priority’
The four low priority attributes identified were cost evaluated before treatment, complaint system, resting area for pet owners and being a large facility. Perhaps customers in Beijing are not used to having complaint systems in place or to getting an estimate of costs before treatment begins.
Quadrant D — ‘exceeding expectations’
Attributes in this quadrant included operating hours, holiday operating, reservation system and parking. The low importance given to parking may well be due to the small proportion of people with cars and reliance on walking or public transport.
Overall access to veterinary services, at least in Beijing, appears not to be a problem for pet owners.
IPA is a valuable method for veterinary practice managers in all countries as a means of monitoring a wide range of service attributes. The focus on the four quadrants gives a clear indication to managers of where improvements in service quality are required
Conclusions
The application of the IPA method to veterinary service provision in Beijing was limited by the number of attributes being examined and only tentative conclusions can be drawn regarding overall veterinary service satisfaction in Beijing or other large Chinese cities.
The results in Figure 1 show a broad level of satisfaction with the veterinary services used by Beijing pet owners. This is in contrast to some of the problems identified by Xi (2005) and Li (2009) but may reflect some level of consumer ignorance by those interviewed about certain veterinary practices. The more focused analysis of Figure 2 allocated service attributes to four quadrants of the Importance–Performance matrix. The key finding is that there is significant opportunity for Chinese veterinary organizations to improve their service offering with respect to service attitude and treatment costs.
However, with a rapidly developing market such as that for pets in China, attitudes towards veterinary service provision will not remain static. A more extensive study extending beyond Beijing would provide more reliable comparative data. Further, more detailed consumer insights could be obtained using in-depth interviews or focus groups and would allow comparison with the work of Brockman et al (2007) and Dobson (2008). The list of veterinary service attributes could be usefully extended with reference to Woodcock and Barleggs (2005).