Abstract
Abstract
Background
The SERVQUAL model is widely used to evaluate healthcare service quality; however, evidence regarding expectation–perception gaps remains fragmented across healthcare settings. Existing studies have primarily interpreted these gaps as indicators of patient dissatisfaction, potentially overlooking broader challenges in healthcare service delivery. This study aimed to quantify SERVQUAL expectation–perception gaps across healthcare settings and explore their implications for healthcare quality evaluation from a service design perspective.
Methods
A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. Electronic databases were searched from inception to January 2026. Studies applying the SERVQUAL model in healthcare settings and reporting quantitative expectation–perception data were eligible. Twenty-five studies involving 9,640 participants were included. Random-effects meta-analysis using restricted maximum likelihood (REML) estimation was performed to calculate pooled mean differences (MDs) after scores were harmonized to a common five-point scale. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.
Results
A statistically significant average negative expectation–perception gap was identified across healthcare settings (MD = −0.578; 95% confidence interval (CI), −0.781 to − 0.376; 95% prediction interval (PI), −1.662 to 0.505; p
Conclusions
An average negative SERVQUAL expectation–perception gap was observed across the included studies, with the largest pooled mean gaps occurring in Assurance, Reliability, and Responsiveness. However, these findings should be interpreted cautiously because of the extreme between-study heterogeneity, prediction intervals crossing the null, and the predominance of cross-sectional evidence. The observed gaps may reflect context-dependent service delivery misalignments involving communication, coordination, responsiveness, and patient journeys. A service design perspective may therefore complement conventional healthcare quality evaluation and support context-sensitive, patient-centred quality improvement.