Purpose Few scholars have so far explored how healthcare service quality affects patient dissatisfaction, leading to negative behavior responses when a healthcare service fails. The purpose of this paper is to examine how different service quality attributes affect patient dissatisfaction leading to a variety of asymmetric negative behavior responses. Design/methodology/approach Following a survey of 453 dissatisfied outpatients in Korea, structural equation modeling with a series of post hoc analyses is used to test the research model. It consists of five hypotheses. Findings Outcome quality is found to be the most significant variable affecting patient dissatisfaction, followed by administrative quality, interactive quality, and environmental quality. Dissatisfied patients tend to engage more in active behaviors (e.g. negative word-of-mouth, switching, and complaining) than in remaining passive in a non-linear way. Also, the mediating role of dissatisfaction is found to be significant. Research limitations/implications This paper has empirically identified the most significant service quality attributes that lead to dissatisfied patients and negative behaviors on their part. These findings indicate that different quality attributes of service failure lead to different actions. However, this study has suffered from a few limitations as a result of its research context and scope. Originality/value This paper is one of the very few empirical studies examining the relationships among the output and process quality attributes, patient dissatisfaction, and actual behaviors in a healthcare service failure context.
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