Before the service encounter. Referral variables influence patient perceptions of a specialist's service quality.

Relationships with referring providers are important to specialists for more than just ensuring a supply of incoming patients. They also offer an opportunity to influence the service referral variables, which unfortunately are not under the direct control of the specialist. Target providers must try to "manage" the service referral variables whenever possible. Patients are not objective in their evaluations of service quality, basing decisions solely on the actual service provided. For the endodontists in this study, almost 9% of the variance in service quality scores can be explained by factors related to the referral process alone. Consequently, the evaluation of the service is dependent to a significant degree on what happens before the patient arrives at the office. All of the service referral variables studied--perceived choice, amount of information, and attitude toward being referred to another provider--had at least as much influence on perceived service quality as waiting time did. And, two of the referral variables--perceived choice and attitude toward the referral--were as influential on patients' behavioral intentions as was the perceived cost of the service.