quality in tourism destination

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Home > Books > Mobilities, Tourism and Travel Behavior - Contexts and Boundaries

A Comprehensive Review of the Quality Approach in Tourism

Submitted: 15 March 2017 Reviewed: 31 July 2017 Published: 20 December 2017

DOI: 10.5772/intechopen.70494

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This study summarizes the evolution of the quality approach in tourism. Environmental issues are also addressed, as there are strong interdependencies between these two areas. Especially in tourism, the quality-environment integration is essential. The study reveals the diversity of quality and environmental models currently used worldwide, including general models for quality assessment and management, applied in all areas, and also the tourism-specific models. The objectives of this synthesis are to achieve a systematization of the information on the quality and environment approach in tourism, and to highlight the main axes of changes. The conclusions formulated illustrate the future directions to improve the quality approach in tourism, concerning both the quality models and their implementation. The results of this comprehensive review are useful to the tourism coordination structures at national and regional level, and also to academics and researchers, to better understanding the trends in quality approach and optimizing their quality-related actions. The workpaper is based on the reports of World Tourism Organization and other tourism professional structures, as well as studies and researches published in specialized journals related to quality and environment approach in tourism.

• quality in tourism
• quality management
• environmental management
• integrated quality management
• quality general and specific models

Author Information

Diana foris *.

• Faculty of Food and Tourism, Transilvania University of Brasov, Brasov, Romania

Maria Popescu

• Faculty of Economics and Business Administration, Transilvania University of Brasov, Brasov, Romania

Tiberiu Foris

*Address all correspondence to: [email protected]

1. Introduction

The purpose of this section is to clarify what meanings have the concepts of quality, quality management, and quality of the tourism product.

1.1. The meanings of quality and quality management

Quality is a common term used in everyday speech, but with various meanings. The term “quality” defines “an essential, or distinctive characteristic, property, or attribute; character with respect to fineness, or grade of excellence; superiority; excellence” [ 1 ].

In the modern industry, the first practical approach to quality was in a technical perspective, product related. But the quality thinking has evolved over time. The modern quality approach, specific to the last decades, is customer related: the quality is evaluated based on the customer requirements, and it means “fitness for use” [ 2 , 3 ]. In this case, the term quality does not have the popular meaning of “best” in any absolute sense, it means best for certain target groups of customers; if a product or service meets expectations, then the quality has been achieved.

Taking into account customer orientation, Kosar and Kosar consider that “quality is a market category that encompasses the totality of creation and realization of tangible products and services, on the level to which their properties ensure the compliance with the requirements of demand” [ 4 ]. But the quality approach is more than marketing related: it covers the entire organization and includes all processes on which the client satisfaction depends. This holistic approach to quality in the organization context is generically called “Quality Management.” Quality management presumes an approach of quality within the entire organization, given that satisfying customers and other stakeholders’ requirements represent the mission of the whole system. As Juran highlights, quality is no longer a technical issue. It is a business issue and corresponds with the organization’s mission to satisfy the stakeholders needs and expectations [ 5 ]. Achieving quality in organization is a matter of management; as Feigenbaum (1983) says “quality is a way of manage.”

Implementation of quality management within the organization involves the development of processes, structures, methods, etc., by which there are systematically achieved planning, doing, controlling, and quality improvement. This succession summarizes the cycle of management activities in a modern approach [ 3 ]. Quality management integrates some basic principles: customer focus, leadership, engagement of people, improvement, process approach, evidence-based decision making, and relationship management, which are the defining elements of modern management [ 6 ].

A wider perspective on quality, which takes into account not only the requirements of customers but also of other interested parties, is synthesized in the expressions “Total Quality,” or “Total Quality Management,” extensively used in specialized studies and also in practice [ 2 , 3 ]. TQM (abbreviation of Total Quality Management) defines a management philosophy characterized by integrating quality across the organization in order to satisfy customer and other stakeholders’ requirements. The “total” attribute associated with quality term suggests the broad meaning assigned to quality, both in terms of coverage and objectives. Total quality refers to all areas of activity of the organization; it pursues the full satisfaction of the beneficiaries, through performances, deadlines, and prices, while obtaining economic advantages; it also presumes broad involvement in quality achievement of all staff [ 3 ].

The introduction of the expressions “quality management” and TQM date back to the 1990s and synthesizes an evolved level of quality approach from the perspective of management. It has developed with the major contribution of several specialists, the best known being Deming, Juran, Feigenbaum, Crosby, and Ishikawa [ 7 , 8 ]. This evolution process culminated in the emergence of the international standards for quality systems—the family of ISO 9000 standards (in 1987, the first edition), which favored the promotion of quality management principles and methods in all activity areas. The application of these standards in tourism is discussed in Section 2.1.

1.2. Particularities of the quality in tourism

Assessing the quality of tourism services involves clarifying the concept of tourism product and to identify its defining features.

Simply put, tourism products can be defined as products that satisfy the needs of tourists. The first important characteristic of the tourism product is its complexity: the tourism product is a composite one, consisting of several goods and services offered to satisfy the tourists needs. It generally includes accommodation, transportation, and dining, as well as attractions and entertainment. Consequently, measuring quality of the tourism product must consider a lot of product distinguished features.

Furthermore, a tourism product is often related to a tourist destination. According to Webster’s Dictionary, destination means “a place set for the end of a journey.” In tourism, the term destination generally refers to an area where tourism is a relatively important activity, generating significant revenues. World Tourism Organization (UNWTO) defines the “tourist destination” concept, as: “A physical space with or without administrative and/or analytical boundaries, in which a visitor can spend an overnight. It is the cluster (co-location) of products and services, and of activities and experiences along the tourism value chain, and a basic unit of analysis of tourism. A destination incorporates various stakeholders and can network to form larger destinations” [ 9 ]. In terms of size, a tourist destination can be a city, village, or resort but also may include many cities, regions and even an entire country.

Whether it is an organization or a tourist destination, in both cases defining and evaluating quality of the tourism product are difficult issues. They require consideration of a collection of services, as transport, room accommodation, some specific menu, and the opportunity to sit on a beach or to make trips, and also other tangible and intangible elements related to the natural environment, culture and heritage of the region, atmosphere and hospitality. All these elements are parts of the tourism product, which is therefore “not only a collection of tangible products and intangible services, but also psychological experiences” [ 10 ].

Within the tourism literature, it is widely accepted that tourism primary sells a “stage” experience, and accordingly, the managers of the tourism businesses may seek to influence the tourists’ experience [ 11 ]. O’Dell points out that experiences involve more than the tourists, “the tourism industry is also part of the generation, staging, and consumption of experiences” [ 12 ]. According to Neuhofer et al., “the creation of successful experiences is the essence of the tourism and hospitality industry” [ 13 ]. In this regard, the OECD report on tourism trend and policies stresses that “Policies at national, regional and local level increasingly focus in identifying, nurturing and investing in product development experiences that emphasize unique selling points for particular destinations” [ 14 ].

One can conclude that a tourism product is a complex amalgam, including tangible products, intangible services, and psychological experiences. The main mission of any tourism organization or destination is providing memorable experiences for their customer, resulting in customer satisfaction, superior value, and competitive advantage. These aspects must be considered when addressing quality in tourism, which is performed under specific forms in all organizations and coordination structures of the tourism sector.

2. Review of the quality approach in tourism

Focusing on quality has become one of the key success factors for the tourism service providers and tourism industry in general. Current quality approach in tourism is the result of growing various consumers’ needs, in the context of highly increasing competition, market globalization, and development of modern technology.

The quality approach in tourism is a dynamic process that has evolved over time with the development of the tourism sector. A comprehensive review of this evolution is presented below. The analysis includes quality and environment models used in the tourism industry, as follows: (1) general models for quality evaluation and certification; (2) specific models for classification of the tourism organizations and quality certification; (3) quality approach in tourist destinations; and (4) environmental models and marks. A brief synthesis of the quality approach in tourism, stages, and trends is presented at the end.

2.1. General models for quality evaluation and certification

The movement for quality in tourism is older (as will be seen in Section 2.2), but the quality approach in tourism organizations gained increased relevance in the last two decades of the twentieth century, in connection with the appearance of the SERVQUAL model for evaluation of service quality and international standards for quality systems (ISO 9000 series). Both are general models applied worldwide and in all activity fields, including tourism.

SERVQUAL is the best known model for assessing service quality, created by Parasuraman et al. [ 15 ]. There have been a large number of studies based on SERVQUAL models—initial version or other, conducted in various fields of services, including the tourism industry. Some publications present considerations and reviews of the studies on the evaluation of tourism services quality conducted during the last decades, e.g., [ 16 – 18 ]. There are also many case studies based on SERVQUAL model conducted in various types of tourism organizations, such as hotel [ 19 – 21 ], restaurant [ 22 ], airline tourism [ 23 ], sport tourism [ 24 ], tour operator [ 25 ], etc.

The analysis of these studies reveals the differences of the services' quality characteristics examined under the SERVQUAL dimensions, depending on the nature of tourism organizations and services: hotels, restaurants, transportation agencies, spa, casino, etc. Most of the case studies used modified versions of the SERVQUAL dimensions scale, considering that the versions proposed by Parasuraman et al. are not entirely valid for all tourism sectors. But despite these differences relating to quality characteristics of the tourism services, the majority of the researchers consider that using SERVQUAL models in tourism has important implications for marketing and management decision makers, one of the major benefits being the identification of areas to improve quality of services.

In our opinion, this type of study, based on SERVQUAL model, is generally the subject of scientific papers and cannot be systematically used by organizations to assess the quality of services. A more practical approach is the implementation within tourism organizations of quality management system (QMS) based on the international standard ISO 9001. ISO 9001—“Quality Management Systems—Requirements” is the most popular standard for management systems, applied worldwide in all fields. It is useful to any organization, regardless of its size, activities carried out or type of product [ 26 ].

According to ISO 9000, QMS is “a set of interrelated or interacting elements that organizations use it to formulate quality policies and quality objectives and to establish the processes that are needed to ensure that policies are followed and objectives are achieved” [ 6 ]. ISO 9001 processes refer to planning the product and service quality, establishing work rules to prevent nonconformities, controlling quality of products and processes, and reducing identified non-compliances by corrective actions. Regularly performing this cycle of activities ensures that the organization can repeatedly achieve and deliver products with certain features. It should be emphasized that, although ISO 9001 makes no reference to the economic performances, QMS requires systematic improvement actions aiming to prevent and reduce losses, and these actions implicitly determine the costs’ reduction. In a hotel, for example, nonquality includes problems such as slow service, incorrect room temperature, billing errors, inappropriate service of the waiters, etc. It is important for these issues to be known, and that measures are taken to eliminate them. Besides these systematic improvement actions (named “incremental” improvement or “step by step”), the companies must also be constantly concerned with the introduction of new customer experiences, something they have not done before. The extension and efficiency of improvement actions is an important criterion for characterizing the QMS performance.

There is no official statistics on the status of ISO 9001 implementation in the tourism industry, only the results of the analyses carried out in various geographic areas (countries or regions), based on empirical research. These studies identify two categories or currents of opinion: the first highlights the importance and positive effects of the implementation of ISO 9001 model in tourism, and the other is a critical one.

So, several empirical studies conducted in the last decades reveal the growing interest of the tourism organizations in implementing and certifying QMSs based on ISO 9001 model, and the benefits obtained. Examples below are illustrative, and they refer to hotels from Spain [ 27 ] and Croatia [ 28 ], medical centers in Spain [ 29 ], travel agencies in China and Hong Kong [ 30 ]. In Croatia, in 2012, 40 travel agencies of the Association of Croatian Travel Agencies (UHPA), as well as the UHPA's office, have implemented QMSs based on ISO 9001, through a project supported by the Ministry of Tourism. In Spain, Alvarez’ survey on 223 selected hotels from Basque Country Business Guide illustrates that the most of them (72%) have quality certification, but the most popular was “Caledad Turistica,” the Spanish Trademark for the tourism sector [ 27 ].

On the other hand, the analyses carried out highlight the relatively low number of the tourism organizations ISO 9001 certified, and the causes that explain this situation. The survey conducted at Egyptian travel agencies, in 2008, shows that 84% of the respondents have not applied a formal Quality Management program; only 4% had already implemented a formal quality system, the other 12% of them being in the stage of preparation [ 31 ]. A similar situation, consisting in a small number of tourism organizations ISO 9001 certified, is presented in other studies, referring to Croatia [ 28 ], Portugal [ 32 ], and Romania [ 33 ]. It is notable that a small number of big tourism companies do have quality systems ISO 9001 certified as can be seen from the information published on their websites and on other promotional materials.

There are also critical studies on ISO 9001 implementation in tourism related to the efficiency of QMSs. As the literature consistently shows, the implementation of the ISO 9001 standard in tourism can be very different from one organization to another, considering the motives, tools, and results [ 34 – 36 ]. The researchers consider that the efficient functioning of the QMS must be reflected in improved performance, expressed by the evolution of the number of customers, the number of new customers, the losing effect of certain customers, etc., with customer satisfaction being crucial to achieve the objectives related to financial performance of the organization. However, an empirical study carried out with guests of the Spanish and Italian hotels shows that quality-certified hotels did not receive a significantly better statistical evaluation from their customers [ 36 ]. Frequently, customers are not aware of what the QMSs consistent with ISO 9001 are. The study’s authors underline the potential dangers in inferring directly that quality certification in the hospitality industry leads to superior customer satisfaction.

Generally, the causes of low effectiveness of QMSs based on ISO 9001 model do not differ in tourism compared to other activity areas, the most important being: formal application of the standard requirements, with accent on the QMS documentation; focusing on technical issues, without taking into account social aspects; lack of the staff training in the field of quality; and low commitment of the staff in achieving quality, especially of the senior management [ 37 ]. Zajarskas and Ruževi consider that “implementation or improvement of management system is primarily strategic management of change,” most problems being at the level of strategic management [ 38 ]. In many cases, the certification ISO 9001 is intended to improve the corporate image rather than internal practices and organization effectiveness. According to Dick et al., managers should consider that internal drivers are the key to quality certification success. Consequently, top management should be involved to produce a robust quality system, which incorporates the utilization of quality improvement tools and generates greater internal benefits and customer satisfaction [ 35 ]. According to Kachniewska, one of the causes of QMS inefficiency is the superficial knowledge of the standard, which encourages the belief that ISO 9001 is irrelevant to the tourism sector [ 39 ]. This probably explains why the tourism industry searches for a new internationally recognized quality standard that would be more applicable for the tourism sector. The results of this work are presented in Sections 2.2.2 and 2.3.

Besides ISO 9001, the opening toward the application of more complex models aiming to achieve excellence is also notable. Broadly speaking, “excellence” means “greatness—the very best.” Currently, the term is commonly used in the economic and administrative environments, in relationship with the modern vision of management: achieving excellence involves the creation of a performing management system that ensures customer satisfaction and benefits for all members of the organization and for society [ 3 ]. According to Mann et al., “business excellence is about achieving excellence in everything that an organization does (including leadership, strategy, customer focus, information management, people, and processes), and most importantly achieving superior business results” [ 40 ]. All these elements are found in the TQM philosophy.

The most popular models of excellence are “Malcolm Baldrige” and “European Foundation for Quality Management” (EFQM) [ 2 , 3 ]. In Europe, some hotels have conducted evaluation processes based on the EFQM model, EFQM Recognised for Excellence being the proof of high-quality business approach, ability to innovate and commitment to deliver excellent services. The following examples are illustrative: Lake Hotel Killarney, Crowne Plaza Hotel Dundalk, Pembroke Hotel Kilkenny, Skylon Hotel, in Dublin, Ireland (EFQM Excellence Awards, Dublin, 2015). In the Caribbean, 13 businesses in the tourism accommodation sector, representing hotels, beach resorts, villas etc., were hospitality assured (HA) certified. HA certificate meets the EFQM criteria and symbolizes the business excellence in tourism and hospitality, being supported by the British Hospitality Association and the Caribbean Tourism Organization. There are also a small number of applications on achieving excellence in tourism organizations carried out in research studies [ 41 , 42 ]. Of note are the initiatives for developing standards and awarding the excellence in tourism (an issue addressed in Section 2.2.2).

2.2. Specific models for classification of tourism organizations, and quality certification

Quality certification and evaluation of the tourism organizations have a long history and include more schemes and models presented below.

2.2.1. Classification systems of tourism organizations

The term classification, also called grading, rating, and star rating [ 43 ], refers to breaking down and ranking accommodation units into categories. The European Standardization Committee defines the expression “accommodation rating,” or “classification scheme,” as “a system providing an assessment of the quality standards and provision of facility and/or service of tourist accommodation, typically within five categories, often indicated by one to five symbols” [ 44 ].

The general purpose of hotel classification is the creation of a ranking based on specific criteria, and the assignment of a symbol that certifies the services’ level. The classification creates conditions for the determination of different tariffs corresponding to the hotel or restaurant ranking and provides useful information to make potential guests aware of what they can expect before making a booking. The classification also serves as a reference for the implementation of institutional and public policies to support tourism passing to another level of quality.

The beginnings of the tourism entities’ classification are placed in the last century and are connected to “AAA Diamond Ratings System” and “Forbes Travel Guide” in USA and “Michelin Guides” in Europe. But presently, there are wide and diverse classification schemes of tourism establishments. There are several workpapers on this topic, which reveal the extent and diversity of the existing schemes worldwide [ 39 , 45 – 49 ]. As these studies show, between the classification systems, there are differences related to the following aspects: number of categories and name or symbols associated; classification criteria; classification character, obligatory or voluntary; frequency of evaluation. It must be stressed that in the EU, and worldwide, not only are the classification systems different from country to country, but there is also diversity in the level of comfort related to the grading and classification criteria. A single tourist destination often employs multiple classification schemes. It is therefore difficult to understand and compare the quality of tourism services, and especially to consumers, it is difficult to appreciate the significance of the various rating schemes not to mention their reliability.

Although the diversity of classification schemes has disadvantages, UNWTO specifies that it is unlikely to reach a single official classification, given the great diversity of contexts in which tourism organizations operate. In this regard, Taleb Rifai, Secretary-General of UNWTO, says: “There is no worldwide standard for official hotel classification systems, and there may will never be one, due to the incredible diversity of the environmental, socio-cultural, economic, and political contexts in which they are embedded” [ 43 ]. The same conclusion results from the analysis made in the EU setting up that one European hotel classification scheme may be considered an unfeasible demarche [ 50 ].

There are, however, concerns for harmonizing the classification schemes from tourism by introducing common rules. In this regard, we must mention the recent UNWTO recommendations for revising the hotel classification systems such as certification performed by independent third parties; integration of guests’ reviews into hotel classification schemes; global focus on sustainability and accessibility to be reflected in the classification criteria. Likewise, updating the certification criteria to general trends and considering data collected from the guests is recommended [ 43 ].

To mention is the improvement of the classification systems in favor of extending and integrating new criteria, with emphasis on quality and sustainability. The result of this dynamic process is the creation of combined schemes that include criteria for classification of the tourism establishments and also for quality certification. The European Hospitality Quality (EHQ) model launched in 2009 by HOTREC (abbreviation for Hotels, Restaurants and Cafés) should be mentioned. EHQ classification is based on a criteria catalog, some of these criteria being compatible with the main clauses of ISO 9001 standard, adapted to the particularities of tourism [ 51 ]. There are also other classification systems in connection to quality marks and labels used in tourism industry. Scotland, Iceland, and Australia are among the countries that include the quality element in their hotels’ classification [ 43 ].

Another improvement axis consists of the global focus on sustainability reflected in the classification criteria. The Hensen study finds that “recently updated hotel classification systems reflect different viewpoints on whether and how to incorporate environmental management practices” [ 52 ]. The author identifies three situations: environmental standards are included as a requirement for a certain star rating; classification systems recognize external environmental certification next to their ratings; external environmental certification is required as minimum standards in the rating scheme. As Hensen concludes, it is still open to question whether environmental management practices should be integrated into classification schemes or remain complementary approaches.

Integrating guests’ reviews into hotel classification systems is another important current change, favored by the evolution of online networks and review sites. Online guests’ reviews related to facilities and services’ quality of tourism organizations or destinations are instruments increasingly used today, along with the official classification and certification of hotels, restaurants, and other tourist establishments. Certain social media websites are becoming more popular and are likely to evolve into primary travel information sources [ 53 – 55 ]. The most important travel sites include TripAdvisor, Expedia, Hotels.com, and Travelocity etc., but their number continues to rise. These platforms represent systems that analyze the information on websites and social networks in order to find the overall consumers’ rating for a particular establishment. The information thus obtained has multiple uses: it is helpful for customers in choosing the location for travel; it provides data on the service quality used to enhance the overall performance of the tourism organizations and sector; and the online guests’ reviews are useful in the process of rating and/or awarding quality marks in tourism [ 54 , 56 ].

Regarding the use of online guests’ reviews in the classification of tourist establishments, recent studies highlight the need to harmonize the conventional rating systems and social media platforms [ 52 , 54 , 57 ]. As Hensen says, one can talk about a democratization of the rating process that “will lead to an innovation revolution whereby hotels seek to respond quicker to consumer trends as they have a direct feedback loop to their position in the market” [ 57 ]. The UNWTO report [ 54 ] shows that several countries are moving toward integrated models, distinguishing the next two variants: independent functioning of the two models and respectively their full integration. In the first case, online evaluations are done separately, and their results are included in the organization promoting documents. The second variant, of full integration, is a model in which the overall guests’ review ranking is included as criterion within the official classification scheme. According to the UNWTO report, Norway and Switzerland each have documented models for integrating online guests’ reviews and hotel classifications, and United Arab Emirates, Germany, and Australia are also involved in developing integrated systems. In both cases, the integration could effectively help to further reduce the gap between guests’ experiences and expectations.

2.2.2. Tourism specific models for quality awards: marks, labels, and quality certification

Tourism quality marks are marks used for tourism products and organizations that attest the fulfillment of some quality standards. According to Foris, “Quality mark is a model of good practices for implementing and certifying the quality of tourism services, as a voluntary option of the economic operators in the field” [ 47 ]. Quality marks are awarded to those tourism establishments that apply good quality management practices and provide improved service quality standards and facilities, over the legal requirements of their specific official classification.

Awarding quality mark is usually complementary to the star ranking. The main differences between classification schemes and quality mark programs in tourism are synthesized and summarized by Foris [ 47 ]. The author underlines that quality certification in tourism can become an effective management tool, designed to develop the level of services’ quality. Improving quality does not mean moving to a superior level in the star ranking system but increasing customers’ satisfaction and ensuring that they receive the best services corresponding to the category of the tourism unit.

Using quality marks is an advantage for the provider of the tourism services: the quality mark and the associated label distinguish it from other similar units and may be used for promotion, marketing, and other customer targeting purposes. Awarding quality marks helps to improve the organization image and increases the customer confidence in the company’s ability to consistently provide services to certain standards and adequate prices. From customer perspective, it means added value, in terms of improved facilities and service quality at their chosen establishment. As Handszuh (2004) says, “going by quality parameters and standards and subjecting tourism establishments to certification can be considered a new force driving the tourism sector into a higher level of excellence” [ 39 ].

It must be stressed that using quality marks is not a new approach in tourism. Both Forbes Travel Guide and Michelin Award have served as quality certification marks for several decades. A specific model also exists in a luxury category, “The Leading Hotels of the World” (LHW) being considered one of the most significant quality awards that meets the most exacting standards with reference to all aspects affecting guests’ comfort: accommodations, cuisine and other services, facilities, and employees’ behavior [ 58 ]. Other classification systems can also include quality criteria whose fulfillment is completed by quality certificates. For instance, in England, the Gold, Silver, and Breakfast Awards complement star and rosette ratings based on the AA classification scheme [ 59 ].

At present, there are wide ranges of quality marks and labels used in tourism worldwide, which have or does not have a direct link with any classification system [ 47 , 48 ]. They were launched by professional associations or governmental agencies and are different in terms of reputation, criteria, and certification procedure. It is noteworthy that in the last two decades, many programs have been initiated to implement national quality brands in tourism, e.g., “Caledad Turistica” in Spain (2000), “Qualité Tourisme™” in France (2005), “Cyprus Tourism Quality” in Cyprus (2014), Quality Label for Swiss Tourism in Switzerland (1997), “Qualmark ® ” in New Zealand, T-QUAL Accreditation in Australia, etc. Through these actions, governments aim to achieve national competitive advantages by supporting the implementation of quality systems within tourism organizations.

The movement for simplifying and coordinating national tourism certification is most visible in the EU countries. The European Directive 2006/123/CE and the requirements of the European Parliament Report (2007) call on the European hospitality industry ”to pursue its work in relation to the setting up of a European umbrella for quality management systems,” “to promote labeling processes regarding tourist accommodation undertaken in the different Member States, and to promote quality models that have proven effective elsewhere (for example the ‘Qualmark’ in New Zealand) in order to improve visibility” [ 60 ]. In response to these directives, the European Parliament’s Commission started preparatory work of the European Tourism Quality Label implementation, whose basic principles for the new label were set in 2012. There is also the possibility of extending the label to cover more than purely quality criteria, like environmental criteria, or broader criteria covering corporate social responsibility and sustainability. These actions are circumscribed to the long-term strategy launched by the European Travel Commission in February 2014, “Destination Europe 2020,” which includes a set of marketing, branding, and promotion actions for Europe as a tourist destination.

2.3. Quality approach in tourist destinations

ISO 9001 and other general and specific models for quality assessment and management have been adopted in many manufacturing and service organizations, at the company level. But in tourism, this managing quality manner is not sufficient, the alternative being the extensive approach of quality at tourist destination level. This situation is explained by the fact that the quality of tourism services not only relies on internal resources and services offered by tourism providers but also depends on the features of external environment in which tourism organizations operate. In this regard, Kachniewska says that, “In the short term, the existing quality systems of individual tourism companies may increase their competitiveness. However, in the long term, lack of the ability to satisfy the needs of their customers may result in a gradual decrease in the sales of tourism products offered by these companies” [ 39 ]. Additional factors, such as quality of destination facilities and infrastructure, public transport, hospitality, security, sanitary conditions, etc., also influence the satisfaction of tourists. To be simultaneously successful in all these different areas, a global approach at the tourist destinations level is necessary.

Focusing on tourist destinations is one of the current trends within the evolution of quality management in tourism. UNWTO, through its Technical Committee on Tourism and Competitiveness (CTC), has drafted a technical/operational definition of the quality of a tourist destination: “The result of a process which implies the satisfaction of all tourism products and services needs, requirements, and expectations of the consumer at an acceptable price, in conformity with mutually accepted contractual conditions and the implicit underlying factors such as safety and security, hygiene, accessibility, communication, infrastructure, and public amenities and services. It also involves aspects of ethics, transparency and respect toward the human, natural, and cultural environment” [ 61 ]. As one can see from this definition, the quality of the tourist destination is more than customer-centered, it envisages all stakeholders: tourists, organizations that provide tourism services, the local community, and also, natural, cultural, and social environment.

In accordance with this perspective, in 2003, the European Commission launched a specific model for quality management in tourist destinations, namely integrated quality management (IQM), in order to support sustainability and quality-oriented approach in an integrated manner. Integration, in this case, has two dimensions. First of all, different from the traditional approach of integrated management systems (see Section 2.4), IQM is not organization focused: this model refers to various tourism organizations from a tourist destination and other tourism-related aspects, such as infrastructure, environmental protection, cultural heritage protection. Second, IQM aims to satisfy the needs of all interested parties: tourists/visitors, tourism service providers, local population, and community. According to Vajčnerová, IQM of tourist destination is a demarche which takes into account improving visitors’ satisfaction, and it does so while seeking to improve the performances of tourism service providers, the quality of the local population life, as well the environment quality [ 62 ].

IQM implementation is a complex issue that requires developing mechanisms, structures, processes, and instruments for quality systematic management at the tourist destination level. In this regard, the determinant role lies within the management structures of the tourist destinations, known as Destination Management Organizations (DMOs). The whole demarche within IQM system is based on the logic of continuous improvement principle and supposes planning, realizing, monitoring, and improving quality as a cyclical ongoing process.

The effective functioning of IQM is not possible without a set of planning and controlling tools of the quality, including relevant indicators. For this purpose, some evaluation tools were created by the European Commission, namely QUALITEST and ETIS, aiming to help European tourist destinations become more competitive [ 63 ]. The main goals of these models are setting targets at destination level; measuring their progress over time, and by comparison with best practices (benchmarking); and assisting the public investment decisions on tourism development and management.

QUALITEST was launched in 2003 and includes an indicators system which is associated to four key objectives that IQM aims to satisfy: high level of tourism satisfaction; high level of the local tourism industry performance; higher quality of local people’s lives; higher environmental quality. Applying QUALITEST is based on surveys, all criteria being represented within a specific questionnaire addressed to each group of interest, tourism companies, and tourists [ 64 ]. Applications based on QUALITEST are not numerous [ 62 , 65 , 66 ] and highlight the difficulties in implementing this model. For this reason, probably, another model has been developed.

ETIS (acronym from “European Tourism Indicator System for Sustainable tourist destinations”) is the second European toolkit especially designed to help DMOs in the process of managing and monitoring the sustainable development of tourist destinations. It is a complete management system of a destination based on a set of sustainability indicators [ 67 ]. ETIS was launched by the European Commission in 2013 and revised in 2015–2016. In each of these phases, ETIS implementation was based on a great number of pilot studies (over 100 destinations) in order to demonstrate that ETIS implementation is feasible, both logistically and financially. Some information on these applications is published on the EC website ( http://ec.europa.eu ).

In the context of the ETIS implementation, a core issue is designing a decision support system (DSS) for tourist destinations management, based on Business Intelligence tools. This is a task of the DMOs, together with the selection of an appropriate set of indicators, “able to provide the most solid foundation for the decision making” [ 63 ]. According to Iunius et al., a small number of studies treat this subject, some of them being theoretical articles and fewer practical approaches [ 68 ]. The article’s authors state that most of the DSS-based projects implemented in European tourist destinations are not functional. They also suggest that an innovative DSS can be developed based on “Qualité Tourisme” certification/labeling system adopted at European level. The study refers to DIMAST Project (Destination Intelligent Management for Sustainable Tourism), aiming the development of an innovative process to implement the European Tourism Indicators System for Sustainable Destinations (ETIS). Its final goal is to create an innovative information system to support decision-making of GDSS type (functional model) that should directly and actively support the participatory management of sustainable tourism development and is capable of achieving long-term competitiveness within the destination Braşov county.

In addition to the European toolkits presented above, there is a new global tool called global sustainable tourism review (GSTR), managed by a non-profit organization named “Green Destinations.” GSTR was introduced in 2014 by a number of sustainable destination networks [ 69 ] in order to measure, monitor, and improve the sustainability profile of tourist destinations. GSTR is based on UNWTO destination criteria (GSTC-D, see Section 2.4.2) that is fully integrated with ETIS but is more complex. There is also an evaluation support tool, the Green Destinations platform, a database developed for contains data of more than 1000 destinations.

2.4. Environmental models and marks

As the previous section shows, sustainability is integral part of modern quality approach at the tourist destinations level, taking into account the connection of quality with sustainable development and of tourism with the environment in general, this section presents the general and specific models for environmental management at the tourism organizations level.

Organizations around the world, including those of the tourism industry, are becoming increasingly aware of the need for environmental management and sustainability. The term “sustainability” is in relation with the collocation “sustainable development” (SD) that was introduced in 1987 and defined as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [ 70 ].

In the traditional approach of sustainability, three dimensions are taken into account: the ecological, social, and economical. From the environment point of view, sustainability means minimizing any damage to the environment (flora, fauna, water, soils, energy use, contamination, etc.), while trying to value the environment in a positive way, through protection and conservation. Social aspects include concern for activities that do not harm and revitalize the social structure or culture of the community where it is located. And from economic perspective, sustainability means assuring business continuity to the benefit of the owners, employees, and local community [ 45 ].

Sustainable tourism organizations support the environmental conservation, social development, and local economies. But applying the sustainability principles in organizations and the environmental protection, in particular, are not easy. In fact, it is a complex problem in any industry and organization, which requires systematic actions of planning, controlling, and continuous improvement. A starting point in this approach could be the implementation of environmental management systems based on ISO 14001 model, or specific environmental models in tourism, presented below.

2.4.1. Environmental management systems, ISO 14001 and EMAS

The ISO 14000 series of environmental management standards appeared in 1996 (the first edition) and are intended to assist organizations manage the environmental effect of their activity. The ISO 14001 standard gives the generic requirements for an environmental management system (EMS) and promotes useful tools for managing environmental impact of the organization activity. EMS is based on process approach, the system’ processes including establishing the organization's environmental policy, planning the EMS and implementing it, checking for corrective actions, and management review [ 71 ]. The organizations compliant with this standard are able to avoid risks and costly mistakes by incorporating environmental controls into daily operations.

ISO 14001 is designed to reduce environmental damage and industrial waste, and it applies to all businesses. Tourism is one of the domains where the environmental issues occupy a key position. In the hotel industry, especially, there are various initiatives for the environmental preservation, given that hotels have a significant environmental impact, and therefore, their contributions and responsibilities toward the environment should not be ignored. The hotel industry uses large amounts of energy resources for functions such as transportation, cleaning and laundering, food services etc., and it also releases waste in different forms. Accordingly, environmental dimensions of hotels include water, energy, wastes, purchasing, emissions, indoor air quality, and noise [ 72 ]. Considering these aspects, the implementation of environmental management practices is essential for all hotel operations, resulting in a greater sustainable development of the hotel industry. In this regard, Peiró-Signes et al. say that “sustainability is actually one of the main opportunities for the hospitality industry” [ 73 ]. As Vaz points out, within the tourism domain, “sustainability seems to be the backbone which supports and allows the reconciliation of the different interests of tourism suppliers, tourists, and local communities” [ 74 ]. All these actors must take into account the economic, environmental, and social aspects of products and production systems and to carry out sustainable practices within their daily activity.

As more and more tourism organizations, and especially hotels, are interested in implementing environmentally friendly practices, many are looking to ISO 14001 certification to help them achieve their goals. There are several studies that reflect the growing interest of tourism organizations and destinations for implementation and certification of EMSs based on the ISO 14001 model. Some of these workpapers illustrate the results of the EMSs implementation, based on case studies [ 75 – 78 ]. The effects are measured by reducing energy consumption, raw materials, and maintenance costs, with all these savings resulting in additional profit. Some researchers specify that the EMSs implementation can bring benefits to a company not only regarding the economic results, but also in terms of improving the company‘s image [ 79 ], and clients’ perception related to hotel comfort and quality [ 73 ]. Chan and Hsu review and synthesize 149 hospitality-related studies published in the last two decades. In conclusion of this analysis, they found the increasing of the EMS maturity, the evolution of the environment approach in organizations from the basic issues, related to environmental policies and practices, to the environmental indicators and benchmarking [ 80 ].

However, ISO 14001 certification has a small share in the tourism industry. Based on the survey conducted in 36 hotels from different parts of New Zealand, Ustad points out the existence of several models for environmental certification. This analysis shows that a small number of surveyed hotels (6%) are ISO 14001 certified, the majority of the hotels having environmental systems based on Qualmark Green and Green Globe 21 models. The analysis also shows that there are hotels with more than one certification: 44% of the hotels surveyed hold only one certification, 31% of the hotels have two types of certifications, and a further 8% of hotels have three environmental certifications [ 72 ]. Matysek and Krivoken make a similar observation on certification patterns used in the Australian tourism industry, where the certification based on specific environmental models was preferred to the EMS certification in compliance with ISO 14001 [ 81 ]. These specific tourism patterns will be presented in Section 2.4.2.

Another general model, “Eco-Management, and Audit Scheme” (EMAS), exists in Europe. EMAS, which predates the ISO 14000 standards, is a voluntary regulation that was created to promote improved environmental performance among the EU companies. According to the European Committee for Standardization, compliance with ISO 14001 satisfies most of EMAS’ requirements, but the European regulation takes into account additional elements to support organizations that continuously improve their environmental performance [ 82 ].

In the tourism field, in 2013, about 300 hotels, camping grounds, nature reserves, and other leisure and accommodation facilities in Europe were using EMAS to improve their environmental performance. Among them are such prestigious names as the Ritz Carlton and Scandic hotels in Berlin, and educational tours operator Studiosus [ 82 ]. Recently, a guideline was elaborated, aiming to promote EMAS and the EU ecolabel in the tourism sector in line with the objectives of the European Commission framework, starting from successful initiatives already implemented. More details on the EU ecolabels are presented in Section 2.4.2.

2.4.2. Specific environmental models, and marks in tourism

As several studies show [ 45 , 79 , 83 ], the environmental management in hotels started in the USA in the form of initiatives by various associations and activities which begun in 1993, when the Prince of Wales launched the International Hotels Environment Initiative (IHEI). But the environmental certification of tourism services began in Europe, with the Blue Flag Campaign for beaches in Denmark, in 1987, and the “Silberdistel” label for lodgings and restaurants in Austria, in 1988. According to Bien, in the decade between the Earth Summit (1992) and the International Year of Ecotourism (2002), more than 60 environmental tourism programs were developed, and their number continued to grow [ 45 ]. In connection with these programs is the usage of environmental labels, which are symbols—pictures or logos indicating that a product has been manufactured and operates in consideration of the environment. In other words, labeling gives information about the environmental impacts associated with the production or use of a product.

Currently, there are many different environmental certification systems and corresponding awards and ecolabels. A synthesis of the best known certification programs for sustainable tourism launched in the middle of 1990s is presented by Hensens [ 52 ] and includes global application models, e.g., Green Globe (1993), Green Key (1994), Leaders in Energy and Environmental Design (LEED, 2000), and regional application models, e.g., Green Key Global—applied in USA and Canada, Green Leaf Eco Standards—in South Africa etc. The main environmental programs are also presented by Goldstein and Primlani, which differentiate the next three categories: Environmental Certification Programs Specific to Hospitality, Green Building Certification Programs, and Product-Specific Standards and Certification Programs [ 84 ]. In addition, there are environmental certifications of tourism organizations based ISO 14001 and EMAS models, whereof it was talking in Section 2.4.1.

The global list of environmentally friendly and sustainable tourism certification programs, labels, and standards has been continuously compiled and updated by ECOTRANS, a European network of experts and organizations involved in tourism, environment, and regional development founded in 1993. ECOTRANS is running the DestiNet portal, which offers a free Knowledge Base and DestiNet Services for making tourism more sustainable. The data provided by DestiNet show that today there are more than 100 independent certificates for environmentally friendly and/or sustainable tourism services, destinations, and tour operators [ 85 ]. The large majority of these environmental programs and labels are in Europe, and fewer are performed in Africa, Asia-Pacific, the Caribbean, and the Americas.

Certification models for environmental systems apply in tourism organizations, but the success of these actions largely depends on the national framework of the environment approach in tourism. In this regard, an example of good practice is Australia, where the environment certification programs in tourism are coordinated by Ecotourism Australia (EA), an organization created in 1991, which in 1996 launched the world's first National Ecotourism Accreditation Program (NEAP) [ 83 ].

Awarding the environmental marks and ecolabels are based on certification programs that include specific criteria. In order to develop a common language about sustainability in tourism, a set of Global Sustainable Tourism Criteria (GSTC) has been promoted since the early 1990s, by UNWTO together with The Rainforest Alliance, and the United Nations Environment Programme (UNEP). The GSTCs are organized around four main themes: (1) Effective sustainability planning; (2) Maximizing social economic benefits for the local community; (3) Enhancing cultural heritage; (4) Reducing negative impacts to the environment. In present, there are two sets of global criteria: Hotel & Tour Operator Criteria (GSTC-H&TO) and Destination Criteria (GSTC-D). The current version of these criteria is available online [ 86 ] According to Hall et al., GSTC specifies minimum requirements for tourism businesses and destinations to protect resources and promote responsible travel practices [ 87 ].

The European Commission also has several initiatives for sustaining sustainable development of tourism in Europe. In chronological order, they include sectoral reference documents (SRD) for the tourism sector in addition to EMAS [ 88 ], the EU ecolabels, and the two specific tools for the sustainable management of destinations, namely QUALITEST and ETIS, already presented in Section 2.3.

The EU ecolabel was established in 1992 and forms an important component of the European Commission’s strategy to support green growth and ecoinnovation. The “EU ecolabel” (the Flower) applies in all domains, including tourism. Awarding this mark for tourist accommodations is a voluntary certification based on specific criteria and can be requested by all types of accommodation facilities (hotels, guest houses, mountain lodges, private room providers, tourist farms, and camp grounds) for environmentally friendly tourist accommodations. Currently, there are two separate sets of criteria and labeling schemes: one for tourist accommodation services (TAS) and the second for campsite services (CSS). The application of the EU ecolabel is officially recognized throughout the EU for tourist accommodations from 2003 (2003/287/EC) and for campsite services from 2005 (2005/338/EC), respectively.

In the context of growing interest in ecolabeling, in the last decades, the number of studies related to the extension, implementation, and effectiveness of these programs has been increasing. According to Lubbert, “there is a myriad of ecolabels of varying quality, criteria, contents, and scope, causing customer confusion to the point of preferring to ignore them” [ 83 ]. Hamele appreciates that Europe has far more “green” certification programs than any other region of the world [ 89 ]. As Golden outlines, the rapid proliferation of ecolabels in the market is accompanied by a high level of redundancy [ 90 ]. In Mihalic’s opinion, some tourism ecolabels have poor reputation and suffer from lack of credibility. They often refer to the natural environment and do not take into account the social and economic aspects [ 91 ].

Ban et al. underline the benefits of ecolabeling for tourists, tourist enterprises, and tourism industry. In the authors’ opinion, an ecolabel will always be related to economic efficiency, although it requires a longer period of achievement [ 92 ]. The impact eco certification has on purchase behavior is one of the predilection objects of research: several case studies indicate that the majority of tourists does not seem to be affected by eco certifications [ 93 , 94 ], and others, referring to Europe, show that ecolabeling represents an important communication gate to consumers, almost half of the respondents saying that ecolabeling plays an important role in their purchasing decisions [ 95 ].

But, although there are many environmental programs and ecolabels, some researchers consider that ecolabeling in the tourism industry is still in early stage [ 95 , 96 ]. According to Graci and Dodds, despite there have been efforts in America and Europe to implement environmental certification schemes, “certification doesn’t appear to have a significant effect on spreading sustainable tourism practices overall” [ 97 ]. In order to improve the certification efficacy, Graci and Dodds formulate some recommendations including developing international standards and a clear ecolabeling system; linking quality with environmental and social criteria; focusing on educational and training programs for the industry and consumers too. One example on the linkage between eco certification and quality is presented by Dodds and Joppe, who speak about the partnership between Green Globe and Australia’s AAA to award green stars to products, using an existing quality standard to promote eco principles [ 98 ]. To be awarded a Green Star, an accommodation property must achieve a set of environmental criteria, including energy efficiency, waste minimisation, and water management. Green Stars make it possible to identify tourism businesses committed to reducing the environmental impacts of their operation.

It must mention that integrating quality and environment systems is an actual objective of the organizations in all areas, and it materializes in so-called “integrated management systems” (IMSs). According to Beckmerhagen, the integration is achieved through “putting together the different functions and elements of specific management systems into a single and more effective IMS” [ 99 ] and can embrace all the processes and elements that need to be controlled by organization. It is important to stress that the IMS collocation, as defined above, refers to all management systems based on international standards (e.g., QMS—ISO 9001, EMS—ISO 14001, etc.) and should not be confused with the IQM systems for quality assurance in tourist destinations (see Section 2.3).

2.5. Conclusions on the stage and evolution of quality approach in tourism

The previous presentation reveals the diversity of the models applied in tourism, in relation to the quality and the environment approach and their evolution. Table 1 presents synoptically these models, differentiating between general patterns and tourism-specific models.

Table 1.

General, and tourism specific models for quality and environment.

The previous table includes environmental models along with those related to quality, taking into account the strong links between these aspects, which justify their integrated approach. In tourism, customer satisfaction depends directly on environmental resources, consisting of climate, nature, culture, and traditional architecture. These elements greatly contribute to the attractiveness of tourist destinations and determine the customer satisfaction. On the other hand, economic viability of tourism depends strongly on enhancing quality of the local environment, and achieving this purpose supposes to promote the sustainability principles in tourism.

Taking chronologically the evolution of the quality approach to tourism, it can see that the first models appeared in the first half of the last century, being applied even today in tourism establishments classification. But most of them, both general patterns and specific models on quality and environment in tourism, date from the end of the twentieth century and the beginning of the twenty-first century. This process is in a continuous dynamicity, by adding new models and upgrading existing ones.

In the category of general models, the best known are the international standards for quality systems, and respectively environmental systems, applicable in organizations from all fields of activity. As the previous analysis showed (see Sections 2.1, and 2.4.1), the share of tourism organizations ISO 9001 and ISO 14001 (or IMAS) certified is relatively low, the tourism-specific patterns being better suited to the peculiarities of the field. But it is worth mentioning that the development of the tourism-specific models was increasingly taking into account the harmonization with the international standards for management systems that incorporate the philosophy and principles of modern management. Applying the basic principles of quality management (ISO 9000, 2015)—“Customer focus,” “Leadership,” “Engagement of people,” “Improvement,” “Process approach,” “Evidence-based decision making,” and “Relationship management”—represents key factors whether it is about quality achievement, environment preservation, or other aspects on which performance of the organization depends.

Tourism specific models for classification, and respectively quality or environment certification, have evolved along with the development of tourism, both in number and in terms of assessment criteria. Referring to the environment approach, Haaland and Aas appreciate that the jungle of labels and the lack of systematic reviews is a challenge not only for the customers but also for the industry itself, in terms of overall credibility, market values, and actual environmental effects and impacts [ 100 ]. This observation is also valid with regard to the quality certification and classification of tourist establishments.

Also of note is the concern of finding common rules for the harmonization of classification schemes and quality certification models, without, however, pleading for the uniformity of these tools. The analysis of those approaches (see Section 2.2.1) highlights the following major axes of change: extension of the number of indicators on the basis of which the classification of the tourist units is done; integration of classification schemes and quality certification models; integration of online guests’ review into the classification systems.

In terms of improving the tourism classification models, there are some results consisting in the extension of classification criteria related to quality and environment. The most known is EHQ model of HOTREC, but other examples also exist of national classification schemes in tourism which include quality criteria. One of the quality criteria refers to the assessment of customer satisfaction. This requirement can be solved in a classic way (via surveys based on questionnaire conducted by the tourism company), but the modern approach is to evaluate the results of online customers’ reviews off the social media platforms. Integrating online guests’ reviews in the process of rating and/or awarding quality marks in tourism is one of the recent changes of quality approach in tourism, with notable results (see Section 2.2.1). With respect to inclusion of environmental requirements within classification schemes, the adopted solutions are different from country to country in terms of number of requirements and manner of presentation (dissipated or separate standards).

In terms of improving the tourism specific models for environmental performance management, the most visible result is the creation of common evaluation criteria (see Section 2.4.2). A set of global sustainable tourism criteria (GSTC) has been promoted by UNWTO and UNEP in the early 1990s, in order to develop a common language about sustainability in tourism. In the EU also, the EU ecolabel and the set of criteria and labeling schemes for tourist accommodation services (TAS, 2003) and for campsite services (CSS, 2005) were launched.

Another important aspect in the evolution of the quality and environment approach in tourism is the focus on tourist destinations (see Section 2.3). The main objective of this approach is to manage the various components of tourist destinations as a system, considering the satisfaction of tourists, and also the three pillars of sustainability: the economic profitability, the social, and environmental. Initiatives on this line exist at the European level—consisting of IQM model, and QUALITEST and ETIS as toolkits, and also at the international level—GSTC-D criteria established by the UNWTO and UNEP, respectively GREEN DESTINATION standard. As already mentioned, European and international instruments are different, but their harmonization was envisaged.

As shown in Section 2.3, the results of these models implementation are modest, one of the reasons being the short time since their launch. Another reason is the complexity of the implementation process of IQM in tourist destination, which includes developing new management structures, planning, and control tools, data management systems, etc. In this regard, dissemination of the results of applied studies on this issue is important. The emergence of “Practical Guidelines for Integrated Quality Management in Tourism Destinations” also supports the IQM implementation, being useful to all stakeholder categories: tourism managers, academics, professionals, and decision makers.

In terms of paternity of the quality and environmental models, several situations are distinguished. The first models have been created by professional organizations. At present, professional organizations are also involved, but increasing coordination of those programs is done at the international level, through UNWTO. Regional structures in the Americas, EU, Asia, and Africa are even important. The existence of general rules does not mean the patterning of models, but it provides some benefits: facilitates the understanding of quality and sustainability concepts and the harmonization of their approach, generating important advantages for all stakeholders.

It should be noted that the existence of common international or regional models does not guarantee their successful implementation in tourism organizations. The coordination at the national level (see Section 2.2.2) is another key factor in the success of activities related to quality and environment in tourism. Adopting and awarding of national quality and environmental standards and marks are not simple; it supposes the legislative development, organizational, and methodological framework for quality and environment certification in tourism. Some of the success examples in the implementation of national systems are presented in Section 2.2.2.

3. General conclusions and research agendas

Quality approach in tourism is a central subject of about a quarter century, both in theory and practice. These demarches have resulted into elaboration and implementation of some models and standards for the tourist units’ classification, respectively the quality certification. The diversity of models currently used makes their understanding difficult, being a challenge both to customers and service providers in terms of their credibility, market value, and implementation effects. Difficulties are amplified by the fact that, in parallel with quality tools, the environmental approach to tourism has evolved, and a variety of environmental certification standards and models have been elaborated. It can be said that although there is a visible and even increasing interest in quality in tourism, there is a lack of global understanding of quality and links to new practices related to the environment and sustainable development.

The reason for the orientation toward this subject has its roots in the authors' belief that a comprehensive review of the approach to quality and environment in tourism will contribute to a better understanding of the concepts regarding the quality and environment approach in tourism, and the links between them. At the same time, systematization of the information on existing models and their using contribute to identifying the directions of change in the quality approach in tourism, considering both the proposed models and the way of implementation.

Taking into account the comprehensive review and the conclusions presented above, future research directions are formulated on three levels of action: global and regional actions, national actions, and institutional actions.

(1) Increasing the involvement of the UNWTO, the EU commissions, and other regional coordination bodies in addressing quality and environment in tourism resulted in the development of common rules, models, criteria, quality, and environment guides.

These actions aiming to create unitary rules and tools for quality and environment management in tourism should continue. A periodical review and upgrading of the existing management tools is necessary, taking into account the new requirements and also the observations resulting from their implementation. A direction to improve tourism-specific models is to achieve a better harmonization with the international standards for management systems. The harmonization of models applied at the organization level with those used to the tourist destinations should also be analyzed.

The tourist destinations quality remains a research direction, and it targets both the tools created (IQM, ETIS) and their implementation.

(2) The development of national systems for quality and environmental management in tourism is a factor with a strong impact on the performance of the tourism industry.

Considering that in many countries, there are not national quality systems in tourism, or they are inefficient, it is important for future studies to be more focused on good practices examples and for projects to be initiated to implement national systems for quality assessment and certification in tourism or to improve those that already exist.

It is important to take into account the need for harmonizing the national systems with global and/or regional models, at the level of principles, concepts, methodologies, and action tools, for quality and environmental management.

(3) The development of national systems creates the framework for the implementation of quality and environment-oriented management methods in tourism organizations. But in the end, quality and environmental performances depend on the actions undertaken at the level of each tourism organization. From this perspective, future research studies must be directed to developing tools for quality and environment management systems and respectively to improving the process of implementation of those systems in organizations.

Given that SMEs, which have limited resources, are predominant in tourism, it is opportune to develop studies of analyzing and optimizing the key processes on which quality depends, namely human resources, customer relationship management, information management, and quality assessment. In terms of institutional quality assessment, the creation of QMS evaluation grids is recommended. The way tourism companies manage online guests' reviews, which presently are the primary tools of customer feedback, also needs study.

Likewise, the aspects related to human resources in tourism need to be further studied, in order to support the broad implementation of modern Human Resource Management practices in tourism. In this regard, the staff training and the development of appropriate organizational culture to achieve quality and environment objectives in tourism are priority issues.

In the end, it must be said that regardless of the models used, achieving success in implementing new management practices is not an objective, but a “journey” that includes the continuous improvement of the expected performance and the tools used. The change process is done from top to bottom, under the coordination of superior management. Making changes is not possible in the absence of leadership.

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© 2017 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

UN Tourism | Bringing the world closer

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Data, intelligence and trends

The Tourism Market Intelligence and Competitiveness department (TMIC) generates market knowledge in order to enhance the understanding of world tourism trends and their economic dimension

Our research provides the latest tourism market intelligence and identifies good practices for successful development and marketing of destinations. 

UNWTO generates knowledge in order to enhance the understanding of tourism trends and the economic impact of tourism through the:

• Collection and analysis of tourism data
• Analysis of key global trends and their impact on tourism
• Analysis of tourism market segments and products
• Development of short- and long-term forecasts.

Governance and Policy

The development and management of tourism destinations requires a holistic approach to policy and governance.

UNWTO works to provide guidance and share good practices on policies and governance models aimed to effectively support the tourism sector at the different levels: national, regional and local.

Governance has two specific dimensions:

• Directive capacity of government , determined by  coordination and collaboration  as well as by the participation of networks of stakeholders.
• Directive effectiveness,  determined by institutional  skills and resources  that support the ways in which processes are conducted to define goals and search for solutions and opportunities for relevant stakeholders, and by the provision of tools and means for their joint execution.

In this sense, UNWTO works to support its Members in their efforts to develop efficient governance models / structures and policies, focusing  among others on:

• Tourism policy and strategic planning
• Governance and vertical cooperation, i.e. national-regional-local levels
• Public Private Partnership (PPP)

Quality of a Tourism Destination is defined by UNWTO as “the result of a process which implies the satisfaction of all tourism product and service needs, requirements and expectations of the consumer at an acceptable price, in conformity with mutually accepted contractual conditions and the implicit underlying factors such as safety and security, hygiene, accessibility, communication, infrastructure and public amenities and services. It also involves aspects of ethics, transparency and respect towards the human, natural and cultural environment. Quality, as one of the key drivers of tourism competitiveness, is also a professional tool for organizational, operational and perception purposes for tourism suppliers.”

UNWTO provides practical guidelines and showcase good practices for destinations in their efforts to improve the quality of visitor experience all through the supply chain and to launch destination quality systems.

Further information in publication “Practical Guidelines for Integrated Quality Management in Tourism Destinations”.  World Tourism Organization (2017). UNWTO, Madrid. Publication available on the UNWTO E-library.

Competitiveness

UNWTO defines (1)  Competitiveness of a Tourism Destination  as “the ability of the destination to use its natural, cultural, human, man-made and capital resources efficiently to develop and deliver quality, innovative, ethical and attractive tourism products and services in order to achieve a sustainable growth within its overall vision and strategic goals, increase the added value of the tourism sector, improve and diversify its market components and optimize its attractiveness and benefits both for visitors and the local community in a sustainable perspective.”  (1) See UNWTO Definitions as adopted by the 22nd session of the General Assembly held in Chengdu, China (11-16 September 2017) click in  UNWTO definitions .

COMPETITIVENESS COMMITEE (CTC)  

Destination Management

In recent years, there has been increasing recognition of the need for sound and planned management of tourism destinations.

Destination management consists of the coordinated management of all the elements that make up a tourism destination. Destination management takes a strategic approach to link-up these sometimes very separate elements for the better management of the destination. Joined up management can help to avoid overlapping functions and duplication of effort with regards to promotion, visitor services, training, business support and identify any management gaps that are not being addressed.

Destination management calls for a coalition of many organizations and interests working towards a common goal, ultimately being the assurance of the competitiveness and sustainability of the tourism destination. The Destination Management Organization’s (DMO) role should be to lead and coordinate activities under a coherent strategy in pursuit of this common goal.

Though DMOs have typically undertaken marketing activities, their remit is becoming far broader, to become a strategic leader in destination development. This is a vital ingredient for success in every tourism destination and many destinations now have DMOs to lead the way.

From a traditionally marketing and promotion focus the trend is to become leading organizations with a broader mandate which includes strategic planning, coordination and management of activities within an adequate governance structure with the integration of different stakeholders operating in the destination under a common goal. Destinations wherein such an organization is not still in place are increasingly creating or plan to create a DMO as the organizational entity to lead the way.

From a traditionally marketing and promotion focus the trend is to become leading organizations with a broader mandate which includes strategic planning, coordination and management of activities within an adequate governance structure with the integration of different stakeholders operating in the destination under a common goal. Destinations wherein such an organization is not still in place are increasingly creating or plan to create a DMO as the organizational entity to lead the way. UNWTO has identified three areas of key performance in destination management at DMO level: Strategic Leadership, Effective Implementation and Efficient Governance. UNWTO supports its Members and Destination Management/Marketing Organizations through the UNWTO.QUEST - a DMO Certification System. UNWTO.QUEST  promotes quality and excellence in DMOs planning, management and governance of tourism, by means of capacity building. UNWTO.QUEST Certification evaluates the three areas of key performance in destination management at DMO level: Strategic Leadership, Effective Implementation and Efficient Governance. With a training and capacity building component, UNWTO.QUEST is a strategic tool which allows the DMOs to implement an improvement plan to achieve the criteria and standards of the Certification with the aim of enhancing their management processes and thus contribute to the competitiveness and sustainability of the destinations they represent.

Related links

• UNWTO Guidelines for Institutional Strengthening of Destination Management Organization (DMOs) - Preparing DMOs for new challenges
• EVENT: International Seminar on Destination Management
• UNWTO.QUEST

Tourism Products

As defined by UNWTO, a Tourism Product is "a combination of tangible and intangible elements, such as natural, cultural and man-made resources, attractions, facilities, services and activities around a specific center of interest which represents the core of the destination marketing mix and creates an overall visitor experience including emotional aspects for the potential customers. A tourism product is priced and sold through distribution channels and it has a life-cycle".

UNWTO works to support the sector in the sustainable development of:

Rural and Mountain Tourism

Mountain Tourism  is a type of "tourism activity which takes place in a defined and limited geographical space such as hills or mountains with distinctive characteristics and attributes that are inherent to a specific landscape, topography, climate, biodiversity (flora and fauna) and local community. It encompasses a broad range of outdoor leisure and sports activities".

Rural and mountain tourism have a high potential to stimulate local economic growth and social change because of its complementarity with other economic activities, its contribution to GDP and job creation, and its capacity to promote the dispersal of demand in time (fight seasonality) and along a wider territory.

Gastronomy and Wine Tourism

As global tourism is on the rise and competition between destinations increases, unique local and regional intangible cultural heritage become increasingly the discerning factor for the attraction of tourists. 

The Committee on Tourism and Competitiveness (CTC) of UNWTO define Gastronomy Tourism as a type of tourism activity which is characterized by the visitor’s experience linked with food and related products and activities while travelling. Along with authentic, traditional, and/or innovative culinary experiences, Gastronomy Tourism may also involve other related activities such as visiting the local producers, participating in food festivals and attending cooking classes. Whilst Eno-tourism (Wine Tourism), as a sub-type of Gastronomy Tourism, refers to tourism whose purpose is visiting vineyards, wineries, tasting, consuming and/or purchasing wine, often at or near the source.

Sports Tourism

Sports tourism is one of the fastest growing sectors in tourism. More and more tourists are interested in sport activities during their trips whether sports are the main objective of travel or not. Sport events of various kinds and sizes attract tourists as participants or spectators and destinations try to add local flavours to them to distinguish themselves and provide authentic local experiences. Mega sport events such as Olympics and World Cups can be a catalyst for tourism development if successfully leveraged in terms of destination branding, infrastructure development and other economic and social benefits.

Shopping Tourism

More importantly, shopping is one of the major categories of tourists’ expenditure, representing a significant source of income for national economies both directly and through the many linkages to other sectors in the economy. 

Urban Tourism

According to UNWTO, Urban Tourism is "a type of tourism activity which takes place in an urban space with its inherent attributes characterized by non-agricultural based economy such as administration, manufacturing, trade and services and by being nodal points of transport. Urban/city destinations offer a broad and heterogeneous range of cultural, architectural, technological, social and natural experiences and products for leisure and business".

Urban tourism can represent a driving force in the development of many cities and countries contributing to the progress of the New Urban Agenda and the 17 Sustainable Development Goals, in particular, Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable . Tourism is intrinsically linked to how a city develops itself and provides more and better living conditions to its residents and visitors.

Fulfilling tourism’s potential as a tool of sustainable and inclusive growth for cities requires a multi-stakeholder and multilevel approach based on close cooperation among tourism and non-tourism administrations at different levels, private sector, local communities and tourists themselves. Likewise, the sustainable development and management of tourism in cities needs to be integrated into the wider urban agenda.

ORIGINAL RESEARCH article

Service quality in tourism public health: trust, satisfaction, and loyalty.

• 1 Shenzhen Tourism College, Jinan University, Shenzhen, China
• 2 Asia-Pacific Academy of Economics and Management, University of Macau, Macau, China
• 3 Department of Integrated Resort and Tourism Management, Faculty of Business Administration, University of Macau, Macau, China

The spread of COVID-19 and large-scale travel restrictions has caused serious damage to the global tourism industry. Tourists pay additional attention to public health services and their health during travel, but studies on tourism public health service quality (TPHSQ) are limited. Therefore, this study aims to define TPHSQ and revise and validate its scale. The result of exploratory factor analysis (EFA) indicates that TPHSQ includes two dimensions “overall environmental image” and “public health facilities and management.” And based on 456 valid samples, the relationship among TPHSQ, tourists’ trust, satisfaction, and loyalty was validated using the multiple linear regression models. Results revealed the importance of the TPHSQ in improving tourists’ satisfaction and recovering their trust and loyalty. These results provided several implications for research, practice, and society that can benefit diverse stakeholders, which could accelerate the recovery of the tourism industry.

Introduction

At the beginning of 2020, the COVID-19 epidemic has spread globally in just a matter of weeks. This unprecedented public health crisis, which is called a black swan event, has caused an adverse impact not only on public health but also on the tourism industry. According to the data released by the World Tourism Organization, the global tourism industry will lose $1.3trillion in revenue by 2020. In addition, the total number of global tourist arrivals will drop by 1billion, or 74%, compared with the previous year, making 2020 “the worst year in tourism history” ( UNWTO, 2021 ). More and more tourists are unwilling or prohibited to travel because they are worried about being infected or threats to their personal safety during travel. Therefore, some scholars also predicted that after the outbreak, tourists will pay additional attention to public health services and their health and safety during travel ( Wen and Jiang, 2020 ). In this context, tourism practitioners must clarify the importance of tourism public health services to reconnect with tourists and regain their confidence.

From the practical perspective, effective public health services and guidelines in the post-epidemic era play an important role in the recovery of the tourism industry. For example, in the United States, the NY State Park required visitors to practice social distancing by keeping at least six-feet distance from each other ( The NY State Park, 2020 ). Moreover, in Japan, the Imperial Hotel installed thermal imaging cameras at the entrance to help measure guests’ temperatures and used trays to hold cash and credit cards during the payment process ( Imperial Hotel Osaka, 2020 ). From the theoretical perspective, many previous studies showed that service quality can cause changes in many factors, such as satisfaction, trust, loyalty, and perceived risk ( Melian-Alzola and Martin-Santana, 2020 ; Cong, 2021 ). Thus, in the tourism public health service context, this study predicted that a high-quality tourism public health service could improve tourist trust (TT) and satisfaction. Moreover, such a service could further influence travelers’ revisit intentions and recommendations, which is beneficial to help tourism destinations recover from this public health crisis.

However, most scholars only explored the importance of tourist destinations’ cleanliness and environment. Research related to tourism public health service quality (TPHSQ) and its impact on tourist loyalty (TL) is limited. For example, Zhou et al. (2015) found that destination cleanliness should obtain great attention from management. Hanafiah et al. (2019) also identified safety and cleanliness as important attributes of tourist experience quality. Using data on the rural TPHSQ, Sun (2018) verified that local tourism management departments should establish a feedback mechanism on the rural TPHSQ. Thus, the current study makes significant contributions to the literature by defining and measuring TPHSQ. The study also explores the mechanism of the influence of TPHSQ on tourists’ loyalty by using the multiple linear regression models and Bootstrap mediated effect test. The results will provide some managerial implications for destination management organizations (DMOs) from the perspective of tourism public health service in the post-pandemic era, even in the future.

Literature Review

Tourism public health quality.

Previous studies covered the aspects of the TPHSQ. Specifically, with regard to sanitation and hygiene factors, Milman (2009) evaluated the experience attributes of 608 tourists in the theme park. He confirmed that in addition to “service,” the most important factors are “courtesy, cleanliness, safety, and security.” He also showed that the “worshipping environment” is an extremely important part of the tourist experience. Then, for studies on public health facilities, Wang et al. (2020) explored the relationship between public environmental facilities and environmentally disturbing behaviors. They emphasized that tourism destination management departments should pay additional attention to public environmental facilities construction and immigration. For example, road construction should be reasonable, and the trash cans should be placed in places that tourists can easily find. Regarding the medical and health services during travel, Plentz (1978) proposed that protective vaccination in long-distance tourism is a problem of public health service. Previous studies always focused on one or some aspects of the TPHSQ but lacked a systematic definition and classification. Therefore, based on previous studies, this study obtained a clear definition of tourism public health service. That is, tourism public health service is a service provided by DMOs to improve tourist satisfaction (TS) and facilitate tourists to stay in a clean and healthy environment. Examples include providing a clean and hygienic tourist environment and necessary sanitation facilities and setting up a mature sanitation feedback mechanism. Meanwhile, the TPHSQ is the sum of the characteristics of this type of service.

In addition, although very few scholars studied this field, measuring TPHSQ is not very difficult because several proposals have been made on the multidimensional structure of service quality, such as the SERVQUAL scale ( Parasuraman et al., 1988 ), SERVICESCAPE ( Bitner, 1992 ), and SERVPERF ( Cronin and Taylor, 1992 ). Among all these frameworks, SERVQUAL ( Parasuraman et al., 1988 ) is the most successful assessment tool of service quality. This framework includes five dimensions, namely, assurance, reliability, tangibility, empathy, and responsiveness. Nonetheless, the dimensions of SERVQUAL were found to be not fully applicable to this research. Thus, this study referred to this scale and further revised it through exploratory factor analysis (EFA) to form a new TPHSQ Scale.

Tourist Trust

Trust originated in psychology in the 1950s. Deutsch (1958) agreed that a trust is an act of believing in choice. In the context of tourism, tourist trust is widely accepted to play an important role in influencing their behavioral intentions. In other words, trust is somewhat predictive of tourist travel behaviors, such as revisit intention, commitment, and behavioral intention ( Camara, 2019 ). In an earlier study, when people perceive a higher level of risk, trust has a stronger effect on creating behavioral intentions ( Anderson and Karunamoorthy, 2003 ). Moreover, considering that public health service is closely related to each visitor’s health and safety, when the service involves their health, tourists tend to be more sensitive. Some relevant literature on medical tourism and health services also provided some evidence. For instance, Isa et al. (2019) proved that patients’ trust is having a direct relationship with perceived medical quality, relationship marketing, and word-of-mouth (WOM). Iranmanesh et al. (2018) stated that trust has a significant impact on the attitude of Muslim medical tourists to Islamic medical treatment.

Tourist Satisfaction and Loyalty

Satisfaction and loyalty are not uncommon in tourism studies. In the 1970s, as the concept of “marketing” became more pervasive in the tourism industry, Pizam (1978) pioneered the concept of “tourist satisfaction,” which is the result of comparing tourists’ expectations before travel with their experience. Since then, many scholars have provided other concepts of satisfaction, mainly from the expectation theory and the emotional nature of experience. Similarly, the concept of tourist loyalty also comes from marketing and mainly consists of behavioral and attitudinal loyalty ( Warshaw and Davis, 1985 ). Loyalty reflects the comprehensive evaluation of a destination’s products and services, including a tourist’s preference for the destination. Moreover, currently, in tourism studies, revisit intention and WOM recommendations are the most common indicators to measure loyalty.

Evidently, many scholars have verified the relationship between service quality and consumer loyalty, satisfaction, and trust from different areas, such as the in-flight services ( An and Noh, 2009 ), mobile telecommunication industry ( Aslam et al., 2018 ), and the most discussed by scholars, banking services ( Lee and Moghavvemi, 2015 ; Fauzi and Suryani, 2019 ). In addition, in the unique field of blood donation, Melian-Alzola and Martin-Santana (2020) confirmed the impact of service quality on donor satisfaction and the effect of these two constructs on donor loyalty with a sample of 3,000 donors. This relationship is also not uncommon in the context of tourism. In the case of medical tourism, the significant positive relationship among the loyalty dimensions of revisit intention, recommendation, and positive recommendation has also been proven ( Loke, 2020 ). Jeaheng et al. (2020) examined the relationship among halal-friendly hotel service quality and perceived price, satisfaction, trust, and revisit intention. Hence, although few scholars have explored the TPHSQ, we make the following hypotheses:

H1: TPHSQ has a positive and significant influence on tourist loyalty.

H2: TPHSQ has a positive and significant influence on tourist satisfaction.

H3: TPHSQ has a positive and significant influence on tourist trust.

Considerable academic debate about the relationship between trust and satisfaction exists. Although some studies ( Al-Ansi and Han, 2019 ; Melian-Alzola and Martin-Santana, 2020 ) showed that customer satisfaction has a positive effect on trust, others showed that customers’ positive perception of trust affects their satisfaction ( Chang, 2014 ; Wu et al., 2016 ; Amoako et al., 2019 ). In the field of tourism, Wu et al. (2016) found that trust is an important predictor of patient satisfaction in medical tourism. Amoako et al. (2019) also showed that customer satisfaction is influenced by trust and commitment in the hospitality industry.

Loyalty is one of the tourist intention behaviors. Many scholars verified that tourist trust can predict tourist intention behaviors ( Wu et al., 2018 ). Therefore, the relationship between tourist trust and loyalty is also evident. Han and Hyun (2015) indicated that in a competitive medical tourism market; trust in the staff and clinic significantly affects tourists’ intentions to revisit clinics and the destination country. In addition, Jeaheng et al. (2020) found that trust has a positive and significant impact on Muslim guests’ revisit intention at the halal-friendly hotel. Hence, the following hypotheses were developed:

H4: Tourist trust has a positive and significant influence on tourist satisfaction.

H5: Tourist trust has a positive and significant influence on tourist loyalty.

Some pieces of empirical evidence support the relationship between satisfaction and loyalty in the tourism context ( Priporas et al., 2017 ; Tanford and Jung, 2017 ). In addition, Bitner (1990) found that tourist satisfaction and loyalty are closely related. Therefore, destinations, tourism marketers, and local communities aim to generate satisfaction because of its strong relationship with loyalty ( Oliver, 2014 ). If the tourists are less satisfied with the services, then they will not recommend or revisit the destination to a large extent. Thus, the following hypothesis is proposed:

H6: Tourist satisfaction has a positive and significant influence on tourist loyalty.

Previous studies found that tourists with higher satisfaction also have higher loyalty ( Tanford and Jung, 2017 ). As mentioned earlier, several studies showed that tourism service quality and satisfaction are significantly related. Therefore, this study predicted that satisfaction will play a mediating role in the proposed theoretical model of the TPHSQ. This notion is similar to that of Peric et al. (2020) , who reported that visitor satisfaction affects the relationship between service quality and loyalty. Moreover, a positive relationship is observed between service quality and tourist trust ( Jeaheng et al., 2020 ). Additional research confirmed that as the trust increases, tourists are more likely to revisit the destination ( Han and Hyun, 2015 ). Based on this, the following hypotheses are developed:

H7: Tourist satisfaction mediates the relationship between TPHSQ and tourist loyalty.

H8: Tourist trust mediates the relationship between TPHSQ and tourist loyalty.

Figure 1 graphically illustrates the conceptual model in this study.

Figure 1 . Proposed model. TPHSQ, tourism public health service quality; TT, tourist trust; TS, tourist satisfaction; and TL, tourist loyalty.

Methodology

Measures and questionnaire development.

The questionnaire survey of this empirical study is divided into five parts. The first part mainly includes the demographic and personal background information of the participants. The second part is about the TPHSQ, mainly including the cleanliness of the environment and the public toilet, and whether to establish infirmaries and the public health service system in the scenic area. Then, the third part is used to measure the tourist trust, and the fourth and fifth parts are, respectively used to evaluate tourist satisfaction and loyalty after travel. Notably, we have set up two questions at the end of the first part of the questionnaire. One of which is “Which tourist attraction you have been to most recently?”, which could help tourists recall their most recent travel experience. Moreover, if they skip this question and do not answer, then the questionnaire will be considered invalid. The other question is a simple mathematical question, which is also used to test the validity of the data. All items were assessed using a five-point Likert-type scale ranging from extremely disagree (1) to extremely agree (5).

Based on the literature review, the measurement items for the study variables were adopted ( Aydin and Özer, 2005 ; Yoon and Uysal, 2005 ; Lee et al., 2007 ; Paparoidamis and Chumpitaz Caceres, 2007 ; Bai and Guo, 2010 ; Žabkar et al., 2010 ; Guo et al., 2013 ). In particular, items regarding TPHSQ were adapted from previous studies ( Sun, 2018 ). Moreover, the study was manually revised based on the original scale because of the limited universality and robustness of the original scale. First, 10 general visitors and two experts were invited to review the scale successively to check for accuracy. Second, we repeatedly discussed and compared their suggestions, and the original 38 measurement indicators were reduced to 16. Afterward, to ensure the scientificity and validity of the scale, the pilot test and EFA were conducted, and finally, a formal scale with 11 indicators was formed.

Previous research shaped other extended study variables, (e.g., tourist trust; Aydin and Özer, 2005 ; Paparoidamis and Chumpitaz Caceres, 2007 ; Guo et al., 2013 ) and included five items (e.g., “I trust completely the staff in this tourism destination.”). Then, tourist satisfaction toward this travel was measured with three scale items (e.g., “Overall, I am satisfied with my experience during this travel”), which were acquired from previous studies ( Yoon and Uysal, 2005 ; Lee et al., 2007 ; Žabkar et al., 2010 ). Another three items were adapted for tourist loyalty ( Bai and Guo, 2010 ), for example, “If I have the opportunity, I will promote the positive information of the destination to others.”

Data Collection and Sample Characteristics

In this study, a convenience sampling method was used to distribute questionnaires through online social media platforms from December 17 to December 29, 2020. The link for participants to fill out online is https://www.wjx.cn/hj/4fv9udv8u0mxcf9ancaiza.aspx . Then, 593 questionnaires were eventually received, and of which, 456 were valid, having an effective rate of 76.9%. These samples came from 33 provinces, municipalities, and autonomous regions in China except Tibet. As shown in Table 1 , 34.6% of the respondents ( n =158) were male, and 65.4% ( n =298) were female. Most of them were between 19 and 24years old, or 44.7% and those under 56years old accounted for 97.8%. In addition, more than half of the respondents, 62.9% ( n =287), held an undergraduate degree. Table 1 summarizes the participants’ information.

Table 1 . Sample profile.

Data Analysis Tools and Procedures

At the beginning of this study, SPSS 22.0 was used to analyze the data and perform descriptive statistics on the demographic characteristics of the respondents. Next, the total sample ( N =456) is divided into S1=150 and S2=306. The former is used for EFA and the reliability test, whereas the latter uses AMOS 22.0 software for confirmatory factor analysis (CFA) and hypothesis testing. Furthermore, to test the influence of multiple intermediaries on loyalty, this study used Hayes’s Model 6 and Bootstrap methods to conduct a series of intermediary analyses, verifying the intermediary role of tourist trust and satisfaction.

Exploratory Factor Analysis and Reliability Test

This study employed EFA to measure TPHSQ and used principal components factor analysis and varimax rotation to perform factor extraction in SPSS software. Then, Cronbach’s alpha was used to check the internal consistency of each dimension. The results showed that the Cronbach’s alpha of each dimension of the TPHSQ initial scale was between 0.903 and 0.932, and that of each dimension exceeded the threshold of 0.75. This result indicates that the initial overall reliability of the scale and each dimension is very good, which is suitable for further analysis of other indicators.

Furthermore, values from the Kaiser–Meyer–Olkin measure of sampling adequacy and Bartlett’s test of sphericity were obtained to verify the appropriateness of factor analysis in the data. The Kaiser–Meyer–Olkin measure of 0.918 indicates that the factor analysis is suitable based on the 0.8 guideline, which interprets 0.8 and above as meritorious ( Hair et al., 2010 ). From another perspective, the Bartlett test of sphericity of 0.00 also indicates that the variables are suitable for factor analysis.

Table 2 shows that the two factors are named “Overall environmental image” and “Public health facilities and management,” with a cumulative variance contribution of 72.096%. In the EFA, after the maximum variance is orthogonally rotated, the item with the factor loading value of less than 0.4 and the loading value on two or more factors simultaneously is greater than 0.4 should be deleted ( Maskey et al., 2018 ). According to the above standards, after several rounds of deletion, the scale finally retained 11 items and deleted five.

Table 2 . Exploratory factor analysis (EFA) and reliability test.

Confirmatory Factor Analysis

Confirmatory factor analysis was performed by using AMOS software. As shown in Table 3 , the Cronbach’s alpha value is between 0.800 and 0.893, and all constructs exceed the threshold of 0.75, indicating that the internal consistency among each scale is acceptable ( Christmann and Van Aelst, 2006 ).

Table 3 . Confirmatory factor analysis (CFA) and reliability analysis.

The results also showed that the final CFA model has good fitting index (χ 2 =221.17, df=170, χ 2 /df=1.301, RMSEA=0.031, GFI=0.940, NFI=0.963, IFI=0.991, TLI=0.988, and CFI=0.991). The CR values for all the constructs ranged from 0.806 to 0.884, which exceeded the threshold value of 0.70 ( Hair et al., 2010 ), and the factor loading of each item is between 0.5 and 0.9. Moreover, as the average variance extracted (AVE) values from all constructs ranged from 0.411 to 0.582, most of them are greater than 0.5 ( Fornell and Larcker, 1981 ). This result shows that the scale has good convergent validity. Then, as shown in Table 4 , the square root value of AVE is greater than the correlation coefficient of each and other variables, indicating that each dimension has high discriminative validity.

Table 4 . Correlation coefficient matrix.

Hypothesis Testing

This study predicted that improving the TPHSQ would increase tourist loyalty (H1), trust (H2), and satisfaction (H3). The results showed that TPHSQ had a significant positive effect on loyalty ( B =0.172, p <0.05), and TPHSQ significantly and positively affected tourist trust ( B =0.972, p <0.05) and satisfaction (B=0.341, p <0.05) as shown in Table 5 .

Table 5 . Regressions analysis.

This study verified the relationship between tourists’ trust in public health services and their satisfaction. The results showed that a significant positive effect exists between tourists’ trust in public health services and their satisfaction ( B =0.677, p <0.05). The results supported H4.

Hypotheses 5 and 6 indicated that tourist trust and satisfaction significantly influence loyalty. The results showed that a significant positive correlation exists between tourist trust and loyalty ( B =0.240, p <0.05) and a significant positive correlation is found between tourist experience satisfaction and loyalty ( B =0.615, p <0.05). These results support H5 and H6.

Testing Mediating Effect

To test the effect of multiple mediators on loyalty, the study conducted a series of mediator analyses using Hayes’ Model 6 and Bootstrap methods, and Table 6 shows the results for all paths ( Hayes, 2012 ).

Table 6 . Regression coefficients of serial mediation models estimated using PROCESS.

The results showed that the indirect effect of TPHSQ on loyalty was significant under the influence of chain mediators [ B =0.847, 95% CI: (0.735, 0.966)]. The indirect effect of TPHSQ on loyalty was verified through the significant mediation of tourist trust [ B =0.233, 95% CI: (0.055, 0.477)] and satisfaction [ B =0.404, 95% CI: (0.224, 0.561)]. Thus, this result indicates that tourist trust and satisfaction play a partially mediating role in the effect of TPHSQ on their loyalty, thereby verifying H7 and H8.

The model in this study is a multi-mediator, which involves the relationship between two mediating variables, and these multiple mediating variables showed sequential characteristics and formed a chain of mediators. Therefore, the chain of mediators of tourist trust and satisfaction [ B =0.210, 95% CI: (0.116, 0.337)] needs to be further explored and verified to have a significant effect.

Impact of Tphsq on Tourist Loyalty

First, a significant positive impact is observed from the relationship between TPHSQ and loyalty and the results, which is consistent with the research results of ( Jeaheng et al., 2020 ; Loke, 2020 ). In other words, if tourists perceive high-quality tourism public health services, then they are more likely to recommend to others or revisit. Specifically, Table 3 shows that among the 11 indicators, the respondents were sensitive to “Good natural ecological environment.” This finding shows that these tourists are satisfied with the environment of their most recent travel. In addition, the tourists were least sensitive to “There is an infirmary specially set up for tourists.” This notion can be explained by the fact that the tourists participating in this empirical study had different travel purposes. For tourists, whose main purpose is entertainment, they paid more attention to the basic public health services of the destination, such as the cleanliness of the environment and public toilets. They did not pay special attention to professional medical services. Moreover, a prediction could be proposed. For tourists who are for medical treatment or health, they will pay additional attention to professional medical and health services.

Then, this study not only verified the mechanism of the effect of TPHSQ on loyalty but also concluded that TPHSQ consists of two dimensions, namely, overall environmental image and public health facilities and management. This finding is consistent with the established findings of ( Sun, 2018 ). Specifically, when tourists go to a destination, the first thing they perceive must be the environment and cleanliness of the destination ( Breiby and Slatten, 2015 ; Hanafiah et al., 2019 ). For example, for natural destinations, if the ecological environment in the destination is not well protected or the water in the lakes and rivers is muddy, then such destinations may be meaningless to tourists. In addition, public health facilities and management are another important component of the quality of public health services in tourism, which is consistent with Raposo et al. (2009) in primary healthcare services. The number and layout of the public toilets in a destination, the maintenance of trash cans, and the way to report and complain about public health service problems are all factors that affect tourists’ experience ( Milman, 2009 ).

Mediating Role of Tourist Trust and Tourist Satisfaction

First, the TPHSQ affects tourist trust because public health services are different from other services in that they involve human health and safety, as evidenced by Maslow’s hierarchy of needs theory. In this theory, safety needs are the most sensitive needs of the human, in addition to physiological needs. Therefore, a satisfactory tourism public health service will allow tourists to conduct other experiences without fear ( Loke, 2020 ). Second, the TPHSQ affects satisfaction, and this conclusion is not difficult to draw ( Jeaheng et al., 2020 ). The reason is that tourists are involved in the production of tourism services, and they will use the perceived results of the process as a basis for their basic evaluation of service quality. Therefore, managers must design and provide services that meet expectations and satisfy needs to ensure the perceived effectiveness and satisfaction of tourists.

Furthermore, the current study confirmed a significant positive effect of tourist trust on satisfaction, which is consistent with the findings of Wu et al. (2016) and Amoako et al. (2019) . Interestingly, the relationship between tourist trust and satisfaction has been in academic controversy, with some scholars arguing that satisfaction affects tourist trust ( Song et al., 2014 ; Al-Ansi and Han, 2019 ; Martinez-Navalon et al., 2020 ). However, in this context, tourist trust affects satisfaction, which can be explained by the fact that tourism public health services are closer to the basic needs of tourists, such as health and safety. Although finding tourism public health services with high quality is not the main purpose for tourists, if they lose trust during travel, then satisfaction is even less likely to be achieved. In short, when tourists perceive that tourism public health services meet their expectations, they believe that the destination is trustworthy and reliable because their health and safety will be guaranteed during the trip. Then, they will be able to participate in other services with confidence, and their satisfaction will increase. Moreover, they will be more willing to recommend it to others or revisit it after the trip.

Conclusion and Implications

Tourism public health services are closely related to the health and experience of every tourist. In the post-epidemic era, if tourism companies can ensure that every tourist can receive high-quality public health services during travel, and then this can help regain travelers’ confidence and increase their loyalty and the recovery of tourism industry. This study aims to define and measure the TPHSQ and explore its impact on loyalty. The results showed that the TPHSQ consists of two dimensions, namely, overall environmental image and public health facilities and management. And it is positively correlated with tourist loyalty, and trust and satisfaction play an intermediary role in the TPHSQ–loyalty relationship. In addition, comprehensively, a single intermediary path based on satisfaction is better than a multi-chain intermediary path based on trust–satisfaction. The empirical results supported the theoretical model and hypothesis.

Implications

Some scholars predicted that the panic caused by the COVID-19 outbreak may have a long-term impact on the tourism industry ( Ugur and Akbiyik, 2020 ). Tourists are gradually lacking the confidence to travel, which is detrimental to the recovery of the tourism industry. Therefore, DMOs must adopt effective strategies to boost travelers’ confidence and help businesses recover on time after this public health crisis. One of the most effective strategies is to provide high-quality tourism public health services ( Shi and Lu, 2020 ). Tourism destinations must focus on improving the TPHSQ and providing effective public health services, which in turn will improve tourist experience satisfaction, tourist trust, and loyalty. Therefore, we offer the following implications.

First, tourist destinations must change their attitude toward the overall environment and cleanliness. The cleanliness of the tourist environment is not the core of every travel and tourists are often attracted by other more beautiful landscapes or impressive services. However, as long as the tourists perceive the environment and sanitation below expectations, satisfaction will be greatly affected, especially during a public health crisis ( Jeon and Kim, 2012 ; Wang et al., 2020 ). Therefore, tourist destinations should improve other service factors on the premise of ensuring a clean and healthy environment, such as ensuring good air and water quality and no garbage in the scenic area.

Second, tourist destinations must standardize public health facilities and management. Taking public toilets in scenic spots in China as an example, despite the implementation of the Toilet Revolution policy, unreasonable numbers, low convenience, and poor facilities in the public toilets still exist. In addition, even some of the toilets show a “different” situation, where the exterior decoration is neat and tidy, into the toilet but very poor hygiene ( Sun et al., 2019 ). These cases have seriously affected tourists’ satisfaction, and likely tourists will not revisit or recommend the destination to other potential tourists. In addition, the epidemic has made tourists more concerned about their health and safety ( Wen and Jiang, 2020 ). DMOs must establish a complete public health service system and learn to combine advanced technology or equipment to implement more effective public health service measures. Moreover, DMOs should help tourists obtain public health services safely and conveniently ( Sun, 2018 ). Examples include the following: using robots for services during epidemic prevention and control to avoid direct contact with tourists; using the Internet to accurately calculate the use of public toilets to achieve its efficient use; or actively building a tourism public health information service system through brochures and guides maps, mobile APP, and other forms to provide tourists with convenient public health information services, such as the geographic location, distribution layout, and flow of public health service facilities.

Limitations and Future Research

This study provides valuable management insights for the sustainable development of tourist destinations in the post-epidemic era. However, several limitations exist. One of them is that the current study collected data from Chinese tourists, so the research results may not be applicable to tourist destinations in other countries. Thus, future research can explore cross-cultural aspects for international or cross-cultural tourists. In addition, common problems related to the measurement errors of dependent and independent variables (IVs) exist in linear models. Finally, as the study validated a limited number of variables, future scholars can explore the relationship between the quality of tourism public health services and more other variables, such as tourists’ emotions and perceived risks.

Data Availability Statement

The datasets presented in this article are not readily available but the raw data supporting the conclusions of this manuscript will be made available by the authors to any qualified researcher. Requests to access the datasets should be directed to Jiayu Han [email protected] .

Author Contributions

JH and YZ contributed to the conception of the study. JH collected and organized the data. JH and YZ contributed significantly to analysis and manuscript preparation. YZ and SC performed the data analyses and wrote the manuscript. RL and MZ helped perform the analysis with constructive discussions. MZ is responsible for the overall project. All authors contributed to the article and approved the submitted version.

This research was supported by The Guangdong Provincial Science and Technology Plan Project (grant no. 2018A070712022), all support is gratefully acknowledged.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.731279/full#supplementary-material

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Keywords: tourism public health, service quality, loyalty, trust, satisfaction

Citation: Han J, Zuo Y, Law R, Chen S and Zhang M (2021) Service Quality in Tourism Public Health: Trust, Satisfaction, and Loyalty. Front. Psychol . 12:731279. doi: 10.3389/fpsyg.2021.731279

Received: 26 June 2021; Accepted: 29 July 2021; Published: 30 August 2021.

Reviewed by:

Copyright © 2021 Han, Zuo, Law, Chen and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Mu Zhang, [email protected]

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

What Determines the Perceived Quality of a Tourism Destination?

Table of Content

1. buildings and architecture, 2. religious aspects, 3. local history & culture, 4. national landmarks , 5. regional landscape, 6. climate and weather, 8. transportation.

Recent studies used sentiment analysis to determine the top factors that influence the quality of a tourism destination.

By analyzing online reviews and the words people used, some key topics have emerged that make a destination interesting and desirable.

In this article, we’re going to present 8 key elements that influence the perceived quality of a destination.

Architecture and buildings are some of the most common points of attraction to a tourist destination. 

You will find that tourists are drawn to certain buildings based on reasons that depend on individual interests. These reasons include the structural aspects of the buildings, functional, historical, cultural and aesthetic aspects.  

A good example is highlighted in a case study that was aimed at measuring the value buildings offer tourism. In this study, the Guggenheim Museum building in Bilbao, Spain, was shown to attract tourists to the city because of its renowned architect, Frank Gehry.

Another recent study identified aesthetics as a factor that makes particular buildings so significant to a tourist destination. Buildings with special features or artistic value draw a lot of attention. A few famous examples are the Sagrada Familia in Barcelona, Taj Mahal in Agra, and Saint Basil’s Cathedral in Moscow, among others.

According to a recent issue of the International Journal of Religious Tourism and Pilgrimage , in 2018, out of 1.4 billion tourists globally, about one-third traveled for religious purposes. More to that, in the past decade, faith-based tourism has been on the rise. These numbers are a clear sign of the significance of religious tourism to a destination.

It’s also important to note that religious buildings and sites attract not only people looking to reinforce their beliefs or get spiritual support but different types of tourists as well. 

Many people visit sacred sites due to the historic value of the place, its cultural significance, or architectural importance and beauty. This is evidenced in the Sustainability 2021 study , where most of the Chinese tourists in Spain commented on the aesthetic value of churches in Spain and less about the religious meaning.

Local history and culture refer to the heritage and way of life of the people living in a particular city, region, or locality. 

People preserve their heritage in historic and cultural attractions including archaeological sites, historic buildings, art galleries or museums, local or national parks, ethnic heritage sites, concerts, among others.

Such attractions draw in travelers interested in learning about the heritage of a place. Chinese tourists, for example, visit Spain and Europe for cultural tourism along with gastronomic and shopping tourism. This is a sign of how valuable local history and culture is to a tourist spot.

In fact, a research by Pacific Asia Travel Association reports that culture and heritage tourists spend 38% more when they travel and stay 22% longer than the average tourist. 

Heritage tourism is important to a tourist destination as it helps boost the economy of the destination. It also promotes the preservation of the local culture, customs, and even the natural environment. 

When we talk about national landmarks we are referring to significant man-made attractions in a region. Although these can also fall under buildings and architecture, they deserve a special mention.

National landmarks may include, among others, monuments and natural marvels. Some common examples of these are Stonehenge in England or The Brandenburg Gate in Berlin.

For nature-lovers, regional landscapes are key attractions that add to the quality of a tourism destination. Travelers who gravitate to adventure, appreciate the natural environment and enjoy exploring the outdoors, placing a high value on natural attractions like mountains, caves, beaches, forests, water bodies, nature trails, and deserts.

This form of tourism is known as nature tourism and is often associated with ecotourism which focuses on responsible travel. It helps preserve the natural environment of a place or region and also keeps or improves the quality of life for the locals.

Studies have shown that climate affects tourism in a destination. In some cases, the climate of a place can be the main tourism resource, for example, hot climate in beach destinations. 

On the other hand, the weather conditions at the time tourists are visiting a destination can vary significantly and, therefore, either allow or prevent the tourism activities from taking place. Weather can also influence the enjoyment of tourism activities.

Therefore, both the weather and climate of a place are key considerations for tourists when making their travel decisions. And for tourism businesses, weather and climate can also influence the success of their business operations.

Affordability is a key consideration for many travelers – but that doesn’t mean cheaper destinations are always more preferable.

Research shows that most tourists (and other consumers in general) are inclined to believe that the price of a commodity or service is a good indicator of its quality. 

So the tourist’s perceived quality of the location will determine whether they’ll be willing to pay the price or not. 

How easily can tourists get to your destination? 

This is one of the key factors that influence the desirability of a city or region. This calls for sufficient and easily accessible gateways to a destination e.g. airports, train stations, and other routes. 

But more than just transportation into your destination, the infrastructure within your region is also of great importance. Quality tourist destinations have proper connectivity within the location to ensure ease of movement from one point to the other or from one attraction to the next.

As a destination marketer, make this information easily accessible on your website, brochures, and even social media pages. That will help visitors when planning their trips.                                                                                                                                                                                                                                                               

The quality of any tourist destination is multi-faceted and depends on elements including:

• Buildings and architecture
• Religious aspects
• Local history and culture
• National landmarks
• Regional landscape
• Climate and weather
• Transportation

But apart from the actual quality, tourists also develop perceived quality mostly based on word-of-mouth feedback from other travelers. It’s therefore vital for destination marketers to look at raising both the actual and perceived quality of their tourism destination.

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Evaluating Quality in Tourism Destination Websites of Peloponnese

• Conference paper
• First Online: 12 February 2020
• Cite this conference paper

• Kourtesopoulou Anna 3 ,
• Nikolakakou Christina 4 ,
• Moustakarias Nikos 5 &
• Grapsa Theodoula 4  

Part of the book series: Springer Proceedings in Business and Economics ((SPBE))

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Tourism destination websites contribute significantly to the competitiveness of a tourism destination. Websites and mobile technology are their main digital marketing contributors by providing tailored and up-to-date information. Since limited research has been done about non-commercial travel websites, this study aims to identify whether selected Peloponnese destination websites apply integrated quality as a mean to raise their brand competitiveness.

Methods: A content analysis was performed in order to assess the destination websites quality performance. The used website quality assessment consists of a set of 42 parameters covering content and usability characteristics. The selected tourist destination websites were chosen according to two criteria: (1) their ability to provide at least two options in language Greek and English and (2) their main destination will be either Peloponnese or a region of it.

The results: The analysis of the data revealed that tourism destination websites average performance level was weak. In total they seemed to perform better in content than in usability. According to the result, leading quality indicators of destination websites found to be the audience, the page load time and advertising. However, there is still room for improvements with relation to information accuracy, access, navigation as well as interactivity.

Conclusions: As indicated by the results, there are elements to the selected destination websites that may be improved targeting an excellence quality performance. The destination websites will keep on playing a basic role in tourism communication, thus quality excellence should ensure the optimization of tourist experience and increase the intention for visiting these destinations.

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Anna, K., Christina, N., Nikos, M., Theodoula, G. (2020). Evaluating Quality in Tourism Destination Websites of Peloponnese. In: Katsoni, V., Spyriadis, T. (eds) Cultural and Tourism Innovation in the Digital Era. Springer Proceedings in Business and Economics. Springer, Cham. https://doi.org/10.1007/978-3-030-36342-0_24

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Please note you do not have access to teaching notes, multidimensional destination perception effects over medical tourists’ behavioural in emerging destinations: empirical evidence from china’s international medical tourism pilot area.

International Journal of Tourism Cities

ISSN : 2056-5607

Article publication date: 12 April 2024

This study aims to explore the consumer perceptions of cognition and intention to visit pilot zone of international medical tourism as emerging, developed medical tourism destinations.

Design/methodology/approach

Using a survey-based quantitative method, based on a survey of 439 tourists who have cross-border travel experience, the partial least squares approach was performed to test the hypotheses.

The results show that internal factors had a stronger influence on destination image compared to external factors. Among different factors, preferential policies had the greatest impact on intention to visit. Perceived quality had a stronger effect on intention to visit than preference. Geographical distance had a varied effect, with those furthest away in Northeast China showing greater intention to visit compared to closer regions.

Originality/value

This study explores the impact of multidimensional destination perception on medical tourists’ behavioural intention in emerging destinations by integrating the push-pull theory and theory of planned behaviour and tests how geographical distance affects intention to visit emerging destinations. Using China international medical tourism pilot area as a typical case of medical tourism emerging destinations for empirical analysis. This research offers guidance for branding and marketing strategies, contributes to a deeper understanding of medical tourists’ destination choices, enriches the theoretical explanation of emerging destination choice in medical tourism and provides valuable insights for destination recovery.

• Driving factors of medical tourism
• Destination image
• Perceived quality
• Geographical distance
• International medical tourism pilot area

Jiang, M. , Zhao, L. and Li, Y. (2024), "Multidimensional destination perception effects over medical tourists’ behavioural in emerging destinations: empirical evidence from China’s international medical tourism pilot area", International Journal of Tourism Cities , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJTC-07-2023-0144

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