IC il f4I « KINH Tf MOl QUAN HE GIITA H A N H VI CUA BAC Sl V d l SU* TIN TU^dNG, HAI LONG VA LONG TRUNG THANH CUA BENH NHAN MOT NGHIEN ClTU TAI CAC BENH VIEN TINH LAM DONG Nguyen Thuy Quynh Loan' Le Quang Vinh' Ngay nhan bai: 25/ll.'2014 Ngay nhan lai: 09/01/2015 Ngay duySt dang: 19/05/2015 Long triing ciia benh nhan chlnh la muc tieu cho moi hoat dong ma nhieu benh vien huang tai Muc tieu ciia bai bdo nham xdc dinh vd luang mice dnh huang cua cdc yeu td hdnh vl ciia bde sT (su ldng nghe, sugldi thich vd nghiip vu chuy'en mon) den long lining thdnh thong qua yeu to niem lin vd sir hdi long cua benh nhdn De fdi da khdo sal 24 bdng cdu hoi vol doi tuang khdo sal la cdc benh nhdn tqi cdc benh vien tinh Ldm Ddng Ket qud cho thdy cdc yiu to dnh hudng den su hdi long cua benh nhan la su tin tirdng (P = 0.582), ke den su ldng nghe (P = 0.370) vd gidi thich cita bde sT (P = 0.384); co yeu td tdc dong den su tin tuang cda benh nhdn tdc dong mgnh nhdt la yeu to nghiep vu chuyen mdn (fi = 0.482); su tin tudng (fi = 0.404) vd su hdi long (fi = 0.388) deu co tdc dong ddng ki den long trung thdnh cua binh nhdn Tir dd de tdi da dua mot so hdm }' cho nhd qudn ly benh vien Irong viec qudn ly doi ngii bde sT nhdm ndng cao su tin tuffng hdi long cho binh nhdn de ho ngdy cdng trung thdnh han Patients' loyalty Is a goal for all activities ofthe hospitals The objective of this paper vas lo identify and measure the physician s behavior (listening, explanation and competence) Impacting on loyalty through confidence and satisfaction of patients The research surveyed 247 questionnaires from patients al the hospitals In Lam Dong province The results showed that the factors affecting patients' satisfaction were trust (f3 = 0.582) listening (fi = 0.370) and explanation (P = 0.384) of Ihe physicians: there were factors impacting on the trust of patients in which the strongest factor was competence (P = 0.482); confidence (P = 0.404) and satisfaction (P=0388) had significant impacts on patients' loyalty This paper then suggested the mangerlal implications for hospital managers In managing their physicians to enhance patient's trust and satisfaction so that they become more loyal GiAi thieu Slic khoe luon la m6i quan tatn hang diu cua xa hoi va la diSu quy gia nhdt cua nguoi Mot Ak nuac ma vin ii siic khoe khong diroc quan tam, phin Itjn dan s6 la nhiing nguoi benh tat, 6m yiu thi chic chin khong tranh khoi mot nln kinh tg cung 6m ySu va kem phat triSn Do do, sir giau ngheo cua mot quoc gia phu thuoc phin lon vao chit lugng y te, chu yeu la chit lugng dpi ngu y - Bac sT Vi vay, viec diu tu cho he th6ng y t i noi chung doi ngu y - Bac si noi rieng la dau tu cho tuong lai, cho ca mot su phat trien lau dai va ben virng Trong b6i canh m6i trucmg y te cang co tinh canh tranh cao nguoi dan cham Io den sue khoe ciia minh nhigu hon tlii viec cac benh vien can tap trung nang cao chit lugng doi ngu y - bac sT la ^ TS, Traong Dai hoc Bach Khoa - Bai hoc Qudc Gia TP HCM -Tnidng Dai hgc Bach Khoa - Bai hoc Ouflc Gia TP w r u TAP CHl KHOA HOC TRUONG DAI HOC MO TP.HCM -SO (42) 2015 KO^^ dieu can thiet Boi theo Youssel & Bovaird (1996), cac benh vien cung cap nhieu dich vu giong nhung khac ro ret \k chdt luang dich vu cham soc sire khoe Kotler (1991) cho rang chat lugng dich vu la yiu t6 quan dong gop cong cho chien Iugc cong ty va giup cong ty tfin tai moi truofng canh t r ^ h khde liet Vi vay, mpt nhB-ng ly nham thu hut, giir chan benh nhan va giam tinh trang benh nhSn vugt tuySn vln dang gia tang nhu hien a Viet Nam la chat Iugng dich vu dugc cung cSp nhu thi nko tir ca sa y te va dpi ngu y - Bac sT chinh la luc lugng nong cot quy§t dinh phin lon d^n chat lugng dich vu kham chira benh va tao nen danh tieng cho cac benh vien Hau het cac chii de da va dang dugc nghien cuu nhieu tren the gicri va a Viet Nam chu yeu tap trung vao cac yeu to chat lugng tao nen su hai long cua khach hang doi vai dich vu, dien hinh nhu cac nghien ciiu dua theo mo hinh nam phan cua Parasuraman & ctg (1988), hoac hai phan thuoc tinh dich vu la thuoc tinh ky thuat va thuoc tinh churc nang (Gronroos, 1984) Nham tim huong tiep can mai, nghien cuu ke thira mo hinh nghien cuu cua Gaur & ctg (2011) tap trung den cac nguon luc tuang tac ma cu the la cac yeu to hanh vi: su lang nghe, giai thich va nghiep vu chuyen mon cua Bac sT doi vai long trung cua benh nhan thong qua sir tin tuong, hai long ciia hg qua trinh kham chua benh Viec xay dvmg long trung cua benh nhan cung chinh la phuang phap giiJ chan benh nhan dong hanh ciing voi mgi sir thay doi ciia benh vien Lieu day co phai la huang ma cac nha cung cip dich vu ITnh vuc y te can quan tam dk lam gia tang va tri long trung cua nguai benh hay khong? Do muc tieu nghiSn cun nham lam ro Moi quan he giira hdnh vi cua bde si vdi su tin tudng, hdi long vd long trung thdnh cua ngudi benh lgi cdc binh vien tinh Ldm Ddng Ca s& (y thuyet va mo hinh nghien cihi 2.1 Dich vu vd dich vu y te Dich vu la qua trinh bao gom cac hoat dgng, hanh vi tuang tac giira nha cung cap dich vu va khach hang nham thoa man nhu cku, mong dgi ciia khach hang, cung nhu tao gia tri cho khach hang (Zeithaml & Bitner, 35 2000) Nhu vay, gia tri dich vu thuc su dugc tao khach hang su dung va tieu dCing no, gia tri se tilp tuc dugc tao giua nha cung cdp va khach hang suot qua trinh thu huang cua khach hang Dich vu y te la toan bo cac boat dgng cham soc sue khoe cho cgng dong, nguoi nhim thoa man kip thai va co hieu qua hon cac nhu ciu cang gia tang ve cham soc sue khoe (Eg Y T I - T6 chirc y ti thi giai 2001) 2.2 Hanh vi cua Bac sf frong kham chS-a benh Hanh vi cua Bac si kham chua benh la ling nghe, luu tam den nhiing cau hoi, lo lang cua benh nhan doi mat vai benh tat va viec chiia tri; giai thich, cung cap thong tin, chia se vai benh nhan va gia dinh hg cac giai doan cua viec chira tri tranh cac tir phirc tap va chuyen mon: nghiep vu chuyen mon quan sat cac trieu chimg ctia benh nhan (kiem tra lam sang), chan doan de cuoi ciing dua phuang thuc chiia trj thich hgp (Pham Nggc Thanh, 2012) 2.3 Sur tin tu&ng, hai long va long trung cda benh nhan Su tin tuang la nhijng mong muon cua nguai tieu diing ma nha cung cap dua vao de cung cap dich vu nhu da hua (Sirdeshmukh & ctg., 2002) Berry & ctg (2008) cong nhan rang cam ket cua benh nhan ve moi quan he cua ho vai Bac sT co Hen quan den nhan thirc niem tin ciia hg Niem tin co dugc benh nhan cam nhan ye Bac sT la chan thanh, dang tin cay va nhan tir (Doney & Cannon 1997) Zeithaml & Bitaer (2000) dinh nghTa su hai long la danh gia ciia khach hang ve san pham hay dich vu dap img nhu cau va mong dgi ciia hp Su hai long dupc coi la ket qua cua moi quan he giua nguai mua - nguai ban ITnh vuc dich vu (Smith, 1998; Huang, 2008; n-ich Gaur & ctg., 2011), va no chiu tac dpng dang ke ciia moi quan he (Weng, 2008) Long trung bao gom cac hanh vi \h y djnh mua Iai, san sang giai thieu hoac truy§n mieng tich cue (Zeithaml & Bitner 2000) Long trung ciia khach hang dupc xem la ket qua cuoi ciing moi quan he va la sire manh thuc su ciia m6i quan he (Reichheld, 1993) 2.4 Moi quan he giua hdnh vi cua Bac si v&i sir tin tu&ng, hdi long cua benh nhan 36 KINH TE' mit di niim tin cua benh nhan Moi quan he tdt giija Bac sT - benh nhan lam gia tang sir hai long va cirng co sy tin tudng cua benh nhan, ciing nhu dgng Iuc va each nhin tich cue \i tinh trang sire khde ciia hp (Skea & ctg., 2004) Tir nhung phan tich tren, gia thuyet dat ra: H3: Cd mdi quan he tich cue giita sir gidi thich cua Bac sT vd su hdi long cua benh nhdn H4: Co mdi quan hi tich cyrc giira su gidi thich cua Bac sTvd su tin tirdng cua benh nhdn Nghiep vu chuyen mdn cua Bde sT: la mirc dp ma benh nhan tin tudng vao kj? nang va kien thuc can thiet cua bac sT de cung cap cho nhu cau cham sdc sue khde ciia hg (Berry & ctg., 2008) Trong mot nghien ciru \i su hai long cua benh nhan, DiMatteo & Hays (1980) phat hien bang chung thuyet phuc ring niu benh nhan cam thay Bac sT cua hp la nhirng ngudi giao tiep tot, thi hg ciing xem la nghiep vu chuyen mdn ve ky thuat va thich hgp cho viec cham sdc hieu qua (trich Gaur & ctg., 2011) Chandon & ctg (1997) cung xac HI: Co moi quan he tich cue giira su ldng dinh nghiep vu chuyen mdn la mpt cac nghe cua Bde $T vd su hdi long ciia benh nhdn yeu to ddng gdp de danh gia ve tuang tac dich H2: Cd mdi quan he tich circ giira sir ldng vu han la hieu qua dich vu Do do, gia thuylt nghe cda Bac sTvd su tin tuang cda binh nhdn dugc phat bidu: Sir gidi thich cua Bac sT: de cap den H5: Cd mdi quan he tich cue giira nhan thuc ciia benh nhan ve kha nang cung cSp nghiep vu chuyen mdn cua bac sT vd su hdi thong tin cua Bac si lien quan din tinh hinh long cua binh nhdn Slic khoe, dugc pham, cham soc, yeu cau thii H6: Cd moi quan hi tich cue giiia nghiip tuc y ti (Stewart & ctg., 1999) Khi kham chiJa vu chuyen mdn ciia bde si vd su tin tuang ciia benh, viec thiet yeu la phai tao dupc m6i quan benh nhdn he diing, giao tiep hai chieu va giai thich cho 2.5 Moi quan he giita su- tin tu&ng, hdi benh nhan ro rang, ngin gpn, dilu dem lai long va long trung thdnh ciia benh nhan hieu qua mpt phan ngi dung kham chua Su hai long la mpt yeu td du bao manh benh Duffy & ctg (2004) chi ro benh nhan ve long trung cac hanh vi tuong tac mong mu6n duge giao tiep tot vdi Bac sT de hg ciia Bac si vdi benh nhan dugc cai thien lam CO th8 cai thi6n m6i quan he va cam thiy dugc gia tang sir hai long, qua dd ciing gia tang long hai long hon Theo kit qua diiu tra cua trung ciia benh nhan (Bowers & ctg., Tongue & ctg (2005) 75% Bac sT phlu thuat chinh hinh tin ring hp giao tiip thoa dang vdi 1994) Theo Crosby & ctg (1990) sir hai long benh nhan, nhung cbi eo 21% benh nhan hai phu thudc vao tuong tac true tilp giiia cac ca long giao tiip vdi cac Bac sT Khi nhan (trich Gaur & ctg., 2011) nen cam nhan cac kiem tra y te va viec di^u tri dugc giai ciia khach hang vh tuong tac true tidp vdi nha thich ro rang, se lam^giam bat cam giac lo lang cung cap dich vu la mdt nhimg yiu to cua benh nhan Thieu su giai thich diy du va quylt djith long trung (Gronroos, 1994) s^ dong thuan giua Bac sT - benh nhan cd the Gia thuyet dugc phat bilu: H7: Benh nhdn cdng hdi long vdi Bac si dan den thit bai dieu tri, hau qua la benh khong dupc chua het va nhung bien chiing thi hg cdng trung thdnh Su tin tudng ctia benh nhan vao Bac si nghiem trpng cd thi xay lam anh huang d8n moi quan he giua Bac sT - benh nhan vdlam ciing da dugc chung minh rang se dan den su hai long cua benh nhan (Baker & ctg., 2003) Su ldng nghe cua Bde sT: de cap den nhan thuc ciia benh nhan ve viec Bac sT san long danh thai gian di ling nghe va chii y den nhirng van de ma hp quan tam (Stewart & ctg., 1999) Theo Swan & Oliver (1987) ling nghe la dieu thiet y^u de tiSp can dinh huong khach hang va co quan h6 tich cue den su hai long khach hang (trich Gaur & ctg., 20II) Su cham chu ling nghe, cam thong, va su dung cau hoi ma lam gia tang su tham gia va gan bo ciia benh nhan voi viec dieu tri thiic day moi quan he than tinh, pha bo tra ngai qua benh nhan CO the chia se thong tin can thiet de bae sT chan doan cbinh xac benh tinh va tuan thii dieu tri theo quy dinh ciia Bac sT tCr tao dugc niem tin cho benh nhan (Tongue & ctg., 2005) Nhan thuc ciia nguai tieu dimg ve hanh vi lang nghe cua nhan vien co tac dpng den viec thiic day moi quan he Iau dai, xay dung long tin va du doan cac tuong tac sau (Ramsey & Sohi, 1997; trich Gaur & ctg., 2011) Vdi nhimg phan tieh tren, gia thuyet dat ra: TAP CHf KHOA HOC TRL/ONG DAI HOC MO TP.HCM - SO (42) 2015 H* Da cd nhiing phat hien rang su tin tudng cac mdi quan he cd tac ddng tich cue din su hai long cac tuang tac dich vu (Hennig Thurau & ctg., 2002; trich Gaur & ctg., 2011) Su tin tudng vao mdi quan he se lam giam sir lo lang va khdng yen tam, dac biet la linh vuc dich vu (Berry & ctg., 2008) Platonova & ctg (2008) cung da tim thiy ylu td niem tin du bao chii ySu cho su hai long va long trung cua benh nhan Do do, gia thuyet duge dat la: H8: Binh nhdn cdng tin tudng vdo Bde sithi hg cdng hdi long H9: Benh nhdn cdng tin tudng vdo Bde sTthi hg cdng trung thdnh TLI cac gia thuyet phat bieu tren, md hinh nghien cuu dugc thl hien d Hinh I Hinh Mo hinh nghien cuu m^ Phircnig phap nghien ciru Nghien cuu dugc thuc hien qua hai giai doan: Nghien cmi so bp (nghien ciru dinh tinh vdi cac thang ke thira tir nghien cuu cua Gaur & ctg (2011), tiln hanh thao luan nhom vdi tmdng khoa, Bac sT va phong van sau vdi benh nhan tai cac benh vien Da Khoa I Lam Ddng (TP Da L^t), Da Khoa II Lam Ddng (TP Bao Ldc) de dieu chinh, bo sung cac biln nhim cd dugc thang hoan chinh; kit qua cd dugc 27 bien quan sat, su dung thang Likert dilm vdi "su lang nghe cua Bac sT - SLN" (5 bien), "su giai thich cua Bac sT - SGT" (5 biln) "nghiep vu chuyen mdn NVC" (4 bien), "su tin tudng ciia benh nhan STT" (5 biln), "su hai long ciia benh nhan SHL" (4 biln), "long trung cua benh nhan - LTT" (5 biln) Nghien ciiu chinh thirc (nghien ciiu dinh Iuang dugc thuc hien theo phuong phap lay mau thuan tien bang bang cau hdi, phan tich dir lieu de kiem dinh thang va cac gia thiet, sd lieu dugc xir ly bang phan mim SPSS phien ban 20.0) Kit qua nghien ciiu Co 247 mau dupc chinh thirc sii' dung lam du' lieu cho nghien ciiu vdi doi tugng la cac benh nhan din kham chCJa benh hoac dang nim dilu tri tai cac benh vien Da Khoa I Lam Ddng, Da Khoa II Lam Dong, Da Khoa Hoan My (Tp Da Lat); xet vl tudi co 61.5% thuoc nhdm tuoi tir 18 - 35; ve nghe nghiep cd din 50.7% la ndng dan, cdng nhan, budn ban, lao dpng tu do; dilu cung phii hgp vdi mirc thu nhap kha thap ciia ngudi dan d Lam Ddng chii ylu tir den trieu/thang (41.3%), dudi trieu/thang (28.3%), cung CO nhiing ngudi co muc thu nhap cao tren 10 trieu/thang nhung khong nhieu (7.7%), lai la - 10 trieu/thang (22.7%) Kiem djnh thang Ket qua phan tich Cronbach's alpha cho thay he sd cac nhan to cd gia tri khoang 0.797 den 0.911, ldn hon 0.6 nen cac thang deu dat yeu cau Ket qua phan tich EFA cho thay, tat ca cac bien quan sat phan tan nlian td, co bien bi ioai (SGTi, NVC4), Iai 25 bien vdi he so tai tir 0.57 den 0.891, ldn ban 0.5 va chi tai len nhan to; cac he sd KMO, Eigenvalue va tdng phuong sai trich (TVE) deu dat yeu cau (Bang 1); nhu vay thang dat gla tri hpi tu va gia tri phan biet Gia tri cac thang duac tinh lay trung binh cac bien quan sat de dai dien cho khai niem can nghien ciiu phan tich hdi qui tiep theo Bang Ket qua phan tich nhan to Nlmn 16 Bign SLN SLN3 846 SLN4 794 SLN2 SGT WC LTT 787 SLNl 73fi SLN5 697 SGT4 781 SGT5 756 SGT3 653 SGT2 570 NVC2 891 NVCI 776 NVC3 703 LTT3 879 LTT2 857 LTTI 824 LTT4 819 SHL STT KINH i f ddng phin ldn den niem tin ciia b?nh nhan (dilu dugc the hien rd hon qua ket qua md hinh tilp theo) ,846 SHL2 Md hinh hdi qui giiia cdc yeu to hdnh vi 843 SHL4 cua Bde sivd su tin tudng cita benh nhdn: ,783 SHLl Kit qua hdi qui cd he sd sig = 0.000 va ,846 STT2 R^dicu chinh = 0-5 chimg td md hinh phu hgp va 829 STTl giai thich dugc 50% phuang sai su tin tudng 74! STT3 ciia binh nhdn Ckc gia thuyet Hi H4, H^ deu 662 STT4 dugc chip nhan (sig ', / (1), 67 -68 Gronroos, C (1984) A service quality model and its marketing implications European Journal of Marketing, 18 (4), 36-44 Kotler, P (1991) Marketing Management: Analysis, Planning, Implementation and Control Prentice-Hall Englewood Cliffs, NJ Parasuraman, A., Zeithaml, V A., & Berry, L L (1988) SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality Journal of Retailing, 64, 12-40 Platonova, E A., Kennedy, K N., & Shewchuk, R M (2008) Understanding patient satisfaction, trust, and loyalty to primary care physicians Medical Care Research and Review, 65 (6), 696-7\2 Reichheld, F F (1993) Loyalty-based management Harvard Business Review, 34, 64-73 Skea, Z., Harry, V., Bhattacharya, S (2004) Women's perceptions of decision-making about hysterectomy BJOG, III (2), 133-142 Stewart, A 'L., Napoles-Springer, A., Perez-Stable, E., Bindman, A, Pinderhughes, H., & Washington, A (1999) Interpersonal processes of care in diverse populations Milbank Quarterly 77 (3) 305-39 Sirdeshmukh, D., Singh, J., & Sabol, B (2002) Consumer trust, value, and loyalty in relational exchanges Journal of Marketing, 66 (1), 15-37 Pham Nggc Thanh (2012) Quan he giira ngudi cham sdc va ngudi dugc cham sdc (can bd y tl va benh nhan) Cd tai website: http://www.medinet.hochiminhcity.gov vn/ttyh^shkhkt/quanhe.htm ^^ji t^* Tongue, E H R., Forese, L L (2005) Communication skills for patient-centered care: researchbased, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients Journal Bone Joint Surg Am, 87, 652 - 658 ., i Weng, H C (2008) Does the physician's emotional intelligence matter?: Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction Health care management review, 33 (4) 280-288 B^*' -* Youssef, F N., Nei D., & Bovaird, T (1996) Health care quality in NHS hospitals International Journal of Health Care Quality Assurance, 9{\), 15-28 ftfii* Zeithaml, V A., & Bitner, M J (2000) ServicesMarketing: Integrating Customer Focus across the Firm McGraw-Hill Boston, MA ... manh thuc su ciia m6i quan he (Reichheld, 1993) 2.4 Moi quan he giua hdnh vi cua Bac si v&i sir tin tu&ng, hdi long cua benh nhan 36 KINH TE' mit di niim tin cua benh nhan Moi quan he tdt giija Bac... 3.492) va su tin tudng cua benh nhdn (mean = 3.380) vin chua cao, do viec danh gia long ^jMifiia^B^'^' 39 trung thdnh ciia benh nhdn chi d miic trung binli (mean = 3.303) Vdi miic dp trung nay,... cam ket cua benh nhan ve moi quan he cua ho vai Bac sT co Hen quan den nhan thirc niem tin ciia hg Niem tin co dugc benh nhan cam nhan ye Bac sT la chan thanh, dang tin cay va nhan tir (Doney &