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I TGNG IUAN & Cac nhan td tac dong dgn si/ thoa man cua khach hang do'i vdi chS't Itfrfng phuc vu l^ham chfita bdnh phu san tai Trung tam y td' phd'Nha Trang Nguyin Huynh Thai Tam (*), Nguyin Thi Hidn (**) Muc dich cda nghiin cihi ndy Id xdc dinh cdc yi'u td tdc ddng de'n su thda mdn cua b$nh nhdn ddi vdi chdt iuang phuc vu khdm chda benh phu san tgi Trung tdm Y li thdnh phd Nha Trang, xdc dinh miic dd quan trgng tuang dd'i giUa cdc yiu id, ddnh gid mdc thoa mdn ciia binh nhdn Nghien cdu duac ihuc hiin tgi Trung tdm Y li thdnh Nha Trang tit thdng 03 thdng 06 ndm 2009 Nghiin cdu dd dua trin md hinh ludng chd't lugng dich vu SERVQUAL (Parasuraman & cdng su,19B5) di ddnh gid mdc dd hdi long cda benh nhdn Thong qua phdn tich 500 mdu hgp li bdng phdn mem SPSS vd AMOS, CO yiu td chinh dnh hudng din su thoa mdn cua khdch hdng ddi vdi chdt lugng dich vu khdm chda binh phu sdn tai Trung tdm Y te thdnh phd Nha Trang bao gdm: thdi nhiet tinh cdm thdng, dd tin cay, su ddm bdo, phuang lien hffu hinh, chi phi khdm chffa benh Tdt cd cdc yiu tdndy deu tdc dgng din sU thoa mdn cua khdch hdng Nghien cffu tren khong chi dUa cdc gidi phdp de ndng cao chdt lugng dich vu khdm chffa benh phu sdn tgi Trung tdm y li Nha Trang md ddng gdp vdo viec thii't ldp mo hinh chung ludng chdt lugng dich vu y te tgi Nha Trang cilng nhutgi Viit Nam Tff khda: Chdt lugng djch vu Identifying factors that affect patients' satisfaction about quality of gyneco-obstetrical treatinent service at Nha Trang City Medical Center Nguyen Huynh Thai Tam (*), Nguyen Thi Hien (**) The objective of this study is to identify factors that affect patients' satisfaction of quality of gynecoobstetrical treatment service at Nha Trang city Medical Center, to rate relatively the importance of these factors, and to evaluate the satisfaction of patients using the service.The analysis of 500 questionnaires through SPSS and AMOS sotfware shows that there are six components which construct the service quality, namely (1) Reliability, (2) Response, (3) Staff, (4) Price and (5) Tap chi Y te Cfing cdng, 1.2010, Sd 14 (14) 43 IT6NS QUAN & HGHIEN ctiu I Tangibility All of them affect patient's saticfaction.This study not only offers solutions to improve gyneco-obstetrical treatment service but also contributes to construct model for measuring quality of medical services in Nha Trang City and in Vietnam Key words: Service quality Tdc^a {*) Nguy§n Hujnh Thii TSm - Ke win vien - Tnmg tam Y te phd Nha Trang Di^n thogi: 098 989 575 Email: nguyenhiiynhthaitam@gmaU.com Nguyen Thi Hiln - Tien si - K£' toin tnrdng, Giang vien chinh Dign thoai- 0905 110367 Email hiendhnt@gmail.com D$t vS'n dfi Tai khoa san Trung tdm Y td thanb phd Nha Trang, vifie cham sde va Iam thda man cae nhu can khdm chffa bpnh san phu khoa cua bfinh nhan Id dilu can Ihiet, ddc bipt dilu kifin xa hpi hod y td dffng Irffdc sff thdch thffc cua nhieu ddi ihu canh tranh De ton tai va phdt trien thi Trung tara Y Ifi' Nha Trang ein cd nhffng chidn Irfdc phil hdp nham thu hdt khdch hang hdn nffa Bfin canh lam giam ihifi'u cdc irffdng hdp khifi'u nai eua benh nhdn, edc nha quan ly eua Trung tam phai bieu rd chd'l iffdng dich vu kham ehffa bfinh phu san md minh dang eung cap dffde hinh iff nhffng ydu id' then chdt nao de tff dd lam cd sd eai tie'n eae ydu td nham nang cao cha't Iffdng dieh vu va ddpffngtd't hdn nhu cdu cua bfinh nhdn Xua't phdt Iff nhffng ly neu tren, viee tidn hanb nghifin cffu nhSm xdc dinh, phdn tieh ddnh gia cae ye'u id' tdc dfing ddn sff hai long cua bfinb nhan ddi vdi chd't Iffdng dieh vu khdm ehffa bfinh phu san tai Trung ldm Y lfi'ihanh phd'Nha Trang la hdi sffc can thidt Dd'i trfldng va phU'dng phap nghifin cii'u 2.1 Ddi tUdng nghien cdu Bfinh nhan de'n khdm chffa bfinh san phu khoa khdng ed the Bao hiem Y td (BHYT) hoac the BHYT khdc tuyfi'n 2.2 PhiOfngphdp nghien cdu 44 Tap chi Y te Cfing cdng, 1.2010, Sd 14 (14) Nghifin cffu tidn hanh Iheo hai giai doan nghifin cffu sd bfi va nghifin cffu chinh Ihffc, Nghifin cffu sd bp dffde Ihffc hipn bling phffdng phdp dinh tinh qua ky thuat thao ludn nhdm, Bffdc nghifin cffrf nhim khdm phd cdc ydu id tdc ddng Ien sff thda man eua bpnh nhdn ngodi nhffng yeu td'dffde dffa mo hinh nghifin effu dl xuat, Nghifin cffu dinh tinh nham xdc dinh edc nhdn idva cdc thupe tinh Iffdng Nghifin effu dinh Iinh tidn hanb qua ky thuat ihao ludn nhdm vdi 20 ngffdi (phdng va'n ddi gdm ngffdi Id ehuyfin gia irong linh vffe kinh le', y id; phong vd'n ddt gdm 15 ngffdi la edc khach bang thffdng xuyen sff dung dich vu lai Trung tam Y te' Nha Trang) Sau phin nghifin erfu dinh tinh cae bien quan sdt se dffde ebinh sffa, bd sung cho phu hpp hdn, Iam cd sd cho vifie xdy dffng bang can hdi 6i lidn hanh nghifin cffrf dinh Iffdng Nghien cffu chinh thffc dffde thtfe hien bang phrfdng phdp dinh Irfdng ihong qua bang cdu hdi phdng va'n Brfdc nghien cffu nham ddnh gid cde thang do, xac dinh mrfc dp quan trpng cua edc ydu to Iffdng mffe dfi quan trpng cua eae bidn, Iffdng mffe dp thoa man, Iffdng mffe dd cam nhdn va kiem dinh cdc gia thuyet da drfdc nfiu d phan Irfin Khao sdt dinh Iffdng thffc hifin tai Trung lam Y id thdnh phd Nha Trang tff thdng 03/2009 den 06/2009, Ddi tffdng chpn raau la bpnh nhdn den khdra chffa benh san phu khoa khdng ed the BHYT hoac the BHYT khdc tuyen, lay mdu thudn tien Md hinh Iffdng gdm 39 bidn quan sdt, theo nghifin crfu cua BoIIen (1989) kich thffdc mlu tdi ITfiNGQBAN&HGHIENCUUI thidu la i l n so vdi cdc ffdc Iffdng m o hinh (li Ip 5:1), M o hinh nghifin cffu cd 39 ffdc Irfdng, nfin kich thrfdc mdu d r f k i d n e b a p n h d n drfdc Id 390, sau phdt h a n h 700 bp cau hoi, ket qua thu drfde 500 bp cdu hdi hdp Ie Nghifin cffu sff dung thang Likert mffe dp, tff ( I ) Rdt khong hai ldng ddn (5) Rd't hai Idng Iffdng sff thoa man cua khdch hang ve ehl't Iffdng dich vu, Md hinh nghifin effu d l nghi nhff sau: Vi = Po + PiXii + P2X2i + • ••+ M n i + % Yi: la bien phu thugc, diTiJc xem li stf dioa man ciia khich hing Xi: li ydu to anh htfdng dfi'n stf thoa man cda khich hing (D6 tin egy, stf dim bio, ihii dfi nhiet Unh, cim thfing, phtfdng u^o hCTu hinh, chi phi khim chfia bfinh) p: la h? sd cfi lic dgng Itfdng tfng ^ sai sd Clia mfi hinb Srf dung phan m i m SPSS 16.0 vd A M O S 16.0, tidn h a n h k i e m dinh ihdng qua cdc bffdc: ( I ) ddnh gid sd bp thang va dp tin cdy cda bien Irfdng b^ng h§ so' Cronbach Alpha va dp gia tri (factor loading) bang phdn tich nhdn Id'kham pha E F A [ I ] , (2) sff dung ky thudt phan tich nban td khang dinh CFA[2] de kiera nghifim chdt che hdn v l tinh ddn nguyfin, dp tin cay tdng hdp, dp gid tri (hpi tu, phan bipt) c u a cdc khdi nifim, (3) sff dung md hinh SEM[3] de k i e m dinh dp thich hdp eua md binh vd gid tri Iifin he ly thuye't, kie'm dinh gia thuyfi't (4)kidm dinh Bootstrap de' ddnh gid tinh b i n vffng eda rad hinh - Gidi tinh chidm 100% la nff - Dd Iudi: drfdi 32 Iudi, s d Iffdng 391 ngffdi, chidm 78,2%, ehiem ty Ifi ldn m l u Cho thay d a p d^g nhu can khdm chffa benh phu san d dd tudi sinh san ndy rat cao - Thu nhdp: dffdi tripu, sd' Iffdng 312, ehie'm 62,4%, chifi'm ty lfi Idn mdu 3.2 Ddnh gid sdbd thang 3.3 P h § n tich n h n td'kham p h a ( E F A ) K d i q u a phan lieh nhdn td'd 31 bidn quan sdt Iffdng srf thda man, drfde nhdm thanb ihanh pban cd'u dieh vu theo rad hinh Parasuraman: tin cdy, dam bao, c a m tbdng hffu hinh, ehi phi Cac bifi'n deu cd s d > 0.4 nfin deu quan trgng irong phdn tich cae nhan td'va cdc irpng s d deu c d y nghia thie't thrfc vd nhan id giai thich drfdc 57,518% bidn ihifin eua quan sdt Cdc thdng sd ihdng ke cua tffng bidn irong md hinh Bdng I Cdc thong sd thing ki cua titng bien mo hinh He (0 chin ihu^n hit, > (Ccn.un.I K d t q u a nghifin cii^ 3.1 Ke't qua thdng ke mo td Dff lipu phdn tich ddng cd mdu n = 500, vdi Ihang Likert khoang (trf I: ra't khdng hoan loan hai Idng ddn 5: ri't hdi Idng), gid tri trung binh (mean) eda ede bie'n chat Iffdng dich vu ed sff khdc bifit khd cao (trung binh (TB)=3.01 -> 4.25), d§c bipt khaeh hang chffa hdi long ve Mffe gid phd hdp vdi tdi t i l n - (TB = 3.01 dd Ifich ehuan (DLC) = 1.331), nhan vien Trung lam ludn ddp ffng ddng yfiu can cua Anh/chi - (TB = 3,16, D L C = 1.244) Anh/chi hoan todn hai Idng vdi chi phi phai tra - (TB = - D L C =1.090) Thang "Sff Ihda man eha'l Irfdng dich vu k h a m chffa benh san phu khoa lai Trung ldm Y t d Nha Trang" vdi 05 thdnh p b l n va 33 bidn Iffdng Kdt qua phan tieh dd tin cdy ihang da Ioai 02 bifi'n (vi ed irfdng quan bidn long nho bdn 0.3) cdn Iai 31 bifi'n drfa vdo phdn Iich EFA, eae p h i n thang sau loai bidn deu ed cac hfi s d Cronbach Alpha > 0.6 dat yfiu c l u TincG> ' Sid Error 525 ]-!5 Bcla e=cO„ >f ' SiE ^013 003 ah|n ,„ 773 l.»3 125 0.'8 130 330 MI Sam bao J03 DJS 113 5.35* MM Muet Iillll 192 W7 184 112 jm -592 I.CS« Hmi blnb 205 042 220 4«M MO 586 1.707 115 035 131 233 MI -719 1J9S Cbi pbi R-hieu Chi«l, = 0.409 748 lJ3t S,f =0.000 Kfi't qua phdn tich hdi qui cho iha'y md hinh khdng bi vi p h a m hifin iffdng da epng tuydn hp so' phdng dai phffdng sai cua cdc bifi'n ddc lap (VIF) d i u nhd hdn Hifin tffdng tff tffdng quan (tffdng quan chudi) khdng can thifi't phai xet d e n , vi dff lifiu de chay md hinh khdng phai la dff lieu ebuSi ihdi gian Tap chl Y td Cdng cdng, 1.2010, Sd 14 (14) 45 I TU'NG QUAN & NGHIEN Cliu I Ke'l qua hdi quy cdc bifi'n ddc ldp gid tri Sig nhd hdn 0.05 la ede bifi'n cd tdc ddng den sff hai long cua ngffdi bpnh vd tdc dong cung c h i l u dfi'n sff hai Idng eua ngffdi benh Do dd, la cd the ndi rang Iai ca cac bidn dpe lalp d i u ed ide dpng dfi'n sff thda man eua ngffdi srf dung Tai ca eae n h a n i d d i u cd y nghia Irong md hlnh va Idc ddng ciing chieu dfi'n sff thda man eua ngrfdi sff dung, cac hfi sd' hdi qui deu mang dd'u drfdng Cu the: h e s d hdi qui chu^n hda cua bidn "Tin eay" la 0.130, "Dam b a o " la 0.213, "Nhifit anh" la 0.184, "Hffu hinb" la 0.220, "Chi phi k h a m ehffa benh" Id 0.131 ngrfdi sff dung dieh vu tang Ifin 0.130 d i e m ; d i e m danh gid ve sff d a m b a o tdng Ifin difi'ra thi sff ihoa man cua ngffdi sff dung dich vu Iang Ifin 0.213 d i l m ; didm danh gia ve phffdng tifin hffu hinh tdng Ifin difi'm thi sff thda man cua ngrfdi srf dung dich vu tang Ifin 0.220 d i e m ; didm ddnh gid ve chi phi kliam chffa bfinh tang Ifin I d i e m thi srf thda man cua ngrfdi sff dung dich vu ldng Ifin 0.132 d i l m 3.4 Phdn tich nhdn td khdng dfnh (CFA) K i d m dinh md hlnh eae ihang do: Nhff vay, phffdng irinh hdi qui ehuan hda the' hifin mo'i quan hfi tuydn linh giffa sff hai Idng cua ngffdi bpnh vdi cdc nhan id: F I , F2, F3, F4, F5 va F6 cd y nghia phffdng phap hdi qui Enter dffde the hien nhff sau: a) Kfi't qua phan lich n h a n td khang dinh (CFA): Cac h e s d t a i tff cdc bifi'n q u a n sdt Ien cdc khai niem thanb phan deu dat yfiu c l u ( >.5) Vi vdy la ed thd kfi't ludn cac bidn quan sal dung de Iffdng cae thdnh phan cua eac ihang ehat Iffdng dich vu kham chffa bfinh dat drfdc gid tri hdi tu ^6=0 184*Fi+0.130*F,+0 220*^3+0.213* F,+0.131*F5 b) Cac chi so'dp phii h d p mo hinh sau dieu ehinh dat yen e l u (Bang 2) Bdng So sdnh phd hgp cua cdctieu chi theo nhom Trong do: Fl: Stf Dhi$t tinh vi cam chfing F2' Stf tm egy F3: PhtfcJng tifin hdu hinh F4: Stf dam bio F5: Chi phi khim chita benh F6: Sff hii Ifing Theo phffdng trinh hdi qui tren thff Iff quan Irong cua cdc thdnh phan lae dpng dfi'n sff hai idng cua ngffdi bfinh dffde lifil kfi nhff sau: F3 ( F4( FI( F5( F2( 0.220) 0.213) 0.184) 0.131) 0.130) Md hlnh giai thich dffde , % sff thay ddi eua bidn "ihda man" Id eae bie'n dde lap md hinh tao ra, cdn Iai 59,1 % bidn thien dffde giai thieh bdi cdc bifi'n khae ngoai rad binh Md binh eho thd'y eae bie'n dpe Idp deu anh hffdng thudn c h i l u dfi'n sff thda man eua ngffdi srf dung d dp tin eay % Qua phffdng trinh hdi qui ehung ta Iha'y difi'm danh gid ve sff nhifit tinh cam thdng tang Ifin I tbi sff thda man cua ngffdi sff dung tang Ifin 0.184 difi'm, giff nguyfin eac bifi'n dpe lap edn lai khdng ddi Tffdng iff nhff vay, diem ddnh gid v l srf tin eay lang Ien thi srflhda man eiia 46 Tap ehi Y td Cdng cong, 1.2010, Sd 14 (14) ZitsOilsl x'm x'/m' Tin cjy Bitu bio Nbr«i Ilnh, 49,498 (14) 35,050 (9) 91.720 (27 3,535 3,894 PbUdng Chl pb( khim cbOa benh HSi leiBg 18,257 (5) a,30D(2) 30 333 (9J 3,397 3,651 4,1S 3,370 p O.OO 0,00 0,00 0,003 0,015 0,000 TU' 0,95 0,941 0,957 0,974 0,956 cn' 0,967 0,965 0,968 0,987 0,985 0,9S3 RMSEA* 0,071 0,OS 0,069 0,073 0,079 O.OGO 0,972 c) Hfi sd'Iffdng quan cua eae khdi nifim ihanh p b l n d i u < va ed y nghia (p
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