0000 VIETNAM NATIONAL UNIVERSITY, HANOI VIETNAM JAPAN UNIVERSITY NGUYEN NAM KHANH ASSESSMENT OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL IN 2018 MASTER’S THESIS BUSINESS ADMINIS[.]
0000 VIETNAM NATIONAL UNIVERSITY, HANOI VIETNAM JAPAN UNIVERSITY NGUYEN NAM KHANH ASSESSMENT OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL IN 2018 MASTER’S THESIS BUSINESS ADMINISTRATION Hanoi, 2019 VIETNAM NATIONAL UNIVERSITY, HANOI VIETNAM JAPAN UNIVERSITY NGUYEN NAM KHANH ASSESSMENT OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL IN 2018 MAJOR: BUSINESS ADMINISTRATION CODE: 60340102 RESEARCH SUPERVISORS: ASSOC PROF DR VU ANH DUNG PROF DR HIROSHI MORITA Hanoi, 2019 ACKNOWLEDGEMENT First of all, I would like to give my sincere thanks to Vietnam Japan University, Yokohama National University, Japan International Cooperation Agency (JICA) with all the members, lecturers and assistants for giving me this opportunity to study and research in an international academic environment I have gained a lot of knowledge and experience through classes and seminars in Vietnam and Japan Secondly, I want to express my deep and sincere gratitude to my two supervisors, Associate Professor Vu Anh Dung, Vietnam Japan University and Professor Hiroshi Morita, Yokohama National University Their wide knowledge and critical thinking have given me motivation, confidence and value to my research They also encouraged and instructed me personally for my thesis I also want to thank Professor Matsui, Associate Professor Pham Thi Lien, Hanh sensei, Hino sensei for what all of you have done with VJU students You always support and share with us your valuable knowledge and experience To Huong san and IPO’s staff, YNU Thank you for your detailed caring to VJU students in Vietnam as well as in Japan Finally, I would like to thank my family, friends and colleagues who supported and encouraged me to finish my thesis Hanoi, 2019 Nguyen Nam Khanh i ABSTRACT Patient satisfaction is an important indicator used for measuring the quality of healthcare facilities Patient satisfaction has an effect on outcomes of medical service providers and reflects efficiency of provided services Therefore, patient satisfaction will be an effective indicator to measure the success of medical service providers This research introduces how to assess patient satisfaction in public hospitals, taking the case of Binh Dinh provincial general hospital In the strategy of Vietnam healthcare system for protecting, caring and improving healthcare in the period 2011-2020, vision 2030 Some issues have been mentioned: Health is the most valuable asset of individuals and all society; medical service is a special social service without profits in public service providers; investing in health is investing for the future and for good nature of society; improvement and modernization of healthcare system towards Equity-Efficiency-Development Currently, medical services in public hospitals are considered not as good as in private hospitals Therefore, the objectives of this research are assessing current situation of patient satisfaction in the hospital and providing some recommendations as the background or reference for public hospitals to improve their medical services ii TABLE OF CONTENTS ACKNOWLEDGEMENT i ABSTRACT ii LIST OF FIGURES vi LIST OF TABLES vii CHAPTER 1: INTRODUCTION 1.1 Background 1.2 Research objectives 1.3 Research questions 1.4 Introduction of Binh Dinh provincial general hospital 1.4.1 Policies of Vietnam healthcare system towards patient satisfaction 1.4.2 Establishment and development process of the hospital 1.5 Structure of research CHAPTER 2: LITERATURE REVIEW ON PATIENT SATISFACTION 2.1 Hospital services 2.2 Service quality 2.3 Customer satisfaction 2.4 Customer satisfaction and service quality 2.5 Overview of patient satisfaction 10 2.6 Role of patient satisfaction 10 2.7 The relationship between service quality and patient satisfaction 11 2.8 Factors impacting patient satisfaction 11 iii CHAPTER 3: RESEARCH METHODOLOGY 16 3.1 Research design 16 3.2 Research process 17 3.3 Data collection 17 3.4 Research model 20 CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 23 4.1 General information of researched patients 23 4.2 Assessment of inpatient satisfaction 25 4.2.1 Inpatient satisfaction on accessibility .25 4.2.2 Inpatient satisfaction on Transparency on information, examination and treatment procedures .27 4.2.3 Inpatient satisfaction on Facilities and equipment 29 4.2.4 Inpatient satisfaction on Medical staff’s behavior and professional capacity .31 4.2.5 Inpatient satisfaction on Results of service provision 33 4.3 Summary of results on inpatient satisfaction 35 4.3.1 Inpatient satisfaction in general and classified by factors 35 4.3.2 Percentage of overall assessment of inpatient satisfaction .36 4.3.3 Classification of patients who will return or introduce to other patients 36 4.3.4 Odds Ratio Analysis .37 CHAPTER 5: RECOMMENDATIONS TO IMPROVE INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 40 iv 5.1 Improving facilities in the hospital 40 5.2 Investing more in medical equipment and information technology to improve service quality .40 5.3 Simplifying complicated administrative procedures .41 5.4 Improving medical staff’s communication skills 41 5.5 Limitations of the thesis 41 CONCLUSIONS 42 LIST OF REFERENCES 43 APPENDIX 46 APPENDIX 50 APPENDIX 52 APPENDIX 53 v LIST OF FIGURES Figure Research process 17 Figure Research model 22 Figure Patient satisfaction by age 24 Figure Summary of inpatient satisfaction on Accessibility 26 Figure Summary of inpatient satisfaction on Transparency on information, examination and treatment procedures .28 Figure Summary of inpatient satisfaction on Facilities and equipment 31 Figure Summary of inpatient satisfaction on Medical staff’s behavior and professional capacity 33 Figure Summary of inpatient satisfaction on Results of service provision 35 vi LIST OF TABLES Table 4.1 Patient classification by sex .23 Table 4.2 The total number of days of hospitalization 24 Table 4.3 Patients using of health insurance card for this treatment .24 Table 4.4 Classification of inpatient satisfaction by accessibility 25 Table 4.5 Classification of inpatient satisfaction by Transparency on information, examination and treatment procedures .27 Table 4.6 Classification of inpatient satisfaction by Facilities and equipment 29 Table 4.7 Classification of inpatient satisfaction by Medical staff’s behavior and professional capacity 31 Table 4.8 Classification of inpatient satisfaction by Results of service provision 33 Table 4.9 Inpatient satisfaction in general and classified by factors .35 Table 4.10 Percentage of overall assessment of inpatient satisfaction 36 Table 4.11 Classification of patients who will return or introduce to other patients 36 Table 4.12 The relation between related factors and inpatient satisfaction .37 Table 4.13 The relation between related factors and patient return 38 vii CHAPTER 1: INTRODUCTION 1.1 Background Health is always among the most important issues and the most valuable asset of individuals and all society Investing in health is investing for development and growth, reflecting the good society With the development trend of health sector, public hospitals gradually have to be autonomous in finance meaning that they must cover all the costs for their operation such as salary, equipment, drugs…etc In this situation, to be survival in severe competition in market economy, public hospitals need to attract more patients Therefore patient satisfaction is one of the most important issues for hospitals as well as a principal indicator reflecting quality and efficiency of medical services For public hospitals, assessment of patient satisfaction will help improve quality of services and reputation, so that hospitals can increase revenue and have effects on other hospitals Pollack (2008) there is a relationship between service quality and patient satisfaction, level of satisfaction is a measurement for the suitability between medical services provided with expectation from patients Satisfied patients will lead to improved financial outcomes, reduce management claims, retain patients and succeed in a competitive environment In current circumstance, there is a difference of medical services between public and private hospitals, services at private hospitals are considered better than at public hospitals Nowadays, patients not only pay attention on quality of medical treatment but also the services that they would receive from medical staff With the development of modern technology in medical treatment, medical services have been highly focused on to increase the competitiveness Raising patient satisfaction in public health will play an important role for public healthcare providers because patient satisfaction determines the survival and development of public hospitals, according to Decree No 55/2012/ND-CP public healthcare providers will be dissolved if the task is not completed in three consecutive years Tam (2007) identified factors of medical service that influenced patient satisfaction including: - Doctor’s technical quality - Doctor’s interpersonal skills - Quality of nurses - Quality of support staff - Efficiency of appointment system - Waiting time - Duration of consultation - Physical environment - Respect for patient’s privacy Bielen and Demoulin (2007) waiting time is not only a satisfaction determinant but also moderates the satisfaction-loyalty relationship Determinants of waiting time include the perceived waiting time, information provided while waiting and waiting environment Anderson, Barbara and Feldman (2007) patient satisfaction ratings were influenced by a core of communication and follow-up care The core qualities are the most important including communication, access, inter-personal skills, care coordination and follow up The quality of medical care processes, quality of healthcare facilities and quality of office staff followed in order of importance Saila et al (2008) the most important determinant was the actual consultation with the doctor, effective communication was the key to patient satisfaction The Professional skills and competencies of staff members, protection of privacy, and perceived usefulness of the visit were highly rated Germaine (13), expectations include the availability of professional care, the individuality of treatment, the competence, experience, maturity, dependability, knowledge, and skills of the nursing staff Tucker and Adams (2001) the most significant issue in patient assessment is the interpersonal relation between patients and service providers 13 Woolley et al (1978) not only considered the importance of expectation of outcome as a predictor of satisfaction in primary care, but also the level of communication about this expected outcome between the patient and the general practitioner Perceived attribute performance: tangible and intangible value that patients receive in the process of using services and the process has a direct impact on evaluating patients’ satisfaction Disconfirmation: customer dissatisfaction to services depends on the levels of product quality A product or service including many factors relating to examination and treatment, facilities, medicine that is not recognized affecting directly to the reduction of patient satisfaction Attribution of cause: the process that individuals give causes of behaviors and events There are two types including external attribution (situational attribution) and internal attribution Equity: the beliefs that people value fair treatment An individual feel satisfied if he is treated fairly as others around him Summary of determinants from previous studies on patient satisfaction Authors Year Contents - Attree - Patient focus Availability and accessibility to patients Open communication and information flow Encouraging a close, sociable relationship Holistic care 2001 - Interpersonal relation skills 2004 - Trusts and believes patients Convenient consultation times Good interpersonal skills Caring and compassionate Clinical skills Good triage system 2001 - Tucker & Adams Infante et al 14 Sofaer and Firminger 2005 - Variety of clinical services Patient-centered care Access Courtesy and emotional support Communication and information Technical quality Efficiency of care organization Structure and facilities Waiting time and the amount of caring Doctor’s technical quality Doctor’s interpersonal skills Quality of nurses Quality of support staff Efficiency of appointment system Waiting time Duration of consultation Physical environment Respect for patient’s privacy - Vukmir Tam 2006 2007 - Anderson, Barbara and Feldman 2007 - Communication Follow-up care Bielen and Demoulin 2007 - Waiting time Andaleeb, Siddiqui and Khandakar 2007 - Saila et al 2008 Doctors’ service orientation Nurses’ service orientation Tangible evidence of facilities Waiting for an appointment Waiting time and communication Lack of reach ability Lack of continuity Lack of participation in decision making - 15 CHAPTER 3: RESEARCH METHODOLOGY 3.1 Research design The research collected data via a questionnaire survey Zikmund (2003) the survey is accurate, quick and inexpensive assessing information about research subjects, a questionnaire survey is a research technique in which information is gathered from a sample of people participating in the study Two major errors of the survey are random sampling error and systemic error There are respondent and administrative errors in systemic errors Non-response errors and response bias are in respondent errors whereas data processing errors, sample selection errors, interviewer errors are in administrative errors These errors may occur in the study Zikmund (2003) business research provides information to help reduce uncertainty, there are three main classes of business research based on function or purpose, namely casual, exploratory and descriptive research Descriptive research is implemented to describe characteristics of a phenomenon or population Distinguishing descriptive research and exploratory research is that descriptive research is based on previous awareness of the nature of the research matters The research implemented in this study can be best understood as mainly descriptive The questionnaire could be electronic or printed questionnaires Pre-testing process of the survey questionnaire is conducted by a trial run with a group of respondents including patients in the hospital The purpose of the test is detecting problems in the questionnaire’s design and instructions The questionnaire was tested for evidence of potential misunderstandings, ambiguous questions, questions that means the same to all respondents 16 3.2 Research process Primary data collection Assessment of inpatient satisfaction in Binh Dinh provincial general hospital Survey questionnaire to collect data of inpatient satisfaction Data processing and analysis Secondary data collection Books, reports, newspapers, internet Recommendations Figure Research process Source: Created by the author 3.3 Data collection The method of data collection is questionnaire survey handed personally to patients in the hospital Zikmund (2003) suggested selecting relevant methods including speed of data collection, cost, and anonymity + Source of information: Primary data and secondary data + Primary data: The primary data is collected through survey questionnaire, which is the main source of information showing the findings of the research + Survey: Zikmund (2003) two basic criteria of a questionnaire are relevance and adequacy A questionnaire is relevant if necessary data is collected and the information of data that 17 is needed to solve the problems is obtained and the adequacy of a questionnaire is decided by being reliable and valid Based on the Decision 4448/QD-BYT by the Ministry of Health, information of patient satisfaction is collected in Binh Dinh provincial general hospital The questionnaire is based on dimensions to evaluate inpatient satisfaction: (1) Accessibility; (2) Transparency on information, examination and treatment procedures; (3) Facilities and Equipment; (4) Medical staff’s behavior and professional capacity; (5) Results of service provision - Respondents: Individual patients using medical services with stable psychology, non-psychiatric diseases and a good health status that meets requirements of the survey in the hospital - Sample size: 300 individual patients using medical services in the hospital - Survey tools: The tool for information collection is survey questions based on 5-level scale of each question measuring from negative side to positive side The number of questions must fully cover dimensions reflecting patient satisfaction with medical services in the hospital + Questionnaire distribution: Questionnaire is delivered directly to patients using medical services in Binh Dinh provincial general hospital The questionnaire was delivered in different time and 300 valid questionnaires have been collected + Scale: Zikmund (2003) defines attitude as an enduring disposition to consistently respond in a way to various aspects of the world including persons, events and objects There are three components: cognitive, behavioral and affective components Direct verbal statements relating belief, behavior or belief are used to assess behavioral intent Obtaining verbal statements generally requires that respondents perform a task, for example, rating, sorting, ranking or making a choice Rating is to estimate the magnitude of quality or a characteristic that an object possesses Quantitative scores are used to estimate the strength of the belief or attitude A Likert-type response scale or multiple-response scale from very poor to very good was used This scale is both 18 parallel and balanced so that responses can be quantified and the differences analyzed appropriately Patient responses were converted into scale for data analysis as followings: very poor = 1, poor = 2, normal = 3, good = 4, and very good = + Sample: Zikmund (2003) suggested that it is important to define carefully the target population so that the proper source of data can be identified In this research, the target population can be identified as inpatients in the hospital The most common criteria of selecting a sample are resources, time, degree of accuracy, need for statistical projections and advance knowledge of population characteristics There are several ways of taking a sample, there are two main groups including probability and non-probability techniques In probability sampling, every element of the population has a selection of known non-zero probability In a non-probability sampling, the probability of any members of population chosen is unknown The ideal to obtain a probability sample by ensuring that the projections of data would be appropriate statistically + Secondary data: From documents, reports such as: Jackie Tam (2007) "Linking quality improvement with patient satisfaction: a study of a health service centre", Anderson, Barbara and Feldman (2007) “What patients want: A content analysis of key qualities that influence patient satisfaction” Policies, regulations: Decision 4448/QD-BYT by the Ministry of Health on defining methods to measure people’s satisfaction with public health services; Decree No 55/2012/ND-CP; Resolution No 30c/NQ-CP of the Government in the field of caring, protection and improvement of people's health Other articles on newspapers, books that are related to patient satisfaction + Data analysis method: The author applies different tools to analyze data: Stata software, Microsoft Office, Graphs, Charts + Research Scope Patients using medical services in Binh Dinh provincial general hospital in 2018 The research focuses on assessing inpatient satisfaction with 300 individual patients who use medical services in the hospital 19 Timing: The primary data is collected in 2018 + Research Schedule: Time (2019) Contents From March to April Data processing April-May Data analysis and writing June Final thesis presentation 3.4 Research model In Vietnam, Decision 4448/QD-BYT by Ministry of Health approves the proposal “Defining methods to measure people’s satisfaction with public health services” giving some groups of criteria for measuring patient satisfaction including Accessibility, Transparency on information and administrative procedures, Facilities, Staff’s behavior and Results of service provision The author based on the proposal by Ministry of Health and the studies by Tam (2007); Bielen and Demoulin (2007); Anderson, Barbara and Feldman (2007)…etc to develop the research model Based on previous studies, summary of factors that affect patient satisfaction in chapter These factors have been put into groups The research model includes the following factors of patient satisfaction Accessibility: Attree (2001) Availibility and accessibility; Sofaer and Firminger (2005) Access…etc + Distance from home to the hospital + Location, signboards and instruction to the hospital + Applying information technology for advertising services + Time of patient visit Transparency on information, examination and treatment procedures: Attree (2001) Open communication and information flow; Tam (2007) Waiting time, Efficiency of appointment system; Saila et al (2008) Waiting for an appointment…etc + Applying information technology for dealing with administrative procedures 20 + Regulations of the hospital, regulation on medical staff’s behaviors + The process and procedures of examination and treatment Facilities and Equipment: Tam (2007) Physical environment; Andaleeb, Siddiqui and Khandakar (2007) Tangible evidence of facilities; Sofaer and Firminger (2005) Structure and facilities…etc + Patient’s room, patient’s bed, canteen + The setup of departments, divisions + Environment, space and atmosphere of service provision rooms Medical staff’s behavior and professional capacity: Sofaer and Firminger (2005) Patient-centered care, Courtesy and emotional support; Infante et al (2004) Caring and compassionate…etc + Following regulations on communication + Serving behaviors + Knowledge and skills on technical and professional capacity Results of service provision: Tam (2007) Doctor’s technical quality, quality of nurses; Infante et al (2004) Convenient consultation times; Andaleeb, Siddiqui and Khandakar (2007) Doctors’s service orientation; Tam (2007) Duration of consultation…etc + Applying information technology for service provision + Time of service provision + The trust on service quality, reputation of the hospital + Level of meeting patient’s expectation 21 Accessibility Transparency on information, examination and treatment procedures Inpatient Satisfaction Facilities and Equipment Medical staff’s behavior and professional capacity Patient Return Results of service provision Figure Research model Source: Bielen and Demoulin (2007); Tam (2007); Anderson, Barbara and Feldman (2007) Decision No 4448/QD-BYT by the Ministry of Health 22 CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 4.1 General information of researched patients After collecting and inputting data into Excel, the data shows results as followings: Table 4.1 Patient classification by sex Sex n % Male 149 49,67 Female 151 50,33 Total 300 100 Source: Data collected from the survey (2018) Summary: There are 300 valid questionnaires that have been collected and the percentage of male is approximately 49,67% compared to the percentage of female is 50,33% The scale of male and female is equal and ideal 34% 27.33% Age 60 23 Figure Patient satisfaction by age Source: Data collected from the survey (2018) Summary: Patients aged from 36-60 have the highest percentage with 38,67%, patients aged under 36 have the lowest percentage with 27,33% and patients aged more than 60 accounts for 34% Table 4.2 The total number of days of hospitalization Average days of hospitalization ± SD Min Max 7,22 ± 6,67 60 Source: Data collected from the survey (2018) Table 4.3 Patients using of health insurance card for this treatment Health insurance card n % Yes 282 94,00 No 18 6,00 Total 300 100 Source: Data collected from the survey (2018) 24 Summary: Most of the patients used the health insurance card for this treatment with the percentage of 94%; only 6% of patients did not use the health insurance card 4.2 Assessment of inpatient satisfaction 4.2.1 Inpatient satisfaction on accessibility The first criteria to assess patient satisfaction is accessibility, accessibility is the first approach of patients to the hospital Table 4.4 Classification of inpatient satisfaction by accessibility Very dissatisfied Dissatisfied or Very or Poor poor n % n % Signboards and maps of direction to different departments of the hospital are clear and easy to see and find Time of patient visit is listed clearly The buildings, stairs and patient rooms are numbered clearly and easily able to be seen The hallways in the hospital 0,67 0,33 Normal Satisfied or Good n n % % Very satisfied or Very good n % 42 14,00 132 44,00 123 41,00 Tải FULL (70 trang): https://bit.ly/3coNXvo Dự phòng: fb.com/TaiHo123doc.net 0,33 0,33 22 7,33 152 50,67 124 41,33 0,33 - - 47 15,67 121 40,33 131 43,67 - - - - 40 13,33 145 48,33 115 38,33 25 are flat and easy to move Patients are able to call medical staff for help when needed - - 0,67 23 7,67 141 47,00 134 44,67 Source: Data collected from the survey (2018) Summary: Patients highly appreciated the item “Time of patient visit is listed clearly” with the percentage of 41,33% very satisfied and 50,67% satisfied The item “The buildings, stairs and patient rooms are numbered clearly and able to be seen easily” that was evaluated very dissatisfied and normal has the percentage up to 16% Tải FULL (70 trang): https://bit.ly/3coNXvo Dự phòng: fb.com/TaiHo123doc.net 28% Satisfaction 72% Dissatisfaction Figure Summary of inpatient satisfaction on Accessibility Source: Data collected from the survey (2018) 26 4.2.2 Inpatient satisfaction on Transparency on information, examination and treatment procedures Table 4.5 Classification of inpatient satisfaction by Transparency on information, examination and treatment procedures Very dissatisfied Dissatisfied or Very or Poor poor n % n % The process and procedures of hospitalization are clear, public and convenient Regulations and necessary information of hospitalization are announced clearly The condition of disease, methods and estimated time of treatment are explained clearly Before testing and using high technology equipment, patients are explained clearly Normal Satisfied or Good n n % % Very satisfied or Very good n % - - 0,33 32 10,67 118 39,33 149 49,67 - - - - - - 0,67 36 12,00 115 38,33 147 49,00 - - 1,00 32 10,67 122 40,67 143 47,67 28 9,33 134 44,67 138 46,00 27 6794699 ... quality of medical services and patient satisfaction in Binh Dinh provincial general hospital, the author decided to choose the topic ? ?Assessment of inpatient satisfaction in Binh Dinh provincial general. .. methodology Chapter 4: Results of inpatient satisfaction in Binh Dinh provincial general hospital Chapter 5: Recommendations to improve patient satisfaction in Binh Dinh provincial general hospital CHAPTER... Ministry of Health 22 CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 4.1 General information of researched patients After collecting and inputting data into