Các yếu tố Ảnh hưởng Đến sự hài lòng của khách hàng sử dụng dịch vụ khám và Điều trị tại trung tâm bảo vệ chăm sóc sức khỏe cán bộ tỉnh quảng ninh

Các yếu tố ảnh hưởng đến sự hài lòng của khách hàng sử dụng dịch vụ khám và điều trị tại trung tâm bảo vệ chăm sóc sức khỏe cán bộ tỉnh Quảng Ninh.

GENERAL INTRODUCTION

The urgency of the topic

In the current autonomy mechanism, patients are playing an important role in the hospital's revenue With the goal of focusing on the patient, on the basis of all activities of the Hospital, it brings high treatment efficiency, convenience, speed, comfort and satisfaction to the patient

Socio-economic life is developing day by day, people's needs are increasingly diversified, in which the need for health care is one of the top concerns of people The quality of care not only depends on machines, materials and equipment, but also depends on many accompanying factors such as knowledge - attitude of medical staff, skills, effective care procedures, etc fruit Satisfaction level of patients and patients' family members is an important source of information contributing to the development of the Hospital Improving the quality of medical examination and treatment is always a central goal and is well implemented by the Hospital to meet the increasing needs of patients

Also stemming from the importance of people's health, the Ministry of Health always advocates building and equipping hospitals with modern facilities and equipment, supporting the training of medical staff to best serve the needs of customers (patients) All of the above works are aimed at satisfying customers or in other words satisfying the highest needs for customers

To improve customer satisfaction using medical services The Ministry of Health has also issued Decision No 29/2008/QD-BYT dated August 18, 2008 on

"Promulgating the Code of Conduct for officials and employees in the medical career of the units"; Decision No 4858/QD-BYT dated December 3, 2013 of the Ministry of Health on the promulgation of the set of criteria for assessing the quality of medical examination and treatment, the promulgation of the set of criteria for assessing the quality of medical examination and treatment as a tool for hospitals to , the inspection team of the health management agency evaluates the quality and

2 ratings of the hospital and publicly informs the people to choose a place for medical examination and treatment

The measurement of factors affecting customer satisfaction using health services will help determine the current level of their medical service response Detect and promptly correct the factors that make customers unsatisfied, further promote the factors that make customers satisfied in order to better serve the needs of customers in the coming time

Satisfaction is a measure of the quality of a medical service provider The world uses the satisfaction index to rank hospitals… In Vietnam, the satisfaction index has been interested by leaders of the Ministry of Health, Department of Health and hospitals However, the method and response efficiency are not really good Satisfaction is influenced by many factors, it is associated with patient expectations, health status, personal characteristics as well as characteristics in each national health system [1] When the patient is not satisfied, the patient himself, the patient's family, and the patient's relatives will not trust the hospital's care for the next visit [3] Therefore, patient satisfaction is an asset of the hospital in its efforts to improve service quality and maintain patient/customer friendliness However, there are many studies on patient satisfaction at hospitals, but none have been conducted at the Center for Health Care Protection for staff across the country Therefore, the topic “Factors affecting the satisfaction of customers using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection” is necessary With the desire to help the Center understand customers and customers' feelings about the services that the Center is providing The Quang Ninh Provincial Center for Health Care and Protection, like other hospitals, performs examination and treatment but is different in terms of patients The number of patients who are staff accounts for 90% and 10% are people Therefore, the service style is also very different Therefore, the research topic also wants to provide a basis to help Quang Ninh Provincial Center for Health Care and Protection in particular and Centers across the country in general can improve the

3 shortcomings, as well as improve the quality of life promote the advantages in their medical service delivery process to improve staff satisfaction.

Overview of research related to the topic

According to the World Health Organization (WHO) Medical services include all services of diagnosis and treatment of diseases and activities of health care and rehabilitation; includes private health services and public health services Currently, we are aiming to serve customers well, all industries including hospitals, customers look to places with the best service to meet their health needs Therefore, hospitals are aiming for patient satisfaction, not stopping at correct treatment, adequate treatment, and patient cure So what factors affect patient satisfaction? , and how to improve that satisfaction becomes one of the main tasks of hospitals in the whole health sector system, which has been and is the issue that many scholars, researchers, administrators management at home and abroad, is a topic discussed at many national and international conferences Here are some studies around the content of the topic

1.2.1 Research situation in the world

(1) Lekidou Ilia and Trivellas Panagiotis (2007), “Patients' satisfaction and quality of careAn empirical study in a Greek central hospital”, a patient-centered study and identification of factors important factors affecting patient satisfaction; The actual survey was carried out based on a sample of 164 patients of a central Greek public hospital Using stepwise regression analysis, significant associations were found that shed light on the determinants of patient satisfaction The results show that visiting hours, doctor's consistency, type of insurance, hospital stay, type of clinic and patient's hygiene compliance have a positive relationship with patient satisfaction

(2) Factors Affecting Customer Satisfaction (2008) “Factors affecting patient satisfaction and healthcare quality” has reviewed 24 articles from international journals that have been systematically reviewed on the determinants ofpatient satisfaction and quality of healthcare Research results have demonstrated that patient satisfaction is a multidimensional healthcare construct that is influenced by

4 many variables Healthcare quality influences patient satisfaction, thereby generating positive patient behaviors such as loyalty Patient satisfaction and healthcare service quality, although different to measure, can be accomplished using a multidisciplinary approach that incorporates patient input as well as assessment of experts The summary has direct implications for healthcare providers They are encouraged to regularly monitor healthcare quality and accordingly initiate service delivery improvements to maintain high levels of patient satisfaction

(3) Bunthuwun Laohasirichaikul, Sirion Chaipoopirutana, Howard Combs (2008)

“Effective customer relationship management of health care a study of hospitals in

Thailand” study using factor analysis and multiple regression techniques applied to the collected data Collected from 500 Thai outpatients from 05 largest private hospitals in Bangkok The findings indicate that four perceptions significantly influence hospital image, customer satisfaction and customer loyalty More specifically, the doctor's interest is the most important factor affecting customer satisfaction and loyalty Therefore, the selection of human resources who are experts, qualified doctors, and a reputation for serving the hospital is very important because they will enhance the reputation and positive image of the hospital, in addition, doctors need to trained in communication skills to create courtesy, comfort, and concern for their patients Besides, the service spirit of nurses is a very important factor that requires training in communication skills to provide care, empathy and courtesy to patients Finally, hospital management must continue to collect data on outpatient perceived service quality on a regular basis In this way, they can monitor the hospital's perceived service quality and continuously improve the quality of their service

(4) Yogesh Pai P and Gaurav Ravi (2011), “Factors Affecting In-patient Satisfaction in Hospital-A Case Study” actual research based on a set of questionnaires with appropriate format for data collection, Likert Scale Seven points were used to measure the respondents' actual satisfaction in the survey on patient satisfaction with healthcare services, the Cronbach's Alpha reliability analysis method was also used used in the survey process, through which research has shown Healthcare is a highly participatory service as it relates to people's health and good behaviour Healthcare

5 providers should manage quality through continuous redesign and understand the factors that have a lot to do with patient satisfaction Affirmation of patient satisfaction is a common work including satisfaction with different hospitals with service components such as front office, food service, housekeeping service, discharge process, facilities provided by the hospital, medical/clinical services and nursing services Healthcare managers should consider these aspects for overall patient satisfaction and outperform companies that do not provide patient satisfaction

(5) Ali Mohammad Mosadeghrad, (2014) Factors influencing healthcare service quality: This study identifies the factors affecting the quality of healthcare in Iran Research using exploratory in-depth interviews with individuals and focus groups was conducted with 222 healthcare stakeholders including healthcare providers, managers, key decision makers policy and payer to determine the factors affecting the quality of healthcare services provided in Iranian healthcare institutions Research has demonstrated that quality in healthcare is a partnership between patients and healthcare providers in a supportive environment Individual provider and patient factors, and factors related to the health care organization, the health care system, and the broader environment affect the quality of health care services strong Quality of health care can be improved with the support of visionary leadership, appropriate planning, education and training, availability of resources, effective management of resources, employees and processes as well as cooperation and cooperation between suppliers

When it comes to health services, the process of building a research model on factors affecting customer satisfaction when using medical services at medical facilities and hospitals Institute is a rather complicated issue, although there have been many studies on this issue before, there are still many limitations in scope, as well as showing only certain aspects of the problem Up to now, there have been a number of studies related to measuring the satisfaction of customers (patients), patients' family members at a number of medical facilities and hospitals across the country such as:

(1) Pham Xuan Lan and Phung Thi Hong Tham (2011) "Factors affecting the satisfaction of outpatients at Ho Chi Minh City General Hospitals", research paper

This is the research process conducted by these authors on 457 outpatients as a representative sample for patients who have been examined, treated and treated at general hospitals in Ho Chi Minh City These patients must have at least used medical services of one of the hospitals such as Nguyen Tri Phuong Hospital, Van Hanh General Hospital and Medic Medical Diagnostic Center (also known as Hoa Hao Hospital) The results of exploratory factor analysis showed that there were 36 components to measure seven factors including: hospital facilities and environment, operational capacity of doctors and nurses, and results of medical examination and treatment, service interest of the hospital, time spent on medical examination and treatment, reliability and cost of medical examination and treatment, Regression analysis results with full sample show that there are five factors affecting customer satisfaction Outpatient satisfaction, in which there are four factors that positively affect satisfaction, in order from strong to weak, are (1) medical examination and treatment results, (2) professional capacity of doctors and nursing care, (3) hospital facilities and environment, (4) hospital care, (5) time factor has a negative effect on outpatient satisfaction

(2) Ly Kim Ngan and Le Thi Thu Trang (2014) Evaluation of the satisfaction level of inpatients on service quality at Can Tho Central General Hospital published in Scientific Journal - University of Science and Technology Can Tho University, No 31, 2014 on pages 8-16 by the author The article argues that service quality is no longer a new concept for those working in the healthcare sector because it is an important factor that increases the competitiveness of hospitals This study aims to assess the level of patient satisfaction with service quality at Can Tho Central General Hospital After surveying 100 inpatients at the hospital, the study adopted the Cronbachs Alpha test method and exploratory factor analysis (EFA) to know that there are 4 factors related to the level of cancer Patient satisfaction about service quality at the hospital is: Satisfied? Quality of care? Quality of examination/treatment? The study also showed a statistically significant difference

7 between patients with education level and health status at discharge and their satisfaction with service quality at Can Tho Central General Hospital Poetry through Chi-square test method

(3) Assoc Prof, Dr Ha Nam Khanh Giao - Truong Ngoc Huong (2017)

"Satisfaction with the service quality of general internal medicine - Cho Ray Hospital" research document, this study was conducted to measure service quality satisfaction at the Department of General Internal Medicine - Cho Ray Hospital, by surveying 200 patients, the KQCAH Model, together with Cronbach's alpha, EFA and multiple regression analysis were used The results show that there are 07 factors affecting patient satisfaction, in descending order: The attention and care of the staff, The efficiency and continuity of the service, Information, The rationality of hospital fees, Relevancy of service, First impressions, and lastly Quality of meals From there, the study proposes solutions to the Management Board to improve patient satisfaction

(4) Dinh Nam (2018) Patient satisfaction is a “measure” of hospital quality Posted at Diendan.chatluongbenhvien.vn of the Ministry of Health - Deputy Prime Minister Vu Duc Dam reiterated a number of issues and requirements that were raised from the first National Forum on Hospital Quality (2013) First of all, it is necessary to change the thinking in medical examination and treatment establishments from treating diseases to treating and saving patients Develop a toolkit for assessing hospital quality according to trends, international and measurable criteria, and especially a mechanism for external organizations to collect information directly from patients

Issues related to people's health from prevention to treatment, quality of medical examination and treatment in general must be public and transparent Director of the Medical Examination and Treatment Administration (Ministry of Health) Luong Ngoc Khue said that improving hospital quality has become a movement and a driving force for hospitals to implement towards patient satisfaction

After 5 years of implementation, the Hospital Quality Criteria has contributed to changing thinking in many medical facilities The patient is placed in a central position

The Ministry of Health has issued 83 criteria on hospital quality standards Many hospitals actively improve the quality and service attitude from the smallest things such as keeping the hospital environment clean and beautiful, hygienic, dedicated patient service attitude, applying many modern treatment methods … Patient safety and satisfaction is a top priority

(5) MSc Nguyen Tien Thanh (2020) Satisfaction of patients and family members during medical examination and treatment at Hanoi public hospital,

Research objectives

Research thesis with the goal of surveying and assessing customer satisfaction for examination and treatment services at the Center for Health Care and Protection of Quang Ninh officials Thereby taking measures to improve customer satisfaction

Determining and measuring factors affecting customer satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection What is the most important factor affecting customer satisfaction? Compare

12 the difference in satisfaction level of each group of subjects surveyed and studied at the Quang Ninh Provincial Center for Health Care and Protection

Measured and analyzed results are given solutions to overcome the factors that make customers unsatisfied Improving the factors affecting customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials.

Research mission

- Modeling the factors affecting customer satisfaction

- Survey customers to collect data

- Analyze to identify and verify the factors affecting customer satisfaction with examination and treatment services at the Center for Health Care and Protection of Quang Ninh officials

- Measure customer evaluation on factors, find solutions to improve customer satisfaction.

Research subjects

- The study will study and measure the factors affecting customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials

- The thesis conducts a practical study on some basic factors affecting customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials

- Customers are using examination and treatment services at Quang Ninh Provincial Health Protection and Care Center: Laboratory, Diagnostic Imaging Room, Internal Medicine Clinic, Procedure Room, Surgery, Room Ophthalmology, Faculty of Medicine.

Research scope

The study was carried out from May 2022 to October 2022

- The study was carried out at the Center for Health Care and Protection of officials in Quang Ninh province.

Research Methods

The study uses qualitative and quantitative methods

- Using the assessments of experts and professional managers to give an overview of the current status of the Center and assess development trends in the coming time

- Using the collected data to analyze and describe the customer satisfaction at the Center for Health Care and Protection of Quang Ninh officials

- Using the regression function to determine the factors and levels affecting customer satisfaction

- Use statistical testing methods to determine the degree of quality disparity between groups.

Anticipated structure of the thesis

Chapter I, the author introduced an overview of the research problem and the necessity of the topic, the topic has research objectives, for object, research scope, research methods and practical significance that the topic brings The layout of the thesis will help the reader have an overview of the content of the research topic

THEORETICAL BASIS ON CUSTOMER SATISFACTION 14 2.1 Theoretical basis of medical services and customer satisfaction

The concept of service

There are many concepts of service that are approached from different angles that have been stated by researchers such as:

C Marx said: "Services are the offspring of the commodity-producing economy When the commodity economy thrives, it requires a smooth, smooth, and continuous circulation to satisfy demand The higher the number of people, the more services will develop"

According to Philip Kotler (Kotler, P & Armstrong, G (2004), Principles of Marketing (volume 2), Stats Publisher) “a service is any activity or benefit that this entity can provide granted to another subject Where the provided object must be invisible and not result in any ownership over an object The production of a service may or may not be tied to a physical product”

According to Kotler & Armstrong, “services are activities or benefits that businesses can offer to customers in order to establish, strengthen and expand long- term relationships and cooperation with customers

Assoc Prof Dr Nguyen Van Thanh said: “Service is a creative labor activity to add value to the material part and to diversify, enrich, differentiate, excel which is the highest become brands, business cultures and high satisfaction for consumers so that they are willing to pay high, thus doing business more effectively”

According to the Vietnam Encyclopedia, services are "service activities to satisfy the needs of production, business and daily life"

According to Bui Nguyen Hung, 2004 "service is a process of behind-the- scenes activities and front-end activities, where customers and service providers interact with each other, The purpose of this interaction is to satisfy customer needs and wants in a way other than expected, as well as create value for customers”

In economics Services are understood as things that are similar to goods but are immaterial There are products that are more about tangible products and those

15 that are more about service products, but most of them are products in the middle of goods and services (source cited wikipedia.org)

Therefore, it can be generalized: Services are intangible activities in which two or more parties participate, One party will provide tangible activities, the other party will receive it, In order to the purpose of satisfying or creating a certain value for the person who accepts the intangible activity.

The concept of health services

According to Assoc Prof Dr Le Quang Cuong, “Medical service is a commodity that the user (patient) often cannot completely choose by himself or herself, but depends a lot on the supplier (health facilities) Specifically, when the patient has a need for medical examination and treatment, the treatment by which method and for how long is completely decided by the doctor Thus, the patient can only choose the place of treatment, to some extent, the person who treats him or her, but cannot actively choose the treatment method On the other hand, because medical services are related to human life, even though they do not have money, they still have to pay for medical examination and treatment (purchase) This special feature is unlike other goods, that is, for non-health goods, buyers can have many options to choose from, even temporarily not buying if they do not have the financial capacity main

Health services are services provided for the purpose of protecting and improving the health of the community, health services are one of the four basic social services - the service delivery system to meet the needs of the community basic human needs and accepted by society

Medical service is a rather special service In essence, medical services include activities performed by medical staff such as medical examination and treatment to serve patients and families (according to website dich vuyte.com)

So it can be generalized: Service Health is the result brought about by the interaction activities of users and service providers to meet health needs: such as medical examination and treatment, consultation, health care at health facilities health facilities such as hospitals, health centers, public and private clinics

Health service quality Health service

Quality includes two components: technical quality and functional quality Technical quality is the accuracy in the process of diagnosis and treatment of diseases Therefore, in a simple sense, image quality can be understood: the quality of medical examination and treatment by doctors, the quality of tests and X-rays, the quality of drug prescriptions, surgery Patients cannot judge Technical quality can be assessed immediately, but through the results after examination and treatment, as well as the use of medical services at the hospital many times to evaluate

Functional quality includes characteristics such as: the facilities of the hospital, the process of organizing medical examination and treatment of the hospital, the way medical staff communicate with the patient, the way, the convenience in the procedure Administration, how the hospital takes care of patients Customers (patients) can easily see the quality of functions when they come to the hospital for medical examination and treatment.

Health care concept

Health care is the maintenance or improvement of health through the prevention, diagnosis, treatment, improvement, or cure of diseases, illnesses, injuries, and physical and mental impairments among people Healthcare is provided by medical professionals and allied medical fields Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, sports coaching and other health professions are all one part of health care It includes work performed in the provision of primary care, secondary care and tertiary care, as well as in the public health sector.

Customer concept

Customers are individuals or organizations that a business is directing its marketing efforts to They are the ones who have the ability to make purchasing decisions The customer is the person who inherits the characteristics and quality of the product or service.

Customer satisfaction concept

There are many different definitions of customer satisfaction and there is quite a bit of debate about this definition

According to Brown (1992), customer satisfaction is a state in which what customers need, want and expect from a product; and service packages are satisfied or exceeded, resulting in repeat purchases, loyalty, and the value of word-of-mouth delight

According to Oliver (1997), satisfaction is the degree to which customer requirements are met Customer satisfaction is the psychological state that customers feel about a company when their expectations are satisfied or satisfaction beyond expectations through consumption of a product or service

Zeithaml & Bitner (2000), customer satisfaction is the customer's evaluation of a product or service that has met their needs and expectations

According to Philip Kotler, customer satisfaction is the level of a person's sensory state resulting from comparing the results obtained from consuming a product/service with their own expectations

- Customer expectations are formed from shopping experiences, from friends, colleagues and from information of sellers and competitors To improve customer satisfaction, businesses need to make additional investments and at least invest in marketing programs

According to Hansemark and Albinsson (2004), “Customer satisfaction is a customer's overall attitude towards a service provider, or an emotional response to the difference between what the customer expects before and what they receive, for the fulfillment of some need, goal or desire”

- Customer satisfaction is the fact that customers base some of their knowledge on a product or service that forms subjective evaluations or judgments

It is a form of psychological feeling after a customer's need is satisfied

- Customer satisfaction is formed on the basis of experiences, especially accumulated when purchasing and using products or services After purchasing and using the product, customers will have a comparison between reality and expectations, thereby evaluating whether they are satisfied or not

- Thus, customer satisfaction can be understood as a feeling of pleasure or disappointment that arises from the comparison between the actual benefits of the product and their expectations Whether or not customers are satisfied after purchase depends on how they compare the actual benefits of the product with their expectations prior to purchase

- We can understand: After customers make the purchase and use of any type of product of a certain business, a comparison between expectations and reality will be formed This will reflect customer satisfaction to products through their ability to meet the needs of those products

- If you want to have customer satisfaction, you should show your own style when communicating with customers You can spend all your time designing a logo, branding or building marketing resources All interactions are received quickly and quite friendly Don't just stop at the requests from the user, but see each interaction as an opportunity to understand the customer better.

The relationship between service quality and customer satisfaction

Service quality is considered as the gap between service expectations and customer perceptions when using the service (Parasurman, Zeithaml and Berry,

Some authors believe that between service quality and customer satisfaction, there is an overlap so these two concepts can be used interchangeably Some other studies suggest that between customer satisfaction and customer satisfaction service quality are two different concepts; customer satisfaction as the result, service quality as the cause; Satisfaction is predictive, service quality is an ideal benchmark

According to Zeithaml and Bitner (2000), service quality and customer satisfaction are two different concepts, while service quality focuses specifically on service components, customer satisfaction is a concept generality

There is still no consensus among researchers on the concepts, but most researchers believe that there is a relationship between service quality and customer satisfaction (Cronin and Taylor, 1992; Spereng, 1996)

According to Spreng and Mackoy (1996), service quality is an antecedent of customer satisfaction, and is shown in the following diagram:

Figure 2.1 Relationship between service quality and customer satisfaction

Therefore, the relationship between service quality and customer satisfaction is a positive relationship In order to improve customer satisfaction, service quality must be improved Customer satisfaction is an inevitable consequence of service quality

* The importance of measuring satisfaction

The health sector is a particular industry, customers have little choice in whether to use or not to use medical services, but rather where it is reasonable to use and meet their highest expectations In fact, because there is no choice, the client will accept medical services How the received value compares to the expected value is another matter Today, with the outstanding development of economy, science and technology, IT People are more and more concerned about their health The medical industry has also grown strongly, and more and more hospitals and medical facilities have been established, in addition to providing good technical service to customers Hospitals are also trying to satisfy customers because this is an important criterion that determines the image of hospitals and medical facilities,

20 helping to affirm the value of the brand However, satisfaction is not sustainable and difficult to quantify The real determinant of customer loyalty is customer value Studying factors to assess customer satisfaction is the motto and goal

The process of research, measurement and evaluation, will help hospitals find the factors that satisfy customers, measure those factors to find the factors that have the strongest impact This will help the hospital adjust and further satisfy customer satisfaction.

Factors affecting satisfaction

Factors affecting customer satisfaction include: Word of mouth; Human needs; Past experience; External communication; Product/service price; Service quality; Customer care; Incentive programs; Convenience in using products/services

- Good product or service quality is the core factor affecting customer satisfaction The more similar the quality of the product/service is to the customer's expectations and to what is advertised, the higher the level of customer satisfaction will be On the contrary, if the product quality is not what customers expect or what is advertised, it will disappoint and reduce customer satisfaction.

Research models

ACSI - The American Customer Satisfaction Index model is developed based on the Swiss model, ACSI was developed by Claus Fornell (Fornell et al., 1996)

(American Customer Satisfaction Index – ACSI)

SERVQUAL measurement procedure is quite lengthy, so this is the basis for the SERVPERF model Based on the model of SERVQUAL by Parasuraman et al., Cronin and Taylor (1992) have produced the SERVPERF model, a variant of SERVQUAL

Model According to this model, quality equals the perceived level (instead of measuring both perceived quality and expectations like SERVQUAL) Cronin and Taylor suggested that service quality would be best reflected by perceived quality

22 without expected quality, as well as weighted evaluation of 5 components and 22 statements similar to SERVQUAL model

(1) Reliability: Expressed through the ability to perform the service appropriately and on time right the first time

(2) Responsiveness: Expressed through the desire and readiness of service staff to provide timely services to customers

(3) Service capacity: Shown through professional qualifications and polite and welcoming service to customers

(4) Empathy: Shows care and concern for each individual and customer

(5) Tangible means: Shown through appearance, staff's clothing, equipment serving the service

* General model of service quality of Brogowicz et al

This model refers to 3 factors: Image, external influencing factors and Traditional Marketing activities (Figure 1.5)

This model aims to identify the service quality-related aspects of traditional marketing activities for planning, implementation and control

Comments on the service used

External influencing factors Company image

Figure 2.4 Integrated service quality model

Planning, implementing and controlling marketing st

Defining the company's mission and goals

Figure 2.5 model Service quality gap Source: Parasuraman et al (1985)

* Model Customer Satisfaction Index (CSI) Word of mouth Personal needs Past experience

Model This model is applied to measure customer satisfaction for industries, businesses, services, etc From there, it can be shown to be evaluated of customers for businesses and services to plan objectives and strategies to improve operational quality

In 1989, the first satisfaction index was born in Sweden (Swedish Customer Satisfaction Barometer-SCSB) with the goal of establishing the customer satisfaction index with the purchase and consumption of domestic products

Customer satisfaction index includes factors (variables), each of which is composed of many specific factors (indicators, items) characteristic of products or services, customer satisfaction is defined as a comprehensive assessment of an enterprise's use of a service or after-sales activity (product) and this is at the core of the CSI model Around this variable is a system of cause and effect relationships derived from initial variables such as customer expectations, business and product image, and quality perceived quality and perceived quality of the product or service associated with the resulting SHL variables such as customer loyalty or customer complaints ) (Le Van Huy (2007), "Using customer satisfaction index in strategic planning of banking business: approach to theoretical model", No 2 (19) - 2007, Journal of Science and Technology, University of Danang)

Some research models on customer satisfaction about health services

* According to Lekidou Ilia and Trivellas Panagiotis: “Patient satisfaction and quality of care: an experimental study in a central Greek hospital”

This study measures patient satisfaction through 3 factors:

- The care of doctors, nurses, midwives

- The importance of the environment inside the hospital

While patient satisfaction has many influencing factors, moreover these factors always change over time

* According to the author group M, Daoud-Marrakchi, S, Fendri-Elouze,

Ch, III and B, Bejar-Ghadhab: With the study: "Development of a scale to measure patient satisfaction in Tunisia"

The study measures patient satisfaction through 7 factors:

Reception (1), Nursing care (2), Information (3), Hygiene (4), Comfort (5), Food (6), Service bill (7)

The study has not yet measured many factors affecting patient satisfaction such as professional qualifications, medical examination and treatment process, results, etc., so the topic has not yet covered many factors

* According to Hong Qin and Victor R, Prybutok at the University of North Texas: “Perceived Service Quality in the Urgent Care Industry”

This study is based on Parasuraman's model and shows the relationship between technical quality and service quality during the study, waiting time as factors affecting patient satisfaction

When studying patient satisfaction, other factors are not mentioned, All research directions only focus on assessing perceived quality of service to assess patient satisfaction

Thủ tục khám chữa bệnh, tái khám

Mức độ hài lòng của khách hàng

Figure 2.6: Research model of customer satisfaction for medical examination and treatment services at Quan Dan Medical Hospital in Tra Vinh province Master thesis, author Chau Thi Thu Hong, Tra Vinh University in 2016:

The study was only studied at the Military Hospital of Military Medicine in Tra province, with a narrow scope, the study only studied a number of factors At the same time, factors affect the general development of medicine and human needs, so customer satisfaction will also be influenced by other factors

* Model "Research on patient satisfaction for Da Nang general hospital" Master's thesis, author Tang Thi Luu, University of Danang 2011: With the research model the author has proposed and investigated Investigate 8 factors affecting patient satisfaction with Da Nang General Hospital The factors are: First impression (1), Efficiency and communication (2), Relevancy (3), Information (4), Usability (5), Care and concern ( 6), Hospital Reputation (7), Hospital Fees (8), (Figure 2.7)

Figure 2.7: Research model of patient satisfaction for Da Nang General Hospital;

The topic is only studied at Da Nang General Hospital, so the generality is not high because the research scope is narrow

The factors affecting patient satisfaction are many, the subject has only studied a few factors At the same time, the factors affecting this satisfaction, also often change over time, so the measurement may be correct in the present, but in the future, that satisfaction may be affected by other factors.

Proposed research model and research hypotheses

Health service quality affects customer satisfaction in the world There have been many studies, in Vietnam so far there have been a number of studies on health service quality affecting patient satisfaction Patients were studied at hospitals such as: Military Hospital of Tra Vinh Province, Da Nang General Hospital, Hoan My Hospital in Da Nang City, Saigon International Hospital for Obstetrics and Gynecology

However, so far, there has not been a systematic study on the factors affecting customer satisfaction when using examination and treatment services at the Center for Health Care and Protection Quang Ninh Province This is the novelty of the subject

The object and scope of the study is a group of customers who are using medical services at the Quang Ninh Provincial Center for Health Care and Protection

Through the process of researching documents on service quality models, customer satisfaction, along with consulting industry experts and practical application in Vietnam, SERVQUAL Model is model is widely believed and applied in research fields, this is the model that contributes to creating service measurement criteria affecting customer satisfaction,

The topic “Factors affecting customer satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and

Protection” Inheriting the theoretical bases of previous studies, the author has chosen the SERVPERF service quality model together with the model in "Research on customer satisfaction for medical examination and treatment services at Military Hospital" People's medicine in Tra Vinh province" Master's thesis, author Chau Thi Thu Hong, Tra Vinh University in 2016, considering the reality of the Center for Health Care and Protection of Quang Ninh Province's staff as a basis to make a research model of the topic

The research model is presented as follows:

Model According to the model established above, the following hypotheses are posed:

H1:The greater the reputation of the Center, the higher the level of customer satisfaction

H2: The higher the professional level of the team of doctors and medical staff, the higher the customer satisfaction will be,

H3: The better and more modern the facilities of the Center are, the greater the customer satisfaction level

H4 : The more enthusiastic and cheerful the service attitude of the medical team, the more enthusiastic the customer, the higher the customer's satisfaction

H5 If the policy is properly implemented, the customer's satisfaction will be high H6:effective results, consultation and treatment, customer satisfaction will be high

Chapter 2, the author presented an overview of the Center for Health Care Protection and Care of Quang Ninh officials and summarized theories related to customer satisfaction, factors affecting customer satisfaction customer satisfaction, in addition, the author has also provided a research model

OVERVIEW OF QUANG NINH PROVINCE'S HEALTH

Overview of the Center for Health Care and Protection Committee of

3.1.1 History of establishment and development

Quang Ninh Provincial Center for Health Care and Protection was established in October 1963, up to now, it has been 59 years, with the function and task of protecting and taking care of the health of people key leaders of the province and cadres under the management of the Provincial Party Committee, operating together with the national staff health protection system, the direct professional direction is the Protection Board health care for central officials

During the process of establishment and development, the cadre health protection system has been under the Ministry of Health since 2002 and was re- established according to Decision No 27-QD/BBT of the Secretariat of the Party Central Committee Since then, the Center for Health Care Protection has operated as an independent Center The Center has made a significant contribution to health care, medical examination and treatment for officials of the Provincial Party Committee and people throughout the province, contributing to promoting socio- economic development and improving life expectancy for staff and residents

In order to improve professional capacity and carry out political tasks of Quang Ninh province, a reality for the Center for Health Care and Protection of Quang Ninh officials is to come up with solutions to do well in health care health care, examination and treatment, doing this job well is a condition for improving professional skills, promoting health care activities, examining and treating staff and people, ensuring the survival and development of the Center, is a solid foundation that makes an important contribution to the process of industrialization, modernization and socialization of the medical industry of the system of Health Protection Centers nationwide in general and the Center for Health Protection in general Protecting and taking care of the health of officials in Quang Ninh province in particular

Figure 3.1 Organization chart of the Center for Health Care and Protection of Quang Ninh Provincial Officials

OFFICE CLINIC RELAX HA LONG

PHARM ACEUTI CAL DEPART MENT

3.1.2.1 Functions and tasks of Quang Ninh Provincial Center for Health Care and Protection

Quang Ninh Provincial Center for Health Care and Protection, currently implementing according to Instruction No 23-HD/BTCTW dated December 24,

2008 of the Central Organization Committee and Decision No 1659-QD/TU dated December 24, 2008 July 27, 2009 of the Standing Board of the Quang Ninh Provincial Party Committee Accordingly, the Center for Health Care and Protection of Employees is directly under the Quang Ninh Provincial Party Committee Currently, the Center has 03 affiliated units (Clinical for Personnel Health Management, Staff Nursing House and Department Office)

The Center for Health Care and Protection of Quang Ninh officials is an agency directly under the Quang Ninh Provincial Party Committee, with the function of advising and performing professional and professional work on management, protection and health care for officials

The Center for Health Care and Protection of Quang Ninh Provincial Officials is under the leadership and direction of the Standing Board of the Quang Ninh Provincial Party Committee; subject to the professional guidance and examination of the Central Committee for Health Care and Protection of cadres, and at the same time guide and inspect the implementation of health care protection and care for district and town officials and equivalent

Advise the Standing Board of the Provincial Party Committee on regimes, policies and solutions to protect health care for officials; Organize preliminary and final reviews and determine the direction and tasks of staff health care protection

To guide and inspect the protection and health care of officials in districts, towns and cities directly under the province (collectively referred to as district level)

Directly monitor and manage the health of the following subjects: retired revolutionary senior cadres, pre-insurrection officers, leaders of departments,

34 departments, directors and equivalents who have retired in the locality, cadres under the management of the Standing Board of the Provincial Party Committee (incumbent and retired) and a number of other subjects decided by the Standing Board of the Provincial Party Committee

Coordinating protection and health care for officials from departmental, departmental, director and equivalent levels of central agencies working in the area Coordinating with the Organizing Committee of the Provincial Party Committee to implement the regimes and policies on health protection and care for officials under the management of the Standing Board of the Provincial Party Committee

Directly directing and managing the activities of specialized units under the Center

* Functions, duties of the department

General Counseling personnel organization, personnel management; directly implement administrative management, financial accounting, emulation and commendation, offline work, party affairs, assisting the Leader in leadership, direction and management

Performing office administrative work, managing electronic medical records, network administration, medical examination and treatment software data, and staff health management; manage seals, archive documents according to regulations; financial management, assets, facilities and equipment; manage and maneuver vehicles and vehicles in service of the agency's work; serving the organization of conferences, meetings, welcoming guests; ensure the protection, safety and internal order of agencies and units

To assume the prime responsibility for coordinating with units in the agency to perform offline tasks; connecting and cooperating with domestic and foreign medical treatment, treatment and convalescence facilities and related units, serving the work of medical examination, treatment and nursing staff's health;

The clinic - Health management under the Centers for Health Care and Care for officials of the provinces and centrally run cities, under the direct leadership of the Department of Health Care and Health Management of provincial and municipal officials provide professional guidance by the Professional Council of Centers for Health Care and Care of Provincial and Municipal cadres in medical examination and treatment, monitoring and management of staff's health and training to improve professional skills

Clinics - Health management of staff members of Centers for Health Care and Care for officials of provinces and centrally run cities have the same functions as the medical examination department of a general hospital of a province or centrally run city and implement working regulations of the Medical Examination Department is specified in the Hospital Regulations issued together with the Decision No 1895/1997/QD-BYT dated September 19, 1997 of the Minister of Health

Provincial Party Committee on the work of serving, nursing and taking care of the health of cadres, organizing the performance of service, nursing and health care work for Chinese officials Central and Provincial Party Committee management;

To organize the service of the province's foreign guests according to the plans of the Office of the Provincial Party Committee, the People's Council and the Provincial People's Committee and relevant departments, agencies and sectors

Actual situation of examination and treatment at Quang Ninh Provincial

Every year, Quang Ninh Provincial Center for Health Care and Protection of Officials serves medical examination and treatment for officials and people, the large number of patients has contributed to reducing the number of patients at local hospitals conscious Specifically:

* Regular medical examination and treatment

- In 2021, the number of patients is: 18,446 turns, of which 9,505 turns of staff (accounting for %)

- In the first 6 months of 2022, the number of patients is: 11,556 turns, of which 8,688 are staff (accounting for %)

* Examination and treatment at home

- In 2021, the number of officers: 985 turns

- 6 months of 2022, number of officers: 858 turns

+ Incumbent and full-time cadres, centrally managed: 12/12 (reaching 100%)

+ Incumbent and former officials, under the management of the Provincial Party Committee: 2,135/1.603 (reaching 76%)

In addition, the Center for Health Care and Protection of Quang Ninh officials also performs a number of other professional medical tasks such as: Covid

19 epidemic prevention and control; Screening test for Covid-19 infections; The implementation of vaccination against Covid-19 and other vaccines… for staff and health workers at major provincial meetings, etc.

Research Methods

The qualitative research process aims to discover and form observed variables to measure research concepts, find out the factors affecting the satisfaction

40 of customers (patients) when examining and receiving treatment at the Center Center for Health Care and Protection of Quang Ninh Provincial Officials

Through research models SERVQUAL model, SERVPERF service quality model, Customer Satisfaction Index (CSI) model

Together with "Research on customer satisfaction for medical examination and treatment services at Military Hospital of Tra Vinh province" Master thesis, author Chau Thi Thu Hong, Tra Vinh University in 2016 Combined with the theoretical basis on the factors affecting customer satisfaction presented in Chapter

II, and the medical examination and treatment process at Cho Ray hospital as the basis for the survey and research model

In the qualitative research part, the author used the group discussion method to give an initial interview questionnaire with 32 questions (appendices) based on the theoretical basis After going to random preliminary interviews with 60 patients, regardless of gender, occupation, to determine whether the questions in the survey are guaranteed to be understood clearly and accurately After that, the author absorbed the opinions of some medical staff, along with the group discussion technique, adjusted it to suit the practice of the Center for Health Care and Protection of Quang Ninh officials and staff patient opinion This is the basis for building the official questionnaire for the survey process on “Factors affecting customer satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection”

The results of the qualitative research process show that: when interviewed, the patients clearly understood the questions raised and answered according to their satisfaction level Some questions with unclear meaning have been adjusted, and duplicate questions have been omitted Finally, the author has given a questionnaire with 26 observed variables belonging to 6 measured factors (Appendix 3) that have the most influence on the satisfaction of patients when using the examination and treatment services at the hospital Center for Health Care and Protection Committee of Quang Ninh Province

After the qualitative research process, the author distributes the survey questionnaires in the studied areas The collected data will be entered and processed by SPSS 20.0 software This software will analyze data through the results of: descriptive statistics (Discriptive Statistic), reliability test (Cronbach's Alpha), exploratory factor analysis (EFA), regression analysis (Linear) Regression), analysis (T-test, ANOVA) to test the difference between interview subjects

The purposes of using quantitative methods when using SPSS software are:

- Evaluate the accuracy of the scale in formal research

- Assess the importance of quantitative research influencing factors

- Check whether there is a difference in satisfaction between different interviewees: gender, occupation.

Build questionnaires and gauges

Based on the initial qualitative research and previous research documents, the author conducted direct interviews, discussions with 10 people All 10 people's opinions were synthesized and adjusted to give an official questionnaire

The official survey consisted of 6 elements and 26 questions respectively, interviewed 200 people

The official interview questionnaire consists of 3 main contents:

Introduction about the purpose of the interview, the name of the research project and the date of the interview

The part of the respondent asked about the personal information of the customer

The part of the question about assessing the satisfaction of customers using the examination and treatment service at the Center for Health Protection and Care of Quang Ninh Province's staff This part will be the level of consent of the customer (patient) when using the examination and treatment services at the Center

The topic applies a 5-point Likert scale from 1 to 5, respectively, to build the questionnaire as follows: (1) Totally disagree, (2) Disagree, (3) Normal, (4) Agree,

After the adjustment process, the official research scale was built with 26 questions representing 26 observed variables that are believed to affect customer satisfaction when using medical examination and treatment services treated at Quang Ninh Provincial Center for Health Care and Protection [Appendix 3], the scale used in the study is a 5-point Likert scale, with (1) Completely disagree, (2) Disagree, (3) Neutral, (4) Agree, (5) Totally Agree

The factors in the questionnaire of the 5-level Likert scale have been coded as follows:

Reputation Factor is measured by 3 observed variables and denoted UT

UT1: The center has made many contributions to the provincial health sector, greatly reducing the number of patients in the province

UT2: Provincial staff health care protection center implements the insurance regime according to the regulations that the patient is received

UT3: Brother (sister); Mr (Ms.) has heard a lot about the effectiveness of using medical services at the Provincial Center for Health Care and Protection of Provincial Officials

Factor Qualification is measured by 3 observed variables and denoted TĐ TĐ1: Medical staff, doctors and medical staff are properly trained and have post-graduate degrees

TĐ2: Medical staff, doctors and medical staff are medical staff with many skills experience and seniority in the health sector

TĐ 3: Medical staff, doctors and staff regularly study and train to improve their professional qualifications

Elements Material is measured by 5 observed variables and denoted by VC VC1: The center has spacious and clean facilities

VC2: The center has modern medical equipment

VC3: The center is fully equipped with paraclinical equipment (X-ray, ultrasound, testing ) to serve the examination and diagnosis

VC4: The center has enough seats, drinking water, fans, and air conditioners while waiting for the examination

VC5: The hospital has a cool garden area

* Service attitude style is measured by 6 observed variables and denoted by PV

Reporter1: Center staff have neat and clean clothes

PV2: Center staff are always ready to help patients

PV3: The medical team, doctors and medical staff ensure to keep customers' secrets

PV4: The medical staff, medical staff welcome the patient happily

PV5: The medical team, doctors, and medical staff consult, always listen to instructions enthusiastically in the process of providing medical services to patients PV6: The medical team and doctors continue to call health care workers after providing treatment and make an appointment for re-examination when necessary

The factor for implementing policy regimes for officials is measured by 5 observed variables and denoted by CĐ

CĐ1: The Center implements policies and regimes for cadres according to Decision No 806-QD/TU dated December 27, 2017 of the Standing Board of the Quang Ninh Provincial Party Committee on the promulgation of Regulations on protection and care of staff's health that the staff is entitled to

CĐ2: Nursing leave in accordance with regulations

CĐ3: Payment of nursing leave in accordance with regulations, clearly and quickly

CĐ4: Mode of annual medical examination and examination, quality and results CĐ5: Dispensing drugs, functional foods in full quantity, high quality products, clear origin, good support for the treatment process

The factor of calling for consultation and re-examination is measured by 4 observed variables and denoted SK

SK1: Post-examination health consultation calls are fully maintained, staff's treatment information is fully and closely updated

SK2: Counselors listen attentively and make reasonable changes in treatment SK3: The process of treating chronic diseases has obvious effects, stabilizing staff health for a long time

SK4: Save time and effort for the elderly, weak, and difficult to travel

Y1: Mr (sister), Mr (Ms.) feel satisfied with the quality of medical services of the Center for Health Care and Protection of Quang Ninh officials

Y2: Mr (sister), Mr (Ms.) are satisfied with the service attitude of the medical team, doctors and medical staff of Quang Ninh Provincial Center for Health Protection and Care

Y3: Quang Ninh Provincial Center for Health Care and Protection will be your first choice when you have a need for medical services

According to Hair & ctg (2006), in order to use EFA, the sample size must be at least 50, preferably 100 In which, the ratio of observations on the variable being measured is 5:1, that is, it is needed at least 5 observed variables are used for 1 measurement variable, preferably 10:1

However, during the research and survey, through 2 times of adjusting the survey questionnaire to match reality and research the research of the topic, the author has given a questionnaire with 26 observed variables and 3 dependent variables of the regression model So, if the ratio is 5:1, the sample size will be: 26 x 5 = 130 research samples, This is also the minimum number of samples for the research of this topic

The author randomly selected patients in the campus and in the clinics of the Center for Health Care and Protection of Quang Ninh officials to survey, the author conducted the survey as follows:

Table 3.1 Distribution of questionnaires survey at Quang Ninh Provincial

Center for Health Care and Protection

No Survey ballot distribution area

- Service attitude - Policies for staff

- Return of results and consultation after examination

The topic of sampling is patients who are being examined and treated at the Quang Ninh Provincial Center for Health Protection and Care, with the following criteria:

- The sample is randomly selected with both men and women

- The sample is selected There are age groups: From over 33 to 90 years old

The interview sample selection process is random, simple but still ensures the overall representativeness of the research population

The interviewers will clearly explain the interview objectives to the interviewees, with a ready-made questionnaire, to ensure that the information interviewed is only used for research for the thesis, not for any other purpose any other purpose

After that, the interview will be conducted directly according to the questions of the questionnaire and instructions to explain if the interviewee does not understand clearly

Gender group of survey sample:

According to gender, the survey sample includes: 123 patients were male, corresponding to 64.7% of the total 190 samples surveyed, female was 67 patients, representing 35.3% of the total 190 patients surveyed (See Table 3.2)

Table 3.2 Statistics Based on Gender

Source: Analysis of cronbach alpha coefficient- Appendix 4

Figure 3.2 Statistics based on Gender Source: Analysis of cronbach alpha coefficient - Appendix 4

- Age group of the survey sample

According to the survey age, there are 02 groups: Group 1 is the patients in the age group from 61 to 90 years old (70.52%) corresponding to 140 patients and group 2 is the group of patients from 33 to 60 years old (29.48%) corresponding to

Table 3.3 Age-Based Statistics Descriptive Statistics

Source: Cronbach alpha coefficient analysis- Appendix 4

Table 3.4 Statistics based on age

Frequency Percent Valid Percent Cumulative Percent

Source: Analysis of cronbach alpha coefficient- Appendix 4

- Education level of survey sample

According to education, the survey has 02 groups: Group 1 is full-time staff (81.05%) corresponding to 154 patients and group 2 is current staff (18.96%) corresponding to 36 patients and (table 3.4)

Table 3.5 Statistics Based on Education

Source: Analysis of cronbach coefficient alpha- Appendix 4

Figure 3.3 Statistics based on education level

In chapter 3, the author has introduced the research process, qualitative research methods and Quantitative, the author has built a questionnaire and scale, coded the scale, presented the sampling method, This is the basis for data entry, through description, statistics, running SPSS software 20.0 for the results and measures in the next chapte

RESEARCH RESULTS

Determining factors affecting satisfaction

4.1.1 Evaluation of the scale by the reliability coefficient Cronbach alpha

According to Tran Duc Long (2006, 46) extracted from Nunally & Burnstein

(1994) Pschy chometric, 3rd edition, NewYork, McGraw Hil) stated as follows: reliability by Cronbach's Alpha coefficient, this is a tool to remove unmeasured variables Variables with item-total correlation of less than 0.3 will be excluded and the selection criterion is that Cronbach's Alpha must be from 0.6 onwards

According to Hoang Trong and Chu Mong Ngoc (2008,24) extracted from Nunally (1978), Psychometric Theory, New York, McGraw-Hill; Peterson (1994),

“A Meta-Analysis of Cronbach's Coeficient Alpha”, Journal of Consumer Research,

No 21 Vo,2, pp 38-91; Slater, S, (1995), “Issue in Conducting Marketing Strategy Research”, Journal of Stategic) states the following: Cronbach's Alpha from 0.8 or higher, approaching 1, the scale is the best, from 0.7 close to 0.8 is usable There are also studies that suggest that Cronbach's Alpha of 0.6 or more for new research and concepts is acceptable

4.1.1.1 Cronbach Alpha of the Center's Reputation Factor Scale Cronbach Alpha's Reputation factor scale of the Center through 3 observed variables: UT1, UT2, UT3 gives the result that the Cronbach's Alpha reliability coefficient is 7.86 > 0.7 and all 3 observed variables have a total correlation > 0.3 Therefore, the Center's Reputation factor scale meets the reliability and is used in the next steps (table 4.1)

Table 4.1 Cronbach's Alpha of Reliability Statistics Center

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Analysis of cronbach alpha coefficient- Appendix 4 4.1.1.2 Cronbach Alpha of the factor scale Professional qualification

Analysis of factor scale Cronbach Alpha Professional qualifications through 3 observed variables:TD1, TD2, TD3 results in the Cronbach's Alpha reliability coefficient being 750 > 0, 7 and all 3 observed variables have total correlation > 0.3 Therefore, the Qualification factor scale of the Center meets the reliability and is used in the next steps (table 4.2)

Table 4.2 Cronbach Alpha of the

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted Item

Source: Analysis of cronbach alpha coefficient- Appendix 4 4.1.1.3 Cronbach Alpha of the factor scale Facilities

Cronbach Alpha analysis of the Center's facility factor scale through 5 observed variables: VC1, VC2, VC3, VC4, VC5 results in a Cronbach's Alpha reliability coefficient of 575 > 0.7, in which 4 observed variables have total correlation > 0.3, 1 observed variable VC4 has total variable correlation < 0.3, so CV4 (table 4.3)

Table 4.3 Cronbach Alpha of the Facility factor scale

Scale Variance if Item Deleted

Corrected Item- Total Correlation 's Alpha if

Source: Analysis of cronbach alpha coefficient- Appendix 4

However, when running for the second time, the remaining 4 variables show

652 > 0.7 and all 4 observed variables have a total correlation > 0.3 Therefore, the Center's Material factor scale meets the reliability and is used in the next steps (table 4.3.1)

Table 4.3.1 Cronbach's Alpha of the Material Factor Scale

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Analysis of cronbach alpha coefficient- Appendix 4 4.1.1.4 Cronbach Alpha of the service

Attitude factor scale The Cronbach Alpha analysis of the service attitude factor scale of the Center through 6 observed variables: PV1, PV2, PV3, PV4, PV5, PV6 gives the results of the reliability coefficient Cronbach's Alpha is 844 > 0.7 and all 6 observed variables have total correlation > 0.3 Therefore, the service attitude factor scale of the Center meets the reliability and is used in the next steps (see table 4.5)

Table 4.4 Cronbach Alpha of the service Attitude factor scale

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Analysis of cronbach alpha coefficient- Appendix 4

4.1.1.5 Cronbach Alpha of the implementation factor scale Policy regime

Analysis of Cronbach's Alpha factor scale, Policy regime of the Center through 5 observed variables: CĐ1, CĐ2, CĐ3, CĐ4, CĐ5 giving Cronbach's Alpha reliability coefficient of 801 > 0.7 and all 5 important variables All observations have a total variable correlation > 0.3 Therefore, the Center's Policy Mode factor scale meets the reliability and is used in the next steps (table 4.5)

Table 4.5 Cronbach Alpha of the factor scale Policy regime

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Analysis of cronbach alpha coefficient- Appendix 4 4.1.1.6 Cronbach Alpha of the factor scale and post-examination counseling

Cronbach Alpha analysis of the outcome-paying factor scale and post- examination counseling of the Center through 4 observed variables: SK1, SK2, SK3, SK4 for the results Cronbach's Alpha reliability coefficient is 676 > 0.7, in which 3 observed variables all have total variable correlation > 0.3, 1 observed variable SK4 has total variable correlation < 0,3 so the SK4 variable is excluded (table 4.6)

Table 4.6 Cronbach's Alpha of the factor scale Return of results and consultation after examination

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Analysis of cronbach alpha coefficient- Appendix 4

However, when running for the second time, the remaining 3 variables show

751 > 0.7 and all 3 observed variables have a total correlation > 0.3 Therefore, the factor scale of Result and post-examination consultation of the Center meets the reliability and is used in the next steps (table 4.6.1)

Table 4.6.1 Cronbach's Alpha of the factor scale Return results and post- examination consultation

Scale Variance if Item Deleted

Cronbach's Alpha if Item Deleted

Source: Cronbach alpha-coefficient analysis Appendix 4

Thus, after testing the reliability coefficient, recording 24 observed variables, the results of the evaluation of the scale of 6 factors are summarized as follows:

- Center's prestige: There are 3 observed variables: UT1, UT2, UT3

- Professional qualifications: There are 3 observed variables: TD1, TD2, TD3

- Facilities: There are 4 observed variables: VC1, VC2, VC3, VC5

- Service attitude: There are 6 observed variables: PV1, PV2, PV3, PV4, PV5, PV6

- Policy regime: There are 5 observed variables: CD1, CD2, CD3, CD4, CD5

- Returning results and consulting after examination: there are 3 observed variables: SK1, SK2, SK3

The summary table of Cronbach's Alpha coefficients is shown as follows: (Table 4.7)

Table 4.7 Summary of Cronbach's Alpha coefficients

Scale Number of observed variables

Source: Cronbach alpha coefficient analysis- Appendix 4

4.2 Factor analysis and research model testing

4.2.1.1 Exploratory factor analysis (EFA) to determine the factors affecting customer satisfaction when using medical examination and treatment services at the Center for Health Care and Protection of Quang Ninh

Officials Exploratory factor analysis (EFA) is used to reduce and summarize data During the research process, we will collect a fairly large number of variables,

59 but based on the correlation between the variables to reduce it to more meaningful groups of variables In this study, when all the collected variables are included, ie 26 variables have been excluded 02 variables: 01 CV4 variable and 01 KS4 variable At that time, these variables will be grouped into groups of related variables to consider and present as the basic factors affecting customer satisfaction when using medical examination and treatment services at the Medical Center Protecting and taking care of the health of officials in Quang Ninh province

The study was conducted using the method of extracting Principal component coefficients with Varimax rotation at the breakpoint when extracting factors with Eigenvalue > 1 Any scale with a total variance extracted from 50% or more is accepted (Gerbing & Anderson, 1988) Variables with a weight (Factor loading) less than 0.5 will be eliminated

According to Hair & ctg (1988, 111), factor loading is the criterion to ensure the practical significance of EFA: factor loading > 0.3 is considered to be the minimum; factor loading > 0.4 is considered important; factor loading > 0.5 is considered to be of practical significance

At each concept has the largest weight difference (Factor loading) and any must reach ≥ 0.3 (Jabnoun & AL-Tamini, 2003) In factor analysis, it is necessary that the KMO coefficient (Kaiser - Meyer - Olkin) must have a large value (0.5 ≤ KMO ≤ 1), which shows that factor analysis is appropriate

If the KMO coefficient is < 0.5 then factor analysis is likely to be inappropriate for the data According to Kaiser (1974), KMO ≥ 0.9 is very good; 0.9

> KMO ≥ 0.8 is good; 0.8 > KMO ≥ 0.7 is fine; 0.7 > KMO ≥ 0.6 is okay, 0.6 > KMO ≥ 0.5 is bad and KMO < 0.5 is unacceptable (Hoang Trong and Mong Ngoc,

In the process of analyzing the type of observed variables, at the same time check and eliminate the variables with multicollinearity phenomenon

Test the appropriateness of EFA and test the correlation of observed variables in the representative measure

When analyzing factors, the study proposed 2 hypotheses:

Hypothesis H 0 : The variables in the population are not correlated with each other

Hypothesis H 1 : The variables in the population are correlated with each other

The results of the Barlett test show that there is a correlation between the variables in the population (sig = 0.00 < 0.05, reject H 0 , get H 1 ) At the same time, the coefficient KMO = 0.901 satisfies the condition 0.5 ≤ KMO ≤ 1, proving that factor analysis to group variables together is appropriate and the data is suitable for factor analysis (See Table 4.8)

Table 4.8 KMO Test and Bartlett's INDEPENDENT

Kaiser-Meyer-Olkin Measure of Sampling Adequacy .749

Source: EFA analysis results – appendix 5

Table 4.9 shows that all factors have Eigenvalues > 1 The extracted variance is 63.609% > 50% is satisfactory With the Principal components extraction method and Varimax rotation, there are 6 factors extracted from the observed variable (table 4.9) This shows us that 6 extracted factors show the ability to explain 63,609% of the variation of the dependent variable in the population Breakpoint when extracting factors is at factor 6 (Figure 4.9)

Table 4.9 Table of total variance extracted

Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared

Extraction Method: Principal Component Analysis

Source: EFA analysis results – appendix 5

Determining the importance of factors affecting satisfaction through

The study performed multivariable linear regression with the single-pass method (Enter method), where:

HLC (Y): Satisfaction - dependent variable The scale of this factor is from 1 to 5 (1: Totally disagree; 5: Totally agree) The HLC variable includes 3 observed variables: Y1, Y2, Y3 a: the free constants

X 1 , X 2 , X 3 , X 4 , X 5 , X 6 are independent variables in the following order: Reputation of the Center, Qualification, Facilities, Thai Service level, Policy regime, Return of results and post-examination consultation

- Statistical parameters in the regression model by the 1st Enter method

- Through the analysis results, we see that the model does not violate the phenomenon of multicollinearity because the exaggeration coefficient of variance of the independent variables (VIF) is small than 2, the phenomenon of series correlation (multicollinearity problem) need not be considered

- In Table 4.17, when considering the t stat and t α/2 of the variables to measure the reliability, the independent variables UT, TĐ, VC, PV, CĐ, SK all meet the requirements because t stat > t α/2 (minimum is 0.111) and Sig values show quite high reliability, both < 0.05 with VC > 0.05 (no effect on dependent variable (table 4.17)

Table 4.17 Information statistics in the regression model by Enter

Standardized Coefficients T Sig Collinearity Statistics

B Std Error Beta Tolerance VIF

Source: Results of Regression Analysis – Appendix 6 4.3.2 Testing multivariable linear regression model

F Test the suitability of the overall linear regression model Shows whether the dependent variable is linearly correlated with the entire independent variable Let's assume H0: a0 = a1 = a2 = a3 = a4 = a5 = a6 = 0

F test and the value of Sig

According to the analysis results, the Sig hypothesis shows that the independent variables in the model are linearly correlated with the dependent variable (table 4.18)

Table 4.18 Check the suitability of the multivariable linear regression model

Total 39.160 189 a Dependent Variable: HLC b Predictors: (Constant), SK, UT, VC, TĐ, CĐ, PV

Source: Regression analysis results – appendix 6

Analysis of satisfaction

From the results in Table 4.17, a multivariable regression equation with standardized Beta coefficient is formed as follows:

Customer satisfaction when using examination and treatment services at Quang Ninh Provincial Health Care Protection Center = 0.267* Reputation of the Center + 0.108* Professional qualifications + 0.291* Service attitude + 0.231* Policy regime + 0.308* Return of results and consultation after examination (1)

Equation (1) also shows that in the independent variables impact and affect satisfaction of customers, the variable "Returning results and consulting after examination" has the largest weight of 0.308 which means that this variable has the most influence on customer satisfaction when using examination and treatment services at the Center for Health Care health care staff in Quang Ninh province, the remaining variables are "Attitude to service" with weight 0.291, "Prestige" is 0.267,

"Policy regime" is 0.231 and "Professional qualification" " is 0.108 Particularly, the variable "Facilities" is 0.081 with the smallest weight, it is necessary to make efforts to equip more equipment and machines to meet customer satisfaction

Regression results show that Facilities are not included in the model tested by Sig, because t is greater than 0.05 Therefore hypothesis H3 does not affect the dependent variable, so it is not accepted and the following factors: Reputation, Professional qualifications, Service attitude, Policy regime, Return of results and consulting have influence directly proportional to the satisfaction of customers using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection Thus, hypothesis H1, H2, H4, H5, H6 for the research model is officially accepted

In the condition: Reputation of the Center, Service Attitude, Return of Results and Post-Examination Counseling do not change If Professional Qualification increases by 1, customer satisfaction increases to 0.108

In the following conditions: Center's prestige, Qualification, Policy, return of results and post-examination advice do not change If Service Attitude increases to

1, customer satisfaction will increase to 0.291

In the condition: Professional qualifications, Service attitude, Policy regime, return of results and post-examination advice do not change If the Center's prestige increases by 1, the customer's satisfaction level increases to 0.267

In terms of: The Center's prestige, Professional qualifications, Service attitude, return of results and post-examination advice remain unchanged if The policy mode is reduced to 1, the customer satisfaction level increases to 0.231

In the condition: The Center's prestige, Professional qualifications, Service attitude, Policy regime remain unchanged If the results are returned and after- examination consultation, the customer's satisfaction level increases to 0.308

In summary, through the results of testing the formal theoretical model, specifically the multivariable linear regression results, we have the adjusted formal theoretical model as follows: (Figure 4.4)

Source: Regression analysis results – appendix 6

Customer satisfaction level Service attitude

4.4.2 Measure and evaluate the level of customer perception in each factor to satisfaction

* Result Return factor and post-examination consultation

Factor Return of results and advice after examination ranked first in the evaluation table with Mean = 4.130 (fair) While the regression analysis shows that this factor has the final impact on customer satisfaction when using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection The difference shows that customers care and appreciate the following issues: Saving time and effort for the elderly, weak, and difficult to travel

The observed variables of this group fluctuate from 3.87 to 4.46 and are quite good In which, the variable SK4: Saving time and traveling effort of elderly staff, weak health, difficulties in travel, and underestimation compared to other variables SK3: Effective treatment of chronic diseases clearly, stabilizing staff health for a long time Thus, the medical team of the Center for Health Protection and Care of Quang Ninh officials need to build a disease model and have an effective treatment regimen to improve customer satisfaction (table 4.19)

Table 4.19 Customer's perception of the factors that return results and post- examination counseling

Observable variables Average score Level

SK1 Post-examination health consultation calls are fully maintained, staff's treatment information is fully and closely updated

SK2.The consultant listened attentively and made reasonable changes in treatment 4.12 Rather

SK3.The treatment process for chronic diseases has obvious effects, stabilizing staff health for a long time

SK4 Saving time and effort for the elderly, weak, and difficult to travel 4.46 Rather

Source: Regression Analysis Results – Appendix 6

Attitude factor ranks second in the rating table with Mean = 4,578 (fair) While the regression analysis shows that this factor has the 5th impact on customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials The difference shows that customers care and appreciate the following issues: Center staff have neat, clean clothes

The observed variables of this group fluctuate from 4.39 to 4.75 and are quite good Including the variable PV1: Center staff with neat, clean clothes have the best rating and the lowest rating PV6: The medical team, doctors maintain phone calls to consult the health of the following staff when providing treatment drugs and appointment for follow-up examination when necessary Thus, the Center for Health Care and Protection of Quang Ninh officials should promote and maintain the call for health advice and remember to remind the schedule of follow-up visits to improve customer satisfaction (table 4.20)

Table 4.20 Customer's perception of the element Service

Observable variables Average score Level

PV1 Center staff have neat and clean clothes 4.75 Rather PV2 Center staff are always ready to help patients 4.66 Rather

PV3 The medical team, doctors and medical staff ensure to keep customers' secrets 4.49 Rather

PV4 The medical team, the medical staff welcome the patient happily 4.65 Rather

PV5 The medical team, doctors, and medical staff always listen to the guidance in the process of providing medical services to patients

PV6 The medical team and doctors continue to call for health consultations for staff after providing treatment drugs and make an appointment for follow-up examination when necessary

Source: Regression Analysis Results – Appendix 6

Reputation Factor the Center's Reputation Factor ranked third in the assessment with Mean = 4,436 (fair) While the regression analysis shows that this factor has the fourth impact on customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials The difference shows that customers care and appreciate the following issues: Mr (sister); Mr (Ms.) has heard a lot about the effectiveness of using medical services at the Provincial Center for Health Care and Protection of Provincial Officials

The observed variables of this group fluctuate from 4.39 to 4.47 and are quite good Including the variable UT3: You have heard a lot about the effectiveness of using medical services at the Center for Health Care Protection, the provincial officials have the best rating and the lowest rating TU1: The center has many contributions to the health sector province, greatly reducing the number of patients in the province Thus, the Center for Health Care Protection and Care of Quang Ninh officials not only examines and treats one subject who is an officer of the Standing Board of the Provincial Party Committee, but needs to expand more subjects for examination and treatment This will contribute to the provincial health sector, significantly reducing the number of patients in the province to improve customer satisfaction (table 4.21)

Table 4.21 Customer's perception of the Center's Reputation factor

Observable variables Average score Level

UT1 The center has made many contributions to the provincial health sector, significantly reducing the number of patients in the province

UT2 The center implements the insurance regime in accordance with the regulations that the patient is received

UT3 You have heard a lot about the effectiveness of using medical services at the Provincial Center for Health Care and Protection

Source: Regression analysis results – Appendix 6

Mode factor ranks fourth in the assessment with Mean = 4.316 (fair) While the regression analysis shows that this factor has the third impact on customer satisfaction when using examination and treatment services at the Center for Health Care Protection and Care of Quang Ninh officials The difference shows that customers care and appreciate the following issues: The Center implements policies and regimes for officials according to Decision No 806-QD/TU dated December

27, 2017 of the Standing Board of the Provincial Party Committee Quang Ninh on promulgating the Regulations on health care protection for cadres to which cadres are entitled

The observed variables of this group fluctuate from 3.56 to 4.71 and are quite good Including variable CD1: The Center implements policies and regimes for cadres according to Decision No 806-QD/TU dated December 27, 2017 of the Standing Board of Quang Ninh Provincial Party Committee on the promulgation of Regulations on protection and care staff health that staff enjoy, with the best rating and the lowest rating CI3: Payment of nursing leave in accordance with regulations, clearly and quickly As such, the Center for Protection and Care of Quang Ninh's cadres' health needs to coordinate well with the Organizing Committee of the Provincial Party Committee to come up with a payment plan for the staff in the fastest way, so that the cadres expect to improve customer satisfaction (table 4.22)

Table 4.22 Customer's perception of the factor Policy regime

Observable variables Average score Level

CĐ1 The Center implements policies and regimes for cadres according to Decision No 806-QD/TU dated December 27, 2017 of the Standing Board of the Quang Ninh Provincial Party Committee on the promulgation of the Regulations on health care protection for cadres that the officials and employees of the province are not aware of set of benefits

CĐ 2 Nursing leave in accordance with regulations 4.71 Rather

CĐ3 Payment of nursing leave in accordance with regulations, clearly and quickly 3.56 Rather

CĐ4 Annual medical examination and check-up, quality and results 4.36 Rather

CĐ5 Dispensing Medicines, functional foods in full quantity, high quality products, clear origin, good support for the treatment process

Source: Regression analysis results – Appendix 6

CONCLUSIONS AND PROPOSED

Conclusion and contribution of the topic

Today, along with the outstanding development in all aspects of social life, the need for health care is one of the top priorities of the people Meeting the health care needs of the people, medical facilities are increasingly growing in size and number, thereby creating strong competition between medical facilities in terms of facilities and expertise subject as well as service quality Talking about service quality is talking about customer satisfaction after experiencing the service Patient satisfaction is the biggest intangible asset of a medical facility, it is directly proportional to the sustainable development and growth of that medical facility Currently, periodic health checks and disease screening when there are no medical symptoms are very popular, the number of customers of medical facilities has also increased Currently, medical facilities have advantages but also bring challenges when the choices of customers are extremely diverse Customer satisfaction when using services at medical facilities is extremely important, determining the development of medical facilities in general and the entire health system in particular

Topic: "Factors affecting customer satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection", The process of survey, measurement and analysis accuracy gave reliable results This is the basis for hospitals in general and the Center for Health Care Protection and Care of Quang Ninh officials in particular to better understand the needs and assess the quality of the services the Center is providing Contributing to helping the Center come up with solutions to improve customer satisfaction, expand the medical service delivery model, create trust to keep old customers and aim to serve new customers

The scale of measuring factors affecting customer satisfaction using medical examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection after adjustment and supplementation is reliable

The main purpose of the study is to point out 5 factors affecting the satisfaction of customers who come for examination and treatment at Quang Ninh Provincial Center for Health Care and Protection, which are:

Among the 5 factors, through the coefficient to assess the level of satisfaction, the factor, the professional level has the strongest influence on customer satisfaction This is an objective result, because most customers using the service are interested in this issue, it determines the outcome of the medical examination and treatment process Specifically, the professional qualification factor has 3 observed variables: TĐ1, TĐ2, TĐ3

The second most important factor that affects customer satisfaction This group of factors includes 5 observed variables: CĐ1, CĐ2, CĐ3, CĐ4, CĐ5 However, the results of the patient's perception of this factor ranked at fourth place and at a good level

The third most important factor that affects customer satisfaction This group of factors includes 3 observed variables: UT1, UT2, UT3 However, the results of the patient's perception of this factor ranked in the third place and at a good level

The fourth important factor that affects customer satisfaction This group of factors includes 5 observed variables: TD1, DR2, DR3, TD4, TD5 However, the results of the patient's perception of this factor ranked at fourth place and at a good level

The first important factor that affects customer satisfaction This group of factors includes 5 observed variables: TD1, DR2, DR3, TD4, TD5 However, the patient's perceived results on this factor ranked fifth and at the best level

The research process on the topic "Factors affecting customer satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection" has contributed and given reasons for Additional basic theories for the research topic, measuring customer satisfaction This is the basis for future research projects at the Quang Ninh Center for Protection and Care of Officers' Health as well as other Centers in the National System of Employee Health Care and Protection and other institutions other health facilities

The research topic also helps clarify the factors affecting customer satisfaction using medical examination and treatment services, there are specific recommendations to improve customer satisfaction.

Implications of factors affecting customer satisfaction using medical

The level of patient satisfaction using examination and treatment services at the Quang Ninh Provincial Center for Health Care and Protection is influenced by many different factors In which, according to the research results of Chapter 4, 5 factors affect the level of customer satisfaction: Prestige, Professional qualifications, Service attitude, Policy regime Return results and advice

The results show the impact of these factors on customer satisfaction This is useful to the leaders of the Center for Health Care and Protection of Officials of Quang Ninh Province in particular and of the Centers of Health Care of Officers of the provinces and cities across the country in general Because these means will help to track and monitor the level of customer satisfaction From there, take positive measures to improve the factors with good influence, improve the factors with bad influence, in order to improve the level of customer satisfaction

From the research, the actual survey to assess the situation at the Center for Health Care and Protection of Quang Ninh officials, the author would like to propose some managerial implications to improve customer satisfaction such as: after:

This is one of the factors that are always the first concern of patients, directly related to the results after using medical examination and treatment services at the Center for Health Care and Protection of Quang Ninh officials The survey results show that the professional level of medical staff has an average level of satisfaction, so the Center needs administrative impacts to improve this factor even higher Specifically:

- Encourage and create conditions for medical staff to study to improve their professional qualifications, have a sense of responsibility at work, cultivate professional ethics, take the word TAM as the first in their work

- It is necessary to make regulations that force doctors to improve their qualifications and ensure information technology

- Sending representatives to participate in medical seminars to expand professional knowledge, access new knowledge, in order to best meet the needs of service providers

- Organizing scientific seminars on medicine to exchange experiences and expertise

- Recruit or train more experienced doctors in specialties such as: Dental - Jaw

- Facial, Radiology, Internal Medicine - Cardiology

- Establishing clubs for patients with chronic diseases: hypertension, diabetes, metabolic disorders, periodically organizing consultation sessions between patients and doctors, building a group of patients with chronic diseases common chronic diseases so that patients have the opportunity to connect with doctors at the same time, the doctor's disease prevention and treatment propaganda to patients in the most effective way

- Strengthen cooperation, exchange and learn from reputable large medical facilities on professional work including: treatment methods, treatment regimens combining drugs and functional foods during treatment treatment to maximize the benefit of the patient

Implement policies and regimes for cadres according to Decision No 806- QD/TU dated December 27, 2017 of the Standing Board of the Quang Ninh Provincial Party Committee on promulgating the Regulation on health protection and care according to regulations

- The Center cooperates with the Organizing Committee of the Provincial Party Committee to have a timely and convenient payment plan

- Annual health check up on schedule

This is the first factor that greatly affects the process of customers choosing to use the examination service at the Center or not The reputation of the Center is not built quickly but is a process of building prestige, trust and contribution

The center needs to contribute more to the health sector of the country, significantly reduce the number of patients in the province, achieve more achievements, participate in scientific research projects This is a factor that requires the Center to take specific measures to improve its reputation:

- Regularly update the Website to provide new information, new research, for customers to better understand the Center, this is a quick way to reach customers

- Encourage doctors to study the stories of Faculty I, Specialization II, in order to contribute knowledge and experience of medical examination and treatment, disease prevention, etc to the Health sector in general and the Center in particular

- Join charity associations, provide free medical examination and treatment for the poor, people in remote and isolated areas, join hands to help patients in difficult circumstances

- The reputation of the Center is built on trust, the quality of services provided, as well as the results after use The center must always ensure to minimize negligence in the provision of its examination and treatment services This is an important basis for building credibility in the hearts of customers

The level of customer perception of this factor is quite high, proving that customers are satisfied with the service style of the medical team and medical staff However, the Center still needs to promote further by the following measures:

- Regularly open training classes to raise awareness of doctors, nurses and staff on how to contact and relate to customers

- For individuals who often come into contact with patients, it is necessary to regularly learn and train communication skills classes, but important is body language such as friendly gestures, caring, smiling

- Care and help more elderly patients

- Promoting the role of implementing the Office Culture, each person who knows the ethical values in the behavioral culture will limit and avoid bureaucratic and harassing behavior

- Patients often want to sympathize with the worries they are experiencing, as well as expect to receive the dedicated and attentive attitude of the medical team, doctors and medical staff Therefore, patients' confidence will be increased when doctors visit, encourage, listen to their explanations This is a factor that helps patients feel secure and confident

- Need to clearly explain about the treatment drugs stated in the prescription

- Must resolutely handle violations, avoid negative situations

This is the factor that customers perceive the best of the 6 factors Besides, the Center needs to do better Some specific governance implications:

- The results of the patient's health examination must be kept confidential and stored by electronic medical records for convenience in health monitoring and care

Limitations and future research

First, this study only focuses on a narrow area, which is the Quang Ninh Provincial Center for Health Care and Protection The research survey was conducted only in some departments and nursing homes of provincial officials The scope is not extensive, the generality is not high The next research direction is to study at many centers in different provinces and cities across the country to ensure a broader, more complete survey, and a more representative sample

Secondly, the factors affecting the satisfaction of customers using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection always change according to the general development of medicine and medical needs human demand It is certain that there will be other factors about customer satisfaction when using medical examination and treatment services that the subjects have not yet learned about This is the research direction for the following topics

Third, this study only tests the scale through Cronbach Alpha reliability coefficient, EFA analysis method The model was tested by multiple linear regression To measure, evaluate and verify the scale, there are many more modern tools that can handle it This is a new direction for future research topics

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