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.

ĐẠI HỌC QUỐC GIA HÀ NỘI TRƯỜNG QUẢN TRỊ VÀ KINH DOANH

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ĐÀO THỊ THANH NGA

FACTORS AFFECTING THE SATISFACTION OF CUSTOMERS USING EXAMINATION AND TREATMENT SERVICES AT QUANG NINH PROVINCIAL CENTER FOR HEALTH CARE AND PROTECTION

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

LUẬN VĂN THẠC SĨ QUẢN TRỊ KINH DOANH

HÀ NỘI - 2022

ĐẠI HỌC QUỐC GIA HÀ NỘI TRƯỜNG QUẢN TRỊ VÀ KINH DOANH

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ĐÀO THỊ THANH NGA

FACTORS AFFECTING THE SATISFACTION OF CUSTOMERS USING EXAMINATION AND TREATMENT SERVICES AT QUANG NINH PROVINCIAL CENTER FOR HEALTH CARE AND PROTECTION

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

Chuyên ngành: Quản trị kinh doanh

Mã số: 8340101.01

LUẬN VĂN THẠC SĨ QUẢN TRỊ KINH DOANH

NGƯỜI HƯỚNG DẪN KHOA HỌC: PGS.TS NGUYỄN NGỌC THẮNG

HÀ NỘI - 2022

GUARANTEE

I hereby declare that this thesis is my own work The results stated in the Thesis have not been published in any other works The data and documents used in this thesis are collected from actual sources, ensuring accuracy, reliability and truthfulness

The factors affecting customer satisfaction are drawn by myself from the process of studying, in theoretical and practical research at the Center for Health Care and Protection of Quang Ninh officials, where I are working

Thank you very much!

THANK YOU

During the process of studying and implementing the thesis, I have received valuable help, suggestions and guidance from teachers and teachers in the Training Department (graduate department) of the School of Management and Business - Hanoi National University

To get the research results today, in addition to my own efforts and efforts, I

also received the thoughtful and dedicated guidance of Assoc Prof Dr Nguyen

Ngoc Thang who has directly guided me during the time of researching the topic

and writing the thesis

Along with that, I also received the help and facilitation of the Board of Directors, the Office of the Center for Health Care and Protection of Quang Ninh officials and colleagues in the agency

With a heart of gratitude, I would like to sincerely thank all the valuable help

of teachers, agencies, organizations and individuals./

Thesis author

Dao Thi Thanh Nga

TABLE OF CONTENTS

GUARANTEE i

THANK YOU ii

LIST OF TABLE vii

LIST OF FIGURE viii

CHAPTER 1: GENERAL INTRODUCTION 1

1.1 The urgency of the topic 1

1.2 Overview of research related to the topic 3

1.2.1 Research situation in the world 3

1.2.2 Research situation in Vietnam 5

1.3 Research objectives 11

1.3.1 Overall objective 11

1.3.2 Specific objectives 11

1.4 Research mission 12

1.5 Research subjects 12

1.5.1 Research subjects 12

1.5.2 Respondents 12

1.6 Research scope 12

1.6.1 Time range 12

1.6.2 Spatial scope 13

1.7 Research Methods 13

1.7.1 Qualitative method 13

1.7.2 Quantitative methods 13

1.8 Anticipated structure of the thesis 13

SUMMARY CHAPTER 1 13

CHAPTER 2: THEORETICAL BASIS ON CUSTOMER SATISFACTION 14 2.1 Theoretical basis of medical services and customer satisfaction 14

2.1.1 The concept of service 14

2.1.2 The concept of health services 15

2.1.3 Health service quality Health service 16

2.1.4 Health care concept 16

2.1.5 Customer concept 16

2.1.6 Customer satisfaction concept 16

2.2 The relationship between service quality and customer satisfaction 18

2.3 Factors affecting satisfaction 20

2.4 Research models 20

2.4.1 Relevant research models 20

2.5 Some research models on customer satisfaction about health services 25

2.5.1 Overseas research model 25

2.6 Proposed research model and research hypotheses 28

SUMMARY OF CHAPTER 2 30

CHAPTER 3: OVERVIEW OF QUANG NINH PROVINCE'S HEALTH CARE PROTECTION CENTERAND RESEARCH METHODS 31

3.1 Overview of the Center for Health Care and Protection Committee of Quang Ninh Province 31

3.1.1 History of establishment and development 31

3.1.2 Organizational structure 32

3.1.2.1 Functions and tasks of Quang Ninh Provincial Center for Health Care and Protection 33

3.2 Actual situation of examination and treatment at Quang Ninh Provincial Center for Health Protection and Care for Officials 39

3.3 Research Methods 39

3.3.1 Qualitative method 39

3.3.2 Quantitative methods 40

3.4 Build questionnaires and gauges 41

3.4.1 Build a questionnaire 41

3.4.2 Scale encoding 42

3.4.3 Sample survey 44

3.4.3.1 Sample size 44

3.4.3.2 Sampling method 45

3.4.4 Sample Summary 46

SUMMARY CHAPTER 3 50

CHAPTER 4: RESEARCH RESULTS 50

4.1 Determining factors affecting satisfaction 50

4.1.1 Evaluation of the scale by the reliability coefficient Cronbach alpha 50

4.1.1.1 Cronbach Alpha of the Center's Reputation Factor Scale Cronbach Alpha's Reputation factor 51

4.1.1.2 Cronbach Alpha of the factor scale Professional qualification 51

4.1.1.3 Cronbach Alpha of the factor scale Facilities 52

4.1.1.4 Cronbach Alpha of the service 54

4.1.1.6 Cronbach Alpha of the factor scale and post-examination counseling 56 4.2 Factor analysis and research model testing 58

4.2.1 Independent variable factor analysis 58

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 58

4.2.1.2 Factor analysis with dependent variable 66

4.2.1.3 Exploratory factor analysis 67

4.2.2 Research model testing 67

4.3 Determining the importance of factors affecting satisfaction through regression analysis 70

4.3.1 Linear regression model testing 70

4.3.2 Testing multivariable linear regression model 72

4.4 Analysis of satisfaction 72

4.4.1 Measuring satisfaction 72

4.4.2 Measure and evaluate the level of customer perception in each factor to satisfaction 75

4.4.2 Analysis of differences in satisfaction among customer groups 80

4.4.3.1 Check the difference in the perceived level of men and women about

satisfaction when using examination and treatment services 80

4.4.3.2 Examining the difference in perceived satisfaction between customers of different ages 82

4.4.3.3 Test the difference in perceived satisfaction among customers with different education 83

SUMMARY CHAPTER 4 84

CHAPTER 5: CONCLUSIONS AND PROPOSED 85

5.1 Conclusion and contribution of the topic 85

5.1.1 Conclusion 85

5.1.2 Contribution of the thesis 86

5.2 Implications of factors affecting customer satisfaction using medical examination and treatment services at the Center for Health Care and Protection of Patients in Quang Ninh Province 87

5.3 Limitations and future research 91

REFERENCES 93

LIST OF TABLE

Table 3.1 Distribution of questionnaires survey at Quang Ninh Provincial Center for

Health Care and Protection 45

Table 3.2 Statistics Based on Gender 46

Table 3.3 Age-Based 47

Table 3.4 Statistics based on age 47

Table 3.5 Statistics Based on Education 49

Table 4.4 Cronbach Alpha of the service Attitude factor scale 54

Table 4.8 KMO Test and Bartlett's 60

Table 4.9 Table of total variance extracted 60

Table 4.10 EFA factor analysis results 62

Table 4.11: KMO test and Bartlett's Test 63

Table 4.12 Table 64

Table 4.13 Rotation Factor Matrix 65

Table 4.14 KMO and Bartlett's Test 66

Table 4.17 Information statistics in the regression model by Enter 71

Table 4.18 Check the suitability of the multivariable linear regression model 72

Table 4.19 Customer's perception of the factors that return results and post-examination counseling 75

Table 4.20 Customer's perception of the element Service 76

Table 4.21 Customer's perception of the Center's Reputation factor 77

Table 4.22 Customer's perception of the factor Policy regime 78

Table 4.23 Customer's perception of the factor Professional qualifications 80

Table 4.25 Comparison table of mean satisfaction values between 2 groups of male and female patients 81

Table 4.26 Test whether there is a difference in perceived satisfaction among customers of different age groups 83

Table 4.27 Test of differences in perceived satisfaction among customers with different education 83

LIST OF FIGURE

Figure 2.1 Relationship between service quality and customer satisfaction 19

Figure 2.2 SatisfactionIndex (ACSI) 21

Figure 2.3 SERVPERF service quality 21

Figure 2.4 Integrated service quality model 23

Figure 2.5 model Service quality gap 24

Figure 2.6 Research 29

Figure 3.2 Statistics based on Gender 47

Figure 3.3 Statistics based on education level 50

CHAPTER 1: GENERAL INTRODUCTION

1.1 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

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

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

1.2 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

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

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

1.2.2 Research situation in Vietnam

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

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, Newspaper Taichinhdoanhnghiep.net, The article presents the results of research on

the status of satisfaction of patients and family members during medical examination and treatment at the Medical Examination Department of a number of public hospitals in Hanoi The author builds 15 observed variables and uses a Likert scale consisting of 5 levels to evaluate, thereby identifying problem groups with long, medium and short empathy distances The study was carried out with 140 patients and 140 family members visiting the study site for a period of 18 months Research results have shown that patients and family members are basically satisfied with the medical examination and treatment process, but there is still a sympathetic gap in the way doctors care, exchange information, listen to doctors, medical staff with patients and the willingness to provide information, a sense of cooperation to support the medical examination and treatment process

(6) Nguyen Thi Hoang Yen, Vo Hong Khoi, Nguyen Ngoc Hoa, (2021) Patient's satisfaction with nursing communication published in Vietnamese Medical Journal, volume 506, issue 01, the article states that: Nimproving the

communication attitude of nurses with patients in treatment care must always be focused on aiming at patient satisfaction because those things greatly affect the quality and effectiveness of care, a study to investigate the relationship between patient satisfaction with nurse communication, assess patient satisfaction with nurse communication at Neurology Center - Bach Mai Hospital since May February 2021

to June 2021 The study followed a descriptive cross-sectional method on 238

randomly selected subjects Data collected by questionnaires on patient satisfaction and nursing communication were developed and conducted by author Dinh Ngoc

Thanh on 197 inpatients at Thai Nguyen A Hospital [1] with a set of 36 completed questionnaires of 2 sets of questions on 5 points of the "Likert scale." With the questionnaire "Patient satisfaction with nursing communication", the rating score from 1 is very dissatisfied to 5 is very satisfied A high score indicates a high level of satisfaction As for the questionnaire "Nursing communication", the rating score from 1 is never to 5 is very often A high score indicates a high level of communication The resultsof the subjects participating in the study had an average age of 52.96 ± 16.4, female predominance (51.3%), marriage rate reached (88%), high concentration at educational level Level II and III (45.8 and 34.9%), the majority have health insurance (89.9%), the average hospital stay is 5-10 (48.3%) The average point of patient satisfaction is 4.33 ± 0.516, the average score of nursing communication: 4.20 ± 0.600 The results of the study show that patients have a high level of satisfaction with nursing communication

self-(7) Nguyen Thi Bich Hanh and Nguyen Duy Anh (2022) Survey on customer satisfaction about the quality of examination services at Hanoi Obstetrics and Gynecology Hospital 3 in 2021, published in the Journal of Medical Science and

Technology Nursing, Nam Dinh University of Nursing, Volume 5, No 1, 2022 A cross-sectional descriptive study of over 400 customers who visited the Hanoi Obstetrics and Gynecology Hospital 3 during the period from December 2020 to the end of the month 06/2021 Customer satisfaction was assessed based on a set of questions about the hospital's activities including: convenience in examination, cost

of examination, waiting time for examination, facilities for examination, and attitude and instructions of medical staff and general assessment of customers after examination Results 400 customers were the subjects of the study, mainly 18-35 years old (83.5%), and most of them were married Satisfaction rate about the criteria of convenience in examination, examination cost, waiting time, facilities, attitude and guidance of medical staff all reached over 50% Regarding the mental state after completing the medical examination, 63 customers rated satisfaction as satisfied and 33.5% rated as very satisfied Conclusion Most of the customers who come for medical examination and treatment at Hanoi Obstetrics and Gynecology

Hospital at the 3rd base rate are satisfied to very satisfied with the quality of services and facilities Waiting time for medical examination and results, the layout

at the examination department and the cost of services at the Hospital are factors evaluated with lower satisfaction than other factors Therefore, there needs to be a change in the stream of medical examination and treatment and closer coordination between nurses and doctors at the clinic to reduce waiting time for customers and thereby improve the quality of examination services Healing

The above is one of many case studies on surveying, assessing patient satisfaction, factors affecting patients when examining and treating at hospitals The authors have applied the most general theories of satisfaction, service quality evaluation models From there, apply to the actual situation and research topic to come up with their research models Thereby, processing and analyzing the investigated data and drawing conclusions for the study

* Conclusions about research projects in Vietnam and the world

From researches in Vietnam and around the world, we can see that, in all activities of providing services and goods, customers are always the central subject Since then, customer satisfaction when using and experiencing services is a key factor leading to success in all production, business activities or service provision of the economy economic Especially for the healthcare industry, customer satisfaction and trust is the only basis for the hospital to operate sustainably As life develops, health is the top concern of people, thereby opening up development as well as competition in medical service providers and healthcare providers , since then, customer satisfaction measures are a popular tool for service providers to re-evaluate their entire service delivery process, the bad points and the factors that did well to continue to expand and develop The factor of customer satisfaction using the service is taken into account first

by the administrator because it is the shortest way to make customers return and use the service for a long time, in addition to customer satisfaction and trust The product is an effective advertising tool for the service provider itself

Summarizing the topics of domestic and foreign studies, most of them use Cronbach's alpha, EFA tools and multiple regression analysis to investigate the

criteria of patient satisfaction with the listed criteria predefined service provider The above data analysis tools are highly accurate and suitable for surveying data, but the criteria for assessing customer satisfaction have so far changed due to demand and ability Customers' requirements are increasingly diversified, customers are increasingly diverse, and the requirements for customer service experience are also increasingly differentiated and stratified

Derived from the reality of working at the Provincial Center for Health Care and Protection of Provincial Officials, which provides medical examination and treatment for subjects who are cadres and people with meritorious services to the revolution This is a group of subjects with a small number in the society who are entitled to the regime and the leaders of Quang Ninh province are particularly interested and grateful Up to now, there has been no research applied to this group of

subjects, so I conducted a research on the topic: “Factors affecting customer

satisfaction using examination and treatment services at Quang Ninh Provincial Center for Health Care and Protection” to survey the satisfaction level of officials

(patients) who come for examination and treatment at the Center for Health Care and Protection of Quang Ninh officials The research results of the topic will be a reference for the Quang Ninh Provincial Center for Health Care and Protection to make changes

to better suit the actual requirements as well as bring a better experience of using the service the best service for cadres in the future

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

1.4 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

1.5 Research subjects

1.5.1 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

1.5.2 Respondents

- 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

1.6 Research scope

1.6.1 Time range

The study was carried out from May 2022 to October 2022

1.8 Anticipated structure of the thesis

Thesis consists of 5 chapters

SUMMARY CHAPTER 1

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

CHAPTER 2: THEORETICAL BASIS ON CUSTOMER SATISFACTION

2.1 Theoretical basis of medical services and customer satisfaction

2.1.1 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 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”

behind-the-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

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

2.1.2 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

2.1.3 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

2.1.4 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

2.1.5 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

2.1.6 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

2.2 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, 1985) 1988)

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

(Spreng and Mackoy, 1996)

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,

Expected

quality

Service quality

Perceived quality

Satisfactio

n

Needs are met

Unmet need Expected

quality

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

2.3 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

2.4 Research models

2.4.1 Relevant research models

* ASCI model

ACSI - The American Customer Satisfaction Index model is developed based

on the Swiss model, ACSI was developed by Claus Fornell (Fornell et al., 1996)

Figure 2.2 SatisfactionIndex (ACSI)

(American Customer Satisfaction Index – ACSI)

* SERVPERF service quality model

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

SERVPERF service quality model

Figure 2.3 SERVPERF service quality

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

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

Service quality expectations

Figure 2.4 Integrated service quality model

Source: Brogowicz et al (1990)

Service parameters provided

Planning, implementing and controlling marketing st

Defining the company's mission and goals

24

* Service quality model (Parasuraman)

Figure 2.5 model Service quality gap

Source: Parasuraman et al (1985)

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

Service expectations

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)

2.5 Some research models on customer satisfaction about health services

2.5.1 Overseas research model

* According to Lekidou Ilia and Trivellas Panagiotis: “Patient

satisfaction and quality of care: an experimental study in a central Greek hospital”

Limitations of the topic

This study measures patient satisfaction through 3 factors:

- The care of doctors, nurses, midwives

- Effectiveness of care

- 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)

Limitations of the topic

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

Limitations of the topic

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

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:

Limitations of the topic

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;

Source: Tang Thi Luu (2011)

Limitations of the topic

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

2.6 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:

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

SUMMARY OF CHAPTER 2

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