Đang tải... (xem toàn văn)
Những đóng góp mới về mặt lý luận (1) Luận án đã chỉ ra được các yếu tố đo lường chất lượng dịch vụ y tế tại bệnh viện công, tập trung vào chất lượng chức năng liên quan đến cách thức cung ứng dịch vụ y tế của bệnh viện. Mô hình nghiên cứu được xây dựng trên cơ sở tổng hợp nhiều nghiên cứu trước đây về chất lượng dịch vụ, trong đó có dịch vụ y tế. Tác giả đã áp dụng mô hình đo lường chất lượng dịch vụ của Parasuraman để đo lường chất lượng dịch vụ y tế tại bệnh viện Đa Khoa Trung Ương Thái Nguyên (nay là bệnh viện Trung Ương Thái Nguyên), xây dựng thang đo chất lượng dịch vụ dựa vào thang đo SERQUAL để tiến hành thu thập số liệu sơ cấp về mong đợi và cảm nhận cũng như sự hài lòng của người bệnh trong quá trình sử dụng dịch vụ y tế tại bệnh viện. Các yếu tố đưa ra trong khung phân tích của luận án là sự kết hợp hợp lý của các yếu tố ảnh hưởng đến chất lượng dịch vụ y tế tại bệnh viện. Những điểm mới về kết quả nghiên cứu (2) Kết quả nghiên cứu của luận án cho thấy rằng chất lượng dịch vụ y tế tại bệnh viện công như bệnh viện Trung Ương Thái Nguyên được đánh giá thông qua 5 yếu tố bao gồm Sự tin cậy, Sự phản hồi, Sự cảm thông, Tính hữu hình và Sự đảm bảo. Năm nhân tố trên đã được xắp xếp theo mức độ quan trọng dựa vào kết quả phân tích của mô hình hồi quy tuyến tính trên cơ sở phân tích số liệu sơ cấp được điều tra tại bệnh viện. Các nhân tố trên đều có tác động cùng chiều đến chất lượng dịch vụ y tế công tại bệnh viện thông qua sự thay đổi tích cực đến nhận thức về chất lượng dịch vụ và sự hài lòng của người bệnh. Sự hài lòng của người bệnh cũng có tác động tích cực đến lòng trung thành và đến lượt mình, sự trung thành của người bệnh là cơ sở cho việc nâng cao chất lượng và sự phát triển bền vững của bệnh viện. (3) Nghiên cứu gợi ý rằng, để nâng cao chất lượng dịch vụ y tế, bệnh viện cần có những thay đổi tích cực nhằm thay đổi nhận thức về sự cảm nhận chất lượng dịch vụ của người bệnh, qua đó làm họ hài lòng hơn, thỏa mãn hơn và sẽ tiếp tục sử dụng dịch vụ của bệnh viện trong tương lai. Bên cạnh đó, cần xây dựng bộ tiêu chí đánh giá chất lượng phù hợp, tập trung và đặc biệt ưu tiên việc cải tiến hệ thống quản lý chất lượng bệnh viện, một yếu tố quan trọng đối với các bệnh viện trong giai đoạn hiện nay, khi mà sự mong đợi của người bệnh ngày càng cao. Bệnh viện cũng cần chú ý đến việc đầu tư cải tiến chất lượng dịch vụ thông qua các nhân tố trong mô hình đánh giá chất lượng dịch vụ (SERVQUAL) từ việc thay đổi nhận thức và thái độ phục vụ của nhân viên y tế, đầu tư thêm trang thiết bị hiện đại, nâng cao tinh thần trách nhiệm, sự cảm thông đối với bệnh nhân đến sự đảm bảo dịch vụ về tính chính xác và hiệu quả. KHẢ NĂNG ỨNG DỤNG TRONG THỰC TIỄN VÀ NHỮNG VẤN ĐỀ BỎ NGỎ CẦN TIẾP TỤC NGHIÊN CỨU * Khả năng ứng dụng trong thực tiễn Kết quả nghiên cứu giúp bệnh viện xác định được những điểm mạnh, điểm yếu và sự hài lòng của người bệnh. Phân tích từ mô hình đánh giá chất lượng dịch vụ (SERVQUAL) chỉ ra rằng các yếu tố đưa ra trong mô hình nghiên cứu có tác động tích cực và cùng chiều đến nhận thức về chất lượng dịch vụ y tế của người bệnh thông qua sự hài lòng của họ. Bệnh nhân càng hài lòng thì chất lượng dịch vụ càng được đánh giá cao. Ban giám đốc bệnh viện có thể thấy được những điểm mạnh, điểm yếu trong việc cung ứng dịch vụ y tế để có các biện pháp cải tiến chất lượng dịch vụ, nâng cao năng lực cạnh tranh của bệnh viện để tận dụng một cách tối ưu các nguồn lực nhằm đáp ứng tốt hơn nữa nhu cầu của người bệnh. Bệnh nhân có cơ hội để bày tỏ quan điểm và ý kiến của mình trong việc đánh giá chất lượng dịch vụ, góp phần cải tiến hơn nữa chất lượng dịch vụ y tế công tại bệnh viện. Nghiên cứu có những đóng góp về mặt lý luận và học thuật cho công chúng về chất lượng dịch vụ nói chung và chất lượng dịch vụ y tế nói riêng, giúp họ nâng cao nhận thức về chất lượng dịch vụ y tế, nhìn nhận đúng hơn về quyền và nghĩa vụ của mình khi tham gia dịch vụ y tế. Trong thực tế, các nhà cung cấp dịch vụ y tế cần đo lường chất lượng dịch vụ y tế và sự hài lòng của người bệnh bời vì điều này có mối quan hệ chặt chẽ với các vấn đề nhạy cảm của bệnh viện và uy tín của bệnh viện trên thị trường. Bằng cách phát hiện được những mảng thiếu sót qua mô hình đo lường chất lượng dịch vụ, các bệnh viện sẽ sử dụng tối ưu hơn các nguồn lực hiện có và làm hài lòng người bệnh với các dịch vụ mà mình cung ứng. Sự hài lòng của người bệnh về chất lượng dịch vụ sẽ là điều kiện cơ bản để họ tái sử dụng dịch vụ và giới thiệu cho người khác cùng sử dụng dịch vụ của bệnh viện. * Những vấn đề bỏ ngỏ cần tiếp tục nghiên cứu Các nghiên cứu trong tương lai có thể làm với phạm vi rộng hơn và có sự so sánh với các bệnh viện công ở các quốc gia khác có điều kiện tương tự Việt Nam. Các tác giả cũng có thể tập trung vào việc xây dựng thêm các thang đo mới để đo lường chất lượng dịch vụ y tế hoặc thêm một số khía cạnh khác phản ánh kết quả trong quá trình thực hiện dịch vụ y tế. Các tác giả cũng có thể tập trung nghiên cứu chất lượng dịch vụ y tế trên quan điểm của người cung ứng dịch vụ. Để có được những hiểu biết sâu sắc hơn, tác giả có thể nghiên cứu thêm về vấn đề chất lượng dịch vụ y tế trong khu vực tư nhân và tiến hành so sánh giữa chất lượng dịch vụ y tế công. Việc hỏi bệnh nhân về mong đợi và cảm nhận của họ về chất lượng dịch vụ cùng một lúc có thể gây nhầm lẫn, các nghiên cứu sau có thể hỏi người bệnh về mong đợi tại thời điểm bệnh nhân nhập viện, sau đó hỏi lại họ về mức độ cảm nhận khi họ sắp ra viện. Điều này sẽ tránh được sự nhầm lẫn giữa mong đợi và cảm nhận của bệnh nhân, tuy nhiên sẽ đòi hỏi nhiều thời gian và công sức hơn. THE NEW SCIENTIFIC FINDINGS New academic and theoretical contribution of the dissertation as follow: (1) The dissertation points out the factors measuring public health service quality in hospital with focusing on functional quality which relates to the manner of delivery of health-care services. The research model is derived from the combination of previous research models, especially applying model of measuring service quality of Parasuraman. The author use SERVQUAL to measure health service quality at health care sector in Thainguyen National Hospital through the patients’ satisfaction. The factors in the conceptual framework are reasonably selected to measure service quality public health services of hospital. Findings and new recommendations from the research results (2) The research results of the dissertation have shown the health service quality are evaluated by five main factors according to their level of importance: Reliability, Responsiveness, Empathy, Tangibility, and Assurrance . The five factors mentioned-above have a direct impact in the same way on patient satisfaction and indirect impact in the same direction on patient loyalty in public health service of Thainguyen National Hospital. Satisfaction has a big impact on patient loyalty, and in turn patient loyalty serves as a basis for a sustainable development of health service of hospital. (3) In order to get better quality of health service, the hospital need to satisfy patient demand through changing their perceived of service quality, thus getting their loyalty. Besides the development of instructor quality, the hospital needs to pay more attention and take priorities in improving the quality management system, one of the indispensable activities and becoming increasingly more important in health facilities in the current period, when the patient''s expectations are higher and higher. The hospital also needs to put their attention in investing in and improving the quality according to the application of five factors in SERQUAL model including: Responsiveness - Empathy - Reliability - Tangibles - Assurance. PRACTICAL APPLICABILITY AND RECOMMENDATIONS FOR FURTHER STUDIES * Practical applicability The study findings help to identify and highlight the weaknesses in health care service of hospital and how is patients ‘satisfaction. The analysis of SERVQUAL model indicates that all patient satisfaction dimensions positively and significantly contributes to patient satisfaction and which also act as an important mediating factor between the satisfaction dimensions and service quality. Hospital’s board of manager can find their strengths and weakness in delivering health services, improving their services quality and enhancing competition capacity of hospital to utilize resources and meet the need of patients. The patients would have chance to express their opinion to contribute to the continuously improvement of health care services in public hospital. The study is also expected to add knowledge about health care services to the public. This will help the public recognize and appreciate health care services. On a practical note, healthcare providers need to measure health service quality and patients ‘satisfaction due to its high correlation with issues essential to the hospital bottom-line and the reputation of the hospital in the market. By identifying defective areas through implementation of the scale and the model, the service provider could address each need and reallocate resources accordingly thus aiming to improve patients’ perceptions and eventually satisfaction with the services provided by the hospital. And since patient‘s satisfaction has been strongly linked to future purchase and recommendation behavior in the current research, this stresses the importance of measuring patient satisfaction in hospitals in accordance with the hospital quality. * Recommendations for future studies Future research may cover wider range with the comparisons of different hospitals or in different countries. The researcher could also add more dimensions to measuring the outcome of healthcare services or develop a new scale for evaluating the quality of services in health care sector. The researcher also focuses on the providers’ point of view in assessing quality of health care services. For the further understanding of health care services, researcher may study quality of these services in the private sector and make the comparison between them. Asking patients about expectations and perceptions at the same time can cause confusion. Future research should ask the patient about the expected moment of admission, and then asked about the perception of the patient after they have experienced the service. This requires more time and effort, but can get better results. There should be regular evaluation, continuously conducting to improve the quality of hospital services, better meet the needs of the patient.
PUBLIC HEALTH SERVICE QUALITY AT THAI NGUYEN NATIONAL GENERAL HOSPITAL A Dissertation Proposal Presented to the Faculty of the Graduate Program of the College of Arts and Sciences Central Philippine University, Philippines In Collaboration with Thai Nguyen University, Vietnam In Partial Fulfillment of the Requirements for the Degree DOCTOR IN PUBLIC ADMINISTRATION NGUYEN THI LAN ANH December, 2016 ii TABLE OF CONTENTS ACKNOWLEDGEMENTS i TABLE OF CONTENTS ii LIST OF TABLES iv LIST OF FIGURES v LIST OF ABRIVIATIONS vi ABSTRACT vii CHAPTER I THE PROBLEM AND ITS SETTING 1.1 Background and Rationale of the Study 1.2 Objectives of the Study 1.2.1 General objective 1.2.2 Specific objectives 1.3 Hypothesis of the study 1.4 Theoretical Framework 1.4.1 Donabedian‘s Model (1988) 1.4.2 Measuring service quality: SERVQUAL model 1.5 Conceptual Framework 11 1.6 The Operational Definition of Variables and other Terms 13 1.7 Significance of the study 15 1.8 Scope and Delimitation 16 1.8.1 Scope of the study 16 1.8.2 Delimitation 16 CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES 17 2.1 Review of related literature 17 2.1.1 The concept of public health service 17 2.1.2 Quality of public health services 19 2.1.3 Factors affecting health service quality 25 2.1.4 Measuring the quality of healthcare service 27 2.1.5 Patients‘ satisfaction 30 2.1.6 Service quality and Relationship with Customer Satisfaction 31 2.2 Review of Related Studies 33 CHAPTER III METHODOLOGY 42 3.1 Research Design 42 3.2 Population, Sample Size and Sampling Technique 44 iii 3.3 Research Instrument 46 3.3.1 Delphi study 46 3.3.2 Cronbach's Alpha 46 3.3.3 Likert Scale 47 3.3.4 Exploratory Factor Analysis (EFA) 48 3.3.5 Analysis of variance (ANOVA) 52 3.4 Ethical Considerations 52 3.5 Data Gathering Procedure 53 3.6 Data Processing and Data Analysis 54 CHAPTER IV DATA PRESENTATION, ANALYSIS AND INTERPRETATION 57 4.1 Some health care indicators in Thainguyen province 57 4.2 General information of Thai Nguyen National Hospital 59 4.3 Current status of public health services at Thai Nguyen National Hospital 67 4.4 Survey results about health services at Thainguyen National Hospital 71 4.4.1 General information of surveyed department 71 4.4.2 General information of respondents 74 4.4.3 Analysis of service quality through SERVQUAL model 77 4.4.4 Exploratory Factor Analysis (EFA) according to the patient‘s perception 88 4.4.5 Regression analysis 97 4.4.6 Analyzing the difference in accordance with personal characteristics 100 CHAPTER V CONCLUSION AND POLICY RECOMMENDATION .104 5.1 Summary of findings 104 5.2 Conclusions 109 5.3 Policy recommendations 111 REFERENCES .117 APPENDIX 121 iv LIST OF TABLES Table 2.1 Summary of service quality (SQ) definition 24 Table 2.2 Types of quality measures 28 Table 2.3 Summary of related studies according to methods and factors in measuring health service quality 39 Table 3.1 Research scheduling and respondent‘s distribution 45 Table 3.2 Scale of Cronbach's Alpha 47 Table 3.3 Likert scale 47 Table 3.4 The process variables measured by Likert scale 48 Table 3.5.Coding factors and items for EFA analysis 51 Table 4.1 Labor structure of TN hospital 63 Table 4.2.Quality score in level of measurement 70 Table 4.3.General Information of departments 72 Table 4.4 Residential of respondents 75 Table 4.5 Classification of respondents according to reasons of choosing hospital 75 Table 4.6 Demographic characteristics of respondents 76 Table 4.7 Expectation and perception of Tangibility dimension 77 Table 4.8 Expectation and perception of Reliability dimension 79 Table 4.9 Expectation and perception of Responsiveness dimension 80 Table 4.10 Expectation and perception of Assurance dimension 82 Table 4.11 Expectation and perception of Empathy dimension 83 Table 4.12 Expectation and perception of overall dimensions 87 Table 4.13 Test of reliability by Cronbach‘s alpha coefficient 88 Table 4.14 Rotated Component Matrix (a) – first rotated time 90 Table 4.15 Rotated Component Matrix – second rotated time 91 Table 4.16 The structure of the scale after the 2nd factor analysis 92 Table 4.17 Results of Cronbach's alpha coefficient after extracting factors 94 Table 4.18 Component Score Coefficient Matrix 95 Table 4.19 Model Summary 97 Table 4.20 Coefficients (a) 98 Table 4.21 ANOVA (b) 98 Table 4.22 Summary of Residuals Statistics (a) 99 Table 5.1 Comparing Dimensions of service quality of the study with theories 107 v LIST OF FIGURES Figure 1.1 Donabedian‘s model in assessing quality of health services Figure 1.2 Model of service quality by PZB 10 Figure 1.3 Modified SERVQUAL model in health care sector 12 Figure 1.4 The conceptual Framework 12 Figure 2.1 Health care environment – setting system regulation 21 Figure 2.2 Factors affecting services quality of Parasuraman 26 Figure 3.1 Research process 44 Figure 3.2 Model of factor affecting service quality at TNH 49 Figure 4.1 Averge Yearly per capita GDP of Thainguyen and Vietnam 57 Figure 4.2 Health personnel density and Hospital bed density of Thainguyen 58 Figure 4.3 Image of Thai Nguyen National Hospital 59 Figure 4.4.Organizational structure of Thai Nguyen National Hospital 62 Figure 4.5 Number of patient from 2013 to 2015 68 Figure 4.6 Total quality score of hospital according to 83 criteria 69 Figure 4.7 Radar chart of quality score in aspects of hospital quality 70 Figure 4.8 Figure of quality improvement in 2014 and 2015 via radar chart 71 Figure 4.9 Examination process maps 73 Figure 4.10 Electronic Table Name 73 Figure 4.11 Electronic transport system for patients 74 Figure 4.12 Survey result of using Health Insurance Card (HIC) 74 Figure 4.13 Expectation and perception of Tangibility dimension 78 Figure 4.14 Expectation and perception of Reliability dimension 79 Figure 4.15 Expectation and perception of Responsiveness dimension 81 Figure 4.16 Expectation and perception of Assurance dimension 83 Figure 4.17 Expectation and perception of Empathy dimension 84 Figure 4.18 Expectation and perception of dimensions 85 Figure 4.19 Satisfaction level of dimensions 101 vi LIST OF ABRIVIATIONS E P W t IT QI SD VN CV Expectations Perceptions Weighted Time Information Technology Quality Improvement Standard Deviation Vietnam Coefficient of Variation EHR GDP IMS HIC PZB QIP TNH JCI EFA VND Electronic Health Record Gross Domestic Products Indicator Measurement System Health Insurance Card Parasuraman, Zeithaml and Berry Quality Indicator Project ThaiNguyen National Hospital Joint Commission International Exploratory Factor Analysis Vietnam Dong USD SPSS TAN REL RES ASS EMP SAT GSO United States Dollar Statistical Package for the Social Sciences Tangible Reliability Responsiveness Assurance Empathy Satisfaction General Statistics Office WHO NHS KMO VIF ANOVA SERVQUAL SERVPERF World Health Organization National Health Service Kaiser-Meyer-Olkin-Kriterium Variance Inflation Factor Analysis of Variance Service Quality Service performance vii ABSTRACT While quality in tangible goods has been thoroughly described and measured by marketers, quality of services has yet a lot to be done Accurate measurement of service quality as perceived by patients has yet to reach a consensus for healthcare organizations Quality has not happen by chance; it needs to be systematically developed with objective planning, staff involvement and considering patient need Today for the health service market in Vietnam and the all over the world, there is a need for a health service quality model that takes into consideration a complete coverage of the dimensions that consumers use in evaluating healthcare service quality The research to be conducted focuses on service quality, patient satisfaction and intentions to return, and the consumer role in the health care service encounter The main objective of this research was to formulate and empirically investigate a fully tested and applicable healthcare service quality model that encompasses the criteria patient use in evaluating health services in Thainguyen province for public sector hospitals Also, research aims to provide a valid and reliable scale with which healthcare providers can use for measurement of the service quality in their organizations The research was composed of two phases The first phase aimed to assess health service quality through SERVQUAL model using questionnaire and through a secondary data gathering process, qualitative interviews with experts and Thainguyen patients The second phase was a full-fledged quantitative survey to test and verify the quality of health service through EFA model and the scale developed for the health care market at Thai Nguyen National Hospital The first phase has enabled the researcher to achieve several goals The in-depth interviews with patients enabled gathering their insight on what are the factors that patients expected and perceived in their recent hospital experience and the secondary data gathering process identified the dimensions uncovered by previous researchers for healthcare service quality A tentative questionnaire was constructed based on this and was further refined through the pilot study and the in-depth interviews with healthcare experts This further developed the previous preliminary questionnaire and model constructs and final modification were done on the questionnaire format preparing it for the next phase of quantitative data collection The second phase enabled the researcher to establish a healthcare service quality model for public hospital as Thainguyen National Hospital in the field functional quality aspect The researcher was able to determine the underlying constructs and sub-constructs viii of healthcare service quality as well as determining which of the sub-constructs have greater impact on the patients ‗overall perception of service quality in the hospital Several relationships were also uncovered between the variables of the patients‘ satisfaction, intention to return and recommend value for money Finally, the role of demographics as a discriminating variable was also established to test whether existed the differences in satisfaction between vary age, income and education groups Marketers can use the model and the scale to evaluate patient perceptions from their health service providers and thus be used as a valuable tool to identify and elevate the level of services in areas that need to be addressed This will ensure a higher level of patient satisfaction and thus ensuring loyalty, repeat patronage and positive recommendation behavior, which is the ultimate goal of health service providers Thus the current research could prove invaluable for improving the level of services in areas defected by the consumers of the service The research findings will help to identify and highlight the weaknesses in health service of hospital and how services quality in the hospital was The analysis of the models indicates that all patient satisfaction dimensions positively and significantly contributes to service quality and which also act as an important mediating factor between the satisfaction dimensions and patient loyalty Hospital‘s board of manager will find their strengths and weakness in delivering health services, improving their services quality and enhancing competition capacity of hospital to utilize resources and meet the need of patients Patients will have chance to express their opinion to contribute to the continuously improvement of public health care services CHAPTER I THE PROBLEM AND ITS SETTING 1.1 Background and Rationale of the Study Health quality can be defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Institute of Medicine, 2001) Major health care quality concerns (such as patient safety and effectiveness of care) are basically the same across different types of countries In a low – income country like Vietnam, quality related problems are much more prevalent Major factors that cause health care quality problems in Vietnam are: Lack of sufficient management (clinical and administrative); Inadequate medical staffs and training; Weak performance monitoring systems; Non-empowered patients and families Once we can assess the relative appropriateness and effectiveness of health services, we can provide optimal care to patients and maximize our use of scarce resources Because of increasing competition, service providers and more demanding patients, service quality has become a watchword for healthcare service providers but as yet has proven difficult to measure Service quality has been directly linked to repeat sales, positive word-of-mouth and recommendation Consumer satisfaction is directly linked to service quality thus perceived quality, patient satisfaction and behavioural intentions are concepts of foremost importance to healthcare marketers (Ross et al., 1987; John Joby, 1992; Paul, 2003) There exists number of shortcomings in medical policies and medical services mechanisms in Vietnam Large investment resources but effective use of resources to supply medical services doesn‘t meet practical requirements posed Currently, people assess the quality of health services are implemented only sensible levels, mainly through external audio visual facilities and the behaviour, reception and care of medical staffs As for the quality of technical, medical science, in fact, underestimate people The provision of health services is now revealing many negative issues such as drug abuse, chemical, laboratory to the attitude, spirit of service, ethics It was real severe economic and popular in many establishments providing health services, both public and private sector (Tran Tuan - Director of the Centre for Research and Training Community Development, Vietnam Union of Science and Technology Associations) Vietnam‘s health sector hasn‘t met the criteria of both quantity and quality of health services for the people The accessibility of people to health services is very difficult, especially for the poor, near poor and remote populations Inequality in the supply and beneficiaries of health services tends to increase Mechanisms and policies in managing operating health sector are inadequate Management information system for health care is not comprehensive and overlaps Quality management system of health services as well as quality inspection of health services in both the public sector and private sector remains weak The management of drug prices in hospitals is inadequate push higher drug costs put pressure on hospital charges for patients (Truong Bao Thanh, 2013) Vietnamese health sector is facing with an imbalance in the demand for health care among central hospitals and local people in the provinces and cities nationwide Demand for health care is increasing, whereas, only a few hospitals in the big city have capabilities to deal with Especially over the last 10 years, the phenomenon of hospital overcrowding has worsened and appeared at all levels The situation of combining 2-3 patients a bed; clinic doctor must examine 60-100 patients per day is common in Central National, provincial hospitals and becomes a priority health issue, an urgent concern of the health sector as well as the entire society needs to be addressed The utilization rate of over 100 % regular beds and ranged from 120 % to 150 %, even up to 200% in some large hospitals (Le Quang Cuong et al., 2011) According to Vietnam health statistics, there are about 40,000 Vietnamese people go overseas for treatment every year They spent more than billion USD for their treatment in developed countries such as Singapore, South Korea, the US, France, and Thailand This figure is estimated to rise to 50,000 people by 2016 Doctors in Vietnam are considered as not inferior to the advanced countries mentioned above It is caused by overworked staff, poor service quality, and complex administrative procedures; cumbersome A survey of over 700 patients taken by VN Express in Vietnam showed that 57 % Vietnamese people not want to use the services of hospitals in the country by the attitude and ethics of the medical staffs It is raising a question of ―Does the medicine of our country have won the confidence of the patient?‖ Medical service is a very special service In essence, health service includes activities performed by medical staff as health examination and treatment for patients and families (Journal of Marketing, 2009) Institute of Medicine (2001) defines quality of health care is the degree to which the health services are provided to individuals and the population to increases the desire of health outcomes and match current professional knowledge Quality of health services will determine the existence of hospital and can be measured through the patients‘ satisfaction Previously, it is thought that the evaluation and quality assurance is limited in developed countries (Thomason & Edwards, 1991), in the developing countries; the problem of improving 124 EMP21 Hospital give patients individual attention EMP22 Employees of hospital understand the needs and wants of patients EMP23 All procedures of health care service in hospital are easy and convenient for patients EMP24 Health service in hospital have operating hours and communication space convenient to all their customers EMP25 No discrimination between HIC and paired fee patients PART 2: PERCEPTIONS A TAN1 Tangible (TAN) Thai Nguyen National Hospital has modern equipment TAN2 The physical facilities at the hospital are visually appealing TAN3 Employees are neat appearing at hospital TAN4 Materials associated with the health care service are visually appealing and clean TAN5 Parking facilities enabled patients to access hospital without undue effort B REL6 Reliability (REL) Health care service of Thai Nguyen National hospital have reliable REL7 The nurses and doctors treated patients with dignity and respect REL8 High quality of doctor and medical staffs REL9 The hospital provides services at the time they promise to so REL10 The hospital keeps patient‘s information and complains on record and keep it secret 125 REL11 Patients were informed of any risks associated with the procedure for any procedures of tests that were recommended to patients‘ related health issues C RES12 Responsiveness (RES) Employees of hospital tell patients exactly when services will be performed RES13 If patients had pain while at the hospital, staffs did everything they could to control the pain RES14 Employees of hospital always be willing to help patients RES15 Employees of hospital have hotline respond to customers‘ requests RES16 Employees of Thai Nguyen C hospital will give prompt service to patients D ASS17 Assurance (ASS) Employees of hospital have the knowledge to answer customers‘ questions quickly and exactly ASS18 Employees of hospital always polite and friendly and gets on well with patients ASS19 The fees applied were reasonable in relation to what other hospital charge for similar services ASS20 Customers (patients and their family) of TN National General hospital feel comfortable in health care services E Empathy (EMP) EMP21 Hospital give patients individual attention EMP22 Employees of hospital understand the needs and wants of patients EMP23 All procedures of health care service in hospital are easy and convenient for patients EMP24 Health service in hospital have operating hours and communication space convenient to all their 126 customers EMP25 No discrimination between HIC and paid fee patients Overall Patient Satisfaction (SAT) SAT26 Overall, I am satisfied with hospital service SAT27 I should definitely choose this hospital again if I need it in the future SAT28 I should recommend this hospital to a friend or relative Recommend for Health care service of hospital ………………………………………………………………………………………………… ………………………………………………………………………………………………… ……………………… Thank you for your support! 127 Appendix 2:FOCUS GROUP DISCUSSION The following section lists the five features concerning hospitals and services of hospital We would like to know how important each feature is when evaluating a Hospital's service quality Please allocate a total of 100 points among the five features according to how important each feature is to you The more important the feature, the more points you should allocate to it Please ensure that the sum of points you allocate to the five features add up to 100 SERVQUAL IMPORTANCE WEIGHTS TANGIBLE: The appearance of Thai Nguyen National Hospital …….points physical facilities, equipment, personnel, and communication materials RELIABILITY: Thai Nguyen National Hospital ability to perform the …… points promised healthcare service dependably and accurately RESPONSIVENESS: Thai Nguyen National Hospital‘s staff‘s …… points willingness to help customers and provide prompt services ASSURANCE: The knowledge and courtesy of the healthcare service …… points employees and their ability to convey trust and confidence EMPATHY: The caring, individual attention the health care service …… points provides to patients Total 100 points Thank you for your support! 128 Appendix 3: RESULTS OFQUANTITATIVE ANALYSIS 3.1.TEST OF RELIABILITY 3.1.1 TANGIBLE Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 761 N of Items 768 Item Statistics Mean Std Deviation N A_1 3.6812 72372 367 A_2 3.6785 78938 367 A_3 3.6894 72162 367 A_4 3.6785 77188 367 A_5 3.7493 72605 367 Inter-Item Correlation Matrix A_1 A_2 A_3 A_4 A_5 A_1 1.000 097 914 246 492 A_2 097 1.000 146 274 193 A_3 914 146 1.000 316 576 A_4 246 274 316 1.000 724 A_5 492 193 576 724 1.000 Inter-Item Covariance Matrix A_1 A_2 A_3 A_4 A_5 A_1 524 056 477 138 259 A_2 056 623 083 167 110 A_3 477 083 521 176 302 A_4 138 167 176 596 406 A_5 259 110 302 406 527 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted A_1 14.7956 4.753 589 838 697 A_2 14.7984 5.681 221 085 825 A_3 14.7875 4.539 675 857 667 A_4 14.7984 4.768 526 560 720 A_5 14.7275 4.456 702 659 656 129 3.1.2 RELIABILITY Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 843 N of Items 841 Item Statistics Mean Std Deviation N B_6 3.5095 83260 367 B_7 3.5640 95277 367 B_8 3.5668 95258 367 B_9 3.3815 80060 367 B_10 3.3869 82160 367 B_11 3.3161 88295 367 Item-Total Statistics Scale Mean if Scale Variance if Corrected Item- Squared Multiple Cronbach's Alpha if Item Deleted Item Deleted Total Correlation Correlation Item Deleted B_6 17.2153 12.913 314 146 871 B_7 17.1608 9.824 796 997 780 B_8 17.1580 9.822 796 997 780 B_9 17.3433 10.931 739 790 797 B_10 17.3379 11.284 639 746 815 B_11 17.4087 11.767 485 258 844 Inter-Item Correlation Matrix B_6 B_7 B_8 B_9 B_10 B_11 B_6 1.000 291 289 195 146 338 B_7 291 1.000 998 631 537 401 B_8 289 998 1.000 633 539 400 B_9 195 631 633 1.000 863 416 B_10 146 537 539 863 1.000 347 B_11 338 401 400 416 347 1.000 130 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted B_6 17.2153 12.913 314 146 871 B_7 17.1608 9.824 796 997 780 B_8 17.1580 9.822 796 997 780 B_9 17.3433 10.931 739 790 797 B_10 17.3379 11.284 639 746 815 B_11 17.4087 11.767 485 258 844 3.1.3 ASSURANCE Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 763 N of Items 757 Item Statistics Mean Std Deviation N C_12 3.5232 89558 367 C_13 3.5041 84243 367 C_14 3.4986 89588 367 C_15 3.5068 89280 367 C_16 3.5804 71169 367 Inter-Item Correlation Matrix C_12 C_13 C_14 C_15 C_16 C_12 1.000 370 914 320 504 C_13 370 1.000 347 422 167 C_14 914 347 1.000 349 428 C_15 320 422 349 1.000 022 C_16 504 167 428 022 1.000 131 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted C_12 14.0899 5.306 770 853 626 C_13 14.1090 6.660 441 241 751 C_14 14.1144 5.391 744 839 637 C_15 14.1063 6.756 373 247 777 C_16 14.0327 7.365 366 280 770 3.1.4 RESPONSIVENESS Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 704 N of Items 700 Item Statistics Mean Std Deviation N D_17 3.5259 83879 367 D_18 3.7330 74627 367 D_19 3.5259 93432 367 D_20 3.6403 77270 367 Inter-Item Correlation Matrix D_17 D_18 D_19 D_20 D_17 1.000 561 626 149 D_18 561 1.000 457 203 D_19 626 457 1.000 214 D_20 149 203 214 1.000 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted D_17 10.8992 3.206 625 488 552 D_18 10.6921 3.656 551 343 608 D_19 10.8992 2.987 596 419 567 D_20 10.7847 4.454 226 060 781 132 3.1.5 EMPATHY Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 719 N of Items 733 Item Statistics Mean Std Deviation N E_21 3.3106 93882 367 E_22 3.6621 81667 367 E_23 3.5940 80046 367 E_24 3.5313 80196 367 E_25 3.4632 88283 367 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted E_21 14.2507 6.729 183 040 792 E_22 13.8992 5.615 574 390 634 E_23 13.9673 5.545 615 663 619 E_24 14.0300 5.324 685 699 590 E_25 14.0981 5.908 423 276 694 3.1.6 SATISFACTION Reliability Statistics Cronbach's Alpha Based on Cronbach's Standardized Alpha Items 981 N of Items 981 Item Statistics Mean Std Deviation N F_26 3.5068 59537 367 F_27 3.5341 61254 367 F_28 3.5395 61221 367 133 Item-Total Statistics Corrected Item- Squared Cronbach's Scale Mean if Scale Variance Total Multiple Alpha if Item Item Deleted if Item Deleted Correlation Correlation Deleted F_26 7.0736 1.462 954 912 974 F_27 7.0463 1.410 965 931 966 F_28 7.0409 1.422 954 912 974 3.2 RESULTS OF EFA KMO and Bartlett's Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy Bartlett's Test of Sphericity Approx Chi-Square 759 6317.134 df 171 Sig .000 Total Variance Explained Extraction Sums of Squared Rotation Sums of Squared Loadings Loadings Initial Eigenvalues Component Total % of Cumulative Variance % Total % of Cumulative Variance % Total % of Cumulative Variance % 6.054 31.863 31.863 6.054 31.863 31.863 3.200 16.842 16.842 2.594 13.651 45.514 2.594 13.651 45.514 3.085 16.235 33.077 1.928 10.149 55.663 1.928 10.149 55.663 2.669 14.049 47.125 1.607 8.458 64.121 1.607 8.458 64.121 2.279 11.996 59.121 1.308 6.886 71.007 1.308 6.886 71.007 2.258 11.886 71.007 959 5.048 76.056 835 4.393 80.449 742 3.905 84.353 605 3.184 87.537 10 528 2.777 90.315 11 482 2.537 92.852 12 436 2.296 95.148 13 309 1.628 96.777 14 179 940 97.716 15 165 868 98.585 16 117 613 99.198 17 079 415 99.613 18 072 379 99.992 19 001 008 100.000 134 Rotated Component Matrix(a) B_8 B_7 B_9 B_11 B_10 E_24 E_22 E_23 E_25 A_5 A_3 A_1 A_4 D_17 D_19 D_18 C_12 C_14 C_16 Component 826 826 700 641 626 762 728 720 655 846 812 774 663 860 809 752 902 874 649 Component Score Coefficient Matrix Component A_1 -.125 120 317 -.037 -.056 A_3 -.125 100 326 000 -.042 A_4 183 -.192 295 -.007 -.098 A_5 061 -.110 374 023 -.114 B_7 290 -.027 -.021 -.011 -.046 B_8 289 -.026 -.021 -.012 -.045 B_9 210 101 -.053 -.040 -.065 B_10 181 100 -.061 -.018 -.053 B_11 277 -.172 063 -.089 056 C_12 013 -.055 -.110 -.045 475 C_14 021 -.071 -.122 -.004 461 C_16 -.162 086 -.011 -.007 326 D_17 -.046 -.038 -.032 414 -.013 D_18 -.028 -.039 -.021 356 -.002 D_19 -.082 -.004 040 394 -.057 E_22 -.077 280 -.036 -.031 036 E_23 -.074 271 -.011 066 -.058 E_24 -.043 271 -.024 059 -.043 E_25 -.040 263 003 -.169 017 135 Extraction Method: Principal Component Analysis Rotation Method: Varimax with Kaiser Normalization 3.3 RESULTS OF REGRESSION ANALYSIS Variables Entered/Removed Variables Variables Entered Removed Model a Method Factor5, Factor4, Factor1, Enter Factor3, Factor2 b a Dependent Variable: SuHaiLong b All requested variables entered b Model Summary Model R 829 Adjusted R Std Error of the Square Estimate R Square a 686 682 Durbin-Watson 33566 1.932 a Predictors: (Constant), Factor5, Factor4, Factor1, Factor3, Factor2 b Dependent Variable: SuHaiLong a ANOVA Model Sum of Squares df Mean Square Regression 89.035 17.807 Residual 40.673 361 113 129.709 366 Total F Sig 158.049 000 b a Dependent Variable: A b Predictors: (Constant), Factor5, Factor4, Factor1, Factor3, Factor2 Coefficients Model Unstandardized Standardized Coefficients Coefficients B (Constant) Std Error -.224 145 Factor1 153 034 Factor2 298 Factor3 Beta a 95.0% Confidence Interval for B t Sig Lower Bound Upper Bound -1.543 124 -.509 061 153 4.554 000 087 219 030 360 9.958 000 239 357 126 028 154 4.472 000 071 182 Factor4 242 027 286 9.119 000 190 294 Factor5 236 032 258 7.325 000 173 300 136 a Dependent Variable: SAT Coefficient Correlations Model Factor5 Correlations Covariances a Factor4 Factor1 Factor3 Factor2 Factor5 1.000 -.037 -.116 -.095 -.433 Factor4 -.037 1.000 -.032 -.134 -.190 Factor1 -.116 -.032 1.000 -.367 -.076 Factor3 -.095 -.134 -.367 1.000 -.144 Factor2 -.433 -.190 -.076 -.144 1.000 Factor5 001 -3.127E-5 000 -8.701E-5 000 Factor4 -3.127E-5 001 -2.825E-5 000 000 Factor1 000 -2.825E-5 001 000 -7.653E-5 Factor3 -8.701E-5 000 000 001 000 Factor2 000 000 -7.653E-5 000 001 b Dependent Variable: SAT Residuals Statistics Minimum Maximum a Mean Std Deviation N Predicted Value 2.4127 5.0546 3.5268 49322 367 Std Predicted Value -2.259 3.098 000 1.000 367 021 075 041 011 367 Standard Error of Predicted Value Adjusted Predicted Value Residual Std Residual Stud Residual 2.4259 5.0563 3.5276 49330 367 -1.36625 73570 00000 33336 367 -4.070 2.192 000 993 367 -4.133 2.202 -.001 1.002 367 -1.40897 74230 -.00084 33932 367 -4.229 2.213 -.002 1.006 367 Mahal Distance 483 17.219 4.986 3.203 367 Cook's Distance 000 089 003 008 367 Centered Leverage Value 001 047 014 009 367 Deleted Residual Stud Deleted Residual c Dependent Variable: SAT 137 3.4 RESULTS OF DISCRIMINANT ANALYSIS In terms of Income Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 248 df2 Sig 363 863 ANOVA SuHaiLong Sum of Squares Between Groups df Mean Square 230 077 Within Groups 129.478 363 357 Total 129.709 366 F Sig .215 886 In terms of age groups Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 664 df2 Sig 362 617 ANOVA SuHaiLong Sum of Squares Between Groups df Mean Square 537 134 Within Groups 129.172 362 357 Total 129.709 366 In terms of Occupation Test of Homogeneity of Variances SuHaiLong Levene Statistic 895 df1 df2 Sig 358 521 F Sig .376 826 138 ANOVA SuHaiLong Sum of Squares Between Groups df Mean Square 4.242 530 Within Groups 125.467 358 350 Total 129.709 366 In terms of Gender Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 1.739 df2 Sig 365 188 3.5 TEST OF CORRELATIONS Correlations F_26 F_26 Pearson Correlation F_27 Sig (2-tailed) N F_27 Pearson Correlation 949 ** 000 367 367 ** 949 Sig (2-tailed) 000 N 367 367 ** Correlation is significant at the 0.01 level (2-tailed) Correlations F_26 F_26 Pearson Correlation F_28 Sig (2-tailed) N F_28 Pearson Correlation 934 ** 000 367 367 ** 934 Sig (2-tailed) 000 N 367 ** Correlation is significant at the 0.01 level (2-tailed) 367 F 1.513 Sig .151 ... status of health services quality at Thai Nguyen National Hospital – a public hospital in Thai Nguyen city; Determine factors affecting functional quality of health service at Thai Nguyen National. .. Thai Nguyen National Hospital 59 4.3 Current status of public health services at Thai Nguyen National Hospital 67 4.4 Survey results about health services at Thainguyen National Hospital. .. Provision of health service quality is the top priority in hospital management, especially in public sector That is why the topic ? ?Public health service quality at Thai Nguyen National Hospital? ??