The mediating role of perceived value in the relationship between service quality and trust a case study of private general hospital in HCMC

UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business LAM HAI NGUYEN THE MEDIATING ROLE OF PERCEIVED VALUE IN THE RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC MASTER OF BUSINESS (Honours) Ho Chi Minh City – Year 2012 UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business LAM HAI NGUYEN THE MEDIATING ROLE OF PERCEIVED VALUE IN THE RELATIONSHIP BETWEEN SERVICE QUALITY AND TRUST – A CASE STUDY OF PRIVATE GENERAL HOSPITAL IN HCMC ID: 60340102 MASTER OF BUSINESS (Honours) SUPERVISOR: DR PHAM NGOC THUY Ho Chi Minh City – Year 2012 ACKNOWLEDGEMENTS I would like to express my sincere gratitude to Dr Pham Ngoc Thuy who has supported me a lot with the thesis preparation and motivated me throughout the journey of the thesis Her professional experiences help me understand research methods as well as useful knowledge for my research I greatly appreciate to all my friends who supported me to the survey at the hospital with me I would like to thank the board management and Doctors at Van Hanh Hospital to allow me to the survey at this hospital and provided necessary information Finally, I would like to send my best regards to all of those who kindly supported me during the data collection phase and the completion of this thesis December 9, 2012 Ho Chi Minh City, Viet Nam Lam Hai Nguyen ABSTRACT Healthcare is a significant part of a country's economy The delivery of health care services is very important of health care system, both to patients and hospitals There are many factors in treatment influencing to patients This research aims to identify the service quality affecting to patient perceived value and the patient perceived value affecting to patient trust A questionnaire has been developed based on the dimension of patient – perceived Total Quality Service ( TQS) in healthcare scale, Corporate reputation scale, Perceived value scale, trust scale and then adjusted by results of in-depth interview of doctors, nurses and patients The number of respondents is 177 people The average duration of the interviews was ten minutes The respondent is that of individuals over the age of 18, who used the hospitalization services of private general hospitals in 12 months (from the interview day) Findings highlight the positive influences of service quality to perceived value and the strong significant impact of perceived value to trust Therefore, investor should improve service quality to gain patient trust Because of limited time and resources, the dimension of service quality has factors while the conceptualization of service quality SERVQUAL features five dimensions: tangibles, reliability, responsiveness, empathy and assurance (Parasuraman et al., 1988) Future researches may consider including more factors to understand deeply in service quality in healthcare TABLE OF CONTENTS CHAPTER 1: INTRODUCTION 1.1 1.2 1.3 1.4 1.5 1.6 Research background Research Problems Research questions and objectives Research scope Research methodology Thesis structure CHAPTER 2: LITERATURE REVIEW & THEORETICAL MODEL 10 2.1 Service quality 10 2.1.1 Organization reputation 10 2.1.2 The Administrative procedures 11 2.1.3 Facilities: 12 2.1.4 Doctor and Nurse care 12 2.2 Patient perceived value 14 2.3 Patient trust 15 2.4 Conceptual model 15 2.5 Hypotheses 17 2.5.1 Relationship between service quality and perceived value 17 2.5.2 Relationship between perceived value and trust 17 CHAPTER 3: RESEARCH METHODOLOGY 18 3.1 Research process 18 3.2 Qualitative study 19 3.3 Measurement scale 19 3.3.1 3.3.2 3.3.3 3.3.4 3.3.5 Construction of measurement scales 19 Measurement scale of the Organization reputation 20 Measurement scale of Administrative Procedures 20 Measurement scale of the facility 21 Measurement scale of Doctor & Nurse care 21 3.3.6 Measurement scale of Patient perceived value 22 3.3.7 Measurement scale of Patient trust 23 3.4 Questionnaire design 25 3.5 Main survey 26 3.6 Data collection 26 3.7 Data analysis 27 CHAPTER 4: DATA ANALYSIS AND RESULTS 28 4.1 Descriptive data analysis 28 4.1.1 Data summary 28 4.1.2 Characteristics Of Respondents 29 4.1.3 Descriptive data 29 4.2 Assessment of measurement scales 31 4.2.1 Cronbach alpha reliability analysis 31 4.2.2 Exploratory Factor Analysis 33 4.2.3 The revised conceptual model 39 4.3 Correlation and Hypotheses testing 40 4.3.1 4.3.2 Correlation 40 Testing assumptions of multiple regression 42 CHAPTER 5: CONCLUSION AND IMPLICATION 47 5.1 Main finding: 47 5.2 Managerial implications 48 5.3 Research limitations and implications for future 48 CHAPTER 1: INTRODUCTION 1.1 Research background Healthcare industry is a special service industry that is paid much attention because it has directed relation to citizens According to the World health organization, the health systems‟ goal is good health, responsiveness to the expectations of the population, and fair financial contribution Vietnam healthcare system relates to government The decision-making powers belong to the central government, which takes inputs from governing authorities of cities and provinces Its healthcare market emphasizes „cure‟ rather than „prevention‟ In mid1993, realizing the need for private foreign investment in medicine, the central government opened the healthcare sector to private local and foreign firms by allowing them to setup clinics and hospitals Since then the number of private hospitals has been growing fast, especially due to the failure of the public sector to meet the country‟s needs of proper healthcare HCMC is invested to become a centralized health care in South region However, the facilities of public general hospitals are worst The top public general hospitals are Cho Ray hospital, Nhan dan Gia Dinh Hospital… Some of these are downgrading significantly Health Ministry has some projects to solve this problem such as: upgrading infrastructure, facilities, training for physician in provinces… Besides this, HCMC will build new public general hospitals On the other hand, private general hospitals also improve their ability to server patients Anh Thuy & Phi Khanh (2012) reports that HCMC has 33 private general hospitals in order to solve the over loaded of public general hospitals In order to compete with public general hospital as well as themselves, private general hospitals are invested modern facilities, human resource to bring the value to patients Providing quality service is considered an essential strategy for successful and survival in today competitive environment (Zeithaml, Berry & Parasuraman,1996) Customer perceived value explores the interaction between the product and service, while service quality generally focuses on the product or service, i.e what the organization provided ( Robert, 1996) 1.2 Research Problems Big cities as HCM have a large population Public general hospitals are not only served for local citizen but also served for other citizens who from provinces to HCMC for their treatment Therefore, these hospitals are always overloaded patients Overloaded in hospital are defined “many people come to hospitals for their treatment at the same time that human resource and capability in hospital can not afford and served patients ” (Ministry of Health, 2012) The percentage of overloaded in public general hospitals such as 115 hospital, Nhan dan Gia Dinh Hospital are 113%, 106%, respectively (Ministry of Health, 2012) Because of overloaded, patients are treated without courteousness and attention Therefore, the trend of treating at private general hospital is increasing According to Health Ministry, the number of private general hospital increased 11.4 % in 2011 The investors should understand what patients receive from hospital‟s service attributes in order to contribute to patient‟s trust How the private general hospitals compete with public general hospitals and with themselves Exploring the affecting of service quality on patient‟s trust will help the owner of private general hospital to improve their business 1.3 Research questions and objectives To solve the problem defined above, the research aims at answering the following questions: How is the service quality affecting to patient‟s perceived value? By understanding this, the owners or investors can identify the right direction for their investment How does the patient perceived value affect to patient trust? By evaluating the relationship between patient perceived value and patient trust, private general hospitals will know how to make the customer‟s comeback Based on the above research questions, the objectives of this study are: To identify the impact of Service Quality on Patient Perceived Value To measure the influence of Patient Perceived Value to Patient Trust 1.4 Research scope The research focuses on private general hospitals in HCMC The respondent is that of individuals over the age of 18, who used the hospitalization services of private general hospitals in months (from the interview day) Children (under 18 years old) and old people (over 60 years old) will not include in the study The respondents choose the private general hospital without health insurance 1.5 Research methodology This research is applied the quantitative method which were reviewed the theoretical background adaptable to the context The selection of the sample was random, a random route in each hospital being established for each of the interviewers The number of respondents is 177 people The average duration of the interviews was ten minutes The respondent is that of individuals over the age of 18, who used the hospitalization services of private general hospitals in 12 months (from the interview day) The data collected will be validated by Cronbach Anpha Reliability Analysis and selected by Exploratory Factor Analysis Finally, the model will be tested by using Multiple Regression Analysis by SPSS version 20.0 1.6 Thesis structure Chapter 1: Introduction This chapter includes an overview of research background, research problems, questions and objectives The research limitation, method and structure are also mentioned Chapter 2: Literature review and conceptual model The chapter consists of a review of previous research on the concepts of Service Quality Dimensions, Patient Perceived Value and Patient Trust Basing on previous research, a conceptual model and hypotheses are presented 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CASE OF PRIVATE GENERAL HOSPITAL IN HCM” Ladies and Gentlemen, My name is Lam Hai Nguyen, I am studying master course of ISB – The university of Economics I am conducting a research “the mediating role of patient perceived value in the relationship between service quality and patient trust- a case of private general hospitals in HCM” I appreciate if you can save your time to answer this questionnaire There is no right or wrong answer The feedback are kept confidential and used for research purpose only Thank you so much for your kind support I GENERAL INFORMATION The recent treatment that you have: < a month During -3 months > monthS 2.Which private general hospital are you often coming? ( Please write the name) _ II CONTENT 3: Neutral 4: Agree 5: Strongly Agree I choose X hospital because of its success The value for money of treatment is worthy I think this hospital is Customer orientation I think many people know this hospital reputation The admission processes are handled promptly and properly In emergency case, I am easy of getting the desired bed on admission It is easy to get appointments to specialists (doctors) in the X hospital I am easy to access to emergency care and services in the X hospital I am easy to get appointments and the required help, advice or information over the phone and at the reception counter The waiting time for me to see doctors is kept minimum in the Out-Patient Department The time spent waiting for diagnostic tests and treatment, at the pharmacy, scan centers, blood banks and laboratories was reasonable 10 11 12 13 14 The waiting rooms, clinical and diagnostic test rooms are adequately quiet, comfortable and clean X hospital has availability of adequate and up-to-date technological capability in the hospital (e.g diagnostic facilities like CT scans, MRI scans, X-rays and ultrasound) to serve patients effectively The pharmacy in X hospital has availability of required drugs in when patients want to buy drugs Strongly agree Note: “X” in the statements below is meant private general hospital that you wrote in question Please read each of the following statements carefully and circle the number that best reflects your opinion: 1: Strongly disagree 2: Disagree Strongly disagree Disagree Neutral Agree 56 57 17 I feel doctors are courteous, patient and attentive to my needs and well being Doctors answer my questions and clearly explain the diagnosis and treatment outcome to me, in a way that I could understand I realize doctors are competent and skilful in their jobs 18 The nursing staffs are courteous 19 The nursing staffs give me prompt and timely attention 20 I realize nurses are competent and skilful in their jobs 21 X hospital provides high quality service 22 Patients treated with equality 23 X hospital can be trusted 24 I feel physician /staff looking out for my satisfaction 25 Doctors at X hospital are always reliable to patients 26 Considering what i would pay for the treatment, i will get much more than my money's worth I think my request in treatment at X hospital is qualified 15 16 27 28 29 30 Considering what i would pay for the treatment, I got a good experience during my treatment Considering what i would pay for the treatment, I feel safe, comfortable with X hospital I think the quality of treatment at X hospital is worth with my money and my time III OTHER INFORMATIONS Gender: Age group:  Female  18- 30 year-old  Male  31- 45 year-old  > 45 -55 year-old  > 55 year-old Occupation:  Staff  Manager / Businessman (Please indicate) _ Marital status :  Single  Married Thank you so much  Retired Others 58 PHIẾU KHẢO SÁT Kính chào Ơng/Bà, tơi tên Lâm Hải Ngun, học viên cao học Viện Đào Tạo Quốc Tế (ISB) – Trường ĐH Kinh Tế TP HCM Tôi nghiên cứu Chất lượng dịch vụ Bệnh viện đa khoa tư nhân TP HCM Rất mong Ông/Bà dành thời gian trả lời Phiếu khảo sát Lưu ý, khơng có câu trả lời hay sai Tất ý kiến Ơng/Bà có giá trị cho nghiên cứu Chân thành cám ơn hỗ trợ Ông/Bà! I THÔNG TIN TỔNG QUÁT Lần khám bệnh gần Ông/Bà cách đây: < tháng khoảng -3 tháng > tháng Ông/Bà thường khám bệnh Bệnh viện Đa Khoa nào? (xin ghi rõ) _ Ơ số 1: Hồn tồn khơng đồng ý Ơ số 5: Hồn tồn đồng ý Các mức độ khác đánh vào ô số 2,3 tương ứng Bệnh viện X nhiều người xem nơi khám điều trị bệnh tốt Theo tơi, chi phí bệnh viện X tương xứng với việc điều trị Tôi nhận thấy bệnh viện X hướng đến nhu cầu bệnh nhân Tơi nghĩ uy tín bệnh viện X nhiều người cơng nhận Đồng ý Hồn tồn đồng ý Xin Ơng/ Bà cho biết mức độ đồng ý phát biểu sau “X” cách chọn đánh dấu (√) vào ô tương ứng, với: Không đồng ý Trung dung Lưu ý: “ X” phát biểu sau để bệnh viện đa khoa Ông/ Bà đề cập câu Hồn tồn khơng đồng ý II NỘI DUNG ĐÁNH GIÁ 59 Quá trình làm hồ sơ bệnh nhân bệnh viện X nhanh chóng xác Trong trường hợp khẩn cấp, tơi làm thủ tục nhập viện dễ dàng bệnh viện X Bệnh nhân dễ dàng đặt lịch hẹn với bác sĩ chuyên khoa bệnh viện X Có thể dễ dàng sử dụng dịch vụ cấp cứu chăm sóc đặc biệt bệnh viện X Bệnh nhân dễ dàng hỏi thông tin xin tư vấn qua điện thoại bàn hướng dẫn 10 Thời gian ngồi chờ gặp bác sĩ khám bệnh bệnh viện X ngắn so với nơi khác 11 Thời gian chờ để làm xét nghiệm chẩn đoán bệnh viện X hợp lí 12 Phịng chờ để khám, chẩn đoán, xét nghiệm bệnh viện X yên tĩnh, tiện nghi 13 Bệnh viện X trang bị thiết bị y tế tiên tiến để phục vụ bệnh nhân hiệu 14 Nhà thuốc bệnh viện X có đủ loại thuốc cần thiết phục vụ bệnh nhân 15 Các bác sĩ bệnh viện X tỏ ân cần, kiên nhẫn, quan tâm tới bệnh nhân 16 Các bác sĩ bệnh viện X ln trả lời giải thích rõ ràng câu hỏi bệnh nhân 17 Tôi nhận thấy bác sĩ bệnh viện X người có chun mơn cao 18 Các y tá bệnh viện X tỏ ân cần với bệnh nhân đến khám chữa bệnh 19 Các y tá bệnh viện X ý tiếp nhận bệnh nhân đến khám chữa bệnh kịp thời 20 Tôi nhận thấy y tá bệnh viện X thông thạo công việc 21 Tôi tin bệnh viện X cung cấp dịch vụ khám chữa bệnh chất lượng cao 22 Bệnh viện X đối xử bình đẳng với tất bệnh nhân đến khám chữa bệnh 60 23 Tôi tin tưởng có kết tốt đến khám chữa bệnh bệnh viện X 24 Nhân viên bệnh viện X làm cảm thấy yên tâm đến khám chữa bệnh 25 Bác sĩ bệnh viện X tạo niềm tin chữa bệnh tốt cho bệnh nhân 26 So với chi phí, thời gian cơng sức bỏ ra, lợi ích nhận từ bệnh viện X tương xứng 27 Tôi nghĩ yêu cầu khám chữa bệnh bệnh viện X đáp ứng đầy đủ 28 So với chi phí, thời gian cơng sức bỏ ra, bệnh viện X cho trải nghiệm tốt trình khám chữa bệnh 29 So với chi phí, thời gian cơng sức bỏ ra, bệnh viện X tạo cho an tâm trình khám chữa bệnh 30 Tơi thấy chất lượng q trình khám chữa bệnh bệnh viện X tương xứng với chi phí, thời gian cơng sức bỏ III THÔNG TIN KHÁC Xin Ông/ Bà cho biết số thông tin cá nhân phục vụ cho việc tổng hợp trình bày kết thống kê:  Nữ Giới tính: Nhóm tuổi:  18- 30 tuổi Nghề nghiệp:  Nhân viên rõ) _ Tình trạng gia đình:  Nam  31- 45 tuổi  > 45 -55 tuổi  Doanh nhân/Quản lý  Độc thân  > 55 tuổi  Về hưu  Đã kết hôn Xin chân thành cảm ơn hợp tác Ông/Bà!  Khác (xin ghi 61 Appendix 2: Factor analysis EFA for independent variable KMO and Bartlett's Test 2nd Kaiser-Meyer-Olkin Measure of Sampling Adequacy Approx Chi-Square Bartlett's Test of Df Sphericity Sig 781.825 66 000 Total Variance Explained 2nd Initial Eigenvalues Extraction Sums of Squared Loadings Facto r Total 10 11 12 847 4.771 1.349 1.263 873 736 653 522 468 443 373 285 265 % of Cumulative Variance % 39.762 39.762 11.239 51.001 10.523 61.523 7.274 68.797 6.135 74.932 5.438 80.370 4.348 84.718 3.898 88.617 3.692 92.309 3.105 95.413 2.379 97.792 2.208 100.000 Total 4.289 919 769 % of Cumulative Variance % 35.742 35.742 7.658 43.400 6.412 49.812 Rotation Sums of Squared Loadingsa Total 3.714 3.023 2.733 Extraction Method: Principal Axis Factoring a When factors are correlated, sums of squared loadings cannot be added to obtain a total variance 62 Pattern Matrixa 2nd Factor DOCNU18 989 DOCNU19 712 DOCNU20 626 DOCNU16 618 DOCNU15 495 PROCE07 PROCE08 PROCE06 PROCE09 ORGRE01 ORGRE04 ORGRE02 Extraction Method: Principal Axis Factoring Rotation Method: Promax with Kaiser Normalization a Rotation converged in iterations KMO and Bartlett's Test 3rd Kaiser-Meyer-Olkin Measure of Sampling Adequacy Approx Chi-Square Bartlett's Test of Df Sphericity Sig 305 758 699 533 331 876 683 513 809 567.983 45 000 63 Total Variance Explained 3rd Initial Eigenvalues Extraction Sums of Squared Loadings Factor Rotation Sums of Squared Loadingsa Total Total % of Cumulative Total % of Cumulative Variance % Variance % 3.934 39.343 39.343 3.473 34.727 34.727 2.924 1.326 13.261 52.604 898 8.985 43.712 2.367 1.249 12.490 65.095 748 7.479 51.192 2.273 708 7.084 72.179 626 6.258 78.437 585 5.853 84.289 481 4.808 89.097 443 4.430 93.528 377 3.772 97.300 10 270 2.700 100.000 Extraction Method: Principal Axis Factoring a When factors are correlated, sums of squared loadings cannot be added to obtain a total variance Pattern Matrixa 3rd Factor DOCNU18 950 DOCNU19 724 DOCNU20 640 DOCNU16 523 ORGRE01 ORGRE04 ORGRE02 PROCE08 PROCE07 PROCE06 Extraction Method: Principal Axis Factoring Rotation Method: Promax with Kaiser Normalization a Rotation converged in iterations 851 687 529 723 635 608 64 Appendix 3: Figure 4.1: Histogram, Scatter Plot of dependent variable Perceived value 65 Figure 4.1: Histogram, Scatter Plot of dependent variable Trust ... between service quality and perceived value Ladhari and Morale (as cited in Bolton and Drew,1991), reported that service quality is the most important determinant of perceived value Ladhari and. .. stages of the patient‟s hospital stay This scale was developed by adapting items of perceived value scales used by Mayuri Duggirala, Chandrasekharan Rajendran, R.N Anantharaman, (2008):  The admission... which indicated that factor analysis was significant for our study The total variance percentage accumulated in the factor was approximately 47% and the factor carried nearly 57% of data indicating