Factors affecting patients satisfaction to the use of nurse call system at hospitals

~1~ HO CHI MINH CITY OPEN UNIVERSITY UNIVERSITÉ LIBRE DE BRUXELLES SOLVAY BRUSSELS SCHOOL OF ECONOMICS & MANAGEMENT MBQPM4 H KIM NGÂN FACTORS AFFECTING PATIENT’S SATISFACTION TO THE USE OF NURSE CALL SYSTEM AT HOSPITALS MASTER FINAL PROJECT MASTER IN BUSINESS QUALITY AND PERFORMANCE MANAGEMENT HO CHI MINH CITY 2014 ~3~ STATEMENT OF AUTHENTICATION I certified that the research would contribute to open an opportunity to develop e-health technology in Viet Nam market as well as enhance the quality service of patient’s care in Viet Nam I also certified that all helps and sources are acknowledged in the thesis ~4~ ACKOWLEDGEMENT “Stay hungry, stay foolish”-Steven Job Although I know a little about Steven Job, I am inspired by his philosophy and talent to build up Apple His stories become a legend to me To start and complete something, it is necessary to “hungry” and “foolish” at the first moment That is my feeling since I have conducted the final thesis To get the value like that, I think I owe a debt of gratitude to people who have loved, cared, and supported me Therefore, I would like to express my first thanks to parents for my present in life Thanks for their love, their teaching during my mature I would like to express my thanks to Dr Jacques Martin who coaches me to complete the final thesis successfully His questions are the challenges for me to correct the orientation of the thesis I would like to express my thanks to my sponsors - Ms Nguyen Thi Hong Thuy – Director of Viet Toan Phat Co., Ltd and Mr Nguyen Van Nam – Technical Expert of Viet Toan Phat Co., Ltd- who support me to conduct the survey in the hospital, provide the specific information and give the value advises in the healthcare sector I would like to express my sincere thanks to my great master, PhD Nguyen Thi Bach Tuyet - Folk Music Artist, who has taught me the value methods to improve my performance in life Last, I would like to express my thanks to Solvay program, all professors, coordinators and friends (Phan Vu An, Nguyen Thi Ngoc Le, Ngo Nguyen Thuy Phuong Thao) who give me the encouragements and the supports in my master journey HCMC, May 15th, 2014 Ho Kim Ngan ~5~ CONTENTS STATEMENT OF AUTHENTICATION ACKNOWLEDGEMENTS CONTENT LIST OF ABBREVIATIONS LIST OF FIGURES LIST OF TABLES ABSTRACT INTRODUCTION ……………………………………………………………….P11 Introduction of Nurse Calling System ………………………………… …P11 Research Problem, Question, Objectives and Scope………………….…P13 2.1 Research Problem………………………………………………………….P13 2.2 Research Question…………………………………………………………P14 2.3 Research Scope…………………………………………………………….P14 Thesis Structure…………………………………………………………….…P14 PART 1: LITERATURE REVIEW & RESEARCH FRAMEWORK…………P15 Technology Acceptance Model (TAM)……………………………………P15 Framework for consumers’ intention to use Nurse Calling System P19 2.1 Categorization of Respondents……………………………………………P19 2.2 Perceived Usefulness………………………………………………………P20 2.2 Perceived Ease of Use…………………………………………………… P20 2.3 Perceived Credibility……………………………………………………… P21 2.4 Personal characteristics of consumers……………………………………P22 2.5 Framework of research…………………………………………………… P23 PART 2: METHODOLOGY AND RESEARCH DESIGN……………………P24 Methodology……………………………………………………………… …P24 1.1 Research Design…………………………………………………………….P24 1.2 Research Strategies…………………………………………………………P24 1.3 Research approach…………………………………………………………P24 Questionnaire and Sampling……………………………………………….P25 Data Analysis Procedures ……………………………………………… …P27 3.1 Descriptive statistics analysis……………………………………………….P28 3.2 Data Examining and Reliability Test of the Measurement Variables.…P28 PART 3: ANALYSIS & DISCUSSION………………………………………P29 Descriptive Analysis……………………………………………………….P29 1.1 Demographic characteristics of Respondents…………………….…P29 ~6~ 1.2 Behavioral Characteristics of Respondents on Use……………….…P32 Reliability Test…………………………………………………………….P34 2.1 Perceived Usefulness……………………………………………………P35 2.2 Perceived Ease of use……………………………………………………P37 2.3 Perceived Credibility…………………………………………………….…P38 Factors affecting Actual Use……………………………………………P40 3.1 Perceived Usefulness………………………………………………….…P41 3.2 Perceived Ease of use………………………………………………….…P42 3.3 Perceived Credibility…………………………………………………… …P43 Differences on Demographic Dimensions……………………………….P45 4.1 Gender of Respondents…………………………………………………….P45 4.2 Age-Group of Respondents……………………………………………….P46 CONCLUSION & RECOMMENDATIONS………………………………… P47 REFERENCE………………………………………………………………….…P52 APPENDIX 1: QUESTIONAIRE……………………………………………….P54 APPENDIX 2: DEVICE AND FUNCTION……………………………………P57 APPENDIX 3: CASE STUDY……………………………… ………………….P61 ~7~ LIST OF ABBREVIATIONS ABBREVIATION DESCRIPTION TAM Technology Acceptance Model NCS Nurse Call System TRA Theory of Reasoned Action PC Perceived Credibility PU Perceived Usefulness PEOU Perceived Ease Of Use ATU Attitude Toward Using TPB Theory of Planned Behavior SN Subjective Norm One Way ANOVA One Way Analysis of Variance ~8~ LIST OF FIGURES Figure 1: Market share of Nurse Call System in Viet Nam ……………… P12 Figure 2: Nurse call system capital yearly ………………………………….P13 Figure 3: Thesis structure ………………………………………………….P1 Figure 4: The Original TAM proposed by Fres Davis (Davis, 1986, p.24) ……P16 Figure 5: First modified version of TAM ………………………………… P17 Figure 6: Final version of TAM ……………………………………………………P17 Figure 7: Research Framework ………………………………………………… P23 Figure 8: Occupation and Treat Time ………………………………………… P30 Figure : % Respondents Treatment in Hospitals ……………………………… P30 Figure 10: Treatment time of 19% respondents said “NO” …………………… P31 Figure 11: Diversity of Age & Gender ………………………………………… P31 Figure 12: Location Diversity …………………………………………………….P32 Figure 13: Numbers of Hospital Used …………………………………………P33 Figure 14: Nurse Call System Used ………………………………………………P34 Figure 15: Perceived Usefulness of Respondents ……………………………….P41 Figure 16: Perceived Ease of Use of Respondents …………………………… P43 Figure 17: Perceived Credibility of Respondents………………………………… P44 ~9~ LIST OF TABLES Table 1: General information in medical field in 2007 and 2008 P11 Table 2: Applications, participants, country and setting used for applying TAM…………………………………………………………………………………… P19 Table 3: Cross Tabulation of EVER USED NURSE CALL SYSTEM & OCCUPATION ……………………………………………………………………… P30 Table 4: General Hospital Information… ………………………………………….P32 Table 5: Reliability of Perceived Usefulness for Patients… …………………….P35 Table 6: Reliability of Perceived Usefulness for Nurse or Aid staff … …………P35 Table 7: Reliability of Perceived Usefulness for Nurse or Aid staff after removing Q17 ………………………………………………………………… P36 Table 8: Reliability of Perceived Ease of Use for Patients ……………… …… P37 Table 9: Reliability of Perceived Ease of Use for Patients after removing Q20 P37 Table 10: Reliability of Perceived Ease of Use for Nurses or Aid Staffs……… P38 Table 11: Reliability of Perceived Credibility for Patients ……………………… P38 Table 12: Reliability of Perceived Credibility for Nurses or Aid Staffs ………… P39 Table 13: The summary of items used for the further analysis ………………….P40 Table 14: The descriptive figures of selected patient variables …………………P40 Table 15: The descriptive figures of TAM scale ………………………………… P44 Table 16: T-test result of Gender of respondents …………………………………P45 Table 17: T-test result of Age group of respondents …………………………… P46 ~ 10 ~ ABSTRACT Purpose – The purpose of the study is to present a new look of consumer’s satisfaction in using Nurse Calling Device in Viet Nam Design/Methodology/Approach - The study is constructed base on Technology Acceptance Model (TAM) with additional factor that are Perceived Usefulness, Perceived Ease-of-Use and Perceived Creditability Paper questionnaire is distributed to consumers The selected respondents are categorized into the age and sex After reliability tests, in-depth analysis is conducted to understand factors affecting consumer’s use and independent sample t-tests are used to examine difference of demographic dimensions Key Findings - From 2007 to 2013, Government has planned to build general hospitals installed these devices in every province However, there is no research to study about consumer’s satisfaction until now This study attempts to choose an appropriate model to evaluate consumer decision in the device, evaluate factors affected to consumer intention to use these and contribute the understanding of consumer’s demand to improve the device in the future Originality/Value – The study provides the level of consumer’s satisfaction in using Nurse Calling System in Vietnam context However, the survey is only conducted in Ho Chi Minh City The result of the study may not cover all consumers’ level Therefore, the study will contribute to create a base for further study in the future Key words – Nurse call system, Perceived Usefulness, Perceived Ease-To-Use, Perceived Creditability ~ 11 ~ INTRODUCTION: Introduction of nurse call system: Nurse call system is the system that ensures hospital staffs can quickly identify the location and level of the calls The system also provides the means that the patient can draw attention of a nurse from his bed whenever required The system has been applied in European countries for few decades In Viet Nam, population growth is average 1.05%1 from 2011 to 2013 Until now, total population is 93 million Total hospital is about 1062 with nearly 100,000 doctors and nurses In below table 1, there is over 100 million times of visiting the hospitals in Viet Nam every year Items Average days of inpatient Total doctors Total nurse & aid Times of inpatient treatment Times of visiting hospital Unit day person person times times 2007 113 39,757 72,682 8,301,099 98,806,044 2008 113 40,505 75,756 8,908,751 103,844,948 Table – General information in medical field in 2007 and 2008 Source: Ministry of Viet Nam healthcare, 2008 The figure shows that there is very high potential risk of medical errors for the patient because of the conflict between the increasing of diseases and limit medical employees Since 2006, Viet Nam government had planned a strategy to develop the hospital system with higher quality service The signal leads to create a competitive game attracting some players such as Commax (Korea), Ackerman (German), and Aiphone (Taiwan), Uniphone and so on However, there is specific style for hospital projects in Viet Nam The product is only sold by the contractor that got the win in the tender In fact, the contractor joining in the tender has to match the basic requirement of experience, human resource capacity and financial capacity It means that the contractor has experienced at least year to conduct the same project with at least amount of 650 million VND Resource capacity requires that the site supervisors have got engineer degree and experienced at least years at the same position in the site http://gso.gov.vn/ ~ 48 ~ intention to use technology application Study showed the coherence among factors which influence to actual use according the construct of TAM Practically, Perceived Usefulness is “the degree to which an individual believes that using particular system would enhance or improve his or her performance” (Davis, 1985) All consumers recognized both physical and mental perspectives Patients had stronger intention to use the health technology if they believe that using new technology would enhance their ability and effectiveness in improving the service quality of patient’s care Data research shows that new technology not only provides the benefits for patients but healthcare staffs In patient’s opinion, they are satisfied to enjoy the high quality of service In healthcare staff’s view, they are satisfied with the professional level Perceived Ease of Use is “the degree to which an individual believes that using particular system would be free of physical and mental effort” (Davis, 1985) Consumers agree that it is easy to use new e-health technology However, the patients reject the first instruction for the use because of some objective reason such as the limit knowledge of the instructor or the disease of forgetfulness Perceived credibility refers to two dimensions – safety and data (care documentation) Based on data research, patients have perceived the safety mentally and physically through the design of new e-heath technology However, in reference data, healthcare staffs reject new e-health technology to support to solve many calls at the same time According to the technical expert, the problem is depended on different physical designs from the manufacturers Finally, new e-health technology has the potential benefits to improve the quality of service, the communication and collaboration with the patients It could help the patients learn more new e-health technology, make the changes of health behavior Especially, it contributes to reduce the risks in healthcare sector Based on the data analysis, knowledge approach and product design are the important factors affecting to consumer’s behavior In the case that consumers feel inconvenience with new e-health technology, they will tend not to use it Knowledge approach refers to the item of the color design (Q21) on Nurse Call System and the item of the instruction how to use Nurse Call System (Q20) The reason is that ~ 49 ~ healthcare is specific sector in Viet Nam Nurse Call System is done the business internally Although the design is followed the internal standard, the e-health device is rarely conducted PR strategy publicly such on the advertisement on newspaper or on media channel Therefore, it creates a gap for Vietnamese to reach the information of new e-health technology It results their inconvenient feeling to use it In addition, product design refers to the item of receiving and solving many calls at the same time Q16 The reason is to depend on the brand of the device selected to install in the hospital The selection relates the budget of each project However, the benefits will only accrue to patients if the technology is accepted and used In some cases, Nurse Call System is failure to gain the users’ acceptance In the research, there are 31 respondents saying “NO” to use new ehealth technology and sharing 19% Most of respondents have treated less than days Some have been treated less than week Others were more than week Besides, the respondents, whose treatment is less than days, are self-employed mostly Somewhat, they are not targeted consumers in the research The respondents of self-employed may not in the objectives of healthcare assurance because they have to register the assurance themselves and they not that mostly They come to the hospitals in serious cases Therefore, they rarely know the knowledge of e-health technology In addition, other respondents are predicted that they have no enough time to reach new e-health technology Therefore, they are afraid of using it Even though, they know the system but it may be rare opportunities to use it with the treatment less than days Limitation & Recommendation: The survey is conducted only in the hospitals in Ho Chi Minh City The sample is collected within 45 days It leads that the research is really limited by the geographic location and time The result of demographic analysis may reflect a part of the context in Viet Nam The factors cannot be defined all Moreover, the researcher has experienced with Nurse Call System in few years Therefore, the result of research cannot match all respects ~ 50 ~ In the future, the researcher should extend geographic location and time to conduct the study to understand deeply consumer’s satisfaction on the use of Nurse Call System In addition, to improve the limitation of knowledge approach, the hospital authority should make the notification in patient rooms It helps them capture the information behind oral instruction It will be better if the hospital invests e-health technology with voice identification The device contributes to fix the gap of forgetfulness for the elderly In the strategy of market development, there should be fair to create the competitive advantages in Viet Nam market It means that the manufacturer should be opened an opportunity to join the tender officially It results that Nurse Call System will be sold officially in the tender or Nurse Call System could be sold in the show room, the clinic stores in Viet Nam It creates an opportunities for the e-health technology to be presented on the media channel It aims to provide the knowledge and the image to consumers such as patients, nurses or employees It helps consumers be familiar with e-health technology in life and understand its function to contribute to improve their standard living It results to reduce the gap of e-health knowledge in Viet Nam Currently, the manufacturer is the third party The contractor is positive to select the brand of product to construct in the site as well as the cost is reasonable In this situation, the employees are the first party and own the budget but they are negative to select e-health technology in the project Consequently, the quality of e-health technology and the performance of the hospital are impacted The reason of the negative position is that the employees, who are Vietnamese, have not experienced well in e-health technology in Viet Nam Sometimes, they confuse to make a decision to select the kinds of Nurse Call System Therefore, they assign the decision of selection to the contractors, and then they could claim the contractors if there is any failure during the hospital operation The solution of the employee makes a barrier for e-health technology to develop in Viet Nam It is very difficult for the sales or manufactures to find an opportunity to develop the e-health product in Viet Nam if they not collaborate with the contractors To fix the gap, the employees could hire the consultant of e- ~ 51 ~ health technology or set the budget to train an expert on the board to conduct the projects It helps them positives to select the new e-health technology It results many opportunities for the sales to join Viet Nam market, create more competitive cost for e-health technology ~ 52 ~ REFERENCE Barbara Van de Castle, Jeongeun Kim, Mavilde L.G Pedreira, Abel Paiva, William Goossen, David W Bates (2004), Information technology and patient safety in nursing practice: an international perspective, International Journal of MedicalInformatics, Volume 73, Issues 7–8, August 2004, Pages 607–614 Burn A.C and Bush R.F (2006), Marketing Research, 5th edition, Pearson: New Jersey Cooper, D.r., & Schindler, P.S (2003), BUssiness research methods (8 ed.): Boston: McGraw-Hill Chuttur M.Y.(2009),“Overview of the Technology Acceptance Model: Origins, Developments and Future Directions”, Sprouts: Working Papers on Information Systems, 9(37) http://sprouts.aisnet.org/9-37 Calvin K L Or, Ben-Tzion Karsh, Dolores J Severtson, et al (2011), Factors affecting home care patients' acceptance of a web-based 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Other province Sex: a- Male b- Female Age: a- < 18 b- 19 – 35 c- 36 – 50 d- > 50 Hospital name: a- French Vietnamese b- Thanh Do c- Binh Duong Columbia d- Hoan My Current occupation: a- Housewife b- Retirement c- Officer d- Businessman e- Self-employed f- Other (please specify) Treatment time: a- < days b- < week c- > week d- > weeks ~ 55 ~ Have you ever used Nurse Call System in hospital? a- Yes b- No B- THE FUNCTION OF USEFULNESS: No Questionnaire Could call nurse/doctor in emergency case Could update new health information quickly 10 Feel the service of patient's care better 11 Device installation is very convenient for patients or their relatives 12 Feel that the device is safe for using (mental safe) 13 Design and material not hurt you (physical safe) Satisfaction level Agree Neutral Disagree If you are nurse/doctor, please continue below questions If not, please move to Part C 14 Could call the support immediately from operation room, emergency room or patient room 15 Calling information sent to master station is correct and fast (room #, patient name, …) In the center, nurse could receive all calls at the 16 same time as well as all information showed on master station 17 In the case of cut-off power, the call is still done without any interruption 18 In the case of failure device, the detail of failure is showed on master station 19 The level of emergency call is classified by the bell ring and flicker light ~ 56 ~ C- THE FUNSTION OF EASE-TO-USE: 20 Patients could use the devices easily through the 1st instruction of the nurse Logo and color designed on devices helps 21 nurse/doctor and patient understand its function easily 22 The physical function of pressing button and pulling cord is easy to use If you are nurse/doctor, please continue below question 23 The information is updated or set up easily through separated module 24 It is easy to upgrade the version of program for the device ~ 57 ~ APPENDIX 2: DEVICE AND FUNCTION Master station:    Installation position: Duty room Features: data-bus for digital data and transmission to the duty room interface Service socket for connecting analysis tools Service and remote access functions Function: o The graphics display with touch-sensitive surface allows clear and structured display of all events as well as easy menu-guided operation for functions such as interconnecting zones or wards or selecting the defined duty settings such as day / night duty All components for connection to the electronic module for the duty room are included One call button, two presence buttons and a doctor call button are integrated into this desktop unit; the remainRing buttons (white and brown) are used for speech communication (systems with simplex communication) o Ackerman product: Information about a maximum calls and presences within the zone are listed simultaneously; use the arrow keys on the touch screen monitor to scroll through further entries All information appears in sequence according to the priority classifcation o Commax product: allow to receive only call at the time Call/Cancel Button & Pear and Multi-push button: (1) (2) (3) ~ 58 ~   Installation position: (1) near the door, Function: a communication between nurse and patient is made through pressing Red button and the red light is turned on The signal is transferred to the duty room with buzzer At the same time, the corridor lamp is lighted to indicate EM Module:    Installation position: mounted on the wall at the above of the door outside, duty room or across corridor Features: room calls (normal call, emergency call, doctor call) Provide acoustics signal for the calls Control of optical signals such as white color – toilet call, red – room call, green and yellow – presence Function: the lamp is lighted when a call is set It indicates the orientation of call for the nurse or staff The lamp is designed to view in any angle when it lights on The lamp notifies the normal call, emergency call, nurse or doctor call It includes parts with colors Red is for emergency call White is for patient call Yellow is for Aid presence Green is for nurse presence The light is OFF the Led corridor light:   Installation position: mounted on the false ceiling in the room with multibeds Function: the lamp is lighted when a call is set It indicates the orientation of bed call for the nurse Pull cord and Cancel Button in Toilet: ~ 59 ~   Installation position: toilet in patient room Function: The pull cord switch is supplied with a 2m pull cord and a red knob for releasing calls If the patient releases a WC call, the signal is transferred to duty room At the same time, the corridor lamp is lighted to indicate the call room The call is cancelled when cancel button is pressed in toilet or the presence button is pressed on the module near the open door Speech module:   Installation position: patient room, operating room or emergency room Function: to communicate between duty room and patient room or room to room The module includes white button and brown button The speech path is always switched on in one direction While one of the participants is speaking, the other participant can only listen, but not reply The participant who initiated the communication determines the speech direction To setup a communication, participant presses the white button to send the speech signal to the person who wants to talk Until the message “SPEECH…” appears on the display module, participant presses brown button and hold it down to speak Press the white button again to close the communication Room Terminal:   Installation position: Operating room Features: presence button (Green and Yellow), normal call, doctor call (code blue), acoustic signals and communication between duty room and operating room ~ 60 ~  Function: Green button is pressed when a doctor comes to the room The signal is transferred to duty room and the light is on during the operation In the case, the doctor wants to discuss with partners outside, Red button is pressed In other case, the doctor requests the support, Code blue is pressed When a supported partner comes to the room, Yellow button is pressed All color lights are ON in duty room The light with different color is also installed the door outside Others:  Zone controller:  Data terminal:  Power supply: ~ 61 ~ APPENDIX 3: CASE STUDY Patient call and Nurse presence: Patient in room 100 presses Call button or Pear button  Red light is ON in Call button  Red light is ON in EM module  The information of room #, bed # is showed on master station or display module in the duty room  Acoustic signal is ON After receiving the signal of patient call, nurse comes to Room 100 and presses Green button  Red button is OFF and Green button is ON At the same time, patient in Room 101 is pressing Call button Emergency call in patient room: In the picture, nurses are in Room 100 and Room 101 But the patient in Room 101 is more serious and nurse wants to get the support She presses Red button again  Red light is flashing (Flashing light is defined an emergency signal)  Green or White light in EM module is flashing  Room # and bed # are showed on master station  Acoustic signal is ON ~ 62 ~ Doctor presence in Operating room: - Operating room 1: Green color is pressed when main doctor comes to Operating room Green light in EM is ON The information of doctor presence is showed in duty room - Operating room 2: there are doctors in Operating room First doctor presses Green button and second doctor presses Yellow button Both of lights in EM are ON All information is showed in Duty room Emergency call in Operating room: In the case of calling the support outside, doctor presses Code Blue Red light in EM is ON All information is showed in duty room ... Perceived Usefulness (PU) and Attitude Toward Using (ATU) the system He hypothesized that the attitude of user toward a system was a major determinant of whether the user will actually use or reject system. .. call system: Nurse call system is the system that ensures hospital staffs can quickly identify the location and level of the calls The system also provides the means that the patient can draw attention... argued that there is a distinction for a patient from “look at to use to the health care device The way that the patient finds the trust to use the system depends on the physical feature and