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PUBLIC HEALTH SERVICE QUALITY
AT THAI NGUYEN NATIONAL GENERAL HOSPITAL
EXECUTIVE SUMMARY
CENTRAL PHILIPPINE UNIVERSITY
DOCTOR IN PUBLIC ADMINISTRATION
NGUYEN THI LAN ANH
DECEMBER 2016
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EXECUTIVE SUMMARY
Title: Public health service quality at Thai Nguyen National General Hospital
(From October, 2016 the hospital has been renamed to Thai Nguyen National
Hospital by Ministry of Health of Vietnam)
Total number of page: 138
Researcher: Nguyen This Lan Anh
Degree Program: Doctor of Public Administration
Institution: Central Philippine University
Jaro, Iloilo City
Region VI
Rational/Introduction of 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
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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; 1 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 5 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
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administrative procedures; cumbersome ... A survey of over 700 patients taken by VN
Express in Vietnam showed that 57 % Vietnamese people do 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 determined 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 medical quality received little interest until recently (Reerinks
and Sauerborn, 1996). For public services, the quality assessment has also received
little attention (Narang and Ritu, 2011). The quality of medical services is assessed
from two points of view: technical and functional (Institute of Medicine, 2001).
Technical quality refers to aspects related to the diagnosis and procedures while
functional quality refers to aspects related to the way services are provided to the
patients (Narang and Ritu, 2010). To be successful in long term a health care
organization must effectively monitor and manage both technical and functional
quality (Babakus and Mangold, 1992). Functional quality is often considered as the
main key to determine the quality by customer perception because it is difficult to
precisely assess the technical quality due to lack of professional experience
(Donabedian, 1980).
Thai Nguyen is a large mountainous province in northern area of Vietnam with
1.2 billion inhabitants. It is nationally known as a No 3 center for training human
resources after Hanoi and Ho Chi Minh City with 6 universities, 11 colleges, 9
vocational center, training nearly 100,000 workers each year. This unique
demographic situation has led to a marked diversity of public health agencies in Thai
Nguyen province. There are one national general hospital, 08 provincial hospitals and
more than fifteen medical centres at district level. For this reason, public health
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agencies in Thai Nguyen were classified differently from other cities of Vietnam.
According to General Statistic Office of Vietnam, in 2013 the province had 520 health
establishments with 23 hospitals and 4719 patient beds; The number of medical staffs
was 4219 persons, doctors per thousand populations was 7.6, number of beds per
thousand populations was 31.6 beds, and the percentage of children under age 1 fully
injected vaccine was 98%. Specifically, the State own unit account for 42% but served
98% of patient bed. The national health program was implemented and performed
relatively well, the state of food safety and hygiene has been improved. However, the
quality of services in some health facilities was not high due to lack of technical
facilities and doctors. (Thainguyen Statistic Office)
Public health services are more favorable with reasonable price for most people
in Thainguyen city. Community pharmacy is recognized as an easily accessible source
of advice in primary health care and pharmacists as competent and well-trained health
professionals. An essential factor to consider when analyzing the quality of health care
in facilities is the perspective of the clients. For clients and communities, quality care
is something that meets their perceived needs. Since a client's needs often differ from
one and other, his/her personal satisfaction ultimately depends on the individual
perception, attitude and expectations. Patient satisfaction is a strong influencing factor
in determining whether a person seeks medical advice, complies with treatments and
maintains a relationship with the provider/health facility. Ultimately, the dimensions
of quality that relate to client satisfaction affect the health and well-being of the
community. The results of the literature review suggest that the most important
dimensions of quality for the client are technical competence, interpersonal relations,
accessibility and amenities.
Thai Nguyen National Hospital (TNH) is located at Phan Dinh Phung ward,
right center of Thainguyen City. The hospital was established in 1951, this is a state
own hospital – one of the largest hospital in Thai Nguyen province and in North
mountainous region. TNH is maintained the first class hospital with bed size of 1200
units, the highest level of treatment is responsible for direct health care for more than
1.2 million people in Thainguyen province, and the ultimate treatment venue in North
moutainous provinces. The hospital has 40 wards, department and centers with high
quality medical staffs. In order to reach the mission of deploying advanced techniques
of thoracic surgeries, tumors, resuscitation, heart disease; the satellite clinics of
leading Central hospital in Northern mountainous area of Vietnam, the completion of
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human resources and enhancing quality of hospital‟s health services is necessary.
Especially, in the coming competitiveness and higher demand as well as quality for
health services boost all hospital to a number of opportunities and threats.
Today for the healthcare service market in Thainguyen, there is a need for a
healthcare service quality model that takes into consideration a complete coverage of
the dimensions that consumers use in evaluating healthcare service quality. Hence, the
evaluations of health services through the patients‟ satisfaction as well as health
provider‟s perspective of awareness and managing quality is needed. 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” was chosen as the dissertation title. The research is conducted with focusing
on service quality, patient satisfaction and intentions to return, as well as the patient
role in the medical service encounter.
Objectives of the Study
General objective
This study concentrates on quality assessment of the public health services at
Thai Nguyen National General Hospital. Thus, improving health service quality as
well as the competition ability of hospital and contributing to meet the strategic
objectives of Vietnam in terms of public health services quality up to 2020.
Specific objectives
Specifically, this study seeks to:
1. Describe the current status of health services quality at Thai Nguyen National
Hospital – a public hospital in Thai Nguyen city;
2. Determine factors affecting functional quality of health service at Thai Nguyen
National Hospital.
3. Examine the overall perceived quality of patients toward the quality of health
services at Thai Nguyen National Hospital;
4. Determine relationships between overall patient satisfaction and factors
affecting their satisfaction level including tangibility, reliability, responsiveness,
assurance, and empathy;
5. Determine relationships between patient demographics characteristics and their
overall level of satisfaction;
6. Propose recommendations for a better healthcare quality improvement at Thai
Nguyen National Hospital.
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Research Hypothesis
- Hypothesis 1 (H1): There are no significant effects of SERVQUAL dimensions as
Tangibles, Reliability, Assurance, Responsiveness, and Empathy on patient‟s overall
perceived of health service quality.
+ H1.1. There is no significant effect of “Tangibility” on patient’s overall
perceived of health service quality.
+ H1.2. There is no significant effect of “reliability” on patient’s overall
perceived of health service quality.
+ H1.3. There is no significant effect of “Assurance” on patient’s overall
perceived of health service quality.
+ H1.4. There is no significant effect of “Responsiveness” on patient’s overall
perceived of health service quality.
+ H1.5. There is no significant effect of “Empathy” on patient’s overall
perceived of health service quality.
- Hypothesis 2 (H2): There are no significant different in overall perceived hospital
service quality of patient according to their personal characteristics as age, gender,
occupation, income and educational level.
+ H2.1. There is no significant different in overall perceived hospital service
quality of patient according to their age.
+ H2.2. There is no significant different in overall perceived hospital service
quality of patient according to their gender.
+ H2.3. There is no significant different in overall perceived hospital service
quality of patient according to their occupation.
+ H2.4. There is no significant different in overall perceived hospital service
quality of patient according to their income.
+ H2.5. There is no significant different in overall perceived hospital service
quality of patient according to their educational level.
- Hypothesis 3 (H3): The higher patients‟ perceive of overall quality of health
service is, the better their satisfaction would be.
- Hypothesis 4 (H4): There is no significant correlation between overall patient
satisfaction and the patients' intention to return and to recommend other for coming
to hospital.
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Conceptual Framework
ANTECENDENT VARIABLE
INDEPENDENT VARIABLE
DEPENDENT VARIABLE
SERVQUAL
Expected Service Quality
DEMOGRAPHICS
Age
Gender
Ethnic
Education
Perceived Service Quality
Occupation
Income
Overall
Perceived
Service Quality
Using HIC
Patient
Satisfaction
5 SERQUAL FACTORS
Tangibility
Reliability
Responsiveness
Assurance
Empathy
Retention to
return or
recommend
Research Design and Procedure
The study used both qualitative and quantitative methods to analyze the health
care service quality. A list of quality assessment indices was formed based on
Donabedian theory and SERVQUAL model. The author divided research process into
two phases:
The first phase: Conduct a qualitative exploration of the characteristics of the
healthcare service in Thainguyen upon which consumer build their perceptions about
the quality of the healthcare service. This was performed through conducting a series
of in-depth interviews from patients as well as business and healthcare experts
frequenting the publichealthcare sector in Thainguyen city. Then the author conducted
a pilot study to test the questionnaire and the reliability of data. Final modification on
the questionnaire format was done, prior to the quantitative data collection procedure.
In the second phase, themes and information from previous phase was
developed into a valid and reliable instrument for measurement of healthcare service
quality. A modified conceptual model of service quality is constructed that was based
on the work of previous authors in the field as well as data gathered from the
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qualitative section of the study. Then a quantitative survey for a sample of patients
frequenting the public healthcare sector in Thai nguyen National Hospital was
performed to test the overall perceived service quality, satisfaction and retention to
return of patients.
The researcher also use descriptive-rational as it describes certain
characteristics of the respondent and its relation with other variables in the study. To
obtain the data needed, a survey design was used by using an interview schedule to get
the right information from the respondents.
Determine
problems
Setting research
objectives
Determine research
problem
Research model
Desk study
Preliminary studies
Group discussion (n
= 10)
Test the questionnaire
(n = 20)
Adjust
Not meet the
Expectation
Meet Expectation
Official questionaire
Delivery
questionaire
(n =367)
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Data
processing
Data
analysis
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Study population and Sampling technique
Population: Individuals have been used Thai Nguyen National General Hospital
service from June to August, 2016.
Sampling Methods: Random stratified sampling technique. Heterogeneous
samples are obtained that reflect, as much as possible, all patients who would
receive health care in the hospital. Evaluating the representativeness of such
samples is problematic. According to the latest statistics from GSO of Vietnam,
every month there is more than 3500 in patients come to stay in Thai Nguyen
National General hospital with different demographical characteristics. The
variability in demographics ensured varied opinions and responses of individuals
covering all the sampling criteria to be used in the present research.
Sampling Criteria: Patients who use public health service in the hospital in
2016, have had at least one overnight stay in the hospital.
Sample Size: Based on research by Hair, Anderson, Tatham and Black (1998) to
refer to the expected sample size. Accordingly, the minimum sample size was 5
times the total number of observed variables. Applying in this study, the number of
observed variables are 25, so we can get n = 125. But the author decided to choose
n equal to 367 patients in order to make the sample be more reliable. It covers
almost one third of the hospital scale of patient bed.
The process of choosing 367 patients will be as follow:
In order to ensure the randomly, representatively, the process of choosing
sample will be followed this procedure:
1.
Ask the patients at 6 departments including 3 types of bed rate from
high, medium and low level and Outpatient Department.
2.
In each department, choose patient according to the list of them in the
record book. Choose name of the patient according to the first letter of
their name.
3.
Choose 3 letters in one day, and continue that process until reach the
number of respondents of 30 - 70 patients in each department.
In the list of patient associated with department, choose only one who
has been stayed at the hospital at least 4 days or more.
Planning the time and department as well as the letter will choose when
conducting survey as follow:
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Level of bed
Order
Department
occupation
Time
rate
Number of
respondents
1
Labor ward
High
July, 2016
67
2
Gastroenterology
High
July, 2016
60
3
Traumatology
Medium
August, 2016
50
4
Cardiology
Medium
August, 2016
40
5
Odontology
Low
August, 2016
30
6
ICU and poison control
Low
August, 2016
30
7
Outpatient department
Special
August, 2016
90
Total
367
In the Pilot study, the number of experts will take part in will be approximately
10 persons, including: Board of director of hospital, Head of department in hospital,
leader of health department in Thainguyen province. The discussion focuses on the
quality of health services in hospital, from the awareness of director, the direction of
manager‟s board to the indicator for health service quality. The author also ask experts
view point of 5 dimensions in the Parasuraman service model that using in assessing
the quality of health service in hospital. And ask them to weight the importance of
each dimension with the assumption that total quality dimension equal to 100 percent.
Data collection and instrumentation
Delphi study
Using the table of the survey questionnaire, interviews. Patients who have been
used hospital‟ services will receive a table of survey question and a detail instruction
to get correctly answers. Objective of survey questionnaire is evaluatingexpectations
and perceptions satisfaction of them with hospital‟s services.
Use SERVQUAL model to evaluate patients‟ satisfaction with hospital health services
follow 5 factors determinants and 25 items.The patients‟ satisfaction is measured by
the gap between the perception and expectations (Perception - Expectation), and use
Liker scale with SERQUAL model to evaluate customer satisfaction.
The five dimensions of SERVQUAL as proposed by Parasuraman et al
(1988), Othman & Owen (2001, 2002) and Jabnoun and Al-Tamimi (2003) will be
adapted and modified in this study. The instrument poses aset of 25 structured and
paired questions designed to assess patients„expectations of service provision and the
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patients „perceptions of what was actually delivered. A five-point Likert-type scale is
used in this study, anchored by - strongly disagree to―strongly agree. Content
validity (wording and meaning) was checked carefully by experts. A pre-test was
then conducted with a group of patients, and minor changes to the scales were made
accordingly to ensure that the questions were not repetitive. The researchers will use
the structured and paired questions to measure Expectation (E) and Perception (P)
for service quality of Hospitals.
Likert Scale
Using the Likert 5 point scale, with choices ranging from 1 to 5 as follows
Scale
Range
Evaluating level
5
4.21 - 5.0
Highly satisfied
4
3.41 - 4.2
Satisfied
3
2.61 - 3.4
Neutral
2
1.81 - 2.6
Dissatisfied
1
1.0 - 1.8
Highly dissatisfied
Use primary data of customer survey by questionnaire to analysis. Data
collected from 367 patients‟ questionnaire to evaluate patients‟ satisfaction and overall
perceived in service quality with health services at Thai Nguyen National Hospital.
Cronbach's Alpha
Assess the reliability of variables through Cronbach's alpha coefficient. In
statistics, Cronbach's is a coefficient of internal consistency. It is commonly used as an
estimate of the reliability of a psychometric test for a sample of study.
Exploratory Factor Analysis
Exploratory factor analysis is a statistical technique that is used to reduce data
to a smaller set of summary variables and to explore the underlining theoretical
structure of the phenomena. It is used to identify the structure of the relationship
between the variable and the respondent. In this research, the author uses Q-type
factor analysis because factors are calculated from the individual respondent. Driving
factor is determined by Principle component factor analysis method in order to drive
the minimum number of factors and explain the maximum portion of variance in the
original variable. The author also intent to use varimax rotation method to simplify
the column of the factor matrix so that the factor extracts are clearly associated and
there should be some separation among the variables.
Factor loading can be classified based on their magnitude:
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Greater than + 0.30 - minimum consideration level
+ 0.40 - more important
+ 0.50 - practically significant
Factor analysis will be used to combine data for regression model
Regression models
Y 0 1TAN 2 REL 3 RES 4 ASS 5 EMP ei
Y: is the overall perceived about service quality of patients
TAN : Tangibility (physical facilities, equipment, and appearance of personnel)
REL : Reliability (ability to perform the promised service dependably and accurately)
RES : Responsiveness (willingness to help customers and provide prompt service)
ASS : Assurance (knowledge and courtesy of employees and their ability to
inspire trust and Confidence)
EMP : Empathy (caring individualized); ei is the stardard error.
Test of validity
Correlation matrix is used to measure correlation coefficient of variables, if the
significant level of variable is higher than 0.5, the correlation is strong and vice versa.
Testing of multi-collinearity
Multi-collinearity is the phenolmena that independent variable have almost linear
relationship. Skipping the mulitcollinearity often makes the standard errors higher, the
statistical value lower and may not be meaningful. To examine this phenomenon, we can
use Pearson correlation matrix. If the correlation coefficient between independent
variables less than 0.5, there is the multicollinearity. In addition, using Variance Inflation
Factor (VIF) to test the phenomenon of correlation between the independent variables
(VIF smaller than 2).
Exploratory Factor Analysis (EFA) including 6 steps:
Step 1: Accreditation conditions for implementing EFA
Including number of observations, number of variables in each dimensions.
Reliability test (Cronbach alpha); KMO and Bartlett's Test
Step 2: Factors extracting
Step 3: Analyse of factor extracting results
Step 4: Naming and interpretation of factors
Step 5: Check the reliability of the scales has edited
Step 6: Analyze each observed variables affect in the same direction or viceverce.
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Analysis of variance
This is a multi - applied method. This is a classification problem, where two or
more groups or clusters or populations are known a priori and one or more new
observations are classified into one of the known populations based on the measured
characteristics. In this study, the author intent to use disciminant analysis to test whether
there are any different in patients‟ perception interms of diferent age, gender, occupation
and level of educational attainment.
Data processing and analysis
Collect documents and related information of health care service from Thai
Nguyen National General Hospital‟spatients who has been used hospital‟s services.
1. Send mail for getting a permission of using data to hospital‟s director. If
approved, the work continues to prepare data collection.
2. Preparing and using tools for data collection: usb, voice recorder, camera …
3. Research conducted on the data collected
* Primary and secondary data
1. Primary data: Data was collected by the research questions and techniques of
interviewing the patients who have usedthe health careservices of the hospital.
2. Secondary data: information, data reporting of health careservices are stored in
the quality management department of the hospital.
* Tools of table of survey questions for patients including 4 parts:
- Part I is general information, the profile of the respondents who use / receive
the health careservice of hospital.
- Part II is the expectation, the desire of patient with 5 elements: Reliability,
Responsiveness, Assurance, Empathy, Tangibles of health careservices.
- Part III is the perception of the customer‟s comments with health care services
by 5 factors: Reliability, Responsiveness, Assurance, Empathy, Tangibles by the
measure of 5-level Likert scale.
- Part IV reviews the patient‟s satisfaction with the health care services of the hospital.
The results of the data collected were processed by using software on our
computer (Excel and SPSS 20.0). Aftercoding and cleaning, the following analyzes were
done: descriptive statistics, reliability assessment of scales, factor analysis, discriminant
analysis and regression analysis.
To meet the aim at being able to evaluate patients‟ satisfaction with health care
service of Thai Nguyen National Hospital, we used the measurement of expectations
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and perceptions on quality of health services and patients‟ satisfaction with health
service quality. Patients‟ satisfaction is measured by the gap between the perception
and expectations (Perception - Expectation). If the gap score proved positive then
patients satisfied and patients‟ satisfaction as the perception over expectations. If the
gap score is negative, indicating the patients' perception of service quality is lower
and did not meet their expectations for the service.
Findings
The following are major findings of the study:
1. SWOT Analysis of Thainguyen National Hospital
Strength
This is a state own hospital and
served as a regional hospital.
Good facilities and modern
equipment.
High quality of human resources.
Good scientific research with support
from Thai Nguyen University of
Medicine.
Good examination, emergency
treatment for patients in normal disease.
Receiving the direct attention by the
Department of Health, Provincial
Committee - People's Council and
Committee, Provincial Health Office.
The hospital has a team of young
civil servants qualified, enthusiastic and
energetic in their work.
Weakness
- Finance is not flexible.
- Facilities and equipment is not
really efficiency used.
- Reward and penalty regime is not
really encouraged doctor and nurse.
- Information system and promotion
are weak.
The budget for health care is not
efficient.
- The facilities are inefficient, although
the Government has been invested to
renovate, expand and upgrade but still
does not meet the requirements because
patients increase overload.
- Lack of captial to invest in high tech
health machinary.
- There is a shortage of human
resources, especially lack of doctors.
Opportunity
Threat
- Capital resources are funded by
- Competition also occurs in health
government and get a lot of attention and
services with private sectors
investment from NGOs.
- The increase of market price and
- The development of medical and
higher living standard
health care services in Vietnam and all
- The higher demand of health care
over the world
services of people
- Living standard of people in Thai
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- The payment policies are not really
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nguyen province increase with higher
flexible for patients.
average potential income per person.
- The
- Invested in upgrading equipment and
expanding Hospital
expectation
of
patients
in
Thainguyen and mountainous areas is
increasing sharply.
2. Status of public health service quality at Thainguyen National Hospital
The board of manager of hospital early awarded about quality improvement. In
2012, hospital built advanced planning stages for hospital quality in the period 20122017. The department of Hospital Quality Council was established also in 2012. In the
period from 2012 to 2013, the hospital has implemented quality improvement
activities according to the plan: Outpatient department and reception area on
Examination and upgrading computer software, connect the tests on the software, fix
repair, building infrastructure such as constructing 7-storey building, home repairs for
scientific department of Neurology, Psychiatry ...
The hospital has provided training and guidance for staffs on the work of the
department to ensure the quality and form buliding logos; slogans ensure scientific
quality of each unit. In the interest of the Party Steering Committee and board of
director of the hospital's effort dragon collective contract staff across units and is
facilitated by the Department of Health, the Institute, the central hospitals and the
close collaboration of the unit under the Department of Health, the unit was gradually
improve the quality of professional activities, as well as other conditions required for
the purposes of the examination unit.
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We can see that the quality score was increased significantly after 1 year (from
2014 to 2015). The board of director had paid attention to qualtiy improvement,
building plan of long –term (5 years) and short-term (every year).
3. Main survey results and findings
The survey results showed that most patients were examined using health
insurance cards (representing 86.4%), including various types of insurance, such as
pension insurance, voluntary insurance, health insurance for the poor, for family
policies .. .. the remaining 20% of patients are subject to premium, health insurance
cards when not in use examined and treated at the hospital.
There have 91% of patients interviewed residents in Thainguyen, of which 52%
is urban population, 48% came from rural areas. Only 9% of the patients come from
other provinces such as Bac Kan, Tuyen Quang, Cao Bang ... So, we can see the
number of patients coming from other provinces were modest. Hospital inpatients in
Thainguyen, most of them come from the rural areas, the rest of them from urban area.
There was 36.3% of patients who choose to care and treatment at the hospital
because the hospital has a good reputation; followed by the level of trust in doctors
(23.6%); then the right choice online (almost 20%); 13.2% selected hospitals is due to
better facilities. Medical expenses by a majority of respondents are in accordance with
the general provisions of the State and of health insurance; spirit of service attitude is
the last option for only approximately 5.3% rate.
The survey showed that, of 367 patients were treated in the hospital at the time of the
survey, 186 male patients and 181 female patients. Percentage of men - and women
are quite similar at 50.7 and 49.3% respectively. The average age of study subjects
was most patients aged 18 to 30 (representing 35.7%); followed by ages 30-60 (31%),
concentrated mainly in the Orthopaedic department, other gastrointestinal and
hepatobiliary obstetrics; 24% of patients over 60 years of age, mostly retired officers,
are treated in cardiovascular internal medicine and digestive ...
About their career, the team with 19.6% are farmers, workers and 26.43% are selfemployed, 12% were retired, 16:07% are State civil servants, students, the rest are
students (approximately 25%). Most patients in the study group had to diagnosis and
treatment for the first time (65%); 35% of patients who have used the services of the
hospital from the 2nd or higher.
Average monthly income of the respondents mainly from 2-5 million,
(45.5%), equivalent to the average income of residents in urban area. Some patients
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have a high proportion of income is very low, only about 4.6%; income patients fairly
(5-10 million) account for nearly 30%, the rest is poor (earning less than 2 million /
month) accounted 19.3%. Educational level of the majority of patients are asking is a
new high school graduation or finished level 2; Some patients have a university degree
and postgraduate very low (only 8.63% occupied). Thus it is possible that people who
have higher levels of education and income are less good option to use medical
services at the hospital.
The gap between expectations and perceived by patients to quality medical
services at hospitals is relatively uniform in all 5 levels (point gap ranged from -0.71 to 0.88) in which is the distance of the highest quality facilities. This suggests that hospitals
need further investment to improve facilities, tangible means of serving patients,
especially improving the garage and the equipment serving healthcare. The gap between
the expected second-largest and the patient's perception of empathy factor of health
workers. The medical staff should have an interest in each patient, listen and understand
them to better serve the health care needs and create trust for their patient greater
confidence in the quality of patient rim. The level of confidence and meet patients to
better evaluate other factors but there is still a certain gap between expectations or
expectations and realistic feel when using the health service of the hospital.
Some conclusions from results of EFA
Firstly, out of 25 variables included in the model, only 19 variables can be
analyzed (statistically significant). The cause may be due to restrictions by the number
of observations (sample is 367 samples).
Secondly, in all 19 variables can be analyzed in the EFA model, results
showed that all of them have a positive effect for each group of factors. Therefore, the
TNH can devise policies to develop and enhance patient satisfaction for each group of
factors in order of priority as follows:
Facilities factor
TAN = 0.317 * A_1 + 0.326 * A_3 + 0.295 * A_4 + 0.374 * A_5
(1) The equipment of the hospital;
(3) Apparel of medical staff, doctor;
(4) Health care services where patients dealing with convenient;
(5) Parking at the hospital.
Reliability factor
REL = 0.290 * B_7 +0.289 * B_8 +0.210 * B_9 + 0.181 * B_10 + 0.277 * B_11
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(1) Hospital staff respect the decision of the patient, understand the needs of the
patient;
(2) Medical staff with higher qualifications;
(3) The appointment and regular treatment done on time;
(4) The hospital stays of patient information a systematic manner and keeps
such information confidential;
(5) Patients should be informed of the risks that may occur during the
implementation of health care services are proposed relating to the health of
patients.
Assurance factor
ASS = 0.475 * C_12 + 0.461 * C_14 + 0.326 * C_16
(1) Patients were provided full information about their condition and be
notified when the service will be implemented;
(2) The patient comfort when in contact with staff at the hospital;
(3) The patient was carefully instructed before hospital discharge.
Responsiveness factor
RES = 0.414 * D_17 + 0.356 * D_18 + 0.394 * D_19
(1) The hospital staff must have good knowledge and answer the patient's
questions correctly and quickly;
(2) The hospital staff must be polite attitude and patient-friendly;
(3) Amount applicable fees must be reasonable, correct regulations.
Empathy Factor
EMP = 0.280 * E_22 + 0.271 * E_23 + 0.271 * E_24 + 0.263 *E_25
(1) The hospital staff understands the needs and desires of the patient;
(2) Medical procedures simple and convenient for the patient;
(3) Hospital staff listens and address patients' questions quickly and logically;
(4) The hospital staff irrespective of insured patients and patient self-closing fees.
Resutl of regression of standardized model is:
SAT = -0.224 + 0.153*TAN + 0.298*REL + 0.126*ASS + 0.242*RES + 0.236*EMP
Conclusions about the regression model:
Firstly, value VIF (Variance Inflation Factor, variance magnification) <10, so we can
conclude there is no phenomenon of multi - collinearity between variables
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Secondly, the model was built with five independent variables (TAN; REL;
RES; ASS; and EMP). The model has good statistical significance (adjusted R and R2
are greater than 0.6).
Third, the variables in the model are statistically significant because the
value of Sig <0.05.
Forth, the order of the variables affecting patient satisfaction is: REL, RES,
EMP, TAN and ASS because standardized Beta coefficients are higher respectively.
Fifth, look at the Model Summary table, we see that the adjusted R2 of the
second model is the 0.682 (68.2%), 68.2% thus changing the dependent variable is
explained by five independent variables.
Sixth, look at the ANOVA table, we see that the column value Sig. = 0.000;
so the regression coefficients of the independent variables other than 0.
The results of discriminant analysis showed that, there are any differences in
the satisfaction between vary age, gender, occupation, and income groups. That means
patients feel satisfy or not depend significantly on the outcomes, not because of
themselves.
Conclusions
The following conclusions are drawn from the results and the findings of the study
Improving the quality of healthcare is an important and leading activity in
the direction of the field of medical examination and treatment of the hospital. This
activity always gets the attention of the board of directors of the hospital. However,
in addition to investments in infrastructure and enhance the responsibility of every
staff, the hospital needs to consider the strengthening of human resources and
finance, improve patient safety and patient satisfaction.
In the past period, in order to improve quality, the hospital has established a
quality management unit to cover and supervise the quality of activities in the hospital.
Thereby, the hospital made a fundamental change in the quality management; this is
also an important step in changing and improving the quality of hospital, contributting
to improve patient satisfaction. Quality management is 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 research results showed that, majority of patients were satisfied with
the attitude of nurses and doctors. The care and positive attitude of nurses help
patients reduce fatigue and trust in hospital. Some advantages should continue to
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