Tài liệu Dissatisfied patients at thien chuong dental clinic

UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business ------------------------------- Nguyen Dao Kim Thuong DISSATISFIED PATIENTS AT THIEN CHUONG DENTAL CLINIC MASTER OF BUSINESS ADMINISTRATION SUPERVISOR: Dr. Nguyen Phong Nguyen Ho Chi Minh City - 2017 UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business ------------------------------- Nguyen Dao Kim Thuong DISSATISFIED PATIENTS AT THIEN CHUONG DENTAL CLINIC MASTER OF BUSINESS ADMINISTRATION SUPERVISOR: Dr. Nguyen Phong Nguyen Ho Chi Minh City - 2017 SUPERVISOR’S REPORT ON THE THESIS PROPOSAL SUBMITTED FOR DEGREE OF MASTER of BUSINESS ADMINISTRATION The thesis proposal title: THE REDUCTION OF CURRENT PATIENTS AT TC DENTAL CLINIC Student Name: Nguyen Dao Kim Thuong Supervisor: Dr. Nguyen Phong Nguyen 1. General comments: • Remarks on the student’s attitude: ………………………………………………………………………………… ……………………………………………………………………… • Remarks on the assignment’s academic quality: ………………………………………………………………………………… ……………………………………………………………………… 2. Overall assessment: Meet requirement for submitting Not meet requirement for submitting 3. Other remarks: − Did the student follow the report schedule? Yes No − The Turnitin plagiarism percentage: Supervisor’s signature Other…………………………. Table of Contents Executive summary ..................................................................................................................................... 2 Part 1: Background ..................................................................................................................................... 3 1.1 Company background ............................................................................................................... 3 1.2 Symptom ..................................................................................................................................... 5 1.3 Initial causes effect map ............................................................................................................ 6 1.4 Updated cause – effect map ....................................................................................................... 9 1.5 Potential central problems of interest .................................................................................... 11 Part 2: Central problem justification ...................................................................................................... 15 2.1 Central problem definition...................................................................................................... 15 2.2 Problem existing ....................................................................................................................... 17 2.3 Problem importance ................................................................................................................ 20 Part 3: Causes validation and solutions .................................................................................................. 21 3.1 List of real causes ..................................................................................................................... 21 3.2 Central cause validation .......................................................................................................... 24 3.3 Solutions.................................................................................................................................... 27 3.3.1 Stage 1: The communication training for employees and manager....................................... 28 3.3.2 Stage 2: Commending and rewarding ................................................................................... 30 Part 4: Appendices .................................................................................................................................... 32 4.1 Interview guide......................................................................................................................... 32 4.2 Transcripts ............................................................................................................................... 33 4.2.1 Transcript 1:........................................................................................................................... 33 4.2.2 Transcript 2............................................................................................................................ 36 4.2.3 Transcript 3:........................................................................................................................... 39 4.3. Survey ....................................................................................................................................... 42 4.4 The comparison about the price ............................................................................................. 44 4.5 Location .................................................................................................................................... 46 4.6 Medication process .................................................................................................................. 47 4.7 References ................................................................................................................................. 48 1 Executive summary Thien Chuong dental clinic was established in 1999 with over 15 years experienced in healthcare industry. Recently, the revenue of clinic is decreasing and the patient’s transaction is also reduced from 2014 to 2016 specifically. This research is written to find possible problems lead to decrease patient then give solution in order to improve and enhance patient engagement. The face to face interview were conducted with three patients and the clinic manager. At the first interviews, explanations for reducing patients were dissatisfied which regarded weak communication between doctor-patient, lack of specialize machine and long time for waiting. Nowadays, health care is not only pay attention to quality of treatment by excellent diagnose, treatment process but also concerns about delivering professional customer service. Patient oriented is the mission that clinic aims to achieve. It can be said that satisfied patient’s needs will get patient’s appreciation, enhance patient engagement and patient loyalty. Patient satisfaction is one of the most priority of some clinics in general and TC in specific target to achieve. For the loss of patients since 2014, the central problem is dissatisfied patients that impact on returning decision of patient which cause by poor communication between dentist-patient. Thus, this research focuses on the solution to solve the poor dentist – patient communication. 2 Part 1: Background 1.1 Company background Thien Chuong dental clinic (TC) is a private clinic was official established in 1999 by Dr. Dao Minh Thien Chuong. It is known as one of the high reputation dental clinic at Tuy Hoa city. It first location was private home at 14 Nguyen Cong Tru street, Ward 1. However, it was a small premise and inconvenience for expanding operation so the clinic moved to new location. The clinic is leasing a house located at 55 Tran Hung Dao street, Ward 1, Tuy Hoa city, Phu Yen province. It is in central Tuy Hoa which nearly 1.5 kilometer away interprovincial coach station, near train station around kilometers, away 700 meters to Tuy Hoa market, around 700 meters and close to administrative office of Ward 1. It can say that its location is belong in densely populated area and also convenience for others accessing. With the slogan “Elevating Vietnamese Smile” TC always cares and understands needs of oral health care as well as oral beauty of every patient. For that reason, all of dentistry equipment and material are selected carefully from classy and prestige manufacturers. This is a kind of family-owned corporation. It operates under the control of Dr. Dao Minh Thien Chuong. In the beginning, it operated and managed by only Dr. Chuong, since 2001 he has co-ordinated with Dr. Vo Ngoc Doan Phuong-his wife and they develop clinic until now. The clinic operates on Monday to Sunday. The clinic official time starts at 8:00 AM and closes at 7:00 PM. On Sunday the clinic close sooner than others at 6:00 PM For over fifteen years of establishment TC has expanded operation scale in which o 2 specialized doctors o 5 dental hygienists 3 o 3 dental assistants o 1 receptionist o 1 accountant o 2 sanitation staffs o 1 security guard Dr. Chuong and Phuong graduated from University of Medicine and Pharmacy at Ho Chi Minh city with Doctor Specialty I degree. Most of the staffs are not required high diploma or years experienced. The 5 dental hygienists with Intermediate Professional degree in which are dental technician and several are pharmacy technician. The receptionist required graduated high school, fluent in using computer skill and good appearance. The accountant must have relevant certificate and at least 1 year experience in this field. Currently, there are six dental clinics in central Tuy Hoa city which two of them are new reputation branches clinic from Sai Gon - Viet My dental clinic and Sai Gon dental clinic. No Name of dental clinic 1 Viet My dental clinic 2 Sai Gon dental clinic 3 Nu Cuoi Xinh dental clinic 4 Nha Chin dental clinic 5 School dentistry 4 6 Hoang Son dental clinic 7 Minh Tri dental clinic Table 1: Dental clinics in central Tuy Hoa city 1.2 Symptom 29,800 29,610 29,600 29,400 29,331 29,200 29,000 28,908 28,800 28,600 28,400 2014 2015 2016 Chart 1: The volume of patients from 2014 to 2016 (Source: Thien Chuong dental clinic finance report 2014-2016) From 2014-2016 the volume of patient was in a decreasing trend was indicated in Chart 1. This made the profit went down in the same stage as Chart 2 showed below. 5 10,000,000,000 9,000,000,000 8,000,000,000 1,689,220,000 1,450,771,440 1,217,338,229 6,897,680,000 7,055,218,560 7,165,981,771 2014 2015 2016 7,000,000,000 6,000,000,000 5,000,000,000 4,000,000,000 3,000,000,000 2,000,000,000 1,000,000,000 operation cost Profit Chart 2: Revenue of TC 2014-2016 (Source: Thien Chuong dental clinic finance report 2014-2016) The loss of profit kept increasing around 18% to 22% by time. This abnormal number was over the acceptable gap 10-15% from doctor manager. Additionally, the operation cost was insignificant changed – it was under 3% for each year in the period 20142016. The operation cost includes budget spend for leasing fee, equipment, salary, and others variable cost increase every year in a fixed amount. Besides, 2015-2016 the manager also controlled cost well by decrease expense from 2.2% to 1.17%. 1.3 Initial causes effect map In depth interview was carried out with three chosen patients aged from over twenty to under forty-five years old who have experienced in service at TC over five times. Gathering information from three patients the researcher realizes there is a common from three point of view is they were uncomfortable with the service at TC, in another way they were dissatisfied with the service was listed down: Difficult access dentists or hygienists, Poor communication between staffs and patients, Poor facilities in the clinic. 6 Per Mr. Nguyen said that he has known TC for 3 years, his daughter and he also experienced service here several times. His last treatment was veneer and was quite satisfied with his teeth but he complained about the service. He had to wait for long time although he did made appointment before and he also said the receptionist was unfriendly. “The receptionist is extremely rude and will not let you get a word in. First rule of customer service is: listen to the patient. I was interrupted three times before I could get my question in. I don’t think a person who work in service industry should do that”. Lastly, he shared that his daughter was braced at VM dental clinic. The staff was consulted kindly and also gave him the detail treatment process although he just only asked for referencing. After that, an interview with Ms. Diem has experienced at TC over a year. Her treatment is braces and the progress is fairly accurate with doctor’s expectation at the beginning stage. She said one of the lack of specialized machine – X-ray machine caused difficulty in diagnosing treatment. Because her jaw structure was complicated with the overcrowding issue so she had to go to Saigon to take X-ray film. That was inconvenience to her by spending more time and cost. Furthermore, because there were many patients so dentists did not spend time to check detail stages, the dental hygienists in charge most of part but they are weak in interacting with patients and their colleague, and they also weak in consulting. “Dental hygienists seem to not know what they're talking about. They don't seem to communicate well with each other and with the doctor. One would say one thing and the other would completely say a different thing. Feel not at ease after my appointment. Things could be better explained and could be more organized. I was nervous at the beginning. Occasionally the dentist does work on the teeth and it probably won’t be every appointment, but he sometimes pop in and check the teeth, to make sure the dental hygienist is doing everything correctly”. She also complained staffs were unprofessional when they were talking loudly while doing. Mr. Cong shared he had a good impression about the clinic by the good interaction with patient of Dr Chuong. However, he complained about the hygienist’s working style that she did not focus on her work and poor at consulting. He said “During my 7 treatment the hygienist was talking on the phone most of the time. I felt it was so annoy. I was so nervous that time if she forgot and drilled a big hole on my teeth. Then, she told one of my wisdom tooth swelled up and the only choice was I had to extract it. But, when I asked whether it was necessary or not to do it she could not explain”. All of interviewers were admitted that the space was quite small especially the waiting room. Sharing by Mr. Cong that “When I came in the peak time, there was no place for me to sit, so I had to wait outside the room.” And Ms. Diem” said “It doesn’t have enough space for many patients so it’s uncomfortable” However, it was clean and ensure institute for medical quality. Mr. Nguyen commented “Cleaning rooms and tools are replaced new every checkup” and Ms. Diem said “Generally, everything is clean and neat, but the waiting room is a bit small, it doesn’t have enough space for many patients so it’s uncomfortable”. According to Mr. Nguyen and Ms. Diem high price is not important to them, Mr. Nguyen explained “I just only care about the quality and service because I believe health care is priceless. But it should appropriate with the quality” From all information of patients and doctors shared, the initial cause-effect map was drawn below for noted signal affect to volume of patient. 8 Long waiting time Unfriendly receptionist The hygienists consult unclear Poor communication between staffpatient Dissatisfied current patients Reducing patients Lack of specialized medical machine Poor facilities in the clinic Small waiting room Map 1: Initial cause-effect map 1.4 Updated cause – effect map The first cause – effect map only based on the information gather through the interview so this was only view point of each patient. The researcher wants to have a general view causes of reducing patients in TC, for this reason the researcher read studies, articles and researches to add another potential problem in the map. The literature cited by Arnold, Todd, Fang, Eric (1) the orientation that a firm takes toward deepening current customer relationship, or developing new customer relationships, has the potential to significantly impact overall firm performance (1-3). There is 44% companies focus (4) on customer acquisition and only 18% on retention (5). 9 Customer is viewed as assets or lifeblood of the company. It can not maintain or grow without customers so not only keep retaining customer is necessary but also concerning on acquiring new customer. After examining relevant literatures, the telephone interview was conducted with two patients and the dentist manager to review new potential problems were skipped in the initial interview. When being asked about the way the access or know about TC, Mr. Cong and Ms. Diem said they did not catch any information about TC from any media channel as newspaper, advertising on TV. The reason is they hardly read local newspaper or watch local television channel, they usually read news from popular websites on the internet and often skip advertisement part on newspaper or TV channel. Per discussing with Dr. Chuong the amount of new customer go to dental clinic was limited because he did not advertise broadly the image of clinic. “In 2010, it took over fifty million VND for advertising on local television and local newspapers but it was not effective". The information interviewed was added in the updated cause-effect map 10 Poor advertising plan Weak acquiring new patients Long waiting time Unfriendly receptionist The hygienists consult unclear Reducing patients Poor communication between staffpatient Dissatisfied current patients Lack of specialized medical machine Poor facilities in the clinic Small waiting room Map 2: Updated cause-effect map 1.5 Potential central problems of interest There are two potential problem cause patient reduction: Dissatisfied current patients and Weak acquiring new patients. Attracting a new customer could cost six times more than retaining an old one (6). Additionally, Dekimpe (7) claimed a critical issue related to the success of company is the ability to retain current customer and make them loyal to the brand. Ganesh (8) was written, “ Loyal customers build business by buying more, paying premium prices and providing new referrals through positive word of mouth over time”. 11 Based on information Dr. Chuong shared was cited above that advertising takes high expense and it over the budget of the clinic. Furthermore, in a period from Jun – Dec 2010 Thien Chuong dental clinic did a small survey about how customers know about it. According to this, over 85% of customer comes from word of mount channel. This strong patient source supports the clinic maintains and attract new patient without spend fund for advertising through media channel. Besides, the profit in 2010 to 2011 did not change which kept remain in this period when the advertising was applied. Compare to the high fund spend for advertising in attract new customer but did not bring any significant value to the clinic operation. Healthcare industry is related to customer service in which customer satisfaction contributes an important role in developing company – clinic. Understanding that spends high cost for attracting new customers do not ensure the equal benefit it can bring for a long time. Meanwhile, retaining customers is not only make a good improvement in the internal structure but also using as a tool to attract new customer by word of mouth which TC is strong currently. Furthermore, the clinic has a small assessment about the level of patient satisfied referred with service quality after each visit time at Thien Chuong dental clinic. As the chart showed below the rate of patient dissatisfied about the service quality was high was accounted for 70% in totally. 12 45% 40% 35% 30% 25% 20% 15% 39% 31% 21% 10% 5% 9% 0% Strongly dissatisfied Dissatisfied Neutral Satisfied 0% Strongly satisfied Chart 3: Patient assess service quality of Thien Chuong dental clinic from Sep 2016 to March 2017 To sum up, combining all information through interview and re-examination by literature, attracting new customer are not necessary to the clinic situation. 13 Long waiting time Unfriendly receptionist The hygienists consult unclear Poor communication between staffpatient Dissatisfied current patients Reducing patients Lack of specialized medical machine Poor facilities in the clinic Small waiting room Map 3: Final cause-effect map 14 Part 2: Central problem justification 2.1 Central problem definition Nowadays, healthcare is not only concern about cure, treatment process but it also refers to customer service in which adapts customer needs. Patient satisfaction is defined as the patient’s opinion of the care received from nursing staff works in hospital and an outcome criterion of nursing care service (9). However, satisfaction is mainly about emotionally through customer expectation and experience in the service. Satisfaction refers generally to the match between expectation and real circumstances of treatment. If expectation and service circumstances are equal, the client is generally satisfied or conversely if the service circumstances fall below expectations, the client is dissatisfied (10). Another term is defined as the appraisal of the extent to which the care provided has met an individual’s (patient’s) expectations and preferences (11). Satisfaction is also a tool use to evaluate quality of service by patient. It can be seen as the healthcare reaction to the context, process and result of the experience (12) From the study of Wagner and Bear (13), there are three antecedents of patient satisfaction related to patients personal element of intrinsic motivation, cognitive appraisal and affective response as Cox (14) has identified − Intrinsic motivation recognizes perceived choice, competence and selfdeterminism as precursors of health behaviors. - Cognitive appraisal includes patient’s interpretation of their situation and perception of their relationship with the nurse (14) - Affective response, defined as positive perception of nurse caring behaviors, strongly correlated with patient satisfaction with nursing care (4, 15-17). Furthermore, (18) listed six causes of patient dissatisfaction were: − Bad experience at the front desk − Long wait in reception area 15 − Unattractive practice − Can’t get a timely appointment − Doesn’t accept their dental insurance − Hygienist who’s a stabber Another cause of patient dissatisfaction is showed as the chart below: Problem type unspecified 4% Communication or customer service problem 8% Difficulty seeing a practitioner 10% Did not report a problem with their health plan 52% Billing or problem payment 13% Delay or denials of coverage or care 13% Chart 4: Reason for patient dissatisfaction under managed care Source: The Kaiser Family Foundation/Harvard School of Public Health (19) Patient satisfaction is measured and evaluated by eight dimensions (20) is listed below • Interpersonal manner: features of the way in which providers interact personally with patients. • Technical quality: competence of providers and adherence to high standards of diagnosis and treatment. • Accessibility/convenience: factor involved in arranging to receive medical care • Finances: factors involved in paying for medical services. • Efficacy/outcomes: the results of medical care encounters. 16 • Continuity: sameness of provider and/or location of care. • Physical environment: features of setting in which care is delivered. • Availability: presence of medical care resources 2.2 Problem existing Per discussion with patients in the previous sections the survey was conducted to evaluated the causes affect patient dissatisfaction at Thien Chuong dental clinic currently. There were 15 respondents was interviewed by doing a short survey. The respondents were range of age from 20 years to over 40 years. Out of 15 respondents over half of patients were female and the remaining were male. The survey was made with twelve questions about five dimensions use to measured patient satisfaction. Furthermore, Likert-style is used to evaluate the satisfaction which from Strong dissatisfied to Strongly satisfied 17