A study on factors ò service quality afecting the satisfaction ò patients in thanh hoa general hópital

Thesis for the Degree of Master A Study on Factors of Service Quality Affecting the Satisfaction of patients in Thanh Hoa General Hospital June 2017 Department of Business Administrat

Thesis for the Degree of Master

A Study on Factors of Service Quality Affecting the Satisfaction of patients in

Thanh Hoa General Hospital

June 2017

Department of Business Administration

Graduate School of Soongsil University

DO MANH HUNG

Thesis for the Degree of Master

A Study on Factors of Service Quality Affecting the Satisfaction of patients in

Thanh Hoa General Hospital

June 2017

Department of Business Administration

Graduate School of Soongsil University

DO MANH HUNG

Thesis for the Degree of Master

A Study on Factors of Service Quality Affecting the Satisfaction of patients in

Thanh Hoa General Hospital

A thesis supervisor: Prof Park, Jong-Woo

Thesis submitted in partial fulfillment of the

requirement for the Degree of Master

June 2017

Department of Business Administration

Graduate School of Soongsil University

DO MANH HUNG

To approve the submitted thesis for the Degree of Master By DO MANH HUNG

Thesis Committee

June 2017

Graduate School of Soongsil University

TABLE OF CONTENTS

ABSTRACT

CHAP TER 1 INTRODUCTION

1.1 Research background 1

1.2 Research objectives : 3

1.3 Research Subject 3

1.4 Research process 3

1.5 Structure of thesis: 5

CHAP TER 2 THEORETICAL B ACKG ROUND

2.1 Definition of service and features of service 7

2.2 Service quality 10

2.3 Customer satisfaction 11

2.4 Relationship between service quality and customer satisfaction 11

2.5 Research models on service quality and cutomer satisfaction 12

2.5.1 5-distance model 12

2.5.2 SERVQUAL model 144

2.6 Some recent studies on customer satisfaction in healthcare sector 15

CHAP TER 3 RESEARCH METHODOLOG Y

3.1 Research Model 18

3.2 Research Hypothesis 19

3.3 Measuring factors 23

3.4 Research Design 26

CHAP TER 4 RESEARCH RESULTS

4.1 Descriptive statistics 29

4.1.1 Classification of samples of age of patients 30

4.1.2 Education-base classification of patients 30

4.1.3 Occupation-based classification 31

4.1.4 Income-based classification 32

4.2 Results of answers to survey questionnaires 33

4.3 Evaluation of reliability of scale of factors 35

4.4 Exploratory factor analysis 37

4.4.1 Results of exploring analysis of independent variables 38

4.4.2 Exploring factor anlaysis of dependent variable 42

4.5 Correlation analysis 43

4.6 Regression analysis 46

4.6.1 Results of regression analysis method by Enter method 46

4.6.2 Testing of research hypothesises 48

4 7 Testing of difference between groups of patients under indicia 50

4.7.1 Testing of difference between group of patients with different ages 51

4.7.2 Testing of difference between groups of patients under their education 52

4.7.3 Testing of difference between group of patients under their occupation 54

4.7.4 Testing of difference between groups under income of patients 56

4.8 Discussion from the research result 58

CHAP TER 5 CONCLUSION

5.1 Summary of the study 61

5.2 Recommendations from the research result 63

5.3 Contributions and meaning of the research 67

5.3.1 Contributions of the research 67

5.3.2 The significance of the study 67

5.4 Limitations of the research 68

5.5 Research directions in the future 68

REFERENCES

APPENDICES

LIST OF TABLES

[Table 2- 1] Summary of some studies on patient satisfaction in healthcare srervices

16

[Table 2-2] Observed variables 23

[Table 4-1] Results of sample size ………29

[Table 4-3] Summary of answers to questionnaires 33

[Table 4-4] Results of testing reliability of scale of factors 35

[Table 4-55] KMO and Bartlett's Test of independent variables 39

[Table 4-6] Total Variance Explained of independent variables .39

[Table 4- 7] Rotated Component Matrix of independent variables 40

[Table 4- 8] KMO and Bartlett's Test of dependent variable 42

[Table 4-9] Total variance explain of………42

[Table 4- 10] Component Matrix of dependent variables 43

[Table 4-11] Pearson correlation coefficient 44

[Table 4-12] Summary of information of estimation method by enter method 46

[Table 4- 13] ANOVA by enter method 46

[Table 4- 14] coefficients of estaimation model by Enter method .47

[Table 4- 15] Statistics of average value under the age of patients 51

[Table 4- 16] Result of variance analysis under ages of patients 52

[Table 4-17] Statistics of average value of education of parents of patients 52

[Table 4-18] Result of variance analysis of education of patients .53

[Table 4- 19] Statistics of average value of group under occupation of patients 54

[Table 4- 21] Statistics of average value of groups under income of patients 57 [Table 4- 22 ] Analysis of variance under income of parents of patients 57 [Table 4-23] Statistical value of factors 59

LIST OF FIGURES

[Figure 2-1] Research Model 19

[Figure 4-1] Education-based classification of patients 31

[Figure 4-2] Occupation-based classification of patients 32

[Figure 4-3] Patient income-based classification 33

[Figure 4-4] Graph of average value of satisfaction point under education 54

[Figure 4-5] Graph of average value of income of patients 58

[Figure 4-6] Relationship between dependent and independent variable .60

ACKNOWLEDGEMENTS

I would like to thank my supervisors Prof Park, Jong-Woo who gave me valuable assistance and advices in completing the dissertation and the MBA course

I also thank to a ll lecturers and staff of Soongsil University and Hong Duc University for their supports

Thanks to Thanh Hoa General Hospital and my workmates who provided

me information to fulfill the research

Specially thanks to my wife and my friends for their encouragement during the time to study and do the research

Patient satisfaction is a multi‐dimensional healthcare construct affected by many variables Healthcare quality affects patient satisfaction, which in turn influences positive patient behaviours such as loyalty Patient satisfaction and healthcare service quality, though difficult to measure, can be operationalized using a multi‐disciplinary approach that combines patient inputs as well as expert judgement The purpose of this study is to research the satisfaction of patients with service quality components in SERVQUAL model

in Thanh Hoa General Hospital, Vietnam

The research methodology to be used is quantitative research methodology through investigation and processing data such as descriptive statistics, scale inspection, factor analysis, and correlation and regression analysis Processing support software is SPSS 20.0

Research result points out the satisfaction of patients who suffer the effect

of four factors (1) assurance, (2) empathy, (3) responsiveness và (4) tangibles

Reliability takes no effect in the general satisfaction of patients Such factors have positive impacts on the satisfaction of patients

The research result shows no difference as per the discrimination signs like age of patients, income of patients‟ parents, career and educational qualification

Finally, the study indicates the limitations and recommendations of research orientation for future studies

Key words: Satisfaction of patients, Health care, service quality SERVQUAL

CHAP TER I INTRODUCTION

1.1 Research background

Health care quality is a global issue The health care industry is undergoing

a rapid transformation to meet the ever-increasing needs and demands of its patient population Hospitals are shifting from viewing patients as uneducated and with little health care choice, to recognizing that the educated consumer has many service demands and health care choices available The closest most of measuring consumers‟ experiences is the occasional satisfaction survey In term of service quality research sector, the pioneering studies are performed by Parasuraman and partners (1985, 1988, 1991) in USA, Gronroos (1984) in Enrope, Kano (1984) in Japan, etc and nowadays the studies on service quality and satisfaction of customers are carried out by various researchers in many fields such as retial (Durvasula and Lysonski 2010 ); health care (Babakus and Mangold, 1992; Mostafa.M.M, 2005; Ahuja M et al, 2011; Chakraborty.R and Majumdar., 2011; Ahmad.R and Samreen.H, 2011; Zarei A et al, 2012; Soita.W.P, 2012), etc Studies on service quality become important topics because of its relationship with costs (Crosby, 1979), benefits (Buzzell and Gale, 1987; Rust and Zahorik, 1993), satisfacttion of customers (Bollton and Drew, 1991; Boulding et al, 1993), cutomers‟ ability to repurchase (Reichelheld and Sasser, 1990) (cited by Buttle F., 1996) This discovery is especially

meaningful to managers and service suppliers to improve products and services aimed to tailor the need of customers better

In health care sector in Vietnam, now there are many different facilities such as the State hospitals, private hospitals and practitioners with the tradition medicine method in the community

Development of economy requires the higher quality of services, especially health care for patients Causes of special concern to patients are the improved income of households and good living conditions resulted in concern and attention to safety and heath of people This results in the pressure put into the treatment service facilities to be renewed to tailot the increasingly high need from people, in which healthcare services is the first

Currently, the studies on satisfaction on customer services were conducted a lot by Vietnamese reseasrchers in numerous fields (For example: Nguyen Thi Phuong Tram, 2008; Nguyen Trung Kien, 2005…) However, the studies on satisfaction on the service quality for patients are limited (For example, Bui Thi Thu Hương, 2009, Pham Nhat Yen, 2008)

From up to now, there is no systematic study to evaluate the satisfaction

of customers on service quality of Thanh Hoa General Hospital to be conducted Some case studies to be conducted only assess the descriptive statistics but not detailedly analyze the essense relationship among factors affecting the satisfaction of patients for hospitals‟s services Thus, a systematic study is necessary to discover and answer the research questions to be offerred

Therefore, as an administration officers at hospital, I choose the topic “A

Study on factors of service quality affecting the patient satisfaction in Thanh Hoa General Hospital” to be my study

1.2 Research objectives

This study offers some main purposes as follows:

The first is to evaluate the status of service quality to be provided by the hospital over major aspects of SERVQUAL model and evaluate the overall quality of customers

The second is to discover the factors to be meaningful and not meaningful for improvement of service quality of hospital in term of statistics

The third is to assess the differences in how population factors affect the satisfaction of patients

Research process is discribed as follows:

Step1: Identify the research matter In this step, the author will define the matters offerred from management, motive, purposes of performing such study

from opinions of guide lecturers Finishing this step, the author will draft the main contents of Chapter 1 and 2 of thesis

Step2: Research model and design the research model: After the research matters, research motive, research objectives and research process as in Step 2, the author will cons ider theory on service quality and research model on satisfaction of customers from other studies Choose a suitable research model with the high reliability and ability to be applied to the research matter in the thesis as a base model of building the the oretical research model Specifically,

in this thesis, the author chooses the SERVQUAL model as a base theoretical model because it is proved on reliability by various studies (see in Chapter 2) Step 3: Develop the investigation questions for data collect ion After the theoretical model to be established, the author conducts the development of investigation questions Such questions are inherited from previous studies and calibrated in appropriateness with the research conditions in patient healthcare sector, especially children To calibrate the aspects in the theoretical model, the author applies the group discussion method for calibration

Step 4: Investigation and data collection, after the final question sheet is completed, the author will deliver the question sheet and collect data from customers for the study Explorary method is to use the directly-delivered written question sheet to the relatives of patients who takes care of patients at hospital The investigation sheets after interviews will be gathered, checked and inputed, cleaned to serve for the next data analysis Together with data

collection, the author will amend and complete the preparation of Chapter 1, 2 and 3 as guided by lecturers

Step 5: Summarize and analyze data Data after being cleaned and coded will be summarized and analyzed with different statistical analysis techniques Analysis data with the support of SPSS 20.0 software and analysis techniques: discriptive statistics, inspection of scale reliability, factor analysis, regression analysis and inspection of research hypothesis

Step6: Complete the thesis This is the final step, the author will evaluate the contribution of study in term of learning and practice, suggestions from research results, limitations and orientations proposed for the next studies with the same topic

1.5 Structure of thesis:

Contents of the thesis include 5 chapters:

Chapter 1: Overview on the thesis, including contents: the reason to choose the topic, research purpose, research object and research scope, research process and real meaning of the topic

Chapter 2: Foundation of theory: Cover the following contents: Service quality, features of service quality, some theories about customer satisfaction; relationship between service quality and customer satisfaction; research models, service quality and customer satisfaction

Chapter 3: Research methodology includes the contents: Present the specific research methodology, qualitative research result, scale calibration and sample information

Chapter 4: Research result includes the contents: analyse data and present the data analysis result

Chapter 5: Conclusion and recommendation include the contents: sammary and discussion on research result, contribution of topic, real meaning

of the topic and preposals on several solutions with the application of research results into the reality, limitations of the topic and recommendations on the next research orientation

CHAP TER 2 THEORETICAL BACKGROUND

This chapter presents the general theories on service, service quality, customer satisfaction, relationship between searvice quality and customer satisfaction, research models and some recent studies on customer satisfaction The contents are as follows:

2.1 Definition of service and features of service

Service is a type of special economic goods and intangible in difference with other tanglible goods and products Researchers own the different opinions

on services and this study introduces some definitions to be cited by various researchers as follows:

According to Zeithaml và Britner (2000), service is a behavior, process and way of conducting any works to create the use-in-value of customers to satisfy the need and desire of cusomters

According toLovelock (2001 cited by Oliveira, 2010), service is an economic activity to generate the value and supply the benefits to customers at a specific time and place as a result of desired change or on behalf of service receiver

According to Kotler & Armstrong (2004), service is activities or benefits which enterprises may contribute to the customers for establishment,

improvement and expansion of longterm cooperation relationship with customers

According to Mairelles (2006 cited by Oliveira, 2010), an intangible service is only evaluated after combining with other functions to be production process and tangible products

In this study, heathcare services are construed to be the entire process; solutions resulted in utilities for patients to meet the demand for their examinination and treatment

Thus, it is possible to understand the services as benefit generating activities to satisfy the demand of customers about any activity Researchers are able to define services in different ways, but with the same unification on the nature of service A book of “Quality administration in the organization” of Nguyen Dinh Phan and his partners (2006) offered several features of service as follows:

Intangibility: Service product is a intangible product with no clear form

or perception prior to use Customers are only able to perceive the service quality when using, interacting with it and impossible to know the service quality beforehand In the other words, service quality is dependent on the subjective perception of user and difficult to measure exactly through specific technical criteria

Inhomogeneity: Service quality has inhomogeneity among times of

service performance and depends on personal perception of customers about the

service On the same service supply cycle, perceiption of different individuals is different; service can be assessed from at low level to perfect level by different customers subject to their expectation Features on inhomogeneity of service make the service standardization become more difficult than the standardization

of other products

Inseparability: Inseparability of service is showed in difficulties in

discriminating the service development and service use as two affairs or separate process One service cannot be separated into separte process, (1) service development process and (2) service use process because of their simultaneity Development and use of most services occur simultaneously This

is basic difference among other tangible goods: Goods is manufactured and put into storage or transferred through distribution to the users, which are two separate processes with separtate separability The service is a process of simultaneous development and use, and customers and suppliers join in the service development process This generates the following matters:

Nonstorability: Service production and use processes occur simultaneously, so its storability is not equal to other tangible goods In the

other words, it is impossible to store services prior to launching

Simultaneity: Simultaneity of service is showed through simultaneous

service production and use It is unable to separate the production process with use process

2.2 Service quality

Service quality is different level of user expectation on service and their perception on service result (Parasuraman, 1988) Service quality fails to be established from various factors It can be said to be a multi-aspect definition Parasuraman and partner (1985) give ten aspects of service quality including (1) reliability; (2) responsiveness; (3) Assurance; (4) access, (5) (courtesy), (6) (communication), (7) (credibility), (8) (security); (9) (understanding customer);

và (10) tangibles From 10 aspects, the next studies summarized with 5 main factors (for instance: Parasuraman and partners, 1988, 1991) of service quality include:

(1) Reliability: Show the ability of proper performance and compliance

with the timelimit

(2) Responsiveness: Show the desire and pleassure of staff serving for

timely service supply to customers

(3) Assurance: Professionality of service staff

(4) Empathy: Show the concern of staff for customers

(5) Tangibles: Clothes and appearance of staff and equipment serving for

services

Thus, it can be seen that service quality is a multi-aspect definition and a comprehensive criterion of different factors In different services, it is measured

by different factors

2.3 Customer satisfaction

Customer satisfaction is emotion status for service products to be used (Spreng and partners., 1996) Bachelet (1995) Definition of customer satisfaction is a emotional reaction of customers to respond their experience fir

a product or service Customer satisfaction is level of emotional status of a person derived from comparizing the results collected from the use of products/services with their expectation (Kotler, 1996) In general, researchers consider the satisfaction as a comfortable feeling when the customers are tailored as expected on the products and services General satisfaction on services is considered as a separate variable in the relationship with service quality components (for example: Atilgan et al (2003), Chow and Luk (2005), Mostafa, 2005; Ahuja et al, 2011; Chakraborty and Majumdar, 2011; Ahmad and Samreen., 2011; Zarei et al, 2012) etc)

2.4 Relationship between service quality and customer satisfaction

The studies point out that service quality and user satisfaction have the tight relationship, the service quality is cause and satisfaction is result (eg: Spereng, 1996, Atilgan et al (2003), Chow and Luk (2005), Amad and Samreen (2011), etc) Relationship between service quality and customer satisfaction is proportional and the service quality takes positive effect on the customer perception

According to Zeithaml and Bitner (2000), service quality and customer satisfaction are two different definitions, the service quality only focus on specific components of service and customer satisfaction is a general definition Following to Cronin and Taylor (1992) and Spereng (1996), service quality and customer satisfaction are supposed to have the relationship with each other

2.5 Research models on service quality and cutomer satisfaction

Studies on service quality and cusomter satisfaction have been conducted systematically over many past years There are some famous models such as quality distance model (Parasuraman and partners, 1985), technical/ functional quality model (Gronroos, 1984), product three-attribute model of Kano (1984), SERVQUAL model (Parasuraman and partners, 1988), models of service satisfaction index (CSI) of countries (Fornell, 2000, Martesen el al, 2000, Le Van Huy, 2007) Therefore, this study introduces some typical research models

to be applied by many researchers

2.5.1 5-distance mode l

5-distance model has been introduced since 1995 by Parasuraman and

partners on Journal of Marketing magazine According to Parasuraman and

partners, the expectations are regarded as dersire of users and the customers‟ expectation is established based on the external oral information, personal need and their experience

The first distance appears when there is difference in cusomter‟s expectation on service quality and service supplier perceiving the customers‟ expectations

The second distance appears when the service suppliers encounter with obstacles in changing their perception on customer‟s expectation into features of service quality It means that the service suppliers are unable to change the cusomter‟s expectations into specific quality criteria of services due to limiations on ability to supply and responsiveness

The third distance appears when the service staff fails to transfer the service as per the defined criteria Because the service supply process is a process with person-to-person relationship, in the event, the service staff is unable to transfer the service to customer as per the supplier‟s defined criteria The fourth distance is impact of advertisement means and information on customer‟s expectation on service quality Advertisement makes the customer‟s expectations change in the direction of more expectations on service Therefore, when using services, if their quality is not the same as advertisement, and promises on advertised services is not the same as the customer‟s experience, the perception on service quality is reduced

The fifth distance is difference in the quality to be expected by custome rs and the quality to be perceived Parasuraman supposes that the service quality is

a function of the fifth distance The fifth distance depends on the previous distance, and shortening this distance requires the previous distance to be

shortened and it a lso enhances the service quality 5-distance service quality model are presented as follows:

Level of perception: Present level of understanding and concern to the separate need of customers and concern to customer expectation

Intangibles: Be conditions, means, and tools serving for the service supply process of enterprises and organizations to customers

SERVQUAL scale is quick to become a famous model to measure the service quality in other fields such as: retail (Parasuraman et al, 1988, Bala et al, 2011; Duvasula and Lysonski, 2010), telecommunication (Seth,Momaya and Gupta, 2008; Khan, 2010; Loke et al, 2011; Zekiri, 2011), education (Stodnick and Rogers, 2008; Hasan et al, 2008; Hanaysha et al, 2011; Oliveira, 2009; Miller and Brooks, 2010) or healthcare service (Mostafa, 2005; Amad and

Samreen, 2011) Thus, this study will consider how the use of 5 factor under SERVQUAL model affects the patient satisfaction in the hospital

2.6 Some recent studies on customer satisfaction in healthcare sector

Study of customer satisfaction for healthcare services was conducted quite early by researchers, popular research models are SERVQUAL model Several studies give more other factors The following is summary of some studies on customer (patient) satisfaction for service quality

[Table 2-1]Summary of some studies on patient satisfaction in

786

1 Reliability 2.Responsiveness

3 Assurance

4 Empathy 5.Tangibles

516 – 532

1 Human performance quality

2 Human Reliability

1.Reliability 2.Responsiveness

The applicability of SERVQUAL,

1.Reliability 2.Responsiveness

3 Assurance

266 – 314

1.Tangibles and Profesionalism 2.Reliability and Responsiveness 3.Assurance and Empathy

4.Feedback and Guidance

Multidisciplinary Research, International Journal of 27 -42

1 Physical Aspects

2 Encounter (Responsiveness, Empathy)

3.Process 4.Policy

1 Reliability and Responsiveness

2 Assurance

3 Empathy 4.Tangibles

5 Reliability

CHAP TER 3 RESEARCH METHODOLOGY

This chapter presents the research methodology such as study model, the research hypothesis, research design and methods of data analysis being conducted The specific contents are as follows:

3.1 Research Model

This study uses SERVQUAL model as a foundation to build theoretical model and its hypothesis about the relationship between service quality and customer satisfaction (Spereng et al, 1996) and which has been proven through numerous studies

in many different areas such as Retail (e.g Durvasula and Steven Lysonski, 2010); telecommunications (Seth,Momaya and Gupta, 2008, Zekiri, 2011;); restaurant service (Chow and Luk, 2005; Andaleeb and Conway, 2006;) and health care (Mostafa, 2005; Ahuja et al, 2011; Chakraborty and Majumdar, 2011; Ahmad and Samreen, 2011; Barser and Joshi, 2011; Zarei et al, 2012; Soita, 2012) Thus the author proposes the research model with the following components: Reliability; Responsiveness; Assurance; Empathy; Tangible

[Figure 2-1 ] Research Model

3.2 Research Hypothesis

Reliability is shown by the accuracy of the services, ability to retain credibility with customers Reliability contributes to make quality of service (Parasuraman and partners, 1985, 1988) Reliability will be the evedence to create credibility and information about a good service or an assurance about the reputation of the service (Wheeland, 2002; Harford, 2004).A customer-trusted service with more reliable than the competitors‟ will bring more sense of customer satisfaction when compared, confidence also affects the percepted value

of overall quality and general customer satisfaction over this service This has been proven through telecommunication studies (Seth, K Momaya and Gupta, 2008; Zekiri, 2011), or even in the field of health care (Babakus and Mangold, 1992; Mostafa, 2005; Chakraborty and Majumdar, 2011; Ahuja et al, 2011;

Customer Satisfaction

Ahmad and Samreen, 2011; Zarei et al, 2012; Soita, 2012) etc Thus, the study poses the following hypotheses:

H1: Hospital reliability has a positive impact on overall satisfaction of the

patients

Hospital‟s assurance is expressed through such aspects as: Professional style of staff, expertise of doctors and nurses, hospital availibity Higher rate of hospital‟s assurance from customers will make customers more satisfied with the services they receive The previous studies in many areas have shown that assurance has a positive influence on the overall satisfaction of the customer For example, studies of Atilgan et al, (2003); Kouthouris and Alexandris (2005) in the field of tourism services in Turkey and Greece; even in the field of health services in studies of Mostafa (2005) in Egypt, studies of Ahuja et al (2010),Chakraborty and Majumdar (2011) in India, or the most recent study of Zarei et al (2012) in Iran, Soita‟s study (2012) in Uganda have further strengthened the hypothesis that assurance affects the service satisfaction For this reason, this study suggests the following hypotheses:

H2: Assurance has a positive influence to the overall satisfaction of

patients

Empathy is an expression of the hospital staff‟s interest towards patients, employees‟ attention towards special needs of patients Examination and treatment are the process of contact among individuals, the patients also involve

in the generation of hospital services Thus, the attention will broadcast the signal

of quality of service, providing the patient's trust in the quality of service and their satisfaction This has been proven through studies of Babakus and Mangold (1992), Chakraborty and Majumdar (2011), Ahuja et al (2011), Ahmad and Samreen (2011, Brahmbohatt, Barser and Joshi (2011), Zarei et al (2012), Soita (2012) in the field of health care For this reason, this study suggests the following hypotheses:

H3: Empathy positively affects the patient's overall satisfaction to the

H4: The higher responsiveness is reviewed, the higher customer

satisfaction is

Tangibles are reflected in the following aspects: Facilities, equipment, personnel, propaganda and promotion documents Customers rating positively the tangibles of a business also positively rate their satisfaction and feeling about their services as better ones According to the theory of asymmetric information (G.Mankiw, 2005; S.Wheelan, 2002), the facilities and tangibles of a business are an indicator of "the promise of good service provis ion", it will create confidence to customers about the service providers The studies showing the positive impacts of tangibles to customer satisfaction, such as studies of Atilgan

et al (2003), Kouthouris and Alexandris (2005) in the field of tourism services; studies of của Chow and Luk (2005), Andaleeb and Conway (2006) in the field

of restaurant services; or studies in the field of health care of Mostafa (2005), Ahuja et al (2011), Ahmad and Samreen (2011), Zarei et al (2012), Soita (2012), etc also show the positive impacts of tangibles on patients‟ satisfaction and feeling to the service quality of the hospital For this reason, this study suggests the following hypotheses:

H5: Tangibles of hospitals have a positive impact on patient satisfaction in

hospitals

In addition to the main research hypothesis above, the author also considers the difference among different customer groups through analysis of variance (ANOVA)

3.3 Measuring factors

The observed variables (questionnaire) used in the study are inherited, refered from previous studies The used questionnaire includes 22 observed variables standardized from Parasuraman et al (1988) and refered to the research questionnaire from the studies of Mostafa (2005) in Egypt, and of Amad and Samreen (2011) in Pakistan in the field of health care At the same time, the author has used a group discussion with patient caregivers to calibrate the measurement aspects of factors for appropriate and meaningful arrangement The specific contents are as follows

[Table 2-2] Observed variables

: You find health care quality as guaranteed

04 Rea4 You feel clinical activities perfomred

correctly

05 Rea5 You find that the hospital staff keep their

07 Ass2

You are informed the exact time of services

to be performed by by medical staff (example: time to recall )

08 Ass3 You find that doctors at the hospital are

always willing to help patients

09 Ass4 You feel that the full services here are always

14 Res1 You find that behaviors of doctors make

Patients become trusted

A.Parasuram

an and et al (1988), Mostafa (2005), Amad and Samreen

2011

15 Res2 You feel safe when performing examinations

and treatment for patients at the hospital

16 Res3 You said that there are always expertised

doctors at the hospital

17 Res4 You said that health workers have the good

knowledge to answer patients‟ questions

18 Ta1 You find the hospital always be cleaned A.Parasuram

an and

et al (1988), Mostafa (2005), Amad and Samreen

VI Overall satisfaction of medical services

22 Sa1 You‟re satisfied with the medical facilities of

the hospital

23 Sa2 You‟re satisfied with the services of hospital

24 Sa3 You will choose the hospital for your

children care when required

25 Sa4 You will recommend the hospital to others

26 Sa5 In general, you‟re satisfied with the quality of

hospital services

3.4 Research Design

Discuss scale adjustment

To build questionnaires, the author inherited research questionnaires from Parasuraman et al (1988) and the questions used by Mostafa (2005) in Egypt, questions of Amad and Samreen (2011) in Pakistan These questions are translated from English into Vietnamese with consultation conducted through a group discussion with the patient relatives (Due to pediatrics, the study directly get feedback from patient caregivers rather than directly asking patients) to make adjustments to questions put for real investigation

Results showed the consensus to the given aspect, the use of the terms is adjusted for simple straightforward understanding because questions translated from English to Vietnamese confuse respondents The following is some groups‟ feedback:

For tangibles, caregivers are interested in issues such as the use of modern machinery, hospital environment that should be clean, neat dress of hospital staff and nice guidances These are factors believed to have affect their feelings when performing treatment