Measuring customer satisfaction towards service quality of the maternity hospital in ho chi minh city

MEASURING CUSTOMER SATISFACTION TOWARDS SERVICE QUALITY OF THE MATERNITY HOSPITAL IN HO CHI MINH CITY In Partial Fulfillment of the Requirements of the Degree of MASTER OF BUSINESS ADM

MEASURING CUSTOMER SATISFACTION TOWARDS SERVICE QUALITY OF

THE MATERNITY HOSPITAL IN HO CHI MINH CITY

In Partial Fulfillment of the Requirements of the Degree of

MASTER OF BUSINESS ADMINISTRATION

In Marketing

by Ms: NGUYEN THI THANH BINH

ID: MBA03004

International University - Vietnam National University HCMC

MEASURING CUSTOMER SATISFACTION TOWARDS SERVICE QUALITY OF

THE MATERNITY HOSPITAL IN HO CHI MINH CITY

In Partial Fulfillment of the Requirements of the Degree of

MASTER OF BUSINESS ADMINISTRATION

In Marketing

by MS: NGUYEN THI THANH BINH

ID: MBA03004 International University - Vietnam National University HCMC

Acknowledge

Firstly, I especially want to thank my advisor, Doctor Nguyen Van Phuong, for his guidance during my research His perpetual energy and enthusiasm in research had motivated all his advisees, including me In addition, he was always accessible and willing to help his students with their research

I am myself showing my deepest thanks to Dr Ho Thanh Phong – Rector and

Dr Nguyen Quynh Mai – Dean and all of colleagues, friends and my classmates of MBA10 who support and create advantageous conditions for me to study and complete this thesis

Finally yet importantly, I would like to give my special thanks to my family whose patient love enabled me to finish this work

Ho Chi Minh /January 2013

Nguyen Thi Thanh Binh

Plagiarism Statements

I would like to declare that, apart from the acknowledged references, this thesis either does not use language, ideas, or other original material from anyone; or has not previously submitted to any other educational and research programs or institutions I fully understand that any writings in this thesis contradicted to the above statement will automatically lead to the rejection from the MBA program at the International University – Vietnam National University Ho Chi Minh City

Copyright Statement

This copy of the thesis has supplied on condition that anyone who consults it understood to recognize that its copyright rests with its author and that no quotation from the thesis and no information derived from it may publish without the author’s prior consent

© Nguyen Thi Thanh Binh/ MBA03004/2010-2012

Table of Contents

Chapter one – Introduction 1

1 Introduction 1

2 Research Problems 2

3 Research Objectives 2

4 Scope 2

5 Implication of research 3

6 Research structure 3

Chapter Two – Literature Review 5

1 Definition of Service 5

2 Features of services 5

3 Service Quality 6

4 Service-quality model 7

5 Customer Satisfaction 11

6 The relationship between service quality and customer satisfaction 12

7 Some empirical findings on service quality in maternity hospital 13

7.1 Dimensions of service quality 15

7.2 Customer satisfaction with service quality of the maternity hospital 15

8 Research Model 16

Chapter Three – Research Method 19

1 The introduction about the maternity hospitals in Ho Chi Minh City 19

2 Scale 21

2.1 Service Quality Scale 21

2.2 Scale of customer satisfaction 23

3 Research Procedure 24

4 Sample Size 25

5 Questionnaire Design 25

6 Analysis techniques 27

6.1 Descriptive Statistics 27

6.2 Testing reliability of scale by Cronbach’s Alpha 27

6.3 Exploratory Factors Analysis (EFA) 28

6.4 Multiple-Regression Analysis 28

Chapter Four - Main Findings 29

1 Sample Description 29

1.1 Age description 29 1.2 Career description 30 1.3 Income description 30

2 Descriptive Statistics of KQCAH scale 31

3 Assessment and Refinement of Scale 35

3.1 Testing the reliability of service quality scale by Cronbach’s alpha 36

3.2 Testing the reliability of customer satisfaction scale by Cronbach’s alpha 38

3.3 Assessment on Service Quality Scale using EFA analysis 43

3.4 Assessment of Customer Satisfaction Scale through EFA analysis 43

3.5 Research Model Adjustment 44

3.6.1 Correlation Matrix: 46

3.6.2 Regression Analysis 47

3.7 Comparison of customer satisfaction level between the maternity hospitals 48

3.8 Discussion of results 52

Chapter Five – Conclusion and Recommendation 54

1 Conclusion 54

2 Recommendations 54

3 Research Limitations 56

List of Tables

Table 1: Dimensions quality 14

Table 2: Factors in study 18

Table 3: Coding variables in measurement scale 25

Table 4: Descriptive Statistics of Human and physical resources 31

Table 5: Descriptive Statistics of Efficiency and Continuty 32

Table 6: Descriptive Statistics of Facilities 33

Table 7: Descriptive Statistics of Information 33

Table 8: Descriptive Statistics of The hospital charges 34

Table 9: Descriptive Statistics of First impression 34

Table 10: Descriptive Statistics of Customer Satisfaction 35

Table 11: Cronbach’s Alpha analysis of KQCAH scale 38

Table 12: Cronbach’s Alpha analysis of customer satisfaction 39

Table 13: Frequency of customer satisfaction 39

Table 14: KMO and Bartlett’s test about service quality 40

Table 15: Rotated Component Matrixa 42

Table 16: Total variance explained 43

Table 17: Cronbach’s Alpha analysis of factors 43

Table 18: Component matrix of customer satisfaction 44

Table 19: KMO and Bartlett’s of customer satisfaction 44

Table 20: KMO and Bartlett’s of new factors 46

Table 21: Model summary 46

Table 22: Coefficients 47

Table 23: Anova 48

List of Figures

Figure 1: Research Model 16

Figure 2: Adjusted Research Model 17

Figure 3: Research process 24

Figure 4: Age description 29

Figure 5: Career description 30

Figure 6: Income description 30

Figure 7: Frequency of customer satisfaction 33

Figure 8: Adjusted research model after EFA analysis 39

Figure 9: Comparison customer satisfaction level between the maternity hospitals 44 Figure 10: Introduction of customers 47

Abbreviation EFA: Exploratory Factors Analysis

KQCAH: The Key Quality Characteristics Assessment for Hospitals

KMO: Kaiser-Meyer-Olkin

JCAHO: Joint Commission on Accreditation of Healthcare Organizations

SERVQUAL: Service quality

SPSS: Statistical Package for Social Sciences

Abstract

Service quality of the maternity hospital is been perceived as an important factor for customer satisfaction The aim of this study is to analyze the customer satisfaction about service quality of the maternity hospital Besides, it is to determine the hospital service quality from the pregnant women’s viewpoints and the relative importance of quality dimensions to improve better service quality for pregnant women and babies This study was been conducted with 225 respondents who are pregnant women or women giving birth within 6 months in the maternity hospitals in

Ho Chi Minh City in 2012 As a result, there are five (05) factors of service quality in the maternity hospitals impacting on customer satisfaction Those are effectiveness and continuity; human and physical resources; the hospital charges; facilities and information This research provides a framework to researchers know The result may help the maternity hospitals to improve better service quality

Keywords: Customer satisfaction, service quality, maternity hospital,

pregnant women

Chapter one – Introduction

1 Introduction

The hospital industry is one of the fastest growing industries today Hospital managers have to understand the quality and the value of services offering to their consumers The positive consequences of companies achieving high levels of customer satisfaction and service quality are well-documented (Rust & Zahorik, 1993; Zeithaml, Berry and Parasuraman, 1996) Indeed, service quality and customer satisfaction issues are very important as companies attempt to differentiate their services and compete effectively in the marketplace (Parasuraman, Zeithaml & Berry [PZB}, 1988; Brown & Swartz, 1989)

A hospital is an institution of health care providing treatment with specialized staff and equipment, but not always providing for long-term patient stay Today hospitals are centers of professional health care provided by physicians and nurses The state, health organizations, health insurances or charities, including direct charitable donations usually provide financial support and other assistance to hospitals There are several kinds of hospitals Types of specialized hospitals include trauma centers, rehabilitation hospitals, children’s hospitals, seniors' (geriatric) hospitals, maternity hospitals and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth Moreover, the

hospitals are been developed in Vietnam However, the author wants to focus the

maternity hospital in Ho Chi Minh City because the author is a pregnant woman The author also wants to know service quality of the maternity hospital in Ho Chi Minh City to choose hospital for giving birth next year Therefore, the author wants to measure customer satisfaction and evaluates the service quality of the maternity

hospitals in Ho Chi Minh City In addition, implications about study for the maternity hospitals to improve better service quality for pregnant women or women give birth whom will come in there

2 Research problems

Much of study and literature in marketing and management recognizes the importance of customer satisfaction Therefore, it would be quite natural that such services would have an impact on the customer satisfaction In this study, the author wants to focus service quality of the maternity hospitals What do pregnant women want to have service quality of the maternity hospital in Ho Chi Minh City? How did the maternity hospitals take care for women giving birth? What do pregnant women expect service quality of the maternity hospitals?

That is the reason for the author to choose this research topic: “MEASURING

CUSTOMER SATISFACTION TOWARDS SERVICE QUALITY OF THE MATERNITY HOSPITALS IN HO CHI MINH CITY”

3 Research objective

 Identify determinants of service quality of the maternity hospital in

Ho Chi Minh City area

 Identify customer satisfaction towards service quality

 Recommend some solutions for maternity hospitals to improve better service quality for pregnant women

4 Scope

The scope of present research includes measuring the quality services and evaluating customer satisfactions for the pregnant women or women gave birth within 6 months in the maternity hospital in Ho Chi Minh City The total duration

2013); the data collection was been conducted in the maternity hospitals in Ho Chi Minh City area

Chapter 1 introduces about service quality of the maternity hospital industry

in Ho Chi Minh City This part will include the reasons of this research and some existing problems need to have optimal solutions to solve

Chapter 02: Literature Review

This chapter addresses the theories of service quality, customer satisfaction, factors that affect customer satisfaction

Chapter 03: Research model

In this chapter, the report will describe in detail the methods and research design including data collection method, population approach Besides, the measurement scale used in proposed model should be included as well

Chapter 04: Main Findings

The previous chapter presented the research methodology Following, this chapter will describe the characteristics of the sample, present the data analysis and discuss the findings of the research

Chapter 05: Conclusions & Recommendations

- Conclusion: Main results of this study

- Recommendations for maternity hospital to improve better service quality

- Research Limitations

Chapter Two – Literature Review

1 Definition of Service

Kotler and Keller (2010) define service as follows:

“A service is any act or performance one party can offer to another that is essentially intangible and does not result in the ownership of anything” (page 386.)

2 Features of services

Services have distinctive characteristics compared to common goods,

includes intangibility, inseparability, variability and perishability (Kotler and Keller, 2010)

- Intangibility: Services are intangible means that they cannot be touched,

gripped, handled, looked at, smelled, tasted or heard Thus, there is neither potential nor need for transport, storage or stocking of services Furthermore, a service cannot

be (re)sold or owned by somebody, neither can it be turned over from the service provider to the service consumer nor returned from the service consumer to the service provider Solely, the service delivery can commissioned to a service provider who must generate and render the service at the distinct request of an authorized service consumer

- Inseparability: The service provider is indispensable for service delivery as

he must promptly generate and render the service to the requesting service consumer

In many cases, the service delivery executed automatically but the service provider must preparatory assign resources and systems and actively keeps up appropriate service delivery readiness and capabilities Additionally, the service consumer is inseparable from service delivery because he is involved in it from requesting it up to consuming the rendered benefits

- Variability: Each service is unique It is one-time generated, rendered and

consumed and can never be exactly repeated as the point in time, location, circumstances, conditions, current configurations and/or assigned resources are different for the next delivery, even if the same service consumer requests the same service Many services are been regarded as heterogeneous or lacking homogeneity and are typically modified for each service consumer or each new situation

- Perishability: Services cannot be stored and available at the time when it was been provided Perishability can be a problem if the demand fluctuates

Each of these characteristics is retractable per se and their inevitable coincidence complicates the consistent service conception and makes service delivery a challenge in each case Proper service marketing requires creative visualization to evoke effectively a concrete image in the service consumer's mind From the service consumer's point of view, these characteristics make it difficult, or even impossible, to evaluate or compare services prior to experiencing the service delivery

3 Service Quality

Managing the quality of service is an interesting subject in Marketing Until now, there have been many studies related to this topic, therefore, also have its definitions were given However, no agreements are been made From the standpoint

of customers, the quality of service means a measure how well a delivered service matches customers’ expectation and satisfies their requirements (Lewis and Booms, 1983)

Quality is one of important elements to service and physical goods, and criteria for consumers in distinguishing and selecting the provider among many

caused difficulty for both assessment of customers (in purchasing process) and providers (in after sales service.)

4 Service-quality model

According to Gronroos (1984), the service quality experienced by a customer has two dimensions: Technical and Functional quality In which Functional quality describes how the service is to deliver and technical quality describes what the customers received during a service delivery The organization’s image works as a filter and can modify positively or negatively the customers’ perception of service quality Gronroos (2007) emphasizes that the followings “Seven criteria of good perceived service quality” are the determinants that need to be considered when evaluating the service quality of any organization: professionalism and skills; attitudes and behavior; accessibility and flexibility; reliability and trustworthiness; service recovery; service scale; reputation and credibility

However, the above Seven criteria of good perceived service quality”, concepts have the similar characteristics to the Parasuraman el at (1985) “Ten determinants of service quality”

Based on this service-quality model, Parasuraman et al., (1988) developed SERVQUAL (Service Quality) scale This is a multi-item scale developed to assess customer perceptions of service quality in service and retail

businesses (Parasuraman et al., 1988) Parasuraman, in his initial paper, introduced the gaps model and established ten possible determinants of service quality (Parasuraman, 1985) Include:

1 Competence (Possession of the required skills and knowledge to perform the

service: knowledge and skill of the contact personnel, knowledge and skill of the operational support personnel, research capability of the organization)

2 Courtesy (Politeness, respect, consideration and friendliness of the contact

personnel: consideration for the customer's property, clean and neat appearance of public contact personnel)

3 Credibility (Trustworthiness, believability and honesty It involves having

the customer's best interest at heart: company name, company reputation, personal characteristics of the contact personnel)

4 Security (Freedom from danger, risk or doubt: physical safety, financial

security, confidentiality)

5 Access (Approachability and ease of contact: Service is easily accessible,

waiting time to receive service is not extensive, convenient hours of operation, convenient location of service facility)

6 Communication (Informing the customers in a language they can understand

and listening to them It may mean that the company has to adjust its language for different consumers: explaining the service itself, explaining how much the service will cost, explaining the trade-offs between service and cost, assuring the consumer that the problem will be handled)

7 Understanding/ knowing the customer (Making the effort to understand the

customer's needs: understanding customer's specific needs, providing individualized attention, recognizing the customer)

8 Tangibles (Physical evidence of the service: appearance of physical facilities,

tools and equipments used to provide the service, appearance of personnel and communication materials, other customers in the service facility)

9 Reliability (The ability to perform the promised service dependably and

accurately: service is performed right at the first time, the company keeps its

promises in accuracy in billing, in keeping records correctly and in performing the services at the designated time)

10 Responsiveness (The willingness and/ or readiness of employees to help

customers and to provide prompt service, timeliness of service: mailing a transaction slip immediately, setting up appointments quickly)

The advantage of these models is able to cover all attributes of service However, its weakness is that measurement is very complicated Therefore, Victor Sower, JoAnn Duff, William Kilbourne, Gerald Kohers and Phyllis Jones (2001) developed KQCAH scale (The Key Quality Characteristics Assessment for Hospitals) and based on theoretical framework of the quality hospital service’s JCAHO (Joint Commission on Accreditation of Healthcare Organizations) to measure hospital quality The authors asserted that nine components of JCAHO are similar with the components of SERVQUAL and it is easier to understand That the components of JCAHO completed SERVQUAL tools and chosen as the theoretical framework on the hospital quality

Using a combination of qualitative and quantitative research mythologies, Victor Sower, JoAnn Duff, William Kilbourne, Gerald Kohers and Phyllis Jones (2001) defined the components of hospital service quality and developed an instrument to measure patient satisfaction The authors formed eight components to measure the quality of hospital services Those are: (1) Respect and caring, (2) Effectiveness and continuity, (3) Appropriateness, (4) Information, (5) Efficiency, (6) Meals, (7) First impression, (8) Staff diversity

- Respect and caring: “with which services are provided The degree to

which the pregnant women/ women gave birth within 6 months or a

designee is involved in her-own care decisions and to which these providing services do so with sensitivity and respect for the pregnant women’s need, expectations, and women gave birth within 6 months differences

- Effectiveness: “with which tests, procedures, treatments and services are

provided The degree to which the care provided in the correct manner, given the current state of knowledge, to achieve the desired or projected outcome for the pregnant women or women gave birth within 6 months

- Continuity: “of the services provided to the pregnant women with respect

to other services, practitioners, and providers and over time The degree to which the care for the pregnant women are coordinated among practitioners, among organizations, and overtime”

- Appropriateness: “of a specific test, procedure or service to meet the

pregnant women’s needs The degree to which the care provided is relevant to the pregnant women’s clinical needs, given the current state of knowledge”

- Efficiency: ‘with which services are provided The relationship between

the outcomes (results of care) and the re-sources used to deliver pregnant women care”

- Information: to help and contact with patients and the patient’s family

For examples: to provide quick information on the treatment, doctors and consultants that are available

- Meals: quality and efficiency of the supply of food such as taste food for

pregnant women, on time and eat the hot food

- First impression: the reputation of the hospital; provide fast service;

dedication and enthusiasm of the doctors and nurses in hospitals; beautiful design; clean; fully equipped for mothers and babies

- Staffs diversity: includes the variety of facial expressions, gender, they

can speak many languages

Therefore, KQCAH has eight components to measure the quality of hospital services KQCAH is a multi-item scale that can provide valid and reliable information to hospital administrators A hospital company with multiple units will find KQCAH that a useful way to compare the quality among its own units So, KQCAH scale selected for theoretical framework for this study

5 Customer Satisfaction

There is general agreement that: Satisfaction is a person’s feeling of pleasure

or disappointment resulting from comparing a product’s perceived performance (or outcome) in relation to his or her expectations (Kotler, 2003) Based on this review, customer satisfaction is been defined as the result of a cognitive and affective evaluation, where some comparison standard is compared to the actually perceived performance If the perceived performance is less than expected, customers will be dissatisfied On the other hand, if the perceived performance exceeds expectations, customers will be satisfied Otherwise, if the perceived expectations are been met with performance, customers are in an indifferent or neutral stage

Customer satisfaction is been defined as a customer’s overall evaluation of the performance of an offering to date This overall satisfaction has a strong positive effect on customer loyalty intentions across a wide range of product and service categories (Gustafson, 2005)

It is been seen as a key performance indicator within business In a competitive marketplace where businesses compete for customers, customer satisfaction is been considered as a key differentiator and increasingly has become a key element of business strategy

6 The relationship between service quality and customer satisfaction

Service quality and customer satisfaction are important concepts to academic researchers studying consumer and customer loyalty (Dawn, Amy & Kent, 1995) There has had research on service and generally, service quality and customer satisfaction are distinct definitions (Bitner, 1990; Boulding & et al., 1993)

The satisfaction of customer, is an overall concept, states their satisfaction when they buy service While service quality is considered by service dimensions (Zeithaml & Bitner, 2000)

According to Oliver (1993), service quality has affected to customer satisfaction It shows that service quality, defined by many different factors, is a determinant of satisfaction

7 Some empirical findings on service quality in maternity hospital

7.1 Dimensions of service quality

Naresh K et al (2004) identified the antecedents of what the international

consumer perceives as service “quality.” This paper aims to examine the differences

in perception of service quality dimensions between developed and developing economies Parasuraman et al (1985) proposed a framework consisting of ten determinants or dimensions of service quality: reliability, access, and understanding

of the customer, responsiveness, competence, courtesy, communication, credibility, security, and tangible considerations

In addition, Parasuraman et al (1988) developed five dimension of service quality that have been empirically tested (Table: Dimensions of quality) and incorporated into their SERVQUAL instrument While a major step forward, these dimensions were developed and tested in industries quite different from the health care industry Other studies have identified potential difficulties related to the SERVQUAL instrument Among the criticisms are questions about predictive and convergent validity and unstable dimensionality Chakrapani (1998) developed a simpler service quality model consisting of three dimensions (Table 1: Dimensions

of quality) This model intended to be simpler and more generalized than are those with more dimensions Simplicity and generalizability reduce the applicability of these dimensions to one specific type of organization

Coddington and Moore (1987) suggest that the top five factors that define quality for health care providers from a consumer’s perspective are (a) warmth, caring, and concern, (b) medical staff, (c) technology equipment, (d) specialization and scope of services available, and (e) outcome (Table 1: Dimensions of quality) The Joint Commission on Accreditation of Healthcare Organization (JCAHO) identifies nine quality dimensions for hospital (Table 1: Dimensions of quality) This list is been closely related to Coddington and Moore’s (1987) five factors and the SERVQUAL dimensions, but is more comprehensive Since the JCAHO, dimensions encompass the SERVQUAL and Coddington and Moore (1987) dimensions and since they were been developed specifically for use in the hospital accreditation process, the nine JCAHO dimensions were selected as the theoretical framework of hospital service quality for this study Therefore, the intent of this study is to develop

a valid and reliable instrument based upon the JCAHO dimensions of hospital service quality

Table 1: Dimensions of quality

Parasuraman

et al.’s SERVQUAL (1988) dimensions

Chakrapani’s (1998) dimensions

Coddington’s (1987) dimensions

JCAHO (1996) dimensions

convenience Accuracy Responsiveness

Tangibles Reliability Responsiveness Assurance Empathy

Service/

Product Dependability/

Support Exceeding Expectations

Warmth/

Caring/

Concern Medical staff Technology- equipment Specialization Services Available Outcome

Efficacy Appropriateness Efficiency Respect & Caring

Safety Continuity Effectiveness Timeliness Availability

7.2 Customer satisfaction with service quality of the maternity hospital

According to Auckland (2008) researched “Maternity services consumer satisfaction survey report”, the present report outlines the result of the

2007 survey of 2,936 women using Maternity Services The objectives of the survey were to measure satisfaction among women using Maternity Services during March and April 2007 and where possible to compare the levels of satisfaction (or percentage of those satisfied) to those recorded in the 2002 survey There was a significant increase in the percentage of women returning home within 12 hours of the birth of their baby (from 8% in 2002 to 14% in the current survey) Across the board, irrespective of when they left hospital, 13% of women reported not feeling

baby needing special care, medical reasons, as well as feeling pressured to leave The

2007 survey demonstrates some clear service changes since the 2002 survey, as well

as highlighting some new information Results about overall satisfaction with service

of the maternity hospital as follows:

Respondents asked to indicate how satisfaction they were with their maternity services The response options given were: “I felt well looked after”; was satisfactory” and “I didn’t feel well looked after” Results indicate that, across the board, more than three quarters of the 2,811 women (or 78%) felt “well looked after”, while another 18% said it was “satisfactory” However, 107 women,

representing 4%, “didn’t feel well looked after”

In addition, through survey of Marketing & Families Newspaper in Vietnam about customer satisfaction in June 2008 on healthcare services and customer care of hospital with 77.75% of reviews are “good”, 21.6% of the reviews are “very good” Also similar to asking your general assessment of how the hospital has 27.64% of the respondents answered “very good”, 71.95% answered “good”, 0.27% answered

“average”

8 Research Model

This research model has eight factors to measure customer satisfaction about service quality of the maternity hospital Principal components factor analysis with very-max rotation determined eight (08) dominant factors present in the data

Figure 1: Research Model

However, the author only used six (06) factors to research for this study Those are respect and caring, effectiveness and continuity, appropriateness, information, efficiency, first impression Because the author had done pilot interview about eight factors but interviewees gave feedbacks that we should drop two (02) factors: meals and staff diversity Their reason were meals which not server all

H1

H2

H5 H4 H3

have a breakfast, dinner, lunch, you will order canteen for serving meals In additions, staff diversity factor is also not to use in hospitals For the international hospitals as Sai Gon international hospital or French – Vietnamese hospital have to recruit staff diversity to server foreigner patient With two factors that only are been used for a hospital so that we cannot compare and design a questionnaire for all hospitals Therefore, the author did not use “Meals” factor and “Staff diversity” factors in the maternity hospitals in Ho Chi Minh City That is reason why the author only used six factors for this study as follows:

Figure 2: Adjusted research model

This is table about factors which are been changed by names in study

Table 2: Factors in study

1 Respect and Caring Human and physical resources

(Doctors & staffs)

2 Effectiveness and continuity Effectiveness and continuity

6 First impression First impression

Hypothesizes the adjusted model had redefined as follows:

H1: There are positive relationship between human and physical resources (doctors & staffs) and customer satisfaction

H2: There are positive relationship between effectiveness and continuity and customer satisfaction

H3: There are positive relationship between facilities and customer satisfaction

H4: There are positive relationship between information and customer satisfaction

H5: There are positive relationship between the hospital charges and customer satisfaction

H6: There are positive relationship between first impression and customer satisfaction

Chapter Three – Research Method

1 The introduction about the maternity hospitals in Ho Chi Minh City

Nowadays, Ho Chi Minh City has many hospitals that serve the people In particular, the maternity hospitals are also one important part of the hospitals and people can know as:

1.1 Tu Du hospital - 284 Cong Quynh, Dist 1, HCMC

Tu Du Hospital was a specialist maternity hospital where was established in

1923 In 1937, it was been built maternity hospital with named Maternite Indochinoise (maternity hospital Indochina) by Professor Dr George Cartoux (French) director On April 8, 2004, the hospital was renamed the Tu Du Hospital with the total number of beds is 1,000 Today, Tu Du Hospital is been known as a leading hospital of obstetrics and gynecology of the country, and is the largest center gynecology in South Tu Du Hospital is successful deployment of new achievements

in the medical field as follows: implementation of ultrasound in obstetrics and gynecology, gynecological laparoscopic surgery (1990), established the Department

of Rehabilitation infants (1996), successful implementation of the method of in vitro fertilization (1997), very preterm infant feeding method Kangaroo, genetics, etc

1.2 Sai Gon international hospital – 63 Bui Thi Xuan, Dist 1, HCMC

Saigon International Hospital was established and started construction in

1996 and in 2000 it was been operated This is a private maternity hospital Saigon International Hospital has modern equipment, full facilities, comfortable room, etc Since the beginning of hospital’s establishment, board of directors have confirmed and defined the hospital that has to run well and effectiveness Saigon International Hospital will share good services for communities and society

1.3 Hung Vuong hospital – 128 Hong Bang, Dist 5, HCMC

Hung Vuong hospital built in 1900, as a Maternity hospital Hung Vuong Hospital has functions:

 Providing the highest level of reproductive health treatment and care

 Performing scientific research, focusing on Reproductive Health

 International Collaboration

 Training under- and post-graduate fellows from medical and nursing universities

 Having the highest technical responsibility for 24 districts of HCMC

Besides, it is one of the first BABY FRIENDLY Hospitals in Vietnam: approved since 1995

1.4 University Medical Center Hospital – 243 A Hoang Van Thu, Dist Tan Binh, HCMC

University Medical Center Hospital established on March 31, 2002 based on the cooperation contract between Ho Chi Minh City University of Medicine and Mekong Obstetrics Hospital Limited Company It is currently operating at 243A Hoang Van Thu Street, Ward 1, Tan Binh District, and Ho Chi Minh City Now it has more than 200 beds, clinic, emergency room, labor room, laboratory, diagnostic imaging, operating room and recovery rooms are equipped with modern machinery University Medical Center Hospital can perform the surgery in obstetrics, gynecology, and laparoscopic surgery Along with a team of professors, doctors, industry experts specialized in Obstetrics, Gynecology, and Pediatric of hospital, they trained basic in Vietnam and abroad University Medical Center Hospital is promoting the advantage of being a basis-leading specialist in the field of care for

2 Scale

To measure customer satisfaction towards service quality of the maternity hospitals in Ho Chi Minh City, we follow previous studies as mentioned above to identify the scale of service quality and customer satisfaction

2.1 Service quality scale

The research applied the concept of rating things with numerical scores This method gives us a number to express the level of satisfaction Normally, scales of five (5-point Liker scale) used to indicate the extreme dissatisfaction and extreme satisfaction The service quality model includes 30 observed variables adjusted for measuring six dimensions of service quality as follows:

a Human and physical resources (doctor & staff)

- Employees respect the patient

- Employees are friendly, polite when they respond patient's need

- Employees are always willing to help the patient

- Employees listen and solve quickly the complaining of patient

- Employees ensure information confidentiality of patient

b Effectiveness and continuity

- The patient can touch and talk easy with hospital’s employees

- Hospital has simple procedure, quickly time for hospitalize

- Employees tried to control the patient’s pain when they were hurt

- Employees are well-trained with high competence

- Patients were allowed to participate in their decisions and treatment

- Patients were carefully instructed before leaving hospital

c Facilities

- The hospital has a quite space

- Hospital employees look clean and are well-dressed

- The hospital has modern equipment and technology

- The hospital has clean room and tidy equipment

- Equipment with utensils is full for mothers and newborn baby

- The hospital has the necessary light

d Information

- The patient don’t have to fill out so many forms of admission

- Phone system for calling employees is ready and in good condition

- The doctor informed the patient about the results of examination testing, treatment

- The patient gets the doctor to provide information quickly

e The charges hospital

- Hospital collects reasonable medical charges

- The hospital charges is clear and easily to understand

- Employees are available for their explaining about the hospital charges

f First impression

- Hospital has reputation

- Hospital is thoughtful of the patient

- Hospital has modern equipment and facilities

- The hospital has a lot of professional and good doctors

- The patient feels comfortable to contact with hospital’s employees

2.2 Scale of customer satisfaction

Based on Perception-Based Customer Satisfaction Model of Athanassopoulos & Iliakopoulos (2003), scale of satisfaction has six observed variables, these are:

- Do you satisfy with your maternity hospital?

- Do you satisfy with human and physical resources in hospital?

- Do you satisfy with effectiveness and continuity of hospital services?

- Do you satisfy with the hospital charges?

- Do you satisfy with facilities on service quality of hospital?

- Do you satisfy with information on service quality of hospital?

Questionnaire design

Pilot test

Questionnaire survey conducting

Data processing and analysis

Findings and recommendations

4 Questionnaire design

After reviewing theories and some empirical reports related to the research problem, the questionnaire was designed which included three parts as follows: Firstly, Part 01 includes common information about the maternity hospital, which pregnant women or women gave birth within 6 months in the maternity hospital in

Ho Chi Minh City

Secondly, Part 02 includes service quality and their satisfaction about maternity hospital Therefore, data from this part played an important role for whole research process There are 36 observed items where 30 first observed variables used to measure the service quality based on KQCAH scale

The last part of questionnaire helped us to classify interviewed objectives as career, age and income

Table 3: Coding variables in measurement scale

Human and physical resources (Doctors & Staff)

1 H1 Employees respect the patient

2 H2 Employees are friendly, polite when they respond patient's need

3 H3 Employees are always willing to help the patient

4 H4 Employees listen and solve quickly the complaining of patient

5 H5 Employees ensure information confidentiality of patient

Effectiveness and continuity

6 E1 The patient can touch and talk easy with hospital’s employees

7 E2 Hospital has simple procedure, quickly time for hospitalize

8 E3 Employees tried to control the patient’s pain when they were hurt

9 E4 Employees are well-trained with high competence

10 E5 Patients were allowed to participate in their decisions and

treatment

11 E6 Patients were carefully instructed before leaving hospital

Facilities

12 F1 The hospital has a quite space

13 F2 Hospital employees look clean and are well-dressed

14 F3 The hospital has modern equipment and technology

15 F4 The hospital has clean room and tidy equipment

16 F5 Equipment with utensils is full for mothers and newborn baby

17 F6 The hospital has the necessary light

Information

18 I1 The patient don’t have to fill out so many forms of admission

19 I2 Phone system for calling employees is ready and in good condition

20 I3 The doctor informed the patient about the results of examination

testing, treatment

21 I4 The patient gets the doctor to provide information quickly

The hospital charges

22 T1 Hospital collects reasonable medical charges

23 T2 The hospital charges is clear and easily to understand

24 T3 Employees are available for their explaining about the hospital

charges

First impression

25 FI1 Hospital has reputation

26 FI2 Hospital is thoughtful of the patient

27 FI3 Hospital has modern equipment and facilities

28 FI4 The hospital has a lot of professional and good doctors

29 FI5 Hospital's landscape is clean

30 FI6 The patient feels comfortable to contact with hospital’s

employees

Customer satisfaction

31 S1 Do you satisfy with your maternity hospital?

32 S2 Do you satisfy with human and physical resources in hospital?

33 S3 Do you satisfy with effectiveness and continuity of hospital

services?

34 S4 Do you satisfy with the hospital charges?

36 S6 Do you satisfy with information on service quality of hospital?

5 Sample size

Firstly, we conducted a pilot test on 20 pregnant women and women giving birth within six (06) months From their comments and suggestions, we completed the final questionnaire design We distributed 250 questionnaires to potential respondents We implemented the survey during one month and received 225 samples After collecting data, we use the Statistical Package for Social Sciences

(SPSS) version 16 to code and refine the database

6 Analysis techniques

6.1 Descriptive statistics

“Descriptive statistics are used by researchers to summarize and "describe" data found during research Typically, researchers deal with lots of data and descriptive statistics provide a way for the researchers to summarize the main properties of a large group of data into just a few numbers This lets the researcher show what the data are without tons and tons of numbers Some examples of descriptive statistics are frequency distributions, measures of center (i.e., mean,

median, and mode), range, and standard deviation

6.2 Testing reliability of scale by Cronbach’s Alpha

Cronbach's α (alpha) is a coefficient of reliability It is been commonly used

as a measure of the internal consistency or reliability of a psychometric test score for

a sample of examinees (Cronbach, 1951) A reliability coefficient is from 0.7 to 0.8 considered acceptability in most of social science application Besides, the item-total correlation coefficient of variable, which is less than 0.30, will be been rejected