assessment of patient satisfaction and healthcare quality improvement in hanh phuc hospital

HO CHI MINH CITY OPEN UNIVERSITY UNIVERSITÉ LIBRE DE BRUXELLES SOLVAY BRUSSELS SCHOOL OF ECONOMICS & MANAGEMENT MBQPM5 NGUYEN THI NGOC HANH “Assessment of Patient Satisfaction and He

HO CHI MINH CITY OPEN UNIVERSITY UNIVERSITÉ LIBRE

DE BRUXELLES

SOLVAY BRUSSELS SCHOOL OF ECONOMICS & MANAGEMENT

MBQPM5 NGUYEN THI NGOC HANH

“Assessment of Patient Satisfaction and Healthcare Quality

Improvement in Hanh Phuc Hospital”

MASTER FINAL PROJECT MASTER IN BUSINESS QUALITY AND PERFORMANCE

MANAGEMENT

Ho Chi Minh City

(2016)

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STATEMENT OF AUTHORSHIP

I would like to confirm that the content presented in this report is the

truthful work and has been conducted and interpreted by myself, under the

direction of Dr Jacques Martin It had not been made from other people’s work published or presented it in the content of the report without acknowledging the original sources

I certify that this report has not been submitted elsewhere in any form for the fulfillment of any other degree or qualification

Ho Chi Minh City, 2016

Nguyen Thi Ngoc Hanh

I strongly believe that the project is helpful for the process of improving customer care in Vietnam in general and in Hanh Phuc hospital in particular and the contribution in the journey to seek patient’s loyalty and satisfaction

Sincerely Nguyen Thi Ngoc Hanh

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TABLE OF CONTENTS

Abbreviations 9

List of Tables, Figures and Appendix 10

Abstract 11

Introduction 12

Overview 12

Background of Hanh Phuc Hospital (HPH) 13

Patient satisfaction survey process in HPH 15

PART 1 THE PATIENT SATISFACTION ASSESSMENT PROCESS Chapter I Patient satisfaction and healthcare service quality 18

1 Healthcare quality management system 18

2 Patient satisfaction and service quality in healthcare 19

3 Relationship between patient satisfaction & service quality 20

4 Dimensions of service quality and customer satisfaction perspectives in healthcare organization 21

Chapter II: Structure of the process 24

1 Workflow of the process 24

2 Description the process 25

Chapter III: Methodology of patient satisfaction survey and analysis 27

1 Participants 27

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2 Instruments 27

3 Procedure of survey patient satisfaction 28

4 Analysis methods 39

PART 2 FINDINGS AND DISCUSSIONS Chapter I: Findings 30

1 Overview 30

2 Overall satisfaction 30

3 Patients satisfaction with appointment and registration process 31

4 Patients satisfaction with hospital facilities 32

5 Patients satisfaction with hospital environment 32

6 Patients satisfaction with waiting time 33

7 Patients satisfaction with hospital staff 34

8 Other comments of patients 35

Chapter II: Discussions and suggestion for quality improvement 37

1 Healthcare quality improvement process 37

2 Discussion and suggestion solutions for quality improvement 39

Conclusion 45

References 48

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ABREVIATIONS

CQI : Continuous Quality Improvement

JCI : Joint Commission International

MOH : Ministry of Health

PCA : Patient Care Associate

HPH : Hanh Phuc International Hospital

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LIST OF TABLES, FIGURES AND APPENDIX

Figure 1: Healthcare Management System Framework, 18

Figure 2: Service quality and customer satisfaction perspectives in healthcare 23

Figure 3: Overall satisfaction rate 31

Figure 4: Satisfaction on hospital environment 33

Figure 5: Satisfaction with waiting 34

Figure 6: Satisfaction of patients with hospital staff 35

Figure 7: Quality Improvement process 38

Figure 8: Patient’s satisfaction with staff instruction and education to patients 42

Figure 9: Satisfaction with staff skills and professionalism 44

Appendix A: Customers’ Satisfaction survey 51

Appendix B: Satisfaction to appointments & registration process 54

Appendix C: Satisfaction to waiting time 55

Appendix D: General satisfaction to hospital staff 56

Appendix E: Satisfaction to hospital staff: skill and professionalism 57

Appendix F: Satisfaction to facility 58

Appendix G: Patient consultation process 59

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ABSTRACT

Patient satisfaction is an important component of the healthcare service quality especially in the competitive environment of modern healthcare today, according to Vietnam MOH and JCI (2015) patient satisfaction is considered as an important criterion to evaluate reputation and quality of a hospital, appraisal of patient satisfaction has been advocated as a reliable and inexpensive way to assess and obtain opportunities for improvement The paper aims to identify the levels of patients’ satisfaction and to develop the framework to assess and improve services’ quality in Hanh Phuc Hospital In this study, 152 participants are randomly selected from patients/ patients’ relatives in Hanh Phuc hospital, the questionnaire basically designed and based on 5 dimension s of SERVQUAL model, integrated into perspectives of healthcare management system instructed

by World Health Organization (WHO) and 5-points Likert scales for measuring The questionnaire attempts to obtain the information how to enhance patient’s satisfaction and how to improve hospital services Generally, the results show that over 59 % (n=89) respondents satisfied and very satisfied with hospital services, besides, 9% (n=14) respondents are unsatisfied, these findings requested hospital managers have to be taken into account to deeply investigate the current hospital situations, where are the gaps and come out the appropriate solutions for improvement The limitations of this paper also are presented and suggestions are given for further researches

Patient satisfaction surveys help to evaluate the patients' perceptions of services of a healthcare organization Continually improving of patient care are vital and necessary activities by gauging level of patient’s satisfaction and dissatisfaction and incorporating results into improvement efforts that can help enhance the overall practice and may reduce the risks in cases of deficiencies to

be identified and improvements are achieved, understanding facilitates hospital administration to enhance quality of service and satisfy patients to a great extent

as well SERVQUAL dimensions developed by Parasuraman et al (1985) integrated into healthcare quality management system and 5-points Likert scales

to develop the instrument for measuring service quality and patient satisfaction of Hanh Phuc hospital and to be used in this report

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Background of Hanh Phuc Hospital (HPH)

Hanh Phuc International Hospital (HPH) is a private hospital, established

in 2011, located in Binh Duong province, with almost 450 staff including more

than 90 physicians (includes fulltime, part time and external contracts), 250

nurses, medical technicians and 110 non-medical and support staff

HPH ORGANIZATIONAL CHART

Key hospital services: The hospital offers multi-specialty healthcare

services, composed by outpatient & health check-ups center, accident &

emergency; medical center, surgical center, and inpatient services include

Internal Medicine ward, Obstetrics, Gynecology, Pediatrics wards and Women

Cancer Center The key healthcare processes of HPH as following:

Vision: To be the hospital of choice for women and children by committing integrated services for patients and their family

Mission: To provide high standards of clinical quality care and personalized service with respect, compassion and understanding

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Patient satisfaction survey in HPH

In the event of patients overloaded in public hospital system in Vietnam, with the shortage of resources in both public and private hospital such as lack of modern medical equipment, lack of experienced medical doctors and other professional staff has put the increasing burden on hospital capacity to meet health care needs, this situation therefore affects the quality of hospital services Quality of health care has become a central issue with the aim of protecting, caring, and promoting health for people However, the current overcrowded and understaffed situation has had significant influence on the quality of hospital care As a result, the low quality of hospital care may lead to poor quality of population health, negatively affecting social and economic development, or more generally it is essential to be aware of how the patients and patient parties evaluating the hospital service

In Hanh Phuc hospital, as a new and private hospital, under pressure of competitive environment, enhance patient satisfaction and quality improvement is crucial to maintain and keep business growth Customers are the most important asset of any organization, Hanh Phuc hospital is not excepted, measuring and reporting on patient satisfaction about health care services has become a major in healthcare industry in general and in HPH in particular; hospital performance is focus on patient comfort, complaint mechanisms and continuity of care Consideration of goals and business strategy, analyses patients’ satisfaction data that based on patients’ survey and feedbacks (Appendix A), the strategic objectives

of HPH is focus on:

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- Increase patients satisfaction

- Increase loyalty of customers

- Reduce patients’ complaints

In order to reinforce customer relation management, evaluates the quality and gets feedbacks from customers via different channels: customers survey/interview, hot line telephone no, internet and social network such as HPH forum, registered forum, employee feedback and reports of patients’ complaints

Amongst of these surveys patients satisfaction though defined questionnaires that conducted for both inpatients and outpatient is a regular activities to get feedback from customers and take into serious account from the customers voice to improve our services Based on culturally appropriate surveys of patient satisfaction with the following specific objectives to be obtained:

a) To identify the dimensions of patient satisfaction based on SERQUAL tool, b) To develop patient satisfaction questionnaires that is valid and reliable for evaluating HPH hospital performance and assessing quality of hospital care c) Collect and analysis of data from patients to determine how patients’ integration can help in improving service quality of hospital

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The report includes 2 main parts with 5 chapters:

Chapter Description

INTRODUCTION

- General introduction of the report

- Background of Hanh Phuc Hospital

- The interesting to perform this report

PART 1: THE PATIENT SATISFACTION ASSESSMENT PROCESS

PART 2: DISCUSSION AND SUGGESTION FOR QUALITY IMPROVEMENT

Summary of the main results of the study, offer a number

of improvement suggestion of implications for hospital managers

CONCLUSION

- Summary of findings

- Points out the limitations of the study and suggest some directions for further work

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PART 1: THE PATIENT SATISFACTION ASSESSMENT PROCESS

CHAPTER I PATIENT SATISFACTION AND HEALTHCARE SERVICES

QUALITY

1 Healthcare Quality Management System

Quality management is a way of doing business that continuously improves products and services to achieve better performance According to American Society for Quality (2008), the goal of quality management in any industry is to achieve maximum customer satisfaction at the lowest overall cost to the organization while continuing to improve the process WHO (2008)

presents the framework of healthcare system as (Figure 1) following:

Service delivery

Access coverage Quality Safety

Improved health (level and equity)

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There are some different definitions regarding on service quality, according to Parasuraman et al (1985) service quality as a "function of the differences between expectations and performance along the quality dimensions" Another view related

to service quality that is a form of attitude representing a long-run overall evaluation (Cronin and Taylor, 1992), in healthcare setting, continuous quality improvement (CQI) play a crucial role, it required that all healthcare workers in the organization hve to understand the same quality terms, speak the same quality language, and share the same quality vision, that encourages all health care members to continuously ask: “How are we doing?” and “Can we do it better?” (Edwards, 2008)

In order to promote quality of care and patient satisfaction, it is important to identify the patients’ needs, acknowledge the degree of satisfaction that can be used

as a means of assessing the quality of health care and reflects the ability of the health care provider to meet the patients’ expectation (Sreenivas & Babu, 2012, p 102)

2 Patient satisfaction and service quality in healthcare

Oliver (1981) defines satisfaction as customers' emotional feelings concerning a particular consumption experience He explains that satisfaction is a consequence of a mental assessment and evaluation of what customers experience and the resulting outcome of the services provided In addition, Ghylin et al.(2008, p.76) points out that by defining service quality, organizations will be able to deliver services with higher quality level presumably resulting in increased

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customer satisfaction Service quality can be defined as a difference between customer’s expectation for service performance prior to the service encounter and their perception of the service received In healthcare setting, patient satisfaction surveys assess the experience of health care and outcomes perceived by patients and/or their relatives As mentioned, customers focus and customer care plays a critical role in improving the quality of service Therefore, evaluating customer satisfaction means evaluating service quality of a firm or an organization perceived by customers

3 Relationship between service quality and customer satisfaction in healthcare

Quality is a means for customer satisfaction, “Quality is defined as the summation of the affective evaluations by each customer of each attitude object that creates customer satisfaction” (Wicks & Roethlein, 2009, p.90) Accordance to Donabedian (1988) patient satisfaction feedbacks used for assessing the quality of care so that the hospital has opportunities for reviewing or setting standards for future care Accordance to Vietnam MOH, patient satisfaction is considered as an important criterion to evaluate reputation and quality of service of a hospital Through evaluation helps to identify the problems of organization where and why patients are not satisfied with, then quality improvement will be taken into consideration for better serving and meeting their expectations Cronin and Taylor, (1992) presents two concepts of customer satisfaction and service quality are intertwined as some researchers believe that customer satisfaction leads to

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perceived service quality, while others claim that service quality leads to customer satisfaction.This point of view has emphasized the importance of patients’ perceptions and patients’ role in the process of improving quality of health care services

4 Dimensions of Service Quality and Customer Satisfaction Attributes in Healthcare

Accordance to Van Iwaarden et al (2003) the SERVQUAL instrument has been the predominant method used to measure consumers’ perceptions of service quality, SERVQUAL model developed by Parasuraman, Zeithaml & Berry in the 1980s that comes as a facilitator to measure, evaluate and manage quality of services and has also been named as a method of analysis of the deficiencies in service from the process to improve the service provided Primarily the SERVQUAL model was developed for service and retail businesses and its objective is to know how customers of a business rate the services offered to them (Parasuraman et al., 1988) The SERVQUAL model is important in grouping customers of a company into different quality dimensions by determining their SERVQUAL score which is very important to know how to target the various ranks SERVQUAL represents service quality as the discrepancy between a customer's expectations for a service offering and the customer's perceptions of services received, requiring respondents to answer questions about both their expectations and their perceptions (Parasuraman et al., 1988) that integrated into

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healthcare organization setting (Figure.1), the questionnaires of customer satisfaction survey is developed as the (Appendix A)

It has five generic dimensions or factors and stated as follows:

(i) Tangibles: Physical facilities, equipment and appearance of personnel the questionnaires focus on spaces, cleanliness of patient rooms and toilets, facilities for patients’ relatives and the appearance of hospital staff

(ii) Reliability: Ability to perform the promised service dependably and accurately, to achieve these purposes the questionnaires focus on how hospital staff responded to patients’ problems, not only health problems but also other particular non-clinical dimensions

(iii) Responsiveness: Willingness to help customers and provide prompt service, waiting time was the most mentioned in this dimension such as waiting time in the emergency /exam room waiting time for the conduct of lab tests and imaging diagnosis, and waiting time for responding to patient requests

(iv) Assurance (including competence, courtesy, credibility and security): Knowledge and courtesy of employees and their ability to inspire trust and confidence

(v) Empathy (including access, communication, understanding the customer): Caring and individualized attention that the firm provides to its customers

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Service quality and customer satisfaction perspectives in healthcare

integrated d as the following figure:

Perceived services quality

Customer loyalty

Figure 2 Service quality and customer satisfaction perspectives in healthcare Adapted

from SERVQUAL dimensions Parasuraman et al (1988)

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2 Description the stages to perform the report

CHAPTER II STRUCTURE OF THE PROCESS

1 Workflow

Stage 1: Identify final project topic

Stage 2: Outline the framework of final report

Stage 3: Develop questionnaire and start the survey process

Approved by Hospital management

Stage 4: Write the report Stage 5: Complete and send full draft of the report to tutor for advice

Approved by Academic Tutor

Revised as Academic Tutor

Start the project

Stage 6: Complete the report and prepare for defense stage

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3 Description of the prcess

It takes 18 weeks to complete this report, from 1st Nov 2015 to 20 Apr 2015, the process to complete this report detailed as following:

Stage 1: Identify the topic of final project

- Acknowledge the current situation of healthcare quality management,

- Identify the actual issue of the hospital and come out the ideas in term of quality performance to propose the final project topic

- Receive the advice and the approval from Academic Tutor on the proposed topic

Stage 2: Outline the framework of final report

- Writing the Proposal of report outline

- Receive the advice and comments from Academic Tutor on the proposed outline

- Revise the outline in accordance to Academic Tutor comments

Stage 3: Develop questionnaire and start the survey process

- Develop the questionnaire and sent to Academic Tutor along with initially writing and get the advice

- Conduct the survey

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Stage 4: Write the report

- Collect data and perform data analysis to achieve the report objectives as outlined

- Analyzing the data from the previous steps

- Write the report Stage 5: Complete and send full draft of the report to tutor for advice

- Complete the full draft of report

- Contacting Academic Tutor to get the advice

- Revising and completing the report

Stage 6 Complete the report and prepare for project defense stage

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CHAPTER III METHODOLOGY OF PATIENT SATISFACTION SURVEY AND

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There are 7 sections of questionnaire arranged in accordance to different stages of consultation and different healthcare professional services during their experiences of treatment in Hanh Phuc that respondents are able to rate and evaluate in accordance to their perceives/experiences

i Appointment and registration

ii Waiting time

iii Hospital Facilities

iv Environment

v Hospital staff

vi Other comments or recommendations

vii Administration information

The table of questionnaires detailed as Appendix A, the data and information

received, analysed and categorized in to levels of priorities and proposed solution to carry out the improvement of services

3 Procedure of survey patient satisfaction

To collect data, the author sought permission and obtained the approval from top management of Hanh Phuc Hospital,

For in patients who hospitalized and stay in the hospital over 1 day due to treatment requested, the questionnaires are distributed by nurses, medical secretary

to patients were discharged from the hospital on that day or were scheduled for discharge

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PART 2: FINDINGS AND DISCUSSIONS

CHAPTER I FINDINGS

1 Overview

Generally, this survey aims to find the degrees of patients’ satisfaction in terms of patients’ experiences though the accessibility of hospital services in Hanh Phuc, the data collection was conducted from Jan 19th, 2016 to Mar 5th, 2016 The questionnaires are distributed by nurses, medical secretary at in-patients wards, objectives of surveys are patients who were discharged from the hospital on that day

or with pre-scheduled for discharge For out-patient, the questionnaires are distributed at the dispensary by pharmacist The patients asked for completing the questionnaires, ant data is collected for synthetic and analysis by author

There are 180 questionnaires distributed, 152 were completed by respondents (rate 84.5%) The ages of respondents from 22 to 65, for pediatric patients, mostly responded by their parents or guardians Amongst of these respondents, there are 32 new patients who first time visit the hospital and the rest 120 patients are returning for treatment and/or clinical examination

2 Overall satisfaction:

It can be seen that 38% (n=58) of the respondents were satisfied with the services provided in the hospital, 21% (n=33) of the patients were very satisfied There are 9% (n=14) of responders were not satisfied with the services, the remain