Assessment of outpatient satisfaction in Binh Dinh provincial general hospital in 2018

This research introduces how to assess patient satisfaction in public hospitals, taking the case of Binh Dinh provincial general hospital.. 20 CHAPTER 4: RESULTS OF INPATIENT SATISFACTI

0000 VIETNAM NATIONAL UNIVERSITY, HANOI

VIETNAM JAPAN UNIVERSITY

NGUYEN NAM KHANH

ASSESSMENT OF INPATIENT

SATISFACTION IN BINH DINH PROVINCIAL GENERAL

HOSPITAL IN 2018

MASTER’S THESIS BUSINESS ADMINISTRATION

Hanoi, 2019

VIETNAM NATIONAL UNIVERSITY, HANOI

VIETNAM JAPAN UNIVERSITY

NGUYEN NAM KHANH

ASSESSMENT OF INPATIENT

SATISFACTION IN BINH DINH PROVINCIAL GENERAL

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ACKNOWLEDGEMENT

First of all, I would like to give my sincere thanks to Vietnam Japan University, Yokohama National University, Japan International Cooperation Agency (JICA) with all the members, lecturers and assistants for giving me this opportunity to study and research in an international academic environment I have gained a lot of knowledge and experience through classes and seminars in Vietnam and Japan Secondly, I want to express my deep and sincere gratitude to my two supervisors, Associate Professor Vu Anh Dung, Vietnam Japan University and Professor Hiroshi Morita, Yokohama National University Their wide knowledge and critical thinking have given me motivation, confidence and value to do my research They also encouraged and instructed me personally for my thesis I also want to thank Professor Matsui, Associate Professor Pham Thi Lien, Hanh sensei, Hino sensei for what all

of you have done with VJU students You always support and share with us your valuable knowledge and experience

To Huong san and IPO’s staff, YNU Thank you for your detailed caring to VJU students in Vietnam as well as in Japan

Finally, I would like to thank my family, friends and colleagues who supported and encouraged me to finish my thesis

Hanoi, 2019

Nguyen Nam Khanh

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ABSTRACT

Patient satisfaction is an important indicator used for measuring the quality of healthcare facilities Patient satisfaction has an effect on outcomes of medical service providers and reflects efficiency of provided services Therefore, patient satisfaction will be an effective indicator to measure the success of medical service providers This research introduces how to assess patient satisfaction in public hospitals, taking the case of Binh Dinh provincial general hospital

In the strategy of Vietnam healthcare system for protecting, caring and improving healthcare in the period 2011-2020, vision 2030 Some issues have been mentioned: Health is the most valuable asset of individuals and all society; medical service is a special social service without profits in public service providers; investing in health

is investing for the future and for good nature of society; improvement and modernization of healthcare system towards Equity-Efficiency-Development

Currently, medical services in public hospitals are considered not as good as in private hospitals Therefore, the objectives of this research are assessing current situation of patient satisfaction in the hospital and providing some recommendations as the background or reference for public hospitals to improve their medical services

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TABLE OF CONTENTS

ACKNOWLEDGEMENT i

ABSTRACT ii

LIST OF FIGURES vi

LIST OF TABLES vii

CHAPTER 1: INTRODUCTION 1

1.1 Background 1

1.2 Research objectives 2

1.3 Research questions 2

1.4 Introduction of Binh Dinh provincial general hospital 2

1.4.1 Policies of Vietnam healthcare system towards patient satisfaction 2

1.4.2 Establishment and development process of the hospital 4

1.5 Structure of research 5

CHAPTER 2: LITERATURE REVIEW ON PATIENT SATISFACTION 6

2.1 Hospital services 6

2.2 Service quality 6

2.3 Customer satisfaction 8

2.4 Customer satisfaction and service quality 9

2.5 Overview of patient satisfaction 10

2.6 Role of patient satisfaction 10

2.7 The relationship between service quality and patient satisfaction 11

2.8 Factors impacting patient satisfaction 11

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CHAPTER 3: RESEARCH METHODOLOGY 16

3.1 Research design 16

3.2 Research process 17

3.3 Data collection 17

3.4 Research model 20

CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 23

4.1 General information of researched patients 23

4.2 Assessment of inpatient satisfaction 25

4.2.1 Inpatient satisfaction on accessibility 25

4.2.2 Inpatient satisfaction on Transparency on information, examination and treatment procedures 27

4.2.3 Inpatient satisfaction on Facilities and equipment 29

4.2.4 Inpatient satisfaction on Medical staff’s behavior and professional capacity 31

4.2.5 Inpatient satisfaction on Results of service provision 33

4.3 Summary of results on inpatient satisfaction 35

4.3.1 Inpatient satisfaction in general and classified by factors 35

4.3.2 Percentage of overall assessment of inpatient satisfaction 36

4.3.3 Classification of patients who will return or introduce to other patients 36

4.3.4 Odds Ratio Analysis 37

CHAPTER 5: RECOMMENDATIONS TO IMPROVE INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL 40

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5.1 Improving facilities in the hospital 40

5.2 Investing more in medical equipment and information technology to improve service quality 40

5.3 Simplifying complicated administrative procedures 41

5.4 Improving medical staff’s communication skills 41

5.5 Limitations of the thesis 41

CONCLUSIONS 42

LIST OF REFERENCES 43

APPENDIX 1 46

APPENDIX 2 50

APPENDIX 3 52

APPENDIX 4 53

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LIST OF FIGURES

Figure 1 Research process 17

Figure 2 Research model 22

Figure 3 Patient satisfaction by age 24

Figure 4 Summary of inpatient satisfaction on Accessibility 26

Figure 5 Summary of inpatient satisfaction on Transparency on information, examination and treatment procedures 28

Figure 6 Summary of inpatient satisfaction on Facilities and equipment 31

Figure 7 Summary of inpatient satisfaction on Medical staff’s behavior and professional capacity 33

Figure 8 Summary of inpatient satisfaction on Results of service provision 35

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LIST OF TABLES

Table 4.1 Patient classification by sex 23

Table 4.2 The total number of days of hospitalization 24

Table 4.3 Patients using of health insurance card for this treatment 24

Table 4.4 Classification of inpatient satisfaction by accessibility 25

Table 4.5 Classification of inpatient satisfaction by Transparency on information, examination and treatment procedures 27

Table 4.6 Classification of inpatient satisfaction by Facilities and equipment 29

Table 4.7 Classification of inpatient satisfaction by Medical staff’s behavior and professional capacity 31

Table 4.8 Classification of inpatient satisfaction by Results of service provision 33

Table 4.9 Inpatient satisfaction in general and classified by factors 35

Table 4.10 Percentage of overall assessment of inpatient satisfaction 36

Table 4.11 Classification of patients who will return or introduce to other patients 36

Table 4.12 The relation between related factors and inpatient satisfaction 37

Table 4.13 The relation between related factors and patient return 38

For public hospitals, assessment of patient satisfaction will help improve quality of services and reputation, so that hospitals can increase revenue and have effects on other hospitals Pollack (2008) there is a relationship between service quality and patient satisfaction, level of satisfaction is a measurement for the suitability between medical services provided with expectation from patients Satisfied patients will lead

to improved financial outcomes, reduce management claims, retain patients and succeed in a competitive environment

In current circumstance, there is a difference of medical services between public and private hospitals, services at private hospitals are considered better than at public hospitals Nowadays, patients do not only pay attention on quality of medical treatment but also the services that they would receive from medical staff With the development of modern technology in medical treatment, medical services have been highly focused on to increase the competitiveness

Raising patient satisfaction in public health will play an important role for public healthcare providers because patient satisfaction determines the survival and development of public hospitals, according to Decree No 55/2012/ND-CP public healthcare providers will be dissolved if the task is not completed in three consecutive years

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With current situation and desire to contribute to improve the quality of medical services and patient satisfaction in Binh Dinh provincial general hospital, the author decided to choose the topic “Assessment of inpatient satisfaction in Binh Dinh provincial general hospital in 2018”

- What is the relation between related factors and inpatient satisfaction?

1.4 Introduction of Binh Dinh provincial general hospital

1.4.1 Policies of Vietnam healthcare system towards patient satisfaction

Satisfaction of patient is the result of medical services provided The level of satisfaction is a tool to assess the quality of healthcare services Some studies have indicated the relationship between quality of service and satisfaction, the higher the quality of health services, the higher the level of satisfaction Satisfaction plays an important role deciding the choices of patients using medical services at health facilities that helps increase revenue for hospitals When patients are satisfied with the services received, they will return in the future and become regular customers Besides that, they may also introduce the positive remarks about the service quality

to other patients that will help hospitals attract more patients therefore improving satisfaction not only helps retain existing patients but also attracts new patients and enhances the reputation for hospitals

Some studies have also indicated that there is a relationship between patient satisfaction and the profit of hospital The satisfaction will help increase profit for hospitals and competition with other healthcare facilities

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Patient satisfaction is also an important factor determining the survival and development of public hospitals that is indicated in Decree No 55/2012/ND-CP: public healthcare providers will be dissolved if the task is not completed in three consecutive years Patient satisfaction has been identified as a significant evidence reflecting the completion of the task

Improving patient satisfaction will have a good effect on healthcare sector because it brings not only benefits to service users but also benefits to healthcare facilities

In the current context of Vietnam healthcare system, central hospitals are overloading therefore the measurement of patient satisfaction is necessary, it will provide useful evidence for reorganizing the process of delivering services that meets the demand of service users

Raising the quality of medical services and reforming administrative procedures in the whole healthcare sector will make a contribution to implement the Resolution No 30/NQ-CP of the Government on protection, caring, and improvement of people’s health The Resolution No 30/NQ-CP regulating the program of administrative reform on the period 2011-2020 with 5 objectives:

- Building and completing the institutional system of market economy towards social orientation

- Creating a fair and ventilated business environment

- Developing a system of administrative procedures that is smooth, clean, and strong from the central government to the local authorities

- Ensuring protection of democratic rights and human rights

- Building a team of officials and civil servants with quality, capacity and qualifications

The program is divided into two phases with the following tasks:

- Phase I (2011 - 2015): ensuring personal satisfaction with services provided

by public facilities in the field of education and health care reaches more than 60% in 2015

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- Phase II (2016 - 2020): ensuring personal satisfaction with services provided

by public facilities in the field of education and health care reaches more than 80% in 2020

1.4.2 Establishment and development process of the hospital

From the first infirmary of 20 beds with less than 10 staff, established in April 1961

in the highland of Vinh Thanh (Ha Tien village) In 1969, the infirmary had an outstanding growth and was eligible for being a hospital Implementing the direction

of the Provincial Department of Health, hospital staff and local people build a new 100-bed provincial hospital, completed in October 1969, at O village - Vinh Thanh The hospital is made of bamboo, but it is tall and spacious in the dense forest with 20 large and small houses

After the liberation of the South, on April 1975, the provincial health officer took over the medical facility, repaired and brought the hospital back to normal operation and transferred the hospital to the current Binh Dinh General Hospital

Provincial General Hospital with a total area of more than 5 hectares is the highest treatment level of the provincial health sector From 1975 until now, the hospital has experienced many historical periods and has always received investment in construction and development, meeting the need of caring and protecting people's health Currently, Binh Dinh General Hospital is one of the large-scale provincial hospitals in the Central Region, Central Highlands, with 1050 inpatient beds; the total number of officials, employees nearly 1300 people; The hospital currently has 07 functional rooms, 33 clinical and subclinical departments Many modern equipment and facilities for diagnosis and treatment have been procured; officials and employees are regularly trained with knowledge, professional and management skills that is the basis for implementing the goal of constantly improving the quality of medical examination and treatment at the hospital, facilitating officials and people in the province have access to high quality of healthcare services

Being a leading facility in the field of medical examination and treatment With a long tradition and a team of highly qualified professional staff in many specialized

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areas For many years, Binh Dinh General Hospital has affirmed its role in implementing the functions and tasks of a provincial general hospital The hospital is planned by the Prime Minister to be a Regional Hospital under Decision No 153/2006 / QD-TTg dated June 30, 2006 " approving the master plan for development of Vietnam's health in the period up to 2010 and vision to 2020 ” On September 19, 2007, the Hospital was recognized by the Provincial People's Committee of level I Hospital according to Circular No 23/2005 / TT-BYT dated August 25, 2005 of the Minister of Health

Along with promoting the strength of the hospital in examination, treatment, caring, protection and improvement of people's health in the province and the region The hospital has actively implemented social activities such as free medical examination for people in remote and disadvantaged areas; coordination with charity organizations to giving meals to serve the poor, participation in disease prevention, humanitarian blood donation etc The Hospital always sets priority target to improve constantly the quality of medical examination and treatment In order to accomplish this goal, hospital leaders appreciate and focus on people as a key factor Therefore, even in difficult times, lack of human and budget, the hospital still tries to prioritize investment in training and human resource development

With a team of highly qualified professional and technical staff, and some modern equipment, Binh Dinh General Hospital is always a reliable medical examination and treatment place for patients and their relatives in the province and nearby provinces

1.5 Structure of research

Chapter 1: Introduction

Chapter 2: Literature review on patient satisfaction

Chapter 3: Research methodology

Chapter 4: Results of inpatient satisfaction in Binh Dinh provincial general hospital Chapter 5: Recommendations to improve patient satisfaction in Binh Dinh provincial general hospital

or training and research for major medical school centers to services designed by an industry-owned network of such institutions as health maintenance organizations (HMOs) The mix of services that a hospital may offer depends almost entirely upon its basic missions or objectives

Hospital services define the core features of a hospital's organization The range of services may be limited in such specialty hospitals as cardiovascular centers, or cancer treatment centers, or very broad to meet the needs of the community, or patient base, as in full service health maintenance organizations (HMOs), rural charity centers, urban health centers, or medical research centers Hospital services are usually the most general in large urban areas or underserved rural areas, broadly encompassing many services ordinarily offered by other providers

2.2 Service quality

Gronroos (1984) argues that customer perceived quality is influenced by a technical and functional dimension The functional quality is more important as long as the technical quality is at a satisfactory level, a high level of functional quality may compensate for temporary matters in technical quality in overall assessments of service quality Technical quality in the healthcare sector based on the basis of the technical accuracy of the diagnoses and procedures Functional quality refers to the way in which the healthcare services delivered to the patients and it is usually the main determinant of patients’ quality perceptions

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Quality is a term that we usually think of an excellent product or service that meets our expectations Quality is based on perceptions of individuals on products and services, these perceptions have been created through past experience of customers Parasuraman, Ziethml, Barry (1985) Service quality is a type of attitude related to satisfaction described as the difference between the customer’s expectations and perception of services

Javetz and Stem (1996) were the first to observe the growing attention to improvement of quality as a result of three important trends characterizing the healthcare sector

- The market has become more competitive, healthcare insurers and providers compete based on economic considerations

- There has been a consumption growth of private healthcare services

- A marked growth of customers’ awareness with their rights in healthcare sector

Hollis (2006) agreed that financial impact is a significant consideration but stressed that the management of consumer perceptions of healthcare quality is also significant with the following reasons:

- Evaluation of quality is related to satisfaction and service re-use intent

- Quality improvement methods require the identification and meeting of patient expectations

Zineldin (2006) Patient satisfaction is an important health outcome and quality measurement and he suggested reasons for the improvement of quality as followings:

- Patient dissatisfaction with high costs and poor quality

- Quality methods give managers ways to solve problems, influence the work, improve relations with health workers, provide ways to reduce waste and save Money

- Unnecessary drugs, surgery and laboratory wastes resources, and harms patients

From the previous authors, quality is a crucial determinant of competitiveness and long-term profitability in both service and manufacturing organizations However, he

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concluded that quality methods used in developed countries were not appropriate for developing countries therefore the different reasons given for quality improvement comparing to those of previous authors

Raja, Deshmukh and Wadhwa (2007) supported the argument that quality management has emerged not only as the most important and long-term strategy for ensuring the survival of organizations, but also leads to business excellence The authors concluded that declining reimbursement, new incentive structures, and increasing competition are placing pressure on providers to deliver healthcare services effectively and efficiently The authors also stated that most healthcare organizations are beginning to realize that quality is necessary for survival

James (2005) argued that the healthcare industry is moving from competition based

on price to competition based on quality and performance

It is obvious from all of the authors mentioned above that high quality of service is vitally important for the survival of healthcare facilities

2.3 Customer satisfaction

Wilson et al (2008) Customer satisfaction has been a great topic for organizations and researchers because customer satisfaction will be an important factor to increase sales, maximize profits, minimize costs, and lead to customer loyalty

Customers play a significant role in the organizational process and are the first aspect

to be considered by managers Customers are always trying to get maximum satisfaction from products and services Winning in today’s severe competition market, it is necessary to build not only the products but also customer relationship that means delivering superior value to the targeted customers Most companies adopts quality management programs which improves the quality of products and marketing processes because quality has a direct impact on product performance and

on customer satisfaction, Kotler et al (2002)

Kotler & Keller (2009) it is termed satisfaction when a customer is contented with products or services, satisfaction can be a person’ feelings of pleasure or disappointment comparing a product’s perceived outcome with their expectations

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Levy (2009) suggested three ways of measuring customer satisfaction

- A survey that customer feedback could be transformed into measureable data

- Focus group where discussions arranged by a trained moderator reveal what customers think

- Informal measures like talking to customers or reading blocs

The National Business Research Institute suggested possible dimensions that can be used in measuring customer satisfaction

- Trust in your employees

- The closeness of the relationship with contacts in your firm

- Other types of services needed

- Your positioning in clients’ mind

2.4 Customer satisfaction and service quality

Cronin & Taylor (1992) customer satisfaction has been considered to be based on the customer’s experience on a particular service encounter, the fact that service quality

is a determinant of customer satisfaction because service quality comes from results

of the services from providers

Oliver (1993) suggested that service quality would be antecedent to customer satisfaction regardless of whether these constructs were cumulative or transaction-specific

Wilson et al (2008) have been more precise about the meaning and measurement of service quality and satisfaction Service quality and satisfaction have certain things

in common; however, satisfaction is a broader term whereas service quality focuses

on dimensions of service

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2.5 Overview of patient satisfaction

Hulka et al (1970) attempted to undertake the initial steps in the conceptualization of the patient satisfaction concept These researchers defined "satisfaction" as the patient's "attitudes toward physicians and medical care.” More specifically, judgment concerning the quality of medical care received from physicians, nurses

Researchers in the consumer satisfaction have the definition of satisfaction as a cognitively based evaluation of product or service attributes These researchers contend that satisfaction is an emotional or affective response to a product or service use (Oliver 1981)

Ross et al (1987) argues that restricting patient satisfaction to perceptions of the

"quality" of health care received is an "inherent weakness." The researcher supports his position by noting that a segment of "healthy but unhappy" patients have been found in several empirical studies Thus, Ross et al suggest that the conceptualization

of the patient satisfaction should be enlarged to include other evaluations (e.g., waiting time, costs…etc.) in addition to purely quality perceptions

Tam (2007) satisfaction is a process of comparing service perceptions with expectations The initial expectations of patients about services considered as a determinant of satisfaction If perceived care is lower than expectation, the outcome will be dissatisfaction When patients meet or exceed expectations, the result will be satisfaction

2.6 Role of patient satisfaction

Pollack (2008) shows that there is a close relationship between patient satisfaction and profits of healthcare providers Patient satisfaction will help to increase profits and improve competitiveness with other hospitals

Patient satisfaction plays an important role for public healthcare providers because patient satisfaction determines the survival and development of public hospitals, according to Decree No 55/2012/ND-CP public healthcare providers will be dissolved if the task is not completed in three consecutive years Therefore, patient satisfaction will be the evidence of task completion of hospitals Improving

2.7 The relationship between service quality and patient satisfaction

Fornell, Johnson, Anderson and Bryant (1996) service quality is one of three antecedents to patient satisfaction with expectation and perceived value

Raja et al (2007) healthcare service quality is relating to activities, interactions, and solutions to customer problems

Badri, Attia and Ustadi (2008) patient satisfaction is considered the most crucial point

in the planning, implementation, and evaluation of service quality

Hollis (2006) argued that there was a strong link between service quality and satisfaction, and it is believed that quality has been defined as perceived satisfaction Sailia, Mattila, Aalto and Kaunonen (2008) patient satisfaction is widely used as an indicator in assessing quality of care

2.8 Factors impacting patient satisfaction

Expectations are believed to be one of the primary determinants of patient satisfaction, expectations reflect the levels of quality that patients expect to receive and it is the result of previous experience

Marley, Collier and Goldstein (2004) differentiate process quality and technical quality Process quality refers to how healthcare services are delivered to patients and technical quality refers to what patients receive

Sofaer and Firminger (2005) identified seven dimensions:

- Patient-centered care

- Access

- Courtesy and emotional support

- Communication and information

- Technical quality

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- Efficiency of care organization

- Structure and facilities

Attree (2001) researched the perceptions of doctors, nurses, managers, patients and their relatives, the study showed the results of five dimensions

- Patient focus

- Availability and accessibility to patients

- Open communication and information flow

- Encouraging a close, sociable relationship

- Holistic care

Infante, Proudfoot, Davies, Bubner, Holton, Beilby and Harris (2004) researched the perceptions of patients and the results showed seven dimensions:

- Trusts and believes patients

- Convenient consultation times

- Good interpersonal skills

- Caring and compassionate

- Clinical skills

- Good triage system

- Variety of clinical services

Andaleeb, Siddiqui and Khandakar (2007) researched patient satisfaction at public, private, and foreign hospitals in Bangladesh Doctors’ service orientation, nurses’ service orientation, and tangible evidence of facilities were the most significant factors

Carman (2000) nursing care was the most significant issue whilst physician care was the third most significant

Vukmir (2006) waiting time and the amount of caring were the most important determinants in the emergency department

Saila et al (2008) the reasons of patient dissatisfaction: having to wait for an appointment, the length of waiting time, communication and information received, duration of consultation, lack of reach ability, lack of continuity, not being able to participate in and contribute to decision making

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Tam (2007) identified factors of medical service that influenced patient satisfaction including:

- Doctor’s technical quality

- Doctor’s interpersonal skills

- Quality of nurses

- Quality of support staff

- Efficiency of appointment system

- Waiting time

- Duration of consultation

- Physical environment

- Respect for patient’s privacy

Bielen and Demoulin (2007) waiting time is not only a satisfaction determinant but also moderates the satisfaction-loyalty relationship Determinants of waiting time include the perceived waiting time, information provided while waiting and waiting environment

Anderson, Barbara and Feldman (2007) patient satisfaction ratings were influenced

by a core of communication and follow-up care The core qualities are the most important including communication, access, inter-personal skills, care coordination and follow up The quality of medical care processes, quality of healthcare facilities and quality of office staff followed in order of importance

Saila et al (2008) the most important determinant was the actual consultation with the doctor, effective communication was the key to patient satisfaction The Professional skills and competencies of staff members, protection of privacy, and perceived usefulness of the visit were highly rated

Germaine (13), expectations include the availability of professional care, the individuality of treatment, the competence, experience, maturity, dependability, knowledge, and skills of the nursing staff

Tucker and Adams (2001) the most significant issue in patient assessment is the interpersonal relation between patients and service providers

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Woolley et al (1978) not only considered the importance of expectation of outcome

as a predictor of satisfaction in primary care, but also the level of communication about this expected outcome between the patient and the general practitioner

Perceived attribute performance: tangible and intangible value that patients receive

in the process of using services and the process has a direct impact on evaluating patients’ satisfaction

Disconfirmation: customer dissatisfaction to services depends on the levels of product quality A product or service including many factors relating to examination and treatment, facilities, medicine that is not recognized affecting directly to the reduction of patient satisfaction

Attribution of cause: the process that individuals give causes of behaviors and events There are two types including external attribution (situational attribution) and internal attribution

Equity: the beliefs that people value fair treatment An individual feel satisfied if he

is treated fairly as others around him

Summary of determinants from previous studies on patient satisfaction

Infante et al 2004

- Trusts and believes patients

- Convenient consultation times

- Good interpersonal skills

- Caring and compassionate

- Clinical skills

- Good triage system

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- Variety of clinical services

Sofaer and Firminger 2005

- Technical quality

- Efficiency of care organization

- Structure and facilities Vukmir 2006 - Waiting time and the amount

of caring

- Doctor’s technical quality

- Doctor’s interpersonal skills

- Quality of nurses

- Quality of support staff

- Efficiency of appointment system

- Waiting time

- Duration of consultation

- Physical environment

- Respect for patient’s privacy

Anderson, Barbara and

- Communication

- Follow-up care

Bielen and Demoulin 2007 - Waiting time

Andaleeb, Siddiqui and

- Doctors’ service orientation

- Nurses’ service orientation

- Tangible evidence of facilities

- Waiting for an appointment

- Waiting time and communication

- Lack of reach ability

- Lack of continuity

- Lack of participation in decision making

in administrative errors These errors may occur in the study

Zikmund (2003) business research provides information to help reduce uncertainty, there are three main classes of business research based on function or purpose, namely casual, exploratory and descriptive research Descriptive research is implemented to describe characteristics of a phenomenon or population

Distinguishing descriptive research and exploratory research is that descriptive research is based on previous awareness of the nature of the research matters The research implemented in this study can be best understood as mainly descriptive The questionnaire could be electronic or printed questionnaires Pre-testing process

of the survey questionnaire is conducted by a trial run with a group of respondents including patients in the hospital The purpose of the test is detecting problems in the questionnaire’s design and instructions The questionnaire was tested for evidence of potential misunderstandings, ambiguous questions, questions that means the same to all respondents

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3.2 Research process

Figure 1 Research process

Source: Created by the author

3.3 Data collection

The method of data collection is questionnaire survey handed personally to patients

in the hospital Zikmund (2003) suggested selecting relevant methods including speed

of data collection, cost, and anonymity

+ Source of information: Primary data and secondary data

+ Primary data:

The primary data is collected through survey questionnaire, which is the main source

of information showing the findings of the research

+ Survey:

Zikmund (2003) two basic criteria of a questionnaire are relevance and adequacy A questionnaire is relevant if necessary data is collected and the information of data that

Primary data collection

Survey questionnaire to collect data of inpatient satisfaction

Books, reports, newspapers, internet

Data processing and analysis

Recommendations

- Respondents: Individual patients using medical services with stable psychology, non-psychiatric diseases and a good health status that meets requirements of the survey in the hospital

- Sample size: 300 individual patients using medical services in the hospital

- Survey tools: The tool for information collection is survey questions based on 5-level scale of each question measuring from negative side to positive side The number of questions must fully cover 5 dimensions reflecting patient satisfaction with medical services in the hospital

+ Questionnaire distribution:

Questionnaire is delivered directly to patients using medical services in Binh Dinh provincial general hospital The questionnaire was delivered in different time and 300 valid questionnaires have been collected

+ Scale:

Zikmund (2003) defines attitude as an enduring disposition to consistently respond

in a way to various aspects of the world including persons, events and objects There are three components: cognitive, behavioral and affective components Direct verbal statements relating belief, behavior or belief are used to assess behavioral intent Obtaining verbal statements generally requires that respondents perform a task, for example, rating, sorting, ranking or making a choice Rating is to estimate the magnitude of quality or a characteristic that an object possesses Quantitative scores are used to estimate the strength of the belief or attitude A Likert-type response scale

or multiple-response scale from very poor to very good was used This scale is both

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parallel and balanced so that responses can be quantified and the differences analyzed appropriately Patient responses were converted into scale for data analysis as followings: very poor = 1, poor = 2, normal = 3, good = 4, and very good = 5

+ Sample: Zikmund (2003) suggested that it is important to define carefully the target population so that the proper source of data can be identified In this research, the target population can be identified as inpatients in the hospital

The most common criteria of selecting a sample are resources, time, degree of accuracy, need for statistical projections and advance knowledge of population characteristics There are several ways of taking a sample, there are two main groups including probability and non-probability techniques

In probability sampling, every element of the population has a selection of known non-zero probability In a non-probability sampling, the probability of any members

of population chosen is unknown The ideal to obtain a probability sample by ensuring that the projections of data would be appropriate statistically

+ Secondary data:

From documents, reports such as: Jackie Tam (2007) "Linking quality improvement with patient satisfaction: a study of a health service centre", Anderson, Barbara and Feldman (2007) “What patients want: A content analysis of key qualities that influence patient satisfaction” Policies, regulations: Decision 4448/QD-BYT by the Ministry of Health on defining methods to measure people’s satisfaction with public health services; Decree No 55/2012/ND-CP; Resolution No 30c/NQ-CP of the Government in the field of caring, protection and improvement of people's health Other articles on newspapers, books that are related to patient satisfaction

+ Data analysis method:

The author applies different tools to analyze data: Stata software, Microsoft Office, Graphs, Charts

+ Research Scope

Patients using medical services in Binh Dinh provincial general hospital in 2018 The research focuses on assessing inpatient satisfaction with 300 individual patients who use medical services in the hospital

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Timing: The primary data is collected in 2018

+ Research Schedule:

From March to April Data processing

3.4 Research model

In Vietnam, Decision 4448/QD-BYT by Ministry of Health approves the proposal

“Defining methods to measure people’s satisfaction with public health services” giving some groups of criteria for measuring patient satisfaction including Accessibility, Transparency on information and administrative procedures, Facilities, Staff’s behavior and Results of service provision

The author based on the proposal by Ministry of Health and the studies by Tam (2007); Bielen and Demoulin (2007); Anderson, Barbara and Feldman (2007)…etc

to develop the research model

Based on previous studies, summary of factors that affect patient satisfaction in chapter 2 These factors have been put into 5 groups

The research model includes the following factors of patient satisfaction

1 Accessibility: Attree (2001) Availibility and accessibility; Sofaer and Firminger (2005) Access…etc

+ Distance from home to the hospital

+ Location, signboards and instruction to the hospital

+ Applying information technology for advertising services

+ Time of patient visit

2 Transparency on information, examination and treatment procedures: Attree (2001) Open communication and information flow; Tam (2007) Waiting time, Efficiency of appointment system; Saila et al (2008) Waiting for an appointment…etc

+ Applying information technology for dealing with administrative procedures

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+ Regulations of the hospital, regulation on medical staff’s behaviors

+ The process and procedures of examination and treatment

3 Facilities and Equipment: Tam (2007) Physical environment; Andaleeb, Siddiqui and Khandakar (2007) Tangible evidence of facilities; Sofaer and Firminger (2005) Structure and facilities…etc

+ Patient’s room, patient’s bed, canteen

+ The setup of departments, divisions

+ Environment, space and atmosphere of service provision rooms

4 Medical staff’s behavior and professional capacity: Sofaer and Firminger (2005) Patient-centered care, Courtesy and emotional support; Infante et al (2004) Caring and compassionate…etc

+ Following regulations on communication

+ Serving behaviors

+ Knowledge and skills on technical and professional capacity

5 Results of service provision: Tam (2007) Doctor’s technical quality, quality of nurses; Infante et al (2004) Convenient consultation times; Andaleeb, Siddiqui and Khandakar (2007) Doctors’s service orientation; Tam (2007) Duration of consultation…etc

+ Applying information technology for service provision

+ Time of service provision

+ The trust on service quality, reputation of the hospital

+ Level of meeting patient’s expectation

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Figure 2 Research model

Source: Bielen and Demoulin (2007); Tam (2007); Anderson, Barbara and Feldman (2007) Decision No 4448/QD-BYT by the Ministry of Health

Transparency on

information, examination

and treatment procedures

Facilities and Equipment

Medical staff’s behavior and

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CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH DINH PROVINCIAL GENERAL HOSPITAL

4.1 General information of researched patients

After collecting and inputting data into Excel, the data shows results as followings:

Table 4.1 Patient classification by sex

Source: Data collected from the survey (2018)

Summary: There are 300 valid questionnaires that have been collected and the

percentage of male is approximately 49,67% compared to the percentage of female

is 50,33% The scale of male and female is equal and ideal

27.33%

38.67%

34%

Age <36 Age 36-60 Age >60

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Figure 3 Patient satisfaction by age

Source: Data collected from the survey (2018)

Summary: Patients aged from 36-60 have the highest percentage with 38,67%,

patients aged under 36 have the lowest percentage with 27,33% and patients aged more than 60 accounts for 34%

Table 4.2 The total number of days of hospitalization

Source: Data collected from the survey (2018)

Table 4.3 Patients using of health insurance card for this treatment

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Summary: Most of the patients used the health insurance card for this treatment with

the percentage of 94%; only 6% of patients did not use the health insurance card

4.2 Assessment of inpatient satisfaction

4.2.1 Inpatient satisfaction on accessibility

The first criteria to assess patient satisfaction is accessibility, accessibility is the first approach of patients to the hospital

Table 4.4 Classification of inpatient satisfaction by accessibility

Very dissatisfied

or Very poor

or Very good

Source: Data collected from the survey (2018)

Summary: Patients highly appreciated the item “Time of patient visit is listed clearly”

with the percentage of 41,33% very satisfied and 50,67% satisfied

The item “The buildings, stairs and patient rooms are numbered clearly and able to

be seen easily” that was evaluated very dissatisfied and normal has the percentage up

to 16%

Figure 4 Summary of inpatient satisfaction on Accessibility

Source: Data collected from the survey (2018)

72%

28%

Satisfaction Dissatisfaction