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 Healthcare Quality
Improvement in Hanh Phuc Hospital”

MASTER FINAL PROJECT
MASTER IN BUSINESS QUALITY AND PERFORMANCE
MANAGEMENT

Ho Chi Minh City
(2016)


3

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


4

ACKNOWLEDGEMENT

In the process of preparation of final report, I have received the helps of my
teachers, my friends, my family, and my colleagues of Hanh Phuc Hospital
I would like to thank all lecturers of the program who offered me valuable
knowledge during the course.
My especial thankfulness to the instruction of Dr. Jacques Martin – Academic
Director and Tutor who guided me on the method and content to do this subject.
I also would like to thank my family, and my classmates who are always
willing support me during the time taking part this program
I express the gratitude to management and colleagues of Hanh Phuc hospital
who greatly support me in the process of collecting data to do the report and
provide me opportunity to complete the course.
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


5

Comments of Academic Tutor:

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


6


7
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

8
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


9
ABREVIATIONS
CQI

: Continuous Quality Improvement

JCI

: Joint Commission International

MOH

: Ministry of Health

PCA

: Patient Care Associate

HPH

: Hanh Phuc International Hospital

HR

: Human resource

LAB

: Laboratory

QI

: Quality Improvement

WHO

: World Health Organization

10
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


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INTRODUCTION

Overview
In the era of globalization and heightened competition, delivery of
quality service is imperative for healthcare providers to satisfy patients.
According to Langabeer (2008, p. 9), the goals of hospital performance
management aims to reduce costs; reduce variability and improve productivity;
improve quality of customer service; and continuously improve business
processes. Regarding on improving the quality of hospital service, “reduced
medical errors and improved patient safety” are crucial to obtain higher level of
patient satisfaction (Langabeer, 2008).
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:


14

-

Patient care and treatment

-

Health check up

-

Surgeries,

-

Para-clinical Diagnostics:
Laboratory
Diagnosis Imaging
Ultrasound,
ECG,
X-ray

Hospital Standard application: HPH hospital is strictly follow Vietnam
Ministry of Health (MOH) regulation, in addition, to obtain and achieve
international level, we are in the pathway to seek Joint Commission
International (JCI) Accreditation Healthcare Quality Standard
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

Chapter I
Patient satisfaction
and healthcare service
quality

The chapter aims to present and review the theories of
healthcare quality management system, service quality,
customer satisfaction, the relationship between service
quality and customer satisfaction, finally, describe
dimensions of service quality and customer satisfaction
perspectives in healthcare organization for measurement
patients satisfaction

Chapter II
Structure of the
process

This section to describe the process and activities to do
this report

Chapter III
Analysis of patient
satisfaction

In this section, the methodology is presented participants,
instrument, description of the instruments of patient
satisfaction survey, methods of collect the data and
analyze the findings

PART 2: DISCUSSION AND SUGGESTION FOR QUALITY IMPROVEMENT

Chapter I
Findings

The chapter describes the results of survey and
demonstrates findings though charts, graphics, tables

Summary of the main results of the study, offer a number
Chapter II
Discussion and
of improvement suggestion of implications for hospital
suggestion for Quality managers.
Improvement
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:
Goals/outcomes

System 6 building blocks
Service delivery

Improved health
(level and equity)

Health workforce
Responsiveness
Financing
Access coverage
Medical products
and technologies
Governance/
Leadership

Social and financial
risk protection

Quality Safety
Improved efficiency

Information

Figure 1: Healthcare Management System Framework, Adapted from WHO -2008


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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


22
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,
customer):
customers

communication, understanding the

Caring and individualized attention that the firm provides to its


23
Service quality and customer satisfaction perspectives in healthcare
integrated d as the following figure:

Tangibles
Perceived services
quality
Reliability

Responsiveness

Customer
Satisfaction

Assurance

Empathy

Customer loyalty

Figure 2. Service quality and customer satisfaction perspectives in healthcare Adapted
from SERVQUAL dimensions Parasuraman et al. (1988)


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CHAPTER II
STRUCTURE OF THE PROCESS

1. Workflow

Start the
project

Stage 1: Identify final project topic

Approved by Academic Tutor
No

Yes
Stage 2: Outline the framework of final report

No

Revised as Academic Tutor
comments

Yes
Stage 3: Develop questionnaire and start the survey process

No

Revised as Academic Tutor
comments
Yes
Approved by Hospital management
Conduct patients surveys
Stage 4: Write the report
Stage 5: Complete and send full draft of the report to tutor for advice

No

Revised in accordance to
Academic Tutor comments
Yes

Stage
Complete
the report
prepare for defense stage
2. Description

the 6:
stages
to perform
theand
report
End the project


25
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


26
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