(Luận văn thạc sĩ) assessment of outpatient satisfaction in binh dinh provincial general hospital in 2018

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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
HOSPITAL IN 2018

MAJOR: BUSINESS ADMINISTRATION
CODE: 60340102

RESEARCH SUPERVISORS:
ASSOC. PROF. DR. VU ANH DUNG
PROF. DR. HIROSHI MORITA

Hanoi, 2019


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

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CHAPTER 1: INTRODUCTION
1.1. Background
Health is always among the most important issues and the most valuable asset of
individuals and all society. Investing in health is investing for development and
growth, reflecting the good society. With the development trend of health sector,
public hospitals gradually have to be autonomous in finance meaning that they must
cover all the costs for their operation such as salary, equipment, drugs…etc. In this
situation, to be survival in severe competition in market economy, public hospitals
need to attract more patients. Therefore patient satisfaction is one of the most
important issues for hospitals as well as a principal indicator reflecting quality and
efficiency of medical services.
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”
1.2. Research objectives
- Assessing current situation of inpatient satisfaction in Binh Dinh provincial general
hospital.
- Analyzing the relation between related factors and inpatient satisfaction.
1.3. Research questions
- What is the current situation of inpatient satisfaction in Binh Dinh provincial general
hospital?

- 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

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CHAPTER 2: LITERATURE REVIEW ON PATIENT SATISFACTION
2.1. Hospital services
According to an article on Encyclopedia of Surgery, hospital services is a term that
refers to medical and surgical services, the supporting laboratories, equipment and
personnel that make up the medical and surgical mission of a hospital or hospital
system. Hospital services cover a range of medical offerings from basic health care
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
-

Quality of service

-

Innocently

-

Speed of service

-

Pricing

-

Complaints or problems

-

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 transactionspecific.
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

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satisfaction will benefit not only service users when they access high quality services

but also healthcare service providers.
In recent years, assessment of patient satisfaction to public healthcare services has
not been implemented uniquely and widely. Currently, there has not been a general
indicator reflecting patient satisfaction towards public medical services.
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
Authors

Year

Contents
-

Attree

-

Patient focus

Availability and accessibility
to patients
Open communication and
information flow
Encouraging a close, sociable
relationship
Holistic care

2001

-

Interpersonal relation skills

2004

-

Trusts and believes patients
Convenient consultation times
Good interpersonal skills
Caring and compassionate
Clinical skills
Good triage system

2001

-

Tucker & Adams

Infante et al

14


Sofaer and Firminger

2005

-

Variety of clinical services
Patient-centered care
Access
Courtesy and emotional
support
Communication and
information
Technical quality
Efficiency of care
organization
Structure and facilities
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

-

Vukmir

Tam

2006

2007

-

Anderson, Barbara and
Feldman

2007

-

Communication
Follow-up care

Bielen and Demoulin

2007

-

Waiting time

Andaleeb, Siddiqui and
Khandakar

2007

-

Saila et al

2008

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

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CHAPTER 3: RESEARCH METHODOLOGY
3.1. Research design
The research collected data via a questionnaire survey. Zikmund (2003) the survey is
accurate, quick and inexpensive assessing information about research subjects, a
questionnaire survey is a research technique in which information is gathered from a
sample of people participating in the study. Two major errors of the survey are
random sampling error and systemic error. There are respondent and administrative
errors in systemic errors. Non-response errors and response bias are in respondent
errors whereas data processing errors, sample selection errors, interviewer errors are
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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