Predictors Of Patients’ Satisfaction Based On Service Quality Dimensions
Qin Bin1 , *Abdul Rahman bin S Senathirajah2 , Rasheedul Haque3
1INTI International University, Malaysia,
2INTI International University, Malaysia, orcid.org/0000-0001-6044-9051
*Correspondence Email Id: [email protected]
3MAHSA University, Malaysia , orcid.org/0000-0001-8170-5413
*Correspondence Email Id: [email protected] DOI: 10.47750/pnr.2022.13.S09.1211
With the implementation of health care reform policy, the quality of medical services has received much attention, which is important to enhance the core competitiveness of hospitals. As people's expectations and demands for the health care are increase, medical institutions need to reform its services to meet the needs of patients to improve their competitiveness. Based on the importance of medical services in the healthcare profession, this study researched the expectation and actual perception of hospital service quality amongst hospital patients.
In this study, we will use the SERVQUAL model to evaluate patient satisfaction, according to the five dimensions of SERVQUAL.
It will utilize a random sampling method, followed by a statistical analysis of the survey results. Finally, a service quality improvement strategy is recommended. It is hoped that through the findinds of this study, it will serve as a guideline for good practices in heathcare service quality.
Keywords: SERVQUAL; Hospital service quality; Patient satisfaction
1.0 INTRODUCTION
In the 21st century, the development of China's service economy has made great progress, and the demand for human services has further expanded, and people's expectations and requirements for the service economy is also rising. The demand for new psychological and social needs beyond basic physical health has been characterized by "higher, newer and more" service quality demands (Qianyu, 2020). At the same time, healthcare providers need to continue to innovate and develop in order to meet the increasing needs of patients, while at the same time responding to the fierce competition in the industry, as patients usually prefer quality services, such as good environmental facilities and good service attitude of medical staff, when technical conditions are equal (Yanshi, 2019).
Patient satisfaction survey is an effective tool to find out the needs of patients, it can truly reflect the level of hospital medical services, and also from the patient's point of view to measure the quality of hospital services. Hospital services are patient-centered, so hospital services should also follow the concept of "patient satisfaction", stand in the patient's shoes to feel the actual needs of patients, in the true sense to meet the different needs of patients. Therefore, the study
of patient satisfaction in hospitals is timely to aid hospitals to improve their medical services from the perspective of patients' perceptions and experiences, and to enhance the quality of hospital services (Xiaocui, 2020).
At present, many hospitals in China also carry out patient satisfaction assessment, but there is a lack of unified and refined norms and standards.Most of the evluation focus on medical staff service attitude and technical operation, ignoring the essence of the overall quality of medical services. Furthermore the analysis of the survey data is also relatively simple, usually only calculating the overall satisfaction rate, resulting in many useful information not being fully applied (Xh, 2021).
Hospitals in Chongqing, China are comprehensive tertiary hospitals approved by the state health department to provide medical care, rehabilitation and health care service contents for the majority of patients. Hospitals in Chongqing vigorously are developing its business construction, it also always insists on medical technology enhancement and service management as its core strategy. Hospitals in Chongqing pay particular attention to and implement the health care reform policy, actively respond to the challenges brought to their hospitals by the public hospital reform policy and the construction of the medical complex, and tightly seize new opportunities and meet new challenges to continuously improve the quality of medical services.
An example is Hospital A in Chongqing which has set a target for service quality improvement in 2022: to increase the total number of patient services by 796 and to complete 1,146,000 consultations. The hospital has also adopted the development concept of "adhering to tradition and innovation to forge first-class service quality" to encourage its medical staff to provide quality services to patients, and has formulated the hospital's 20-year action guidelines accordingly, namely "practising quality services in depth, improving the interface with the health insurance policy system, introducing new technologies for medical. This study is based on the concept of quality service in the healthcare sector. This study examines service quality factors affecting the patient satisfaction of hospitals in Chongqing, China.
1.1 PROBLEM STATEMENT 1.2 Problem Statement
The current medical behavior is no longer a purely technical behaviour . It not only contains different levels of professional content, but also involves all-round communication between people. Frequent occurrences are caused by non-technical factors such as service attitude, right to know, right to privacy, medical expenses, etc. According to a survey by the Chinese Medical Association, among the causes of doctor-patient disputes, "medical staff's poor service attitude" accounted for 49.5%; "inadequate hospital management level" accounted for 21.1%; "medical technology level problems" accounted for 25.6%. Another study found that the satisfaction of non-technical services of medical institutions is much lower than that of technical services and hardware facilities. For example, the satisfaction with medical expenses is only 6.6%, the medical service attitude is 20.5%, and the satisfaction with medical ethics and medical style is 22.2%, and the top factors affecting satisfaction are: medical technology level (98%), service attitude (88%), service price (86%), hospital environment (84%) and so on.
It can be seen that chronologically, patients pay more and more attention to non-medical technology, which is different from the needs of the past. However, the current hospital quality management in China still pays more attention to the technical aspects such as cure rate, and relatively ignores non-technical factors such as service attitude. Hospitals should not only focus on medical technology, but should start to improve service quality, change management, awareness and strategies, and pay attention to the management of non-technical factors.
1.4 Research Objective
The following are the objectives of the study:
RO 1: To examine the extent to which tangible may influence patient satisfaction in Chinese hospitals?
RO2: To examine the extent to which reliability may influence patient satisfaction in Chinese hospitals?
RO3: To examine the extent to which responsiveness may influence patient satisfaction in Chinese hospitals?
RO 4: To examine the extent to which assurance may influence patient satisfaction in Chinese hospitals?
RO 5: To examine the extent to which empathy may influence patient satisfaction in Chinese hospitals?
2.0 LITERATURE REVIEW
2.1 Service Quality
From the customer's point of view, Lewis and Booms (1983) consider service quality as a tool to measure whether the services provided by the company meet the customer's expectations. Bolton and Drew (1991) define service quality as the prior satisfaction of the customer. Gronroos (2002) pioneered the concept of "customer perceived service quality" and the perceived service quality model, arguing that service quality is subjective in scope, and is the result of comparing customers' expectations of service quality with their actual perceived service level; if customers' perceived service is better than their expected service, customers are more satisfied and will consider the company's service quality level to be higher. Lehtinen and Lehtinen (1982) argued that from the customer's point of view, service quality includes both process and output quality, which makes service quality fundamentally different from product quality. Gronroos' (2002) concept of perceived service quality has been the most fundamentally used theoretical basis in the field of service quality management research since its initiation.
From a structural analysis of the components of service quality, Sasser et al.(1978) argued that service quality consists of the quality of outcomes and the interactive processes of the service. From the perspective of the characteristics of the service, Rosander (2001) argued that service quality includes the quality of people performance, equipment performance, information quality, decision quality and output quality. Gronroos (2002) after proposing the concept of customer perceived service quality, believes that service quality should include both technical and functional quality, i.e. the quality of the service outcome and the quality of the service process, and that only if the quality of both aspects are good, will the customer perceived service quality be better. Lehtinen and Lehtinen (1982) divides service quality into physical quality (environment, facilities, products, etc.), interaction quality (interaction between staff and customers) and company quality (company image and reputation). Brady and Cronin (1982) suggest that service quality includes outcome quality, interaction quality and physical environment quality.
In summary, the essence of service quality can be derived as follows: the ultimate goal of service quality is to meet the needs of customers, unlike product quality, service quality is more difficult to measure in practice due to its intangibility and specificity; the evaluation of service quality should not only consider the results of the service, but also involve the process of the service (Yiming, 2004).
2.2 Hospital Service
Hospital services refer to the services provided by hospitals to customers who come to the hospital. In a broad sense, hospital services include the sum of medical inputs, medical service processes and medical outputs provided by hospitals to customers who come to hospitals. No matter which way you look at it, the purpose of hospital services is to save lives and provide medical, health and wellness services to the general public, thus meeting the purpose and desire of patients to come to the hospital. and wishes. In practice, hospital services are not only for patients, but also include the connection between people, money and materials. The concept of hospital services can be summarized as follows: hospitals provide medical care to patients and related personnel on the basis of their medical technology and service personnel, in order to meet people's needs for health care and so on. Hospital services can be divided into therapeutic and non-therapeutic. Diagnosis, treatment, etc. are therapeutic services; registration, payment, etc. are non- therapeutic services, and as people's spiritual and psychological enjoyment and additions increase, hospital services have been derived, such as psychological comfort, spiritual care, etc.
Hospital services have the following characteristics:
Hospital services are provided to a wide range of clients and the demand for hospital services varies. The target group of hospital care includes all people from different places and with different backgrounds. Different people have different needs for hospital services.
The focus of hospital services is the process of hospital services. The hospital provides services to patients through the service environment, facilities and equipment, and the medical staff, so that every person in the hospital is responsible for providing services.
The effectiveness of treatment cannot be accurately evaluated in advance. The effect that a patient will have once they have been treated in hospital can only be known by completing the treatment. In many cases, due to subjective factors and lack of awareness on the part of the patient, if the final result is not what the patient had initially expected, it will cause dissatisfaction amongst patients. It is this lack of certainty that has the potential to provoke patients to question the services provided by the hospital.
3.0 METHOD
3.1 Data Source and Collection Method
For the proper achievement of the objectives of the study; the researcher used primary data source. Primary data was collected using questionnaires. Questionnaires were distributed to the patients of hospital A. The variables were measured using Likert scale and the basic information of the questionnaire included respondents' gender, age, marital status, education, form of medical coverage, occupation, monthly income, and place of residence.
The study in this paper was conducted using the SERVQUAL model to rate patients’ perceptions on a seven-point scale, with 1 being the lowest and 7 being the highest. The questionnaire was divided into three parts: The first part was the patient's perceived quality of service in hospitals. Patients were also asked to select a number from 1 to 7 to represent their own perceived level of service. In the second part, questions included patients' overall satisfaction of the treatment they received from this healthcare service. The third part is a survey of patients' personal data, including gender, age, education, marital status, income, etc. Twenty-two questions were designed based on the 22 items in the five dimensions of the SERVQUAL scale, and the first two sections of the questionnaire consisted of these 22 questions.
3.2 Target Population and Location
The study was conducted at hospitals in Chongqing City. There are a number of hospitals in this area. The hospital services include medical care, rehabilitation and health care services. On average the hospitals have a daily average of over 3,000 inpatients/day, providing quality customer service to patients.
3.3 Sample Size and Sampling Technique 3.3.1 Sample Size
It is well known that generally the larger the sample size the greater the cost. Costs here include not only monetary costs, i.e. the cost of research, but also human costs and time costs. In market research, the budget is often the primary consideration for market researchers or the marketing departments. The sampling size determination method used is based on Krejcie and Morgan (1970) sampling method. For a 3000 inpatients size, the sample size is 341.
3.3.2 Sampling Technique
Kumar (2014) claims that by selecting respondents based on their availability, it is considered a non-probability sampling because it is simple and voluntary. This is known as convenience sampling. Etikan, Musa, and Alkassim (2016) mentioned its easy accessibility, simple, and affordability through the use of convenience method of sampling.
As a result, convenience sampling was used in this study to allow the researcher to collect a large number of completed result in a timely and cost-effective manner.
4.0 RESULTS ANALYSIS
4.1 Reliability Test
In general, the Cronbach's alpha should be greater than or equal to 0.7, the higher the value, the better the reliability.
The Cronbach's alpha value for tangibles was 0.815, the Cronbach's alpha for reliability was 0.733, the Cronbach's alpha for assurance was 0.823, the Cronbach's alpha for empathy was 0.845, the Cronbach's alpha for responsiveness was 0.822, and the Cronbach's alpha for patient satisfaction was 0.861. It can be seen that the reliability coefficient of the questionnaire survey is relatively high, so the measured values have good internal consistency, and the results of the survey data are relatively reliable.
4.2 Pearsons Correlation Table 1.0 Correlation Results
Correlation analysis is a method of analyzing the relationship and degree of correlation between two or more variables.
When the significance is less than 0.05, the difference between the two variables is considered significant, and when the significance is less than 0.01, the difference between the two variables is considered extremely significant. When the correlation coefficient is greater than 0, it means that there is a positive correlation between the two variables, and when the correlation coefficient is less than 0, it means that there is a negative correlation between the two variables.
It can be seen from Table 1.0 that the correlation coefficients between patient satisfaction and tangible, reliability, assurance, empathy and responsiveness dimensions are all greater than 0, showing a significant positive correlation.
4.3 Multiple Regression Table 2.0: Regression Coefficient
Dependent Variable
Patient Satisfaction
Independent Variables Tangible 0.036*
Reliability 0.045*
Assurance 0.002**
Empathy 0.023*
Responsiveness 0.006***
R Square 0.461
Adjusted R Square 0.327
F 26.37
Beta 0.213
P 0.000
*p<0.05 **,p<0.01 ***,p<0.001
The model adjusted R-square was 0.327, indicating that 32.7% of the dependent variable could be explained by the regression equation. The significance of the F test is less than 0.05, achieving a significant level, indicating that the established regression model is a good fit. The significance of tangible, reliability, assurance, empathy and responsiveness is less than 0.05, and the regression coefficient is greater than 0, indicating that the independent variables have a significant and positive impact on patient satisfaction. Assumption H1-H5 of the hypothesis holds.
5.0 Discussion of Findings
H1: Tangibles has a positive and significant influence on patient satisfaction.
Hypotheses H1-5 for research model indicate that the dimensions of tangibility, reliability, responsiveness, assurance, and empathy have good reliability and validity, and are worthy of further research. All five dimensions have a positive impact on patient satisfaction . Among them, tangibility has a significant impact on patient satisfaction. The impact path coefficient of tangibility on patient satisfaction is 0.036, p<0.05, and the effect strength ranks the second among the five dimensions.
H2: Responsiveness has a positive and significant influence on patient satisfaction.
The path coefficient of responsiveness to patient satisfaction is 0.006, p<0.05, indicating that responsiveness has a significant and positive impact on patient satisfaction, and the impact intensity ranks fourh amonst all dimensions.
H3: Assurance has a positive and significant influence on patient satisfaction.
The impact path coefficient of guarantee on patient satisfaction is 0.002, p<0.05, indicating that assurance has a significant and positive impact on patient satisfaction, and asssurance ranks as the weakest dimension.
H4: Reliability has a positive and significant influence on patient satisfaction.
The impact path coefficient of reliability on patient satisfaction is 0.045, p<0.05, indicating that reliability has a significant and positive impact on patient satisfaction, and the impact intensity ranks first amongst all dimensions.
H5: Empathy has a positive and significant influence on patient satisfaction.
The impact path coefficient of empathy on patient satisfaction is 0.023, p<0.05, indicating that empathy has a significant and positive impact on patient satisfaction.
5.2 Limitations of the Study
First of all, the research object of this study is only one hospital in a selected area, which has passed international certification, has international service quality and management level, and is superior to most other hospitals in China.
Therefore, the generalizability of this study is limited. However, if this research form of research is to become more comprehensive and generalizable, further and broader in-depth research on other types of hospitals is needed.
Secondly, due to the limitation of time and resources, this study gathered data for a period of time to conduct a one- time questionnaire survey. Strictly speaking, the best way to investigate should be to investigate patient expectations before patient visits, and to investigate patient perceptions after patient visits. If this method is used, the obtained data may be closer to the real situation, and it is more likely to make a more accurate analysis and a more through discussion.
Thirdly, although the interference of hospital staff was excluded during the distribution of questionnaires in this study, patients may not have been able to complete the questionnaires completely according to their actual feelings due to the protection of personal privacy or other psychological reasons. The conclusions cannot be guaranteed to reflect the real situation. Therefore a combinative use of qualitative research using observation techniques could provide more insightfull findings.
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