QUAN TRj-QUANLY
CHAT LlTdNG DICH VU, HAI LONG, QUY CHUAN CHU QUAN VA TRUNG THANH
BENH NHAN TAI BENH VIEN DA KHOA TiNH BINH THUAN
• DINH PHI HO - QUACH HUfU LOC - DINH NGUYET BICH - PHAM DUY HA
TOM TAT:
Hdu h^t cac benh vien myd'n dia phffdng dang dd'i mat vdi tinh trang bdnh nhan vffdt tuyen trung ffdng, khien tinh trang cdc bdnh vien tuye'n tinh khdng sff dung hd't cdng suat giffdng benh vd trangthid'tbiyte khdng dffdc sff dung hieu qua. Dodo, xdy dtfng thtfdng hieu cho cac benh vidn Myd'n tinh la can thie't va trtfdc hd't la ndng cao cha^t Itfdng dich vu kham, chffa bdnh vd didu tri. Thdi gian qua, cd nhilu nghidn cffu ve md'i quan hd gifla stf hai long dd'i vdi cha't Itfdng dich vu nhiftig xem xet md'i quan hd qua lai giffa hai long vd trung thdnh chtfa dffpc quan tdm.
Ddy la van de thach thffc cho cac nha chinh sach vd quan ly benh vidn. Nghien cffu nay, sff dung dff lieu khdo sat 350 bdnh nhdn didu tri ndi tru tai Benh vien Da Khoa tinh Binh Thudn va dp dung md hinh ca^u trffc tuydn tinh trong phdn tich. Ke^t qua nghien cffu cho thd'y cd md'i quan hd tuyen tinh dtfdng giffa hai long va quy chuan chu quan vdi trung thdnh benh nhan. Cdc ye'u td' dnh htfdng de'n stf trung thanh cua bdnh bao gom: (i) Ddp ffng, (ii) phffdng tien hffu Mnh, (iii) dam bao, (iv) tin cdy va (v) quy chuan chu quan, dac biet la vai trd quan trpng cua "quy chuan chia quan".
Tuf khda: Hai long, quy chuan chu quan, tiling thanh, md hinh cd'u true tuyd'n tinh, Bdnh vien Da khoa tinh Binh Thuan, Vidt Nam.
1. Gidi thi^u
Hau hd't cac bdnh vidn tuye'n dia phtfdng dang dd'i mat vdi tinh trang benh nhan vtfdt tuyd'n trung tfdng, khie'n tinh trang cac benh vien tuye'n tinh khdng sff dung he't cdng sud't gitfdng benh va trang thie't bi y td' khdng dtfdc sff dung hieu qua. Do do, xdy dffng thtfdng Mdu cho cdc bdnh vidn tuye'n tinh la can thie't vd trffdc he't Id ndng cao chd't Iffdng dich vu kham, chffa benh vd dieu tri. Trong thdi
gian qua, cd ra't nhidu nghien cffu ve md'i quan he giffa sff hdi long dd'i vdi chd't Iffdng dich vu nhtfng xem xet md'i quan he qua lai giffa hai long va trung thdnh chffa dffdc quan tam, dac bidt Id quy chuan chu quan cua bdnh nhdn. Ddy cung la vd'n de thdch thffc chd cdc nha nghien cffu va chinh sdch trdng bd'i canh Viet Nam hda nhdp thd'gidi, nhd't Id trong nganh Y Id'-Benh vien dang cd sff qua tai cua cac benh vien tuyen trung ffdng. Nghien cffu nay tap
So 5 - T h a n g 3/2020 103
TAP CHi CONG IHIfgfNG
trung vao (i) Xac dinh md'i quan he giffa hdi long, quy chuan chu quan va trung thanh bdnh nhan;
(ii) Xay difng md hinh dinh Iffdng ve md'i quan hd giffa hai long, quy chud'n chii quan va trung thanh benh nhan. Nghidn cffu tie'n hanh khao sat 350 benh nhdn dieu tri ndi tru tai Benh vidn Da Khoa tinh Binh Thuan nham tao cd sd thffc tidn cho md blnh do Iffdng. Bdnh vien Da khoa Binh Thuan la benh vien cdng lap, thdnh lap nam 1986, Benh vidn da tie'p nhan, dieu tri thdnh cdng nhieu ca bdnh khd. Bdnh vidn dam bao chuyen mdn va ha tang de dam nhdn chffc nang kham, chffa bdnh vd dieu tri tai dia phUdng. Den nay. benh vidn cd 21 chuyen khda vdi 139 bdc sy. quy md 910 gitfdng benh vd hdn 800 cdn bp, cdng nhan vidn.
2. Tong quan ly thuyd't va mo hinh nghidn cu'u
2.1. Chdt Idffng dich vu benh vien Chd't Itfdng dich vu (service quality) la vide cung cd'p dich vu md dap ffng day du nhffng ydu cau. mong ddi va hai long khdch hang. Khdch hdng ddng vai trd quyd't dinh dd'i vdi vide xem xet chd't Iffdng dich vu dffdc cung ca'p (Gan vd cdng sff, 2006; Oyenigy va Joachim, 2008). Dau tien tren the gidi, Parasuraman va cdng stf (1985, 1988) do Itfdng chd't Itfdng dich vu dtfa trdn 5 chieu: dd tin cdy (reliability), tinh dap ffng (responsiveness), tinh dam bao (assurance), phffdng tien hffu hinh (tangibility) vd sff ddng cam (empathy). Md hinh do Iffdng nay vdi tdn gpi phd bid'n la md hinh SERVQUAL, cung cap mdt khdi mem todn didn ve cha't Iffdng dich vu vdi mdt cdng cu de do Itfdng.
Cho dd'n ngay nay, nhidu nghien cffu da ffng dung khai niem chd't Itfdng dich vd md hinh do Iffdng cho cac ngdnh trong cac ntfdc dang phat trien (Dabholkar vd cdng stf, 1996; Angur vd cdng stf, 1999; Newman, 2001; Karatape va cdng sff, 2005). Trong nganh Y te' - bdnh vidn cung ffng dung md Mnh do Iffdng SERVQUAL cho dich vu cham sdc sffc khde, kham. chffa bdnh cua cdc benh vidn (Lim va Tang, 2000; Jabnoun vd Chacker, 2003; Bhat vd Malik, 2007; Arash va cdng sff, 2008; Aagja vd Garg, 2010; Amin va Nasharuddin. 2013).
2.2. Quy chuan chu quan
Quy chuan chu quan (subjective norm) dffdc dinh nghia nhtf nhan thffc cua mot ngffdi md anh hffdng bdi mdi trffdng xa hdi de'n hanh vi anh ta
kM ra quyd't dinh mua mdt san pham hay dich vu (Fishbein va Ajzen, 1975). NbSn thffc do bi tdc dpng bdi anh htfdng xa bdi, bao gdm: (i) ngffdi thdn trong gia dinh, ban be (Cialdini vd cdng sff, 1990;
Smitii va Louis, 2008); (ii) Dong nghidp, dff Man xa hpi {Smith va Louis, 2008).
2.3. Hdi long b$nh nhdn
Theo Ohver (1980), sff hai long (Satisfaction) la phan ffng vd mat tinh cam cua khdch hang lien quan de'n sff khac bidt giffa mong ddi trffdc kM sii dung vd cam nhSn nd sau khi sff dung san pham hoac dich vu. Sff hai long khach hang la ke't qua quan trpng nhd't trong tid'p thi. Nd phuc vu cho viec danh gid thai dp khach hang tff luc mua san phim hoac dich vu ket nd'i de'n dich vu hau mai (Patterson, 2000; Wirlz va Maitila, 2001; Wutz va Lee, 2003; Jamal va Naser, 2003; Mishra, 2009).
Dd'i vdi dich vu cham sdc sffc khde, kham, chffa bdnh cua cdc bdnh vidn, hai long cua benh nhdn dtfdc the hien bdi niem tin cd nhdn cua benh nhan vd gid tri ve mot benh vien va nhff.ag ky vpng trffdc ddy cua ho ve benh vien (Linder-Pelz, 1982; Wirtz va Manila, 2001; Kim va cdng sff, 2008). Do dd.
trong nganh Y td' - benh vidn, sff hai long cua bdnh nhan ddng mot vai tro quan trong trong viec do Itfdng chd't Iffdng cham sdc va tie'p mc tham gia dich vu cua bdnh vien (Grogan va cdng stf, 2000;
Urden, 2002; Moret va cdng stf, 2008; GiU vd WMte, 2009; Alhashem vd cpngstf, 2011; Amin va Nasharuddin, 2013).
2.3. Trung thdnh khdch hdng
Pearson (1996) cho rang, trung thanh khdch hang (customer loyalty) nhtf Id ttf duy rieng khdch hang, ngtfdi cd thdi dp tfa thich mot cdng ty ndo do, thtfdng xuyen mua san phd'm hoac dich vu vd gidi thieu den ngffdi khac. Muc tidu cua tie'p can khach hang khdng chi la lam cho khdch hang hdi long md con lam cho khdch hang trung thanh, khdng chi mua thffdng xuyen san pham hoac dich vu ma cdn gidi thieu nd dd'n ngtfdi khdc (Grogan va cdng stf, 2000; Kotier va Amstrong, 2012). Theo Oliver (1993); Chaudhuri va Holbrook (2001), long trung thdnh cua khach hang ndi ldn xu htfdng cua khdch hang mua va sff dung sdn pham hoac dich vu cua thffdng hieu nao do trong mdt tap hdp cac thtfdng Mdu canh tranh cd mat trdn thi irudng va lap lai hanh vi ndy; bieu Men thai dp hoac hanhvi gan bd vdi nhd cung ca'p dich vu cua khac;-i hang.
104 So 5-Thang 3/2020
QUAN TRj-QUANLY
Kabiraj vd Shanmugan (2011), nhdn didn long trung thanh cua khach hang dtfdc tid'p can dffdi hai gdc dp: (i) Dtfa vao hanh vi cua khdch hang: each tid'p cdn nay xem xet long trung thanh thdng qua hanh ddng mua lap lai, sff dung thffdng xuyen mdi sdn pham/dich vu cua khach hang. Theo each tid'p can ndy thi long trung thanh nhtf mdt ldi cam ke't cua khdch hang mua hoac sff dung thffdng Meu mot san pham hoac dich vu trong tffdng lai, mac dil dnh htfdng bdi nhffng linh hudng va tac dpng cua thi trtfdng CO the Iam thay ddi hanh vi ba't thffdng cua khach hang, (ii) Dffa vdo thdi dp cua khdch hang:
each tid'p can nay muo'n nhd'n manh den y dinh ciia khach hang trong viec lieu dung san pham hay dich vu. Theo Reidenbach va Sandifer-Smallwood (1990), long trung thanh cua khach hang la y dinh lidn tuc sff dung mot cdng ty hoac cffa hang nhd't dinh, tffdng tff vdi viec kham va didu tri lai mdt bdnh vidn ndo dd. Mffc dp trung thdnh thffdng dtfdc ddnh gid dffa tren sff sdn sang sff dung lai dich vu y te', y dinh tham kham lai bdnh vidn hoac gidi thieu cac cd sd cho ngffdi khdc dffdc do Iffdng (Woodside va cong sff, 1989).
2.4. Quan hi giUa chd't lUcing dich vu vd hdi long
Naeem vd Saif (2009) tim thd'y md'i quan hd giffa chd't Iffdng dich vu vd hdi long khach hang trong hd thd'ng ngdn hang d Pakistan va nganh Y te' - bdnh vidn (Manaf vd Nooi, 2009; Andaleeb, 2001). Nhieu nghidn cffu khac tff thap nidn 2000 de'n nay cho thd'y chd't Iffdng dich vu lac dpng dffdng dd'n sff hai long cua khach hang/bdnh nhan (Beeriy, 2004; Ueltschy va cdng sff, 2009; Cai va cdng sff, 2014; Shabbir va cdng stf, 2016).
Hinh 1: Mo hinh nghien cOu SERQ (Service Quality, Chat lupng djch vu
-j TAN (Tangibility, PhUdng tien hOu hinh) -I REL {Reliability, Tin cay) - ^ - 1 ASS {Assurance, D^m bao)
-j RES (Responsiveness, Dap Ling) -I BMP (Empathy, C^m thong)
2.5. Quan he giffa chdt lUdng dich vu - hdi long - quy chuan chu quan - trung thdnh
Raajboot (2004); Beeriy va cdng stf (2004);
Ueltschy va cdng sff (2009); Chang vd cong sff (2009) dffa ra Iranh Man chd't Iffpng dich vu anh hffdng dd'n sff hai long khach hang vd dd'n Itfdt nd, lai tdc ddng dd'n long trung thanh khdch hdng.
Nhieu nghien cffu khac tff thdp men 2000 dd'n nay cho thd'y, chd't Iffdng dich vu tdc dpng dtfdng dd'n sff hai Idng va trung thdnh cua khdch hdng (Lee va cdng Sff, 2011; Kazi, 2011; Pantouvakis, 2013; Cai vd cdng sff, 2014; Rahi va Alnaser, 2017). Trong ngdnh Y td' - bdnh vidn cung tim thd'y md'i quan he sff hdi long vd trung thdnh cua benh nhdn dd'i vdi benh vidn lffa chpn (Fitzpatrick, 1991; Deng vd cdng sff, 2010; Padma va cdng sff, 2010; Anbori va cdng sff, 2010; Kessler va Mylod, 2011; Ahmed va cdng sff, 2017). Hyllegard va cdng sff (2010);
Parkinson va cdng sff (2012); Katherine vd cdng sff (2014) cho rang quy chuan chu quan cua khdch hang tdc ddng de'n hai Idng va trung thanh khdch hdng dd'i vdi sdn pham hoac dich vu. Nghien cffu ciia Sama va cdng sff (2017) cho thd'y chuan chu quan cua khach hang tdc ddng dffdng de'n hai long va trung thanh khdch hang.
2.6. Mo hinh nghien cdu
Dtfa vao tham khao cac ngMen cffu trdn trong 3 thdp men gan day, nhdm nghien cffu lffa chon md hinh nghien cffu cho Benh vien Da Khoa tinh Bmh Thudn nhff md la d Hinh 1.
Gia thuyd't nghien cffu:
HI: Phffdng tien hffu Mnh tdc ddng ddng chieu dd'n sff hai Idng; H2: Tin cay tac ddng ddng chieu de'n sff hdi long; H3: Dam bao tdc dpng ddng chieu
So 5 - T h a n g 3/2020 105
TAP CHJ CONG THIfdNG
de'n sff hai long; H4: Ddp ffng tdc ddng de'n sff hai Idng; H5: Cam thdng tdc ddng dong chieu den sff hai Idng; H6: Phtfdng tidn hffu hinh tdc dpng dong chieu de'n sff trung thdnh; H7: Tin cay tac dpng ddng chieu dd'n sff trung thanh; H8: Dam bao tdc ddng dong chieu dd'n stf trung thanh; H9: Dap ffng tac dpng d6ng chieu de'n sff trung thanh; HIO: Cam thdng tdc dpng ddng chieu de'n sff trung thdnh;
HI I: Quy chuan chu quan tac ddng dong chieu dd'n sff hai idng; H12: Quy chuan chu quan lac ddng
d6ng chieu de'n sff trung thdnh; H13: Sff hdi long tac ddng ddng chieu de'n sff tmng thanh.
Md hinh khdi qudt:
SAT = f (TAN, REL, ASS, RES, SYM, N O R M ) L O Y = f (TAN, REL, ASS,
RES, SYM, N O R M ) L O Y ^f (SAT, N O R M )
Td't ca cdc bid'n trong md hinh dffdc do Iffdng bdng thang do Likert 5 mffc dd. (Bang 1)
(1) (2) (3)
Bang L Thang do va cdc bien quan sat STT
1 1 2 3 4 5 II 6
7 8 9 10 III 11 12 13 14 15 IV 16 17 18 19 20
THANG DO Phuong ti§n hOu hinh (Tangibility)
Thiet bi, may moc kham chOa benh day du, hien dai
Van phdng, tru sd giao dich khang trang, tao su tin tudng cho benh nhan Nhan vien benh vien co trang phuc gon gang va dep
Co sd vat chat, phdng, giudng khang trang, sach se Dich vu sinh hoat day du, thuan Ipi
0$ tin cdy (Reliability)
Benh vien hUa thuc hi^n mot dieu gi do (nhu thiet iap djch vu cham soc benh nhan) vao khoang thdi gian cu the, dieu do se dttoc thuc hi^n.
Khi benh nhSn va ngudi nha gap su cc ve dich vu thi BV iuon dap ilng giai quyet v^n de kip thdi.
B§nh vien CO san cac chuyen gia y te, bac sT, nhan vien y te d cac khoa Benh nhan cam thay an toan va thoai mai khi dieu tn
Duy tri viec cung cap dich vu khong xay ra sai sot Tfnh dap Ung (Resposiveness)
Benh nhan cam thay an toan va thoai mai khi dieu trj Bac sT, nhan vien cd mat ngay khi duoc yeu cau Theo doi benh tinh cua benh nhan iien tuc Luon san sang giUp dd benh nhan
Nhan vien benh vien phan Ung ngay iap tUc vdi cac yeu cau kiem tra va khieu nai cua benh nhan
Tfnh dam bao (Assurance)
Khi BV hUa giO chd"cho benh nhan, hp thuc hien dung nhu cam kd't Web benh vien dap Ung dupe cac yeu cau cija benh nhan ve djch vu ndi tnj tai BV Thdi gian XLI iy thdng tin va tra idi nhUng yeu cau cua benh nhan va gia dinh nhanh chdng.
Nhung giao dich va thong tin ca nhan benh nhan iuon dupe bao mat Goi dieu tn dap Ung thed kha nang cija benh nhan iua chpn
ici-Hieu TAN TAN1 TAN2 TAN3 TAN4 TAN5 REL REL1
REL2 REL3 REL4 REL6 RES RES1 RES2 RES3 RES4 RES5 ASS ASS1 ASS2 ASS3 ASS4 ASS5
106 So 5 - Thang 3/2020
qUAN TRI-QUANLY
STT V 21 22 23 24 25 VI 26 27 28 29 VII 30 31 32 33 VIII 34 35 36 37
THANG BO Sit cam thong (Empathy)
Nhan vien benh vien chU y den tUng benh nhan NhSn vien benh vien hieu nhu cau cu the cua benh nhan Nhan vien benh vien hieu sd thich cua benh nh^n
Y, bac sT CO thai dp td't, tan tinh, chu dao cham soc, dieu tri chd benh nhan Bac sT i|Ch su, an can khi dua ra idi khuyen, giai thich cho benh nhan Chuin chij quan b$nh nhgn (Patient Subjective Norm)
Hiu het nhiJng ngudi ma tdi danh gia cao deu tan thanh viec tdi tham gia d|Ch vij ndi tnj BVnay
Hau het nhUng ngudi quan trpng vdi toi nghi rang tdi nen tham gia djch vu ndi tru BV nay Tdi nghi rang tdi nen tham gia dich vu noi tru BV nay
Dong nghiep khuyen tdi nen tham gia dich vu npi tru BV nay SlJ hai Idng (Patient Satislactlon)
Tdi hai long khi sCl dung cac dich vu ndi tru tai BV Tdi hai idng each thUc quan iy va chat iupng dich vu cua BV Tdi hai idng thai dd phuc vu va iam viec cua bac sT va nhan vien BV Toi hai idng quy tnnh quan iy va thij tuc check in va check cut cija BV Trung thanh b$nh nhan vdi bgnh vl$n (Patient Loyalty)
TiSi iuon nghi den dich vu npi tnJ benh vi$n Da Khoa Binh ThuSn (DKBT) mdi khi cd nhu cau Toi se khong sO dung dich vu benh vien khac khac neu B§nh vien Da Khoa Binh Thuan san sang cung cap
Toi se sii dung trd lai cac dich vu Benh vien DKBT
TCi se gidi thieu dich vu ndi tru benh vien DKBT den nhUng ngudi sii dung khac
KYHlIU EMP EIVIP1 EIVIP2 EIVIP3 EIVIP4 EIVIP5
N0RIVI1 N0RIVI2 N0RIVI3 N0RM4 SAT SAT1 SAT2 SAT3 SAT4 LOY L0Y1 L0Y2 L0Y3 L0Y4
Dff lieu dffpc thu thap thdng qua phdng vSn tru'c tie'p 350 benh nhdn dieu tri tai Benh vidn Da Khoa tinh Binh Thuan tff thdng 9 de'n 11 ndm 2019 theo phffdng phap la'y mdu phi xac sud't, thuan lien bang bang cdu hdi chi tie't de kiem dinh md hinh va cdc gia thuyd't nghidn cffu.
Do md hinh Iy thuye'l vdi mot tap hpp cdc quan hd dan xen. md hinh cd'u true tuye'n tinh (Structural Equadon Model, SEM) difdc sff dung de ki^m dinh cac gia thuye't trdn (Lorence va Mortimer, 1985; Anderson va Gerbmg, 1988).
Theo Hair vd cdng sff (2006); Kline (2011);
Tabachnick va Fidell (2011), phan tich nhdn td' va cd'u true tuye'n tinh dffdc thffc hidn theo quy trinh bao gom 4 bffdc: (i) Kiem dinh tin cdy thang do (Reliability test); (ii) Phan tich nhan to'kham pha
(Exploratory Factor Analysis -EPA); (iii) Phan tich nhdn to' khang dinh (Confirmatory Factor Analysis-CFA) va (iv) Md hinh cd'u true tuye'n tinh (Structural Equation Modeling - SEM).
3. Kd't qua va thao luan 3.1. Mo td ddc diem benh nhdn
- Gidi tfnh va trinh dp van hda: Trong 350 bdnh nhdn khao sat, gidi tinh nam chie'm 58,3%. Trinh dp van hda chu yd'u cua benh nhdn la td't nghidp pho thdng (38,9%). (PTinh 2, Hinh 3)
- Dan tdc vd ndi cff h:u (Hinh 4, fTinh 5) Benh nhan chu yd'u la ngifdi Kinh (74%). Ndi cff tru chu yd'u la TP. Phan Thid't (70,3%).
- The bao hie'm y te' va nghe nghidp (Hinh 6, Hinh 7)
- Phan ldn bdnh nhan cd the BHYT (76,9%).
So 5 - Thang 3/2020 107
TAP CHi CONG THIflfNG
Hinh 2: Gidi tinh ciio benh nhan (%) Hinh 3: Trinh do van hoa cua benh nhan (%)
Nu,41.7
Nam, 5B.3 ^
SauDH Cao dang - Dai hoc THPT THCS Tieu hoc C
1 2.3 1
• • M ^
18
10 20 30
• 34
40 18.9
Hinh 4: Thanh phan dan tdc (%) Hinh 5: Ndi CU tiu (%)
20 40 60 80
Hinh 6: The bao hiem y te (BHYT, %) Hinh 7: Nghe nghiep (%)
Khac Ndng - ngu dan Cong nhan, vien chuc
^
/
A23.1
- 27.1 - 49.
/
0 20 40 60
Nghe nghidp chu ye'u la cdng nhan - vien chffc vd ndng- ngff ddn (76,8%).
3.2. Ket qua phan tich do tin cay
Kd't qua the hien trong Bang 2 cho thd'y: Ngoai trff cac bie'n quan sdt TAN5, RES5, L0Y5 bi loai, cdc bie'n quan sat cdn Iai deu thoa man cac dieu kidn trong phdn tich dp dn cay cua thang do thdng qua hd sd' Alpha > 0,6 vd tffdng quan bie'n - tdng
> 0,3 (Nunnally and Burn.stein, 1994).
3.3. Ket qud phdn tich nhdn to khdm phd (EFA)
Ke't qud dffdc trinh bay trong Bang 3 ^fi thd'y:
Cdc ye'u to tac dpng dd'n sff hdi Idng benh nnan dffpc trich thdnh 05 ye'u td ti/dng ffng vdi cac bid'n do Iffdng cua md hinh Iy thuyd't vdi tdng phuong sai trich la 65,257% tai Eigenvalue la 1,861; EFA cua quy chuan chu quan dffdc trich thanh 4 bie'n quan sat vdi phffdng sai trich la 70,675% lai I.. ^^ .^, ^^^
108 So 5 - T h a n g 3/2020
QUANTRI-qUANlV
STT 1 2 3 4 5 6 7 8
Bang Thang do
TAN REL RES ASS ElVIP NORIVI
SAT LOY
2. Tin cqy thang do va bie'n quan sat b[ logi Bien quan sat
TAN5 Khdng RES6 ASS6 Khdng Khdng Khong L0Y4
H§ so Alpha 0,803 0,864 0,840 0,836 0,838 0,861 0,847 0,840
Ketqua Chat iugng td't Chat iudng to't Chat luong tdt Chat iuong tdt Chat iuong tdt Chat iuong tdt Chat iuong tdt Chat iuong td't
REL5 REL3 REL2 REL1 REL4 EI«P4 EMP2 EIVIP3 EIVIP6 EMP1 RES3 RES4 RESl RES2 ASS2 ASS3 ASS4 ASS1 TAN4 TAN2 TAN3 TAN1 N0RM3 N0RM4 N0RM2 N0RM1
Bang 3 . Ma trgn n han to Component (Nhan to) 1
0,841 0,827 0,826 0,785 0,739
2
0,805 0,793 0,779 0,777 0,737
3
0,841 0,839 0,797 0,787
4
0,835 0,831 0,827 0,770
5
0,823 0,802 0,783 0,749
6
0,862 0,849 0,838 0,813
7 8
S5'5-Tliang3/2020 109
TAP CHi CONG THIflfNG
SAT3 SAT1 SAT2 SAT4 L0Y2 L0Y3 L0Y1
Component (Nhan to)
1 4 1 6
Kaiser-lvleyer-Otkin IVleasure (Thudc dd KMO) BartietfsTest(Sig,)
Kiem djnh Baitiett (IvlLIc y nghTa) Eigenvalues (Gia tn Eigen)
% of Vahance (PhUdng sai trich, %)
0,847 0,000 1,861 65,257
6
0,823 0,000 2,827 70,675
7 0,863 0,861 0,803 0,789
0,814 0,000 2,753 68,819
8
0,896 0,860 0,856 0,716 0,000 2,274 75.811 Ghi chu: Theo Hair vd cdng sU (2006), 0.5 < KMO < 1; kiem dinh Bartlelt cd mdc y nghia nho hem 0,05; he sd
tdi nhdn id cua cdc bii'n quan sdt (Factor Loading) > 0.5; phuong sat trich > 50% vd Eigenvalue > 1.
la 2,827. EFA ciia hai long dffdc trich thanh 4 bie'n quan sat vdi phffdng sai trich la 68,819% tai Eigenvalue la 2,753. EFA cua trung thanh diTdc trich thdnh 3 bie'n quan sat vdi phifdng sai trich Id 75,811 % tai Eigenvalue la 2,274; Ke't qua EFA dUdc sff diing bang phffdng phdp xoay Promax.
3.4. Ke't qua phan tich nhdn to khdng dinh Kd't qua du'dc trinh bay trong Hinh 8 cho thd'y:
md hinh cd Cmin/df = 1,378: TLl = 0,965, CFI = 0,969 va RMSEA = 0,032. Theo Crowley vd Fan (1997); Kline (1998); McDonald va Ho (2002), md
hinh do Iffdng phu hdp vdi dff lieu thffc te phai dam bao phu hdp vdi 4 thffdc do: (i) Cmin/df; (ii) TLI, (iii) CFI. (iv) RMSEA.
Bang 4 cho tha'y, md hinh do Iffdng phu hdp vdi dff heu thffc td'.
3.5. Ke't qud phan tich cd'u true tuye'n tinh (SEM)
Ke't qua dildc trinh bdy trong Hinh 9 cho thd'y:
Md hinh cd gia tri Cmin/df = 1,916; TLI = 0,906;
CFI = 0,919 va RMSEA = 0,051. Nhu-vdy, md hinh tich hdp phu hdp vdi dff lieu thffc td'.
Bang 4. Ket qua gid trj cac thi/dc do
STT
1
2
3
4
Ttiudcdo Chi binh phUdng dieu chinh thed bae tU dd (Cmin/df)
Gia tn tieu chuan
'2/d.f. <= 5(Bentierva Bonett, 1980) Chi Sd TLi (Tucker-Lewis j TLi > 0,90 (Carver va IVlentzer 1999;
index) Hairva cdng SU, 2006).
Chi so thich hop so sanh CFi (Comparative Fit index), Chi so RIVISEA (Root IMean Square Error Approximation).
CFi > 0.90; 0 < CFi < 1, Cang tie'n ve 1 cang phu hop. (Bentler va Bdnett, 1980; Hu va Bentier, 1995).
RMSEA < 0,05, md hinh phii hop tdt;
RMSEA < 0,08, chap nhan; Cang nhd cang tdt.
(Garver va Mentzer, 1999; Hu va Bentier, 1995).
Glatn md hinh
1,378
0,965
0,969
0,032 Kel qua Tdt
Tot
Tot
Tot
110 So 5-Thang 3/2020
QUANTRj-qUANlV
Hinh B: Mo hinh do lUdng
CMIN/df=1.378; TLI=.965;CFI=.969; RMSEA= 032
@—H:
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TAP CHi CONG THiritNG
Hinh 9: Ket qua cua phan tfch cau true tuyS'n tinh
CMIN/df=1.916: TLI=,906;CFI= 919; RMSEA= 051
Ke't qua diTdc trinh bay trong Bang 5 cho thd'y:
Ngoai trff HIO, phan ldn cac gia thuyet deu di/dc chd'pnhdndmffc tincay tff [91%, 99%].
Cac ye'u to' tdc ddng de'n "Hai Idng" theo thff Iff anh hffdng iff cao de'n thd'p: NORM, REL, RES, ASS, TAN, EMP. (Bang 6)
Cac yeu Id' tac dgng dd'n 'Trung thanh" theo thff tff anh hffdng: SAT, RES, TAN, ASS. REL, NORM.
Cac yeu to'tiem an tac ddng dd'n 'Trung thdnh"
theo thff Iff anh hu'dng: SAT. NORM, 3.6. Thdo luqn ket qud nghien cdu Mot Id, sff vdi hai Idng cua benh nhdn chiu tac ddng trffc tie'p bdi 6 thanh phan: Quy chuan chu quan, tin cay, dap ffng, dam bao, phffdng lien hffu hinh va cam thdng. Nhff vdy, gia thuye't Hi, H2, H3, H4. H5 diTdc chd'p nhan. Dieu nay cd nghia la;
khi benh nhdn ddnh gia td't cac ye'u td' nay se Iam cho ho cam thd'y hdi Idng vdi dich vu dieu tri - cham sdc cua bdnh vien.
Hai Id, sff trung thdnh bdnh nhdn chiu tac ddng trffc tid'p bdi 5 thdnh phan: Dap ffng, phffdng den
hffu hinh, dam bao, tin cdy va chuan mffc chu quan. Nhff vay, gia thuyd't H6, H7, H8, H9, H12, H13 dffdc chd'p nhdn. Di^u nay cd nghia la: khi bdnh nhdn ddnh gia td't cac yd'u to' ndy se Iam cho hp trung thdnh vdi dich vu dieu tri - cham soc cua bdnh vidn.
Ba la, md'i quan he hdi Idng, chuan mffc chu quan va trung thanh bdnh nhdn cd tffdng quan vdi nhau theo hffdng: hai Idng vd quy chua'n chu quan tac ddng de'n trung thdnh. Nhu' vay, gia thuyd't HI2, H13 dffdc chap nhan.
~ ~ ~ 4. Kd't lu5n va ham y chinh sach Muc lieu cua nghien cffu xac dinh mdi quan he su^
hai long, chuan mffc chu quan va trung thanh bdnh nhan tai Benh vidn Da Khoa tinh Binh Thuan. Dac biet trong bd'i canh cdc benh vien hiye'n frung u'dng d TP. Ho Chi Minh qud tai, de giff vffng vd md rdng kha nang khdm vd dieu tti npi tru ciaa benh vien hiye'n tinh, hdi long va tmng thanh cua benh nhan la chia khda cho cdc benh vien dia phi/dng phdt trien ben viftig.
Dila tren khdo sdt 350 bdnh nhdn va sff dung md hinh cd'u true tuye'n tinh, nghidn cffu cho ihd'y cd md'i quan he tuyd'n tinh du'dng giffa hai long va quy chud'n chu quan vdi trung thanh benh nhdn.
Cac ye'u to' anh hffdng dd'n sff hai long bao gom:
(i) Quy chuan chu quan, (ii) tin cdy, (iii) dap ffng, (iv) dam bao, (v) phffdng tidn hffu hinh vd (vi) cam thdng, dat biet la vai tro quan trong cua "quy chuan chu quan". Ke't qua nghien cffu cung cd'p cd sd cho khoa hoc cho cdc nha qudn ly benh vien muo'n giff vffng vd md rdng kha nang kham vd dieu tri npi tru cua benh vidn can phai quan tdm de'n sff hdi long, quy chuan chu quan vd trung thdnh bdnh nhan •
112 So 5-Thdng 3/2020
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Bang 5. Ket qua gia thuyet
SAT SAT SAT SAT SAT SAT LOY LOY LOY LOY LOY LOY LOY
<—
<—
<—
<—
<—
<—
<—
<—
<—
<—
<—
<—
<—
REL EMP RES ASS TAN NORM
REL EMP RES ASS TAN NORIVI
SAT Estimate
0,273 0,184 0,228 0,227 0,213 0,324 0,134 0,062 0,197 0,145 0,170 0,090 0,547
S.E.
0,046 0,048 0,051 0,051 0,049 0,047 0,051 0,049 0,055 0,054 0,052 0,053 0,098
C.R.
5,913 3,863 4,461 4,475 4,370 6,916 2,632 1,267 3,577 2,687 3,260 1,684 5,572
P
... ...
***
...
...
...
0,008 0,205
...
0,007 0,001 0,092
***
Ket qua gia thuyet H2 ehap niian H5 ciiap ntian H4 chap niian H3 ctia'p nhan HI chap nhan H11 chap nhan H7 chap nhan HIO khdng cliap nhan
H9 chap nhan H8 chap nhan H6 chap nhan H12 chap nhan H13 chap nhan
Gill chii (Mi^c tin c$y,%) 99 99 99 99 99 99 99 95 99 99 99 91 99 GIti chii: • • * (Sig. = 0.000}.
Bang 6. MCfc dp tdc dong Mi3c dd tac d$ng d^n SAT
SAT = f(REL,EMRRES,ASS,TAN,NORIVI) SAT
SAT SAT SAT SAT SAT long
<—
<—
<—
<—
<—
<—
REL EMP RES ASS TAN NORIVI
H$ so hoi quy 0,273 0,184 0,228 0,227 0,213 0,324 1,449
%
18,84 12,70 15,73 15,67 14,70 22,36 100
Vitri 2 6 3 4 5 1
MUc d$ tac dOng den LOY LOY = f(REL,RES,ASS,TAN,NORM)
LOY LOY LOY LOY LOY LOY
"long
<—
<—
<—
<—
<—
<—
REL RES ASS TAN NORM
SAT
0,134 0,197 0,145 0,170 0,090 0547 1,283
10,8 15,9 11,7 13,7 7,3 44,2 100
5 2 4 3 6 1
Mi3c d$ tac d^ng den LOY LOY = f(SATNORM)
LOY LOY long
<—
<—
SAT NORM
0,547 0,090 0,637
85,9 14,1 100
1 2
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116 So 5-Thang 3/2020
QUANTIII-gUANLV
Ngay nhjii bai: 11/2/2020
Ngay phan bien danh gia va su'a chffa: 22/2/2020 Ngay cha'p nh$n dang bai: 3/3/2020
Tfjong tin tdc gid:
1. PGS.TS. DINH PHI HO TrtfoTng D^i hpc Phan Thiet 2. ThS. BS. QUACH H0U LQC
Benh vien Dai hpc Y DiJpc TP. Ho Chi IVIlnh 3. ThS. DINH NGUYfT BICH
Trtfcfng Dai hpc V5n Hie'n 4. PHAM DUY HA Bao hiem xa hdi Binh ThuSn
SERVICE QUALITY, PATIENT SATISFACTION, SUBJECTIVE NORMS AND PATIENT LOYALTY AT GEP^RAL HOSPITAL OF BINH THUAN PROVINCE
• Assoc.Prof, Ph.D DINH PHI HO Phan Thiet University
• IVIaster. Doctor QUACH HUU LOC
Hospital of University of Medicine a n d Pharmacy Ho Chi Minh City
• Master. DINH NGUYET BICH Van Hien University
• PHAM DUY HA
Department of Social Insurance - Binh Thuan Province
ABSTRACT:
In Vietnam, patients usually come to national level hospitals rather than local hospitals. This situation leads to the inefficiency of local hospitals in using their beds and medical equipment.
Hence, building brands for provincial hospitals is an urgent task in order to improve the quality of medical examination and treatment services in Vietnam. Recently, there have been many studies on the relationship between satisfaction with service quality. However, the reciprocal relationship between satisfaction and loyalty has not been paid attendon. This is a challenging issue for policy makers and hospital managers. This study was conducted by using 350 patient survey data and applying a structural equation model in order to examine the relationship among satisfaction, subjective nonns and patient loyalty. The smdy finds that factors affecting the patient loyalty include: (i) responsiveness, (ii) tangibiUty, (iii) assurance, (iv) reliability and (v) subjective norms.
In addition, the study finds that the subjective norms factor plays an important role in the patient loyalty.
Keywords: Satisfaction, subjective norm, loyalty, structural equation model, Binh Thuan province, Vietnam.
So 5 - Thong 3/2020 117
