I TGNG IUAN &
Cac nhan td tac dong dgn si/ thoa man cua khach hang do'i vdi chS't Itfrfng phuc vu l^ham chfita bdnh phu san tai Trung tam y td'
thanh phd'Nha Trang
Nguyin Huynh Thai Tam (*), Nguyin Thi Hidn (**)
Muc dich cda nghiin cihi ndy Id xdc dinh cdc yi'u td tdc ddng de'n su thda mdn cua b$nh nhdn ddi vdi chdt iuang phuc vu khdm chda benh phu san tgi Trung tdm Y li thdnh phd Nha Trang, xdc dinh miic dd quan trgng tuang dd'i giUa cdc yiu id, ddnh gid mdc do thoa mdn ciia binh nhdn. Nghien cdu duac ihuc hiin tgi Trung tdm Y li thdnh pho Nha Trang tit thdng 03 thdng 06 ndm 2009. Nghiin cdu dd dua trin md hinh do ludng chd't lugng dich vu SERVQUAL (Parasuraman & cdng su,19B5) di ddnh gid mdc dd hdi long cda benh nhdn. Thong qua phdn tich 500 mdu hgp li bdng phdn mem SPSS vd AMOS, CO 5 yiu td chinh dnh hudng din su thoa mdn cua khdch hdng ddi vdi chdt lugng dich vu khdm chda binh phu sdn tai Trung tdm Y te thdnh phd Nha Trang bao gdm: thdi do nhiet tinh cdm thdng, dd tin cay, su ddm bdo, phuang lien hffu hinh, chi phi khdm chffa benh. Tdt cd cdc yiu tdndy deu tdc dgng din sU thoa mdn cua khdch hdng. Nghien cffu tren khong chi dUa ra cdc gidi phdp de ndng cao chdt lugng dich vu khdm chffa benh phu sdn tgi Trung tdm y li Nha Trang md con ddng gdp vdo viec thii't ldp mo hinh chung do ludng chdt lugng dich vu y te tgi Nha Trang cilng nhutgi Viit Nam.
Tff khda: Chdt lugng djch vu
Identifying factors that affect patients' satisfaction about quality of gyneco-obstetrical
treatinent service at Nha Trang City Medical Center
Nguyen Huynh Thai Tam (*), Nguyen Thi Hien (**)
The objective of this study is to identify factors that affect patients' satisfaction of quality of gyneco- obstetrical treatment service at Nha Trang city Medical Center, to rate relatively the importance of these factors, and to evaluate the satisfaction of patients using the service.The analysis of 500 questionnaires through SPSS and AMOS sotfware shows that there are six components which construct the service quality, namely (1) Reliability, (2) Response, (3) Staff, (4) Price and (5)
Tap chi Y te Cfing cdng, 1.2010, Sd 14 (14) 43
IT6NS QUAN & HGHIEN ctiu I
Tangibility. All of them affect patient's saticfaction.This study not only offers solutions to improve gyneco-obstetrical treatment service but also contributes to construct model for measuring quality of medical services in Nha Trang City and in Vietnam.
Key words: Service quality
Tdc^a
{*)
Nguy§n Hujnh Thii TSm - Ke win vien - Tnmg tam Y te thanh phd Nha Trang.
Di^n thogi: 098 3 989 575. Email: [email protected] Nguyen Thi Hiln - Tien si - K£' toin tnrdng, Giang vien chinh.
Dign thoai- 0905 110367. Email [email protected]
1. D$t vS'n dfi
Tai khoa san Trung tdm Y td thanb phd Nha Trang, vifie cham sde va Iam thda man cae nhu can khdm chffa bpnh san phu khoa cua bfinh nhan Id dilu can Ihiet, ddc bipt trong dilu kifin xa hpi hod y td dffng Irffdc sff thdch thffc cua nhieu ddi ihu canh tranh. De ton tai va phdt trien thi Trung tara Y Ifi' Nha Trang ein cd nhffng chidn Irfdc phil hdp nham thu hdt khdch hang hdn nffa.
Bfin canh lam giam ihifi'u cdc irffdng hdp khifi'u nai eua benh nhdn, edc nha quan ly eua Trung tam con phai bieu rd chd'l iffdng dich vu kham ehffa bfinh phu san md minh dang eung cap dffde hinh thanh iff nhffng ydu id' then chdt nao de tff dd lam cd sd eai tie'n eae ydu td nay nham nang cao cha't Iffdng dieh vu va ddp ffng td't hdn nhu cdu cua bfinh nhdn.
Xua't phdt Iff nhffng ly do neu tren, viee tidn hanb nghifin cffu nhSm xdc dinh, phdn tieh ddnh gia cae ye'u id' tdc dfing ddn sff hai long cua bfinb nhan ddi vdi chd't Iffdng dieh vu khdm ehffa bfinh phu san tai Trung ldm Y lfi'ihanh phd'Nha Trang la hdi sffc can thidt.
2. Dd'i trfldng va phU'dng phap nghifin cii'u 2.1. Ddi tUdng nghien cdu
Bfinh nhan de'n khdm chffa bfinh san phu khoa khdng ed the Bao hiem Y td (BHYT) hoac the BHYT khdc tuyfi'n.
2.2. PhiOfngphdp nghien cdu
Nghifin cffu tidn hanh Iheo hai giai doan nghifin cffu sd bfi va nghifin cffu chinh Ihffc, Nghifin cffu sd bp dffde Ihffc hipn bling phffdng phdp dinh tinh qua ky thuat thao ludn nhdm, Bffdc nghifin cffrf nay nhim khdm phd ra cdc ydu id tdc ddng Ien sff thda man eua bpnh nhdn ngodi nhffng yeu td'dffde dffa ra trong mo hinh nghifin effu dl xuat, Nghifin cffu dinh tinh nham xdc dinh edc nhdn idva cdc thupe tinh do Iffdng. Nghifin effu dinh Iinh tidn hanb qua ky thuat ihao ludn nhdm vdi 20 ngffdi (phdng va'n ddi 1 gdm 5 ngffdi Id ehuyfin gia irong linh vffe kinh le', y id;
phong vd'n ddt 2 gdm 15 ngffdi la edc khach bang thffdng xuyen sff dung dich vu lai Trung tam Y te' Nha Trang). Sau phin nghifin erfu dinh tinh cae bien quan sdt se dffde ebinh sffa, bd sung cho phu hpp hdn, Iam cd sd cho vifie xdy dffng bang can hdi 6i lidn hanh nghifin cffrf dinh Iffdng.
Nghien cffu chinh thffc dffde thtfe hien bang phrfdng phdp dinh Irfdng ihong qua bang cdu hdi phdng va'n. Brfdc nghien cffu nay nham ddnh gid cde thang do, xac dinh mrfc dp quan trpng cua edc ydu to do Iffdng mffe dfi quan trpng cua eae bidn, do Iffdng mffe dp thoa man, do Iffdng mffe dd cam nhdn va kiem dinh cdc gia thuyet da drfdc nfiu d phan Irfin. Khao sdt dinh Iffdng thffc hifin tai Trung lam Y id thdnh phd Nha Trang tff thdng 03/2009 den 06/2009, Ddi tffdng chpn raau la bpnh nhdn den khdra chffa benh san phu khoa khdng ed the BHYT hoac the BHYT khdc tuyen, lay mdu thudn tien.
Md hinh do Iffdng gdm 39 bidn quan sdt, theo
nghifin crfu cua BoIIen (1989) kich thffdc mlu tdi
44 Tap chi Y te Cfing cdng, 1.2010, Sd 14 (14)
ITfiNGQBAN&HGHIENCUUI
thidu la 5 i l n so vdi cdc ffdc Iffdng trong m o hinh (li Ip 5:1), M o hinh nghifin cffu cd 39 ffdc Irfdng, nfin kich thrfdc mdu d r f k i d n e b a p n h d n drfdc Id 390, sau khi phdt h a n h 700 b p cau hoi, ket qua thu drfde 500 b p cdu h d i h d p Ie.
Nghifin cffu sff dung thang do Likert 5 mffe dp, tff ( I ) Rdt khong hai ldng ddn (5) Rd't hai Idng do Iffdng sff thoa m a n cua khdch hang v e ehl't Iffdng dich vu,
M d hinh nghifin effu d l nghi nhff sau:
Vi = Po + PiXii + P2X2i + • ••+ M n i + % Yi: la bien phu thugc, diTiJc xem l i stf dioa man ciia
khich hing
Xi: l i ydu to anh htfdng dfi'n stf thoa man cda khich hing (D6 tin egy, stf dim bio, ihii dfi nhiet Unh, cim thfing, phtfdng u^o hCTu hinh, chi phi khim chfia bfinh)
p: la h? sd cfi lic dgng Itfdng tfng
^ sai sd Clia mfi hinb
Srf d u n g p h a n m i m SPSS 16.0 vd A M O S 16.0, tidn h a n h k i e m dinh ihdng qua cdc bffdc: ( I ) ddnh gid sd bp thang do va dp tin cdy cda bien d o Irfdng b^ng h§ so' Cronbach Alpha va dp gia tri (factor loading) b a n g phdn tich nhdn Id'kham p h a E F A [ I ] , (2) sff d u n g ky thudt p h a n tich nban td k h a n g dinh CFA[2] d e kiera nghifim chdt c h e hdn v l tinh ddn nguyfin, dp tin c a y tdng hdp, dp gid tri (hpi tu, p h a n bipt) c u a cdc khdi nifim, (3) sff d u n g md hinh SEM[3] d e k i e m dinh dp thich hdp eua md binh vd gid tri Iifin h e ly thuye't, kie'm dinh gia thuyfi't (4)kidm dinh Bootstrap de' ddnh gid tinh b i n vffng eda rad hinh.
3 . K d t q u a nghifin c i i ^ 3.1. Ke't qua thdng ke mo td
Dff lipu phdn tich ddng cd mdu n = 5 0 0 , vdi Ihang do Likert 5 k h o a n g (trf I: ra't khdng h o a n loan hai Idng d d n 5: ri't hdi Idng), gid tri trung binh (mean) eda ede bie'n do chat Iffdng dich vu ed sff khdc bifit khd cao (trung binh (TB)=3.01 -> 4.25), d§c bipt khaeh h a n g chffa hdi long ve Mffe gid phd hdp vdi tdi t i l n - (TB = 3.01. dd Ifich ehuan (DLC)
= 1.331), n h a n vien Trung l a m ludn ddp ffng ddng yfiu can cua Anh/chi - (TB = 3,16, D L C = 1.244).
Anh/chi h o a n todn hai Idng vdi chi phi phai tra - (TB
= 3 . 0 2 - D L C = 1 . 0 9 0 ) .
- Gidi tinh chidm 100% la nff.
- Dd Iudi: drfdi 32 Iudi, s d Iffdng 391 ngffdi, chidm 78,2%, ehiem ty Ifi ldn trong m l u . C h o thay d a p d^g nhu can k h d m chffa b e n h phu san d dd tudi sinh san ndy rat cao.
- Thu nhdp: dffdi 2 tripu, sd' Iffdng 312, ehie'm 6 2 , 4 % , chifi'm ty lfi Idn trong mdu.
3.2. Ddnh gid sdbd thang do
T h a n g do "Sff Ihda man eha'l Irfdng dich vu k h a m chffa b e n h san phu khoa lai Trung ldm Y t d Nha T r a n g " vdi 05 thdnh p b l n va 3 3 bidn do Iffdng.
K d t qua phan tieh dd tin cdy ihang do da Ioai 0 2 bifi'n (vi ed irfdng q u a n bidn long nho bdn 0.3) cdn Iai 31 bifi'n drfa vdo phdn Iich EFA, eae thanh p h i n thang d o sau khi loai bidn d e u ed cac hfi s d Cronbach Alpha > 0.6 dat yfiu c l u .
3 . 3 . P h § n tich n h 3 n t d ' k h a m p h a ( E F A ) K d i q u a phan lieh nhdn td'd 31 bidn q u a n sdt do Iffdng srf thda m a n , drfde n h d m thanb 5 ihanh p b a n cd'u thanh dieh vu theo rad hinh P a r a s u r a m a n : tin cdy, d a m b a o , c a m tbdng. hffu hinh, ehi phi. C a c bifi'n deu cd trong s d > 0.4 nfin deu quan trgng irong phdn tich cae nhan td'va cdc irpng s d d e u c d y nghia thie't thrfc vd 5 nhan id giai thich drfdc 57,518% bidn ihifin eua quan sdt.
Cdc thdng sd ihdng ke cua tffng bidn irong md hinh
Bdng I. Cdc thong sd thing ki cua titng bien trong mo hinh
'
(Ccn.un.I TincG>
Sam bao Muet Iillll Hmi blnb Cbi pbi
He (0 chin
>
525 125 J03 192 .205 115
Sid Error ]-!5 .0.'8 .DJS .W7 .042 035
ihu^n hit,
Bcla
.130 .113 .184 .220 .131
'
.^013 3 330 5.35*
4 112 4 « M 3 233
SiE
.003 . M I .MM jm MO MI
e=cO„..>f.
ah|n
773 748 -592 586 -719
,„
l . » 3 l J 3 t I.CS«
1.707 1J9S R-hieu Chi«l, = 0.409. S,f =0.000
Kfi't qua phdn tich hdi qui cho iha'y md hinh khdng bi vi p h a m hifin iffdng da epng tuydn d o hp so' phdng dai phffdng sai cua cdc bifi'n ddc l a p (VIF) d i u nhd hdn 2. Hifin tffdng tff tffdng quan (tffdng quan chudi) khdng can thifi't phai xet d e n , vi dff lifiu d e chay md hinh khdng phai la dff lieu ebuSi ihdi gian.
Tap chl Y td C d n g cdng, 1.2010, Sd 14 (14) 45
I TU'NG QUAN & NGHIEN Cliu I
Ke'l qua hdi quy cdc bifi'n ddc ldp gid tri Sig. nhd hdn 0.05 la ede bifi'n cd tdc ddng d e n sff hai long cua ngffdi bpnh vd tdc dong cung c h i l u dfi'n sff hai Idng eua ngffdi benh. Do dd, la cd the ndi rang Iai ca cac bidn dpe lalp d i u ed ide d p n g dfi'n sff thda man eua ngffdi srf dung. T a i ca e a e n h a n i d nay d i u cd y nghia Irong md hlnh va Idc ddng ciing chieu dfi'n sff thda m a n eua ngrfdi sff d u n g , d o cac hfi sd' hdi qui deu m a n g dd'u drfdng. Cu the: h e s d hdi qui chu^n hda cua bidn "Tin eay" la 0.130, "Dam b a o " la 0.213, "Nhifit a n h " la 0.184, "Hffu hinb" la 0.220,
"Chi phi k h a m ehffa b e n h " Id 0.131.
Nhff vay, phffdng irinh hdi qui ehuan hda the' hifin mo'i quan hfi tuydn linh giffa sff hai Idng cua ngffdi bpnh vdi cdc nhan id: F I , F2, F3, F4, F5 va F6 cd y nghia trong phffdng p h a p hdi qui Enter dffde the hien nhff sau:
^6=0 184*Fi+0.130*F,+0 220*^3+0.213* F,+0.131*F5
Trong do:
Fl: Stf Dhi$t tinh vi cam chfing F2' Stf tm egy
F3: PhtfcJng tifin hdu hinh F4: Stf dam bio F5: Chi phi khim chita benh F6: Sff hii Ifing
T h e o phffdng trinh hdi qui tren thff Iff quan Irong cua cdc thdnh phan lae dpng dfi'n sff hai idng cua ngffdi bfinh dffde lifil kfi nhff sau:
F3 ( 0.220) F 4 ( 0.213) F I ( 0.184) F 5 ( 0.131) F 2 ( 0.130)
Md hlnh giai thich dffde 4 0 , 9 % sff thay ddi eua bidn "ihda m a n " Id do eae bie'n dde lap trong md hinh tao ra, cdn Iai 59,1 % bidn thien dffde giai thieh bdi cdc bifi'n khae ngoai rad binh.
Md binh eho thd'y eae bie'n dpe Idp deu a n h hffdng thudn c h i l u dfi'n sff thda man eua ngffdi srf dung d dp tin eay 9 5 % . Qua phffdng trinh hdi qui ehung ta Iha'y khi difi'm d a n h gid ve sff nhifit tinh cam thdng tang Ifin I tbi sff thda m a n cua ngffdi sff dung tang Ifin 0.184 difi'm, giff nguyfin eac bifi'n dpe lap edn lai khdng ddi. Tffdng iff nhff vay, khi diem ddnh gid v l srf tin eay lang Ien 1 thi srflhda man eiia
ngrfdi sff d u n g dieh vu tang Ifin 0.130 d i e m ; khi d i e m d a n h gid ve sff d a m b a o tdng Ifin 1 difi'ra thi sff ihoa m a n c u a ngffdi sff d u n g dich vu Iang Ifin 0.213 d i l m ; khi didm d a n h gia v e phffdng tifin hffu hinh tdng Ifin 1 difi'm thi sff thda m a n cua ngrfdi srf dung dich vu tang Ifin 0.220 d i e m ; khi d i d m ddnh gid ve chi phi kliam chffa bfinh tang Ifin I d i e m thi srf thda m a n cua ngrfdi sff dung dich vu ldng Ifin 0.132 d i l m . 3.4. Phdn tich nhdn td khdng dfnh (CFA) K i d m dinh md hlnh e a e ihang do:
a) Kfi't qua phan lich n h a n td k h a n g dinh (CFA):
Cac h e s d t a i tff cdc bifi'n q u a n sdt Ien cdc khai niem thanb p h a n deu dat yfiu c l u ( >.5). Vi vdy la ed thd kfi't ludn cac bidn quan sal dung d e do Iffdng cae thdnh phan cua e a c ihang do ehat Iffdng dich vu k h a m chffa bfinh dat drfdc gid tri hdi tu.
b) Cac chi so'dp phii h d p mo hinh sau khi dieu ehinh dat y e n e l u (Bang 2).
Bdng
ZitsOilsl
x'm x'/m'
p T U '
cn'
RMSEA*
2. So sdnh do phd hgp cua cdc
Tin cjy
49,498 (14) 3,535 O.OO 0,95 0,967 0,071
Bitu b i o
35,050 (9) 3,894 0,00 0,941 0,965 0,OS
Nbr«i Ilnh,
91.720 (27 3,397 0,00 0,957 0,968 0,069
PbUdng
18,257 (5) 3,651 0,003 0,974 0,987 0,073
tieu chi theo nhom
Chl pb(
khim cbOa benh a,30D(2)
4,1S 0,015 0,956 0,985 0,079
HSi leiBg
30 333 (9J 3,370 0,000 0,972 0,9S3 O . O G O
c) Hfi sd'Iffdng quan cua eae khdi nifim ihanh p b l n d i u < 1 va ed y nghia (p<,05), do dd cdc khai niem ndy dai dp gid tri p h a n bifit,
3.5. Kit qua kiem dinh mo hinh ly thuyet bdng SEM
Cde ehi sd' cd b a n d a n h gia sff thich h(?p eda mo hinh deu thda man, cho thay md hinh x a y dffng phd h d p vdi dff lieu thi irffdng. Kfi't qua kidm dinh mdi quan hfi n h a n qud giffa 5 n h a n t d v d i sff hai long deu Iffdng ede k h a i mfim trong md hinh dat gid tri lifin hfi Iy thuyfi't[8]. Trong 5 nhdn to'idc d d n g ddn sff hai Idng, 3 nhdn t d phrfdng lien hffu hinh, d a m bao vd nhiel Ilnh c a m thdng ed tdc dpng ldn nhl't I l n Iffdl la 0.26, 0.25, 0,15.
3.6. Kiem dinh Bootstrap
Trf m a u ban d i u la 500 quan sal, Vdi dff Iifiu ban dau, ta se linh loan dffde e a c ffdc irfdng (cdc trpng
46 T a p ehi Y td Cdng cong, 1.2010, Sd 14 (14)
I TONG U A N & NGHIEN CllB I
Hinh 1. Mo hlnh SEM
sdhdi qui,...). Tdc gia dung phffdng phap phdn tich Bootstrap (lay raau lap lai ed thay thd tff raau ban diu la 500 mau), trong do mdu ban diu ddng vai Ird damdong[9].
So' lan lay raau lap Iai trong nghifin cffu dffde chpn Id n = 1.000 Iln, kfi't qua tfdc Iffdng vdi 1000 Iln Irf 500 mdu dffde linh trung binb vd gia tri nay cd xu hffdng gan vdi ffde Iffdng tdng the.
Kfi't qua cho thd'y tri tuyfit dd'i CR rd't nhd so vdi 2 nfin cd the ndi la dd chfich Id rd't nhd, khdng ed y nghia ihdng kfi d dp tin cay 95%[ 10].
Va nhff vay, ta cd thfi' kdt luan Id eac ffde Iffdng trong liinh I cd the tin cay dffde.
Bdng 3. H( sdhdi qui
Tluunsfi
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4. Ban lu^n
Cdc thang do Iffdng cae ydu td' tdc ddng vao srf thda man cua ngrfdi sff dung dieh vu sau kbi da dieu chinh va bo sung deu dat drfdc dp tin cay va gia tri
cho phep.
Kel qua kiem dinh md hinh ly thuyfi't eho thd'y tat ea 5 Ihanh pban vrfa nfiu d trfin deu lae dpng dfi'n srf thda man cua ngrfdi srf dung dich vu Itham chrfa bfinh phu san. Trong dd, thdnh phan nhan id' tac dpng manh nhd^t dfi'n srf thda man cua ngffdi sffdung la ye'u id phffdng tifin hilu hinh (0.26), thff hai la ydu id dam bao (0.25), thrf ba Id ydu to' nliiet tinh cam thdng (0.15). Cdn cff trfin tim quan trpng cua eae yfi'u td'nay, cdc nhd cung cd'p dich vu khai ihac cd hieu qua ede yeu id nhdra ndng cao sff hdi long eua khdch hang.
v l mat phffdng phap nghien cffu, nghien crfu ndy gdp pbln vao he ihdng thang do eha'l Iffdng dich vu va sff thda man cua ngffdi srf dung bang each bd sung vao nd mdl he thd'ng thang do chd't Iffdng dich vu va sff thda man cua ngffdi srf dung dieh vu cu the Id dich vu kham chffa bfinh phu san tai Nha Trang.
Cdc nhd nghifin cffu ffng dung ed the xem mo hinh nay nhff la mpl md hlnh Iham khao eho eae nghien ctfu cua minh d cac hffdng nghien cffu khac, va Iai nhifng thi trffdng khae.
Tff kdt qua nghifin cffu ndy, cdc nhd nghifin cffu trong Hnh vrfc eung cap dieh vu cd the sff dung, dilu chinh va bd sung cac bifi'n thudc cdc thang do Irfdng ndy cho cdc nghifin cffu cua minh Irong cdc linh vffe cung ffng dich vu khdc nhau phii hdp vdi dac thd rifing eua nd.
Can eff vao lira quan Irpng eua cae yen td va thdnh phin cua nd tdc ddng ddn srf Ihda mdn cda khach hang, chdng ldi dffa ra cdc giai phdp ndng cao chat Iffdng dich vu nhff sau:
Ve yfi'u td' "hiJu binh" can lam cho bfinh nhdn thay dffde Irang thidt bi eua ddn vi la hifin dai, giff eho khu vffe kham ehffa bfinh Iudn saeh se, thoang mat, dam bao an toan khu vffe de' xe.
Vdi ydu id ""dam bao" can dap ffng dung yen clu eua bfinh nhdn, giai dap thae mac eua bfinh nhan rd rang, thong tin dfi'n bfinh nhdn phai kip thdi, chinh xae.
D I nang eao sff thda man eua khaeh hdng vdi yfi'u td thai dp nhiel tinh, cam thdng can quan lam dfi'n dieu kien an d cua bfinh nhdn khi ndm dilu Iri bfinh lai irung tam, tinh gian bdt tbu tuc lien quan dfi'n kham chffa bfinh, nen quan lam de'n Iinb trang bfinh cua bfinh nhan hdn nffa, nen lim hieu ky yfiu cau cua bfinh nhan.
Ve yfi'u id' "tin cdy " cin ldm cho khdch bang lin
Tap chl Y te C6ng cdng, 1.2010, Sd 14 (14) 47
trfNGII&N&NGHIENCiril
tffdng kdl qua xet nghifim va c h a n d o a n bfinh ciia Trung tdm hdn, flm hieu ky b e n h nhan d e drfa r a ohffng Idi k h u y e n idl vd cd d a o dffc.
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48 Tap chi Y td Cfing cdng, 1.2010, Sd 14 (14)
