Background
Review of relevant literature
Healthcare service quality
Methods
Research model and methods
Data collection
Items | Frequency (%) | Frequency (%) | ||||
---|---|---|---|---|---|---|
Patients | General Public | |||||
Gender | Male | 156 (42.7%) | Outpatient | 138 (37.8%) | Male | 78 (33.6%) |
Female | 209 (57.3%) | Inpatient | 125 (34.2%) | Female | 154 (66.4%) | |
ER | 102 (27.9%) | |||||
Total | 365 (100.0%) | 232 (100.0) | ||||
Medical experiences within 3 months at this hospital | Yes | 238 (65.2%) | Yes | 0.0% | ||
No | 127 (34.8%) | No | 232 (100.0%) | |||
Occupation | Homemaker | 61 | 16.7 | 53 | 22.8 | |
Student | 41 | 11.2 | 31 | 13.4 | ||
Office worker | 38 | 10.4 | 29 | 12.5 | ||
Professional | 32 | 8.8 | 22 | 9.5 | ||
Owner-operator | 16 | 4.4 | 11 | 4.7 | ||
Public official | 37 | 10.1 | 23 | 9.9 | ||
Business person | 39 | 10.7 | 7 | 3.0 | ||
Military | 3 | 0.8 | 0 | 0.0 | ||
Unemployed | 79 | 21.6 | 27 | 11.6 | ||
Other | 19 | 5.2 | 29 | 12.5 | ||
Total | 365 | 100.0% | 232 | 100.0% |
Variables
Dimensions | Measurement variables (Likert type 5-point Scale, 1 = Worst; 5 = Outstanding) | M | SD |
---|---|---|---|
Empathy (EM) | - Polite attitudes of employees (EM1) | 3.32 | .96 |
- Explaining the details (EM2) | 3.29 | .98 | |
- Listen to the patient (EM3) | 3.46 | .87 | |
- Understand and consider the patient’s situation (EM4) | 3.43 | 1.08 | |
- A sense of closeness and friendliness (EM5) | 3.28 | 1.01 | |
- Hospital knows what the patient wants (EM6) | 3.59 | .91 | |
- Hospital understands the patient’s problems as empathy (EM7) | 3.17 | .89 | |
Tangible (TA) | - Degree of securing advanced medical equipment (TA1) | 3.84 | .81 |
- Degree of securing medical staff with advanced skills and knowledge (TA2) | 3.82 | 1.21 | |
- Degree of convenient facilities (TA3) | 3.43 | .98 | |
- Degree of cleanliness of employee uniforms (TA4) | 3.61 | .78 | |
- Overall cleanliness of the hospital (TA5) | 3.53 | .74 | |
Safety (SA) | - Degree of a comfortable and safe environment for receiving treatment (SA1) | 3.78 | .96 |
- Degree of the feeling that doctors would not make misdiagnoses (SA2) | 3.93 | 1.51 | |
- Degree of the feeling that nurses would not make mistakes (SA3) | 3.21 | .83 | |
- Degree of confidence about the medical proficiency of this hospital (SA4) | 3.38 | .94 | |
- Degree of a hospital environment that is safe from infection (SA5) | 3.45 | .92 | |
- Degree of a comfortable and safe environment for patients (SA6) | 3.58 | 1.05 | |
Efficiency (EF) | - Attitudes about not using unnecessary medication(EF1) | 3.25 | .78 |
- Degree of efforts for proving appropriate treatment methods (EF2) | 3.37 | 1.05 | |
- Reasonable medical expenses(EF3) | 3.05 | .84 | |
- Appropriateness of cost for medical services provided (EF4) | 3.37 | .79 | |
- Degree of convenience for treatment procedures (EF5) | 3.45 | 1.01 | |
- Degree of efforts for reducing unnecessary procedures (EF6) | 3.71 | 1.24 | |
Improvements of care service (DI) | - Appropriateness of care service provided (DI1) | 3.02 | .87 |
- Recognition and efforts for the best treatment by the medical staff (DI2) | 3.85 | .92 | |
- Improvement in medical condition as a result of efforts and treatment (DI3) | 3.07 | 1.05 | |
- Degree of improved patient condition after using this hospital care(DI4) | 3.54 | 1.21 | |
- Degree of explanations to the patient to prevent related diseases (DI5) | 3.24 | .88 | |
- Degree of efforts and willingness to prevent disease (DI6) | 3.18 | .94 | |
- Improvement of disease through this hospital’s treatment (DI7) | 3.47 | 1.01 | |
- Degrees of disease prevention to communities (DI8) | 3.81 | 1.42 |
Independent Variables | PCA | CFA | Cronbach’s α | ||||
---|---|---|---|---|---|---|---|
Factor loadings | Eigen values | ||||||
Total | % of variance | Standardized loading | t-value |
p-value | |||
EM1 | .825 | 11.754 | 49.103 | .787 | 17.320 | .000 | .932 |
EM2 | .845 | .765 | 17.149 | .000 | |||
EM3 | .884 | .814 | 18.015 | .000 | |||
EM4 | .873 | .854 | 20.709 | .000 | |||
EM5 | .923 | .823 | 18.238 | .000 | |||
EM6 | .873 | .821 | 18.172 | .000 | |||
EM7 | .795 | .719 | - | - | |||
TA1 | .742 | .701 | 10.015 | .000 | |||
TA2 | .769 | .684 | 9.582 | .000 | |||
TA3 | .784 | 1.374 | 4.801 | .721 | 10.206 | .000 | .807 |
TA4 | .783 | .718 | 10.145 | .000 | |||
TA5 | .725 | .675 | - | - | |||
SA1 | .802 | .784 | 16.145 | .000 | |||
SA2 | .925 | 1.124 | 4.514 | .889 | 21.524 | .000 | .872 |
SA3 | .854 | .827 | 19.450 | .000 | |||
SA4 | .884 | .855 | - | - | |||
EF1 | .821 | .784 | 14.435 | .000 | |||
EF2 | .841 | 1.041 | 4.051 | .798 | 15.045 | .000 | .823 |
EF3 | .834 | .774 | 13.819 | .000 | |||
EF4 | .863 | .801 | - | - | |||
DI1 | .854 | 2.805 | 7.417 | .802 | 11.745 | .000 | .842 |
DI2 | .824 | .785 | 11.402 | .000 | |||
DI3 | .809 | .794 | 11.514 | .000 | |||
DI4 | .801 | .774 | 11.313 | .000 | |||
DI5 | .778 | .701 | 10.962 | .000 | |||
DI6 | .724 | .678 | - | - |
χ
2
| df | P | GFI | CFI | TLI | RMSEA | RMR | |
---|---|---|---|---|---|---|---|---|
Measurement model | 542.425 | 253 | .000 | .897 | .916 | .925 | .052 | .038 |
Recommended value | > .9 | > .9 | > .9 | < .08 | < .08 |
Constructs | Empathy | Tangibles | Safety | Efficiency | Improvement of care services |
---|---|---|---|---|---|
Empathy | 1 | ||||
Tangible | .612*** | 1 | |||
Safety | .733*** | .593** | 1 | ||
Efficiency | .718*** | .681*** | .625*** | 1 | |
Improvements of care services | .754*** | .701*** | .699*** | .758** | 1 |
CR | .943 | .859 | .899 | .865 | .912 |
AVE | .738 | .693 | .704 | .672 | .647 |
Sqrt. (AVE) | .859 | .832 | .840 | .820 | .804 |
Results
Comparative analysis of quality measurement items on treatment type
Analysis of quality measurement items: inpatients, outpatients, and the emergency room
Sum of Squares | DF | Mean Squares | F | p-value | ||
---|---|---|---|---|---|---|
Empathy | Between Groups | 13.172 | 2 | 6.586 | 9.450 | .000*** |
Within Groups | 266.225 | 360 | .697 | 9.450 | .000*** | |
Total | 279.396 | 362 | 9.450 | .000*** | ||
Tangibles | Between Groups | 3.812 | 2 | 1.906 | 4.919 | .008** |
Within Groups | 148.006 | 360 | .387 | 4.919 | .008** | |
Total | 151.818 | 362 | 4.919 | .008** | ||
Efficiency | Between Groups | 3.234 | 2 | 1.617 | 3.098 | .046* |
Within Groups | 199.386 | 360 | .522 | 3.098 | .046* | |
Total | 202.619 | 362 | 3.098 | .046* | ||
Safety | Between Groups | 2.665 | 2 | 1.332 | 1.837 | .161 |
Within Groups | 277.132 | 360 | .725 | 1.837 | .161 | |
Total | 279.796 | 362 | 1.837 | .161 | ||
Improvement of care services | Between Groups | 4.493 | 2 | 2.246 | 5.949 | .003** |
Within Groups | 144.240 | 360 | .378 | 5.949 | .003** | |
Total | 148.732 | 362 | 5.949 | .003** |
Dependent Variable | (I) where | (J) where | Mean Difference (I-J) | Std. Error | Sig. | 95% Confidence Interval | |
---|---|---|---|---|---|---|---|
Lower Bound | Upper Bound | ||||||
Empathy | EM | OUT | −.39753
*
| .10700 | .001 | −.6605 | −.1346 |
IN | −.42925
*
| .10816 | .000 | −.6950 | −.1634 | ||
OUT | EM | .39753*
| .10700 | .001 | .1346 | .6605 | |
IN | −.03172 | .09999 | .951 | −.2774 | .2140 | ||
IN | EM | .42925
*
| .10816 | .000 | .1634 | .6950 | |
OUT | .03172 | .09999 | .951 | −.2140 | .2774 | ||
EM | OUT | −.23242
*
| .07978 | .015 | −.4285 | −.0364 | |
IN | −.21063
*
| .08065 | .034 | −.4088 | −.0124 | ||
Tangibles | OUT | EM | .23242
*
| .07978 | .015 | .0364 | .4285 |
IN | .02179 | .07455 | .958 | −.1614 | .2050 | ||
IN | EM | .21063
*
| .08065 | .034 | .0124 | .4088 | |
OUT | −.02179 | .07455 | .958 | −.2050 | .1614 | ||
EM | OUT | −.21555 | .09260 | .068 | −.4431 | .0120 | |
IN | −.19166 | .09361 | .124 | −.4217 | .0384 | ||
Efficiency | OUT | EM | .21555 | .09260 | .068 | −.0120 | .4431 |
IN | .02388 | .08653 | .963 | −.1888 | .2365 | ||
IN | EM | .19166 | .09361 | .124 | −.0384 | .4217 | |
OUT | −.02388 | .08653 | .963 | −.2365 | .1888 | ||
EM | OUT | −.20217 | .10917 | .181 | −.4704 | .0661 | |
IN | −.16093 | .11036 | .346 | −.4321 | .1103 | ||
Safety | OUT | EM | .20217 | .10917 | .181 | −.0661 | .4704 |
IN | .04124 | .10202 | .922 | −.2095 | .2919 | ||
IN | EM | .16093 | .11036 | .346 | −.1103 | .4321 | |
OUT | −.04124 | .10202 | .922 | −.2919 | .2095 | ||
EM | OUT | −.25906
*
| .07876 | .005 | −.4526 | −.0655 | |
IN | −.21682
*
| .07962 | .025 | −.4125 | −.0212 | ||
Improvement of care Services | OUT | EM | .25906
*
| .07876 | .005 | .0655 | .4526 |
IN | .04224 | .07360 | .848 | −.1386 | .2231 | ||
IN | EM | .21682
*
| .07962 | .025 | .0212 | .4125 | |
OUT | −.04224 | .07360 | .848 | −.2231 | .1386 |
Groups | N | Mean | Std. Deviation | Std. Error Mean | |
---|---|---|---|---|---|
Empathy | Patients | 263 | 3.5776 | .81686 | .04890 |
Publics | 232 | 3.5441 | .86089 | .05434 | |
Tangibles | Patients | 263 | 3.8416 | .62004 | .03712 |
publics | 232 | 3.8255 | .71037 | .04484 | |
Safety | Patients | 263 | 3.5484 | .80627 | .04827 |
Publics | 232 | 3.5837 | .80186 | .05061 | |
Efficiency | Patients | 263 | 3.5251 | .72270 | .04327 |
Publics | 232 | 3.5169 | .72004 | .04545 | |
Improvement of care services | Patients | 263 | 3.7611 | .59980 | .03591 |
Publics | 232 | 3.7317 | .63454 | .04005 |
Difference analysis of quality measurement items: patients and public
Levene's Test for Equality of Variances |
t-test for Equality of Means | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
F | Sig. | t | df | Sig. (2-tailed) | Mean Difference | Std. Error Difference | 95% Confidence Interval of the Difference | |||
Lower | Upper | |||||||||
Empathy | Equal variances assumed | .964 | .327 | .459 | 493 | .646 | .03346 | .07290 | −.10975 | .17668 |
Equal variances not assumed | .458 | 489.102 | .647 | .03346 | .07310 | −.11016 | .17708 | |||
Tangibles | Equal variances assumed | .196 | .658 | .278 | 493 | .781 | .01608 | .05780 | −.09746 | .12962 |
Equal variances not assumed | .276 | 487.236 | .782 | .01608 | .05821 | −.09829 | .13045 | |||
Safety | Equal variances assumed | .009 | .926 | −.504 | 493 | .614 | −.03528 | .06996 | −.17271 | .10216 |
Equal variances not assumed | −.504 | 489.718 | .614 | −.03528 | .06994 | −.17268 | .10212 | |||
Efficiency | Equal variances assumed | .666 | .415 | .130 | 493 | .897 | .00816 | .06276 | −.11514 | .13145 |
Equal variances not assumed | .130 | 489.529 | .897 | .00816 | .06275 | −.11512 | .13143 | |||
Improvements of care services | Equal variances assumed | .084 | .772 | .547 | 493 | .585 | .02931 | .05363 | −.07605 | .13467 |
Equal variances not assumed | .545 | 487.498 | .586 | .02931 | .05379 | −.07637 | .13499 |