不同滿意度模式與就醫選擇間的探討---以北部某一醫學中心為例

Abstract

二十一世紀產業的競爭優勢不只是品質競爭，還要注入創新的元素，再加上敏捷的速度，方能趕上這日新月異的新時代；對於醫療服務產業亦是如此；有良好的顧客滿意度，才能擁有忠誠的顧客群，進而提昇本身的競爭力。 本研究研究目的：(1)探討北部某醫學中心，住院服務滿意度是否具有Kano二維品質特性(2)探討北部某醫學中心，住院服務滿意度與再次就醫選擇之相關性(3)北部某醫學中心住院病患，以Kano二維品質的滿意度與再次就醫間關係的探討。 本研究採橫斷面調查研究法，藉由結構式問卷來蒐集資料，在93年4月10日至5月15日在北部某醫學中心的內科，外科，婦產科與兒科，（不含加護病房、呼吸照護病房），針對已經住院三天以上者，為本次調查母群體，共發出問卷827份，回收508份(回收率為61%)。為使本研究具代表性，僅選取病患自填或小兒科家屬所填寫的問卷，最後以280份問卷進行分析，有效回收率33.6%。 本研究的重要研究結果: (一)醫院住院服務品質要素可以Kano二維品質歸類其品質屬性，分別為「當然品質」十八項、「無差異品質」一項、「魅力品質」一項。 (二)對「行政支援與結果」滿意度較高的病患，病患本人較會考慮再次就醫，再次就醫意願高。 (三)對「主治醫師的照護態度」滿意度較高的病患，推薦親友未來就醫考慮，再次就醫意願高。 (四)對「當然品質」滿意度較高的病患，病患本人及推薦親友未來較會考慮再次就醫，再次就醫意願高。 (五)住院服務品質要素之滿意度結果-最不滿意的前五項1.病房內能夠提供外線電話的撥打接聽服務。2.院方對病患的抱怨，有著善意的回應處理時3.病房提供具安全環境(如止滑措施，扶手裝置)4.醫院能夠使病患，經治療後無其它併發症發生(如院內感染)5.工作人員能夠清楚告知住院時醫療費用的內容(含自費部份及健保部份負擔)，並詳列明細表，且此五項皆屬於「當然品質要素」，「當然品質要素」是基本服務品質，些微的缺乏就會使顧客感到不滿意。 根據以上結果，本研究提出以下建議： (一) 將住院服務品質項目依Kano二維品質模式區分品質要素，以提升病患滿意度。「當然品質要素」應用於日常管理，持續改善醫療服務品質。將「魅力品質要素」增列於流程及制度中，創造競爭優勢。 (二)醫院應持續進行病患滿意度調查之工作，並隨時間的變化而進行測量題目之修正，有些屬於魅力品質的服務要素，可能因為時空的改變或外在環境變遷而變成當然品質，而當然品質即是必須品質，原本就應該具備了，對醫院管理者提供最貼切的訊息，隨時作醫療服務品質之改善。

The competitive advantage for industry in the 21st century lies in not just quality only, but also in innovation and speedy response. It would be similar in health care industry to build up the capability of competition by providing better care to increase customer satisfaction as well as loyalty. The purposes of this study include: 1) discussing whether customer satisfaction of a certain medical center in northern Taiwan be classified by Kano Model of quality measures, 2) the relationship between of hospitalization satisfaction and revisits to this hospital, and 3) exploration the relationship between patients’ satisfaction based on Kano model and revisits of this hospital. This study is a cross-sectional study by structured questionnaire sending to patients of medical, surgical, obstetric and gynecologic, pediatric department in a northern medical center. All patients needed to stay longer than three days. 827 questionnaires were sent out by self-administration during April 10 and May 15, 2004. 508 questionnaires were replied and 280 were valid sample for final analysis with response rate of 33.6%. Major research results of this study are listed below: (Ⅰ)The quality properties of hospitalization service quality elements can be divided via Kano Model into 18 “expected quality” properties, 1 “indifferent quality” property, and 1 “delighted quality” property. (Ⅱ)Patients with higher satisfaction of “administration support and results” often tend to consider revisits. (Ⅲ)Patients with higher satisfaction of “attitudes of care of attending physician” tend to recommend their friends and families to the hospital. (Ⅳ)Patients with higher satisfaction of “expected quality” will be likely to suggest their friends and families to the hospital. (Ⅴ)Results of the hospitalization quality satisfaction: the top five dissatisfaction: 1) phones lines to contact outside at the wards, 2) positive responses of the hospital to the complaints of the patients, 3) environment of safety at the wards (slippery-proof equipment and handrails), 4) Giving patients no complications after therapy (in-hospital infection), 5) hospital staff can clearly tell patients the hospitalization expenses (including expenses by the patients and National Health Insurance) and make a list. These five items are under “expected quality elements,” which are basic service quality. Slight defects will make customers dissatisfied. This study has some suggestions： (i) Dividing the hospitalization service items into quality elements in accordance with Kano Model to improve patients’ satisfaction. “Expected quality elements” could be applied in daily management to continuously improve medical service quality. “Delighted quality elements” could be added into procedures and system to create competitive advantages. (ii) Hospitals shall continue to conduct patients’ satisfaction survey and modify questions with the change of time. Some delighted quality elements may turn to expected quality elements under the changes of time or external environment. Expected quality elements are what a hospital must have to provide. It is essential for hospital administrators with the most appropriate messages to improve medical service quality.