應用SERVQUAL量表探討長期照顧管理中心服務品質與相關影響因素

Abstract

背景：隨著台灣老年失能人口數增加，預期的長期照顧需求量亦逐年上升。研究指出，在長期照顧服務體系中，個案管理(case management)模式能有效管理和輸送，並提供以個案為導向的長期照顧服務。我國各縣市「長期照顧管理中心」即採用個案管理模式，作為現階段長期照顧服務擬定與輸送的基礎，在醫療管理的角度來說，大部分研究是在探討組織功能和運作檢討，闕如服務使用者或家屬的服務品質和滿意度調查。 目的：利用依據PZB服務品質模型發展之SERVQUAL問卷進一步發展適合評估台灣長期照顧管理中心服務品質之問卷，瞭解長期照顧服務申請者對長期照顧管理中心服務重視程度(expected service quality)、服務知覺達成程度(perceived service quality)與知覺服務品質(service quality)和顧客滿意度(satisfaction)，與其相關影響因素。 方法：研究採用修改版SERVQUAL問卷訪談，針對台北市和新北市長期照顧服務申請者對長期照顧管理中心的服務品質與顧客滿意度訪問調查。調查期間為2013年3月25日至2013年5月31日(11週)，共訪問105位曾經接受長期照顧管理中心個案服務之個案或家屬。有效問卷為100份。問卷結果採用SPSS和LISREL統計軟體，進行信效度分析、T檢定、ANOVA、和複迴歸討論，並使用重要性-績效分析法(IPA)以瞭解長期照顧管理中心服務品質迫切改善項目。 結果：研究結果顯示，修改版SERVQUAL問卷信、效度皆佳 (Cronbach’s α＞0.7，驗證性因素分析結果，χ2/ df <5，CFI=0.863、0.933)。在服務重視程度的影響因素中，申請者與服務使用個案關係(p < 0.05)、申請者教育程度達到顯著水準(p < 0.05)；在服務知覺達成的影響因素中，服務使用者身心障礙等級達到顯著水準(p < 0.05)；顧客滿意度的影響因素中，申請者日常生活能力為顯著影響因素(p < 0.05)，而問卷構面的「有形性」(p < 0.05)與「關懷性」(p < 0.01)亦為顯著影響顧客滿意度因素。 重要性績效分析結果顯示，目前長照中心所提供的服務可滿足申請者需要，惟長照中心聯絡方式、長照專員提供服務解決問題以及長照專員瞭解申請者的需求等題項可能落入集中關注區，視為急迫待改善的項目。 結論與建議：本研究結果指出，修改版SERVQUAL問卷確實能有效探討長期照顧管理中心服務品質，包含服務重視程度、服務知覺達成程度及知覺服務品質與顧客滿意度，與其相關影響因素。然因，申請者多數未進入長期照顧管理中心，故在「有形性」構面題項需做調整。此外，申請者服務知覺達成程度與知覺服務品質在「關懷性」構面影響顧客滿意度最高，表示申請者認為長期照顧管理中心對個案及其家庭在服務需求的瞭解與滿足是一影響服務品質與顧客滿意度關鍵因素。進一步以重要性績效分析檢視，該構面非表現最佳者，表示長期照顧管理中心在此一服務品質與顧客滿意度的關鍵因素上，尚需加強，以提升申請者知覺服務品質與顧客滿意度。因此加強關懷性構面內容的訓練，應為長期照顧管理中心首要目標，以提升顧客滿意度。

Background: As population ageing accompanied with increasing disabled older adults, the expected needs of long-term care will increase in Taiwan. Studies have shown that case management used in long-term care might produce better quality of services delivery, as well as provide customer-oriented services to disabled recipients. In Taiwan, thegovernment has introduced case management into the long-term care service devlivery system. However, most of the reports evaluated stuctual and process outcome from organizational operation aspects rather than services quality and recipients’ satisfaction. Objective: To understand the service quality and related factors of the case management service in Taiwan long-term care system by using SERVQUAL questionnaire which was based on PZB model. Methods: This study used modified SERVQUAL questionnaire to examine the gaps of expected service quality and percieived service quality of Taiwan long-term care case management services from service receipients’ point of view. . From March 25, 2013 to May 31, 2013 (11 weeks), 105 service receipients or family caregivers were interviewed and 100 questionnaires were entered for analysis.. We used LISREL to examine the reliability, validity of the modified SERVQUAL questionnaire；and used SPSS to conduct T-test, ANOVA, and multiple regressions to examine the factors related to service quality and service receipients’ satisfaction. The current study further applied importance-performance analysis to identify items that should be concerneded most in thecase management serivces. Results: The modified SERVQUAL questionnaires in this study showed good reliability and validity (Cronbach's α >0.7, χ2/ df <5，CFI=0.863、0.933). The relationships between the respondents and their disabled care recipients, as well as educational level of the respondent were significantly associated with expected service toward case management service (p<0.05); the care recipients’ level of disabilingwas significantly associated with responds’ perceived service quality toward case management service (p<0.05); the care recipients’ number of activity of daily living was significantly associated with the respondents’ satisfaction toward case management service(p<0.05). In the content of modified SERVQUAL questionnaires used in this study, dimension of “Tangibles' (p<0.05) and 'Empathy' (p<0.01) played important roles in predicting responds’ satisfaction toward case management service. The importance - performance analysis also indicated that most respondents were satisfied with with the existing services toward long-term care case managemen provided by Taiwanese government. However, there were some concerns with three tems, which indicating potential unmet expectations toward services received toward services received, such as the the contact information of long-term care management center, long-term care staff’s abilities of problem solving , and long-term care staffs’long-term care staff ’s understanding of of the actual needs of disabled recipients. Conclusions and Recommendations: This study indicated that SERVQUAL questionnaires could be appropriate to apply for predicting services quality and related factor of case management services of Taiwan long-term care system. However, the dimension of 'Tangibles' in the modified SERVQUAL questionnaires would require further revision because most respondents didn’t experience visiting long-term care management centers in Taiwan. In our study, 'Empathy' was the most important factor for predicting perceived service quality and service quality, which indicated this is the factor that service receipients care more. However, there is still rooms for improvment according to the results of importance-performance analysis. Therefore, promoting empathy should be the priority for improving the quality of the long-term care management service for Taiwanese government.