Dissatisfied patients at Thien Chuong Dental Clinic.pdf

UNIVERSITY OF ECONOMICS HO CHI MINH CITY
International School of Business
-------------------------------
Nguyen Dao Kim Thuong
DISSATISFIED PATIENTS AT THIEN
CHUONG DENTAL CLINIC
MASTER OF BUSINESS ADMINISTRATION
SUPERVISOR: Dr. Nguyen Phong Nguyen
Ho Chi Minh City - 2017

SUPERVISOR’S REPORT ON THE THESIS PROPOSAL SUBMITTED
FOR DEGREE OF MASTER of BUSINESS ADMINISTRATION
The thesis proposal title: THE REDUCTION OF CURRENT PATIENTS AT TC
DENTAL CLINIC
Student Name: Nguyen Dao Kim Thuong
Supervisor: Dr. Nguyen Phong Nguyen
1. General comments:
• Remarks on the student’s attitude:
…………………………………………………………………………………
………………………………………………………………………
• Remarks on the assignment’s academic quality:
…………………………………………………………………………………
………………………………………………………………………
2. Overall assessment:
Meet requirement for submitting
Not meet requirement for submitting
3. Other remarks:
− Did the student follow the report schedule?
Yes No Other………………………….
− The Turnitin plagiarism percentage:
Supervisor’s signature

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Table of Contents
Executive summary..................................................................................................................................... 2
Part 1: Background..................................................................................................................................... 3
1.1 Company background............................................................................................................... 3
1.2 Symptom..................................................................................................................................... 5
1.3 Initial causes effect map ............................................................................................................ 6
1.4 Updated cause – effect map....................................................................................................... 9
1.5 Potential central problems of interest.................................................................................... 11
Part 2: Central problem justification...................................................................................................... 15
2.1 Central problem definition...................................................................................................... 15
2.2 Problem existing....................................................................................................................... 17
2.3 Problem importance ................................................................................................................ 20
Part 3: Causes validation and solutions .................................................................................................. 21
3.1 List of real causes..................................................................................................................... 21
3.2 Central cause validation.......................................................................................................... 24
3.3 Solutions.................................................................................................................................... 27
3.3.1 Stage 1: The communication training for employees and manager....................................... 28
3.3.2 Stage 2: Commending and rewarding ................................................................................... 30
Part 4: Appendices .................................................................................................................................... 32
4.1 Interview guide......................................................................................................................... 32
4.2 Transcripts ............................................................................................................................... 33
4.2.1 Transcript 1:........................................................................................................................... 33
4.2.2 Transcript 2............................................................................................................................ 36
4.2.3 Transcript 3:........................................................................................................................... 39
4.3. Survey ....................................................................................................................................... 42
4.4 The comparison about the price............................................................................................. 44
4.5 Location .................................................................................................................................... 46
4.6 Medication process .................................................................................................................. 47
4.7 References................................................................................................................................. 48

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Executive summary
Thien Chuong dental clinic was established in 1999 with over 15 years experienced in
healthcare industry. Recently, the revenue of clinic is decreasing and the patient’s
transaction is also reduced from 2014 to 2016 specifically.
This research is written to find possible problems lead to decrease patient then give
solution in order to improve and enhance patient engagement.
The face to face interview were conducted with three patients and the clinic manager.
At the first interviews, explanations for reducing patients were dissatisfied which
regarded weak communication between doctor-patient, lack of specialize machine and
long time for waiting.
Nowadays, health care is not only pay attention to quality of treatment by excellent
diagnose, treatment process but also concerns about delivering professional customer
service. Patient oriented is the mission that clinic aims to achieve. It can be said that
satisfied patient’s needs will get patient’s appreciation, enhance patient engagement
and patient loyalty.
Patient satisfaction is one of the most priority of some clinics in general and TC in
specific target to achieve. For the loss of patients since 2014, the central problem is
dissatisfied patients that impact on returning decision of patient which cause by poor
communication between dentist-patient. Thus, this research focuses on the solution to
solve the poor dentist – patient communication.

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Part 1: Background
1.1 Company background
Thien Chuong dental clinic (TC) is a private clinic was official established in 1999 by
Dr. Dao Minh Thien Chuong. It is known as one of the high reputation dental clinic at
Tuy Hoa city.
It first location was private home at 14 Nguyen Cong Tru street, Ward 1. However, it
was a small premise and inconvenience for expanding operation so the clinic moved
to new location. The clinic is leasing a house located at 55 Tran Hung Dao street,
Ward 1, Tuy Hoa city, Phu Yen province. It is in central Tuy Hoa which nearly 1.5
kilometer away interprovincial coach station, near train station around kilometers,
away 700 meters to Tuy Hoa market, around 700 meters and close to administrative
office of Ward 1. It can say that its location is belong in densely populated area and
also convenience for others accessing.
With the slogan “Elevating Vietnamese Smile” TC always cares and understands
needs of oral health care as well as oral beauty of every patient. For that reason, all of
dentistry equipment and material are selected carefully from classy and prestige
manufacturers.
This is a kind of family-owned corporation. It operates under the control of Dr. Dao
Minh Thien Chuong. In the beginning, it operated and managed by only Dr. Chuong,
since 2001 he has co-ordinated with Dr. Vo Ngoc Doan Phuong-his wife and they
develop clinic until now.
The clinic operates on Monday to Sunday. The clinic official time starts at 8:00 AM
and closes at 7:00 PM. On Sunday the clinic close sooner than others at 6:00 PM
For over fifteen years of establishment TC has expanded operation scale in which
o 2 specialized doctors
o 5 dental hygienists

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o 3 dental assistants
o 1 receptionist
o 1 accountant
o 2 sanitation staffs
o 1 security guard
Dr. Chuong and Phuong graduated from University of Medicine and Pharmacy at Ho
Chi Minh city with Doctor Specialty I degree. Most of the staffs are not required high
diploma or years experienced. The 5 dental hygienists with Intermediate Professional
degree in which are dental technician and several are pharmacy technician. The
receptionist required graduated high school, fluent in using computer skill and good
appearance. The accountant must have relevant certificate and at least 1 year
experience in this field.
Currently, there are six dental clinics in central Tuy Hoa city which two of them are
new reputation branches clinic from Sai Gon - Viet My dental clinic and Sai Gon
dental clinic.
No Name of dental clinic
1 Viet My dental clinic
2 Sai Gon dental clinic
3 Nu Cuoi Xinh dental clinic
4 Nha Chin dental clinic
5 School dentistry

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6 Hoang Son dental clinic
7 Minh Tri dental clinic
Table 1: Dental clinics in central Tuy Hoa city
1.2 Symptom
Chart 1: The volume of patients from 2014 to 2016
(Source: Thien Chuong dental clinic finance report 2014-2016)
From 2014-2016 the volume of patient was in a decreasing trend was indicated in
Chart 1. This made the profit went down in the same stage as Chart 2 showed below.
29,610
29,331
28,908
28,400
28,600
28,800
29,000
29,200
29,400
29,600
29,800
2014 2015 2016

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Chart 2: Revenue of TC 2014-2016
(Source: Thien Chuong dental clinic finance report 2014-2016)
The loss of profit kept increasing around 18% to 22% by time. This abnormal number
was over the acceptable gap 10-15% from doctor manager. Additionally, the operation
cost was insignificant changed – it was under 3% for each year in the period 2014-
2016. The operation cost includes budget spend for leasing fee, equipment, salary, and
others variable cost increase every year in a fixed amount. Besides, 2015-2016 the
manager also controlled cost well by decrease expense from 2.2% to 1.17%.
1.3 Initial causes effect map
In depth interview was carried out with three chosen patients aged from over twenty
to under forty-five years old who have experienced in service at TC over five times.
Gathering information from three patients the researcher realizes there is a common
from three point of view is they were uncomfortable with the service at TC, in another
way they were dissatisfied with the service was listed down: Difficult access dentists
or hygienists, Poor communication between staffs and patients, Poor facilities in the
clinic.
6,897,680,000 7,055,218,560 7,165,981,771
1,689,220,000 1,450,771,440 1,217,338,229
-
1,000,000,000
2,000,000,000
3,000,000,000
4,000,000,000
5,000,000,000
6,000,000,000
7,000,000,000
8,000,000,000
9,000,000,000
10,000,000,000
20 1 4 2015 2016
operation cost Profit

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Per Mr. Nguyen said that he has known TC for 3 years, his daughter and he also
experienced service here several times. His last treatment was veneer and was quite
satisfied with his teeth but he complained about the service. He had to wait for long
time although he did made appointment before and he also said the receptionist was
unfriendly. “The receptionist is extremely rude and will not let you get a word in. First
rule of customer service is: listen to the patient. I was interrupted three times before I
could get my question in. I don’t think a person who work in service industry should
do that”. Lastly, he shared that his daughter was braced at VM dental clinic. The staff
was consulted kindly and also gave him the detail treatment process although he just
only asked for referencing.
After that, an interview with Ms. Diem has experienced at TC over a year. Her
treatment is braces and the progress is fairly accurate with doctor’s expectation at the
beginning stage. She said one of the lack of specialized machine – X-ray machine
caused difficulty in diagnosing treatment. Because her jaw structure was complicated
with the overcrowding issue so she had to go to Saigon to take X-ray film. That was
inconvenience to her by spending more time and cost. Furthermore, because there
were many patients so dentists did not spend time to check detail stages, the dental
hygienists in charge most of part but they are weak in interacting with patients and
their colleague, and they also weak in consulting. “Dental hygienists seem to not
know what they're talking about. They don't seem to communicate well with each
other and with the doctor. One would say one thing and the other would completely
say a different thing. Feel not at ease after my appointment. Things could be better
explained and could be more organized. I was nervous at the beginning. Occasionally
the dentist does work on the teeth and it probably won’t be every appointment, but he
sometimes pop in and check the teeth, to make sure the dental hygienist is doing
everything correctly”. She also complained staffs were unprofessional when they were
talking loudly while doing.
Mr. Cong shared he had a good impression about the clinic by the good interaction
with patient of Dr Chuong. However, he complained about the hygienist’s working
style that she did not focus on her work and poor at consulting. He said “During my

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treatment the hygienist was talking on the phone most of the time. I felt it was so
annoy. I was so nervous that time if she forgot and drilled a big hole on my teeth.
Then, she told one of my wisdom tooth swelled up and the only choice was I had to
extract it. But, when I asked whether it was necessary or not to do it she could not
explain”.
All of interviewers were admitted that the space was quite small especially the waiting
room. Sharing by Mr. Cong that “When I came in the peak time, there was no place
for me to sit, so I had to wait outside the room.” And Ms. Diem” said “It doesn’t have
enough space for many patients so it’s uncomfortable” However, it was clean and
ensure institute for medical quality. Mr. Nguyen commented “Cleaning rooms and
tools are replaced new every checkup” and Ms. Diem said “Generally, everything is
clean and neat, but the waiting room is a bit small, it doesn’t have enough space for
many patients so it’s uncomfortable”. According to Mr. Nguyen and Ms. Diem high
price is not important to them, Mr. Nguyen explained “I just only care about the
quality and service because I believe health care is priceless. But it should appropriate
with the quality”
From all information of patients and doctors shared, the initial cause-effect map was
drawn below for noted signal affect to volume of patient.

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1.4 Updated cause – effect map
The first cause – effect map only based on the information gather through the
interview so this was only view point of each patient. The researcher wants to have a
general view causes of reducing patients in TC, for this reason the researcher read
studies, articles and researches to add another potential problem in the map.
The literature cited by Arnold, Todd, Fang, Eric (1) the orientation that a firm takes
toward deepening current customer relationship, or developing new customer
relationships, has the potential to significantly impact overall firm performance (1-3).
There is 44% companies focus (4) on customer acquisition and only 18% on retention
(5).
Reducing patients
Dissatisfied current
patients
Long waiting time
Poor
communication
between staff-
patient
Unfriendly
receptionist
The hygienists
consult unclear
Poor facilities in
the clinic
Lack of specialized
medical machine
Small waiting room
Map 1: Initial cause-effect map

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Customer is viewed as assets or lifeblood of the company. It can not maintain or grow
without customers so not only keep retaining customer is necessary but also
concerning on acquiring new customer.
After examining relevant literatures, the telephone interview was conducted with two
patients and the dentist manager to review new potential problems were skipped in the
initial interview.
When being asked about the way the access or know about TC, Mr. Cong and Ms.
Diem said they did not catch any information about TC from any media channel as
newspaper, advertising on TV. The reason is they hardly read local newspaper or
watch local television channel, they usually read news from popular websites on the
internet and often skip advertisement part on newspaper or TV channel.
Per discussing with Dr. Chuong the amount of new customer go to dental clinic was
limited because he did not advertise broadly the image of clinic. “In 2010, it took over
fifty million VND for advertising on local television and local newspapers but it was
not effective".
The information interviewed was added in the updated cause-effect map

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1.5 Potential central problems of interest
There are two potential problem cause patient reduction: Dissatisfied current patients
and Weak acquiring new patients.
Attracting a new customer could cost six times more than retaining an old one (6).
Additionally, Dekimpe (7) claimed a critical issue related to the success of company is
the ability to retain current customer and make them loyal to the brand. Ganesh (8)
was written, “ Loyal customers build business by buying more, paying premium
prices and providing new referrals through positive word of mouth over time”.
Reducing patients
Weak acquiring
new patients
Poor advertising
plan
patients
Long waiting time
Poor
communication
between staff-
patient
Unfriendly
receptionist
The hygienists
consult unclear
Poor facilities in
the clinic
Lack of specialized
medical machine
Small waiting room
Map 2: Updated cause-effect map

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Based on information Dr. Chuong shared was cited above that advertising takes high
expense and it over the budget of the clinic. Furthermore, in a period from Jun – Dec
2010 Thien Chuong dental clinic did a small survey about how customers know about
it. According to this, over 85% of customer comes from word of mount channel. This
strong patient source supports the clinic maintains and attract new patient without
spend fund for advertising through media channel. Besides, the profit in 2010 to 2011
did not change which kept remain in this period when the advertising was applied.
Compare to the high fund spend for advertising in attract new customer but did not
bring any significant value to the clinic operation.
Healthcare industry is related to customer service in which customer satisfaction
contributes an important role in developing company – clinic. Understanding that
spends high cost for attracting new customers do not ensure the equal benefit it can
bring for a long time. Meanwhile, retaining customers is not only make a good
improvement in the internal structure but also using as a tool to attract new customer
by word of mouth which TC is strong currently.
Furthermore, the clinic has a small assessment about the level of patient satisfied
referred with service quality after each visit time at Thien Chuong dental clinic. As the
chart showed below the rate of patient dissatisfied about the service quality was high
was accounted for 70% in totally.

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To sum up, combining all information through interview and re-examination by
literature, attracting new customer are not necessary to the clinic situation.
31%
39%
21%
9%
0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Strongly
dissatisfied
Dissatisfied Neutral Satisfied Strongly
satisfied
Chart 3: Patient assess service quality of Thien Chuong dental clinic from Sep
2016 to March 2017

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Reducing patients
patients
Long waiting time
Poor
communication
between staff-
patient
Unfriendly
receptionist
The hygienists
consult unclear
Poor facilities in
the clinic
Lack of specialized
medical machine
Small waiting room
Map 3: Final cause-effect map

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Part 2: Central problem justification
2.1 Central problem definition
Nowadays, healthcare is not only concern about cure, treatment process but it also
refers to customer service in which adapts customer needs. Patient satisfaction is
defined as the patient’s opinion of the care received from nursing staff works in
hospital and an outcome criterion of nursing care service (9).
However, satisfaction is mainly about emotionally through customer expectation and
experience in the service. Satisfaction refers generally to the match between
expectation and real circumstances of treatment. If expectation and service
circumstances are equal, the client is generally satisfied or conversely if the service
circumstances fall below expectations, the client is dissatisfied (10). Another term is
defined as the appraisal of the extent to which the care provided has met an
individual’s (patient’s) expectations and preferences (11). Satisfaction is also a tool
use to evaluate quality of service by patient. It can be seen as the healthcare reaction
to the context, process and result of the experience (12)
From the study of Wagner and Bear (13), there are three antecedents of patient
satisfaction related to patients personal element of intrinsic motivation, cognitive
appraisal and affective response as Cox (14) has identified
− Intrinsic motivation recognizes perceived choice, competence and self-
determinism as precursors of health behaviors.
- Cognitive appraisal includes patient’s interpretation of their situation and
perception of their relationship with the nurse (14)
- Affective response, defined as positive perception of nurse caring behaviors,
strongly correlated with patient satisfaction with nursing care (4, 15-17).
Furthermore, (18) listed six causes of patient dissatisfaction were:
− Bad experience at the front desk
− Long wait in reception area

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− Unattractive practice
− Can’t get a timely appointment
− Doesn’t accept their dental insurance
− Hygienist who’s a stabber
Another cause of patient dissatisfaction is showed as the chart below:
Chart 4: Reason for patient dissatisfaction under managed care
Source: The Kaiser Family Foundation/Harvard School of Public Health (19)
Patient satisfaction is measured and evaluated by eight dimensions (20) is listed below
• Interpersonal manner: features of the way in which providers interact
personally with patients.
• Technical quality: competence of providers and adherence to high standards of
diagnosis and treatment.
• Accessibility/convenience: factor involved in arranging to receive medical care
• Finances: factors involved in paying for medical services.
• Efficacy/outcomes: the results of medical care encounters.
Problem type
unspecified
4%
Communication
or customer
service problem
8%
Difficulty seeing a
practitioner
10%
Billing or
problem payment
13%
Delay or denials
of coverage or
care
13%
Did not report a
problem with
their health plan
52%

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• Continuity: sameness of provider and/or location of care.
• Physical environment: features of setting in which care is delivered.
• Availability: presence of medical care resources
2.2 Problem existing
Per discussion with patients in the previous sections the survey was conducted to
evaluated the causes affect patient dissatisfaction at Thien Chuong dental clinic
currently.
There were 15 respondents was interviewed by doing a short survey. The respondents
were range of age from 20 years to over 40 years. Out of 15 respondents over half of
patients were female and the remaining were male.
The survey was made with twelve questions about five dimensions use to measured
patient satisfaction. Furthermore, Likert-style is used to evaluate the satisfaction
which from Strong dissatisfied to Strongly satisfied

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1 2 3 4 5
Places where you can get medical care are
very conveniently located
- - 20% 47% 33%
I booked the schedule before I came here 33% 33% 13% 13% 7%
Waiting long time at the clinic - 33% 40% 27% -
I hardly ever see same doctor when I go
for medical care
- 27% 27% 27% 20%
The amount charged for medical care
services is reasonable
- - 13% 40% 47%
The clinic has enough necessary tools for
treatment process
- 7% 20% 47% 27%
The dentists are very careful to check
everything when examining their patients
and diagnose accurately
- - 7% 47% 47%
The hygienists are very careful to check
everything when examining their patients
and diagnose accurately
- - 13% 47% 40%
The dentists show their professional
interacting with patients
- - 13% 40% 47%
The hygienists show their professional
- 13% 20% 53% 13%
The receptionist shows her professional
27% 47% 13% 13% -
The rooms are clean and pleasant - - 20% 47% 33%
The treatment gets improving result - - 13% 47% 40%

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There are two potential causes lead highest patient satisfaction rate are the
accessibility with dentists or hygienists and the poor communication between staffs
and patients.
The short interview was conducted by telephone with five chosen patients to justify
the result above is the real causes of the dissatisfaction.
All of respondents (five out of five) agreed that the location is convenience; pleasant
and clean atmosphere; reasonable price; efficiency treatment; and the good technical
and interaction skill of dentists.
The respondents said the clinic locates on the main street in central Tuy Hoa that easy
to find and visit.
The physical environment here was clean, pleasant atmosphere, change new
equipment and follow sterile tools rule by changing new equipment after checking
another patient- the majority respondent claimed. The stationary staffs always keep
the rooms and restroom clean. Additionally, doctors and patients wear blouse and
mask most of the time contact with patients. At this point, the respondents shared that
clinic had done pretty well
The respondents also feel happy with the treatment. They see the improvement in the
process and get good result. According to them, the treatment fee is nearly equal to
others and the gap is insignificant.
The respondents were fairly happy when they communicate with doctors. They said
that dentists explain medical problem to them clearly so they feel secure about their
illness. Furthermore, doctors know how to keep patients away from worrying, they
make a joke and show their empathy with patient fears.
Most of them commented the front desk staff was fairly rude and not respect patients.
The dental hygienists also difficult in communicating with each other. Ones shared
“The hygienists seem to not know what they're talking about. They don't seem to
communicate well with each other and with the doctor. One would say one thing and
the other would completely say a different thing”

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The majority of respondents said that the clinic was fitted all necessary equipment.
However, the clinic lacked of specialized machine that support for diagnosing difficult
case as X-ray machine.
Throughout the treatment process most of respondents did not meet same doctors but
they did not feel inconvenience about this. This is because two doctors here are same
as level. When being asked about the technical skill, all of respondent said that
doctors and hygienists carefully exam, give clear advice for patient to avoid illness.
All of respondents complained about the long waiting time, most of them usually
waited from 10 to nearly over 15 minutes and most of them did not schedule before
they visited doctors.
2.3 Problem importance
Patient satisfaction brings both tangible and intangible benefits to the clinic by the
clearly amount of number – profit and valuable reputation which last long and more
efficiency than spend money on advertising to attract new patients. An increase of 5%
in customer loyalty can boost a firm’s profitability by 25-85% (21). Additionally,
patient satisfaction enhances hospital image, which in turn translates into increased
service use and market share (22).
Furthermore, benefits of providing exemplary customer service (23) :
• Satisfied patient return to the provider for future care – leading to customer
retention.
• Satisfied patient will refer others to the practice – increasing volume and
market share for provider.
• Satisfied patients comply with the recommendations and procedures and have
better acceptance of needed treatments.
• Patients who feel good about their healthcare provider are less likely to
consume associate’s time with complaints or take legal action.
• Patient’s appreciation acts as a self-motivator for manager and all associates to
work better.

21
The clinic had a small survey from March-September of 2014 showed that over 85%
volume of patient comes from “word of mouth” introduced by relative relationship as
friends, relatives, colleague, etc. For this reason, it can be a strong tool for clinic
boost its reputation but also a harmful way injures clinic reputation. Specifically, once
patients feel dissatisfied with the value clinic brings to them, they will spread their
negative opinions and hinder new other patients from approaching the clinic’s service.
This will influence to the reputation of the clinic seriously.
Besides, mentioned above the vast majority profit comes from the current patients so
the more patient feel happy with the value clinic bring to them, the more they return.
Maintaining this repeat action of patient will turn them become loyal customers that
keep using clinic service as the priority choice.
In brief, when patient’s expectation and needs are adapted they will bring the
sustainable benefit to the clinic which not only the profit but also the trustworthy that
very important element in medical care industry
Part 3: Causes validation and solutions
3.1 List of real causes
According to the survey above there are three potential real causes:
Patient waiting time is the time a patient takes at each service point before being
served and the overall time a patient spends in a facility from arrival to the registration
desk till the time of leaving the facility or last service (24). The amount of time a
patient wait to be seen is one factor which affects utilization of healthcare services.
Thus, long waiting is a barrier to patients perceived about good quality service (25).
Keeping patients waiting unnecessarily can be a cause of stress for both patient and
doctor (26). Waiting time is a tangible aspect of practice that patients will use to judge
health personnel, even more than their knowledge and skill.
An anecdotal source of dissatisfaction with health care reported by patients is having
to wait a long period of time in the office (27). Pumwani Maternity hospital findings
of a study showed that patients who waited for less than 30 minutes were more

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satisfied than those who waited for more than 60 minutes and therefore longer patient
waiting time was found to affect patient satisfaction (28).
The patient’s turn is distributed by First In First Serve rule that according to the
patient arrival time. The expectation average length of a visiting is around 30-60
minutes depending on the level of each cases.
Furthermore, personnel attending to patient in the clinic, there were only 2 dentists, 5
dental hygienists and 3 dental assistants who attended to nearly 80 patients each day
on an average. However, depending on each day of week. The high patient’s
transaction only focused on the weekend and others is spread out.
Chart 5 Patient's transaction on Oct – Dec 2016
Resources Process
Staffing
(number of
workers)
Activity time
(minutes per
patient)
Receptionist Paper work, data entry 1 05-10 min
Dental assistants Prepare tools, assisting for 3 05-10 min
0
50
100
150
200
250
300
350
400
450
500
Mon Tue Wed Thu Fri Sat Sun
Patient's transaction
Oct Nov Dec
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dentists and dental hygienist,
record reports,
Dental hygienists Primary treatment 5 15-40 min
Dentist
Checkup, diagnose and
specialized treatment
2 10-30 min
Table 2: The amount of time spending per case
According to the observed process from patient reached the front desk staff in the
clinic and completed the registration then waited in turn take in average 10-20 minutes
then called by a nurse to see the dentist to check and oversee the oral problem.
Currently the clinic is spending budget for building new clinic’s location and facilities
No Detail Quantity Cost
1 Fixed asset - House 1 3,500,000,000
2 Material for building facilities - 350,000,000
3 Decoration furniture - 150,000,000
4 X-ray machine 1 130,000,000
5 Dental chair 3 180,000,000
6 Others - 100,000,000
Total 4,410,000,000
Table 3 Budget for building new location
Basing on above analysis, long waiting time and poor facilities can be eliminated. The
data given about showed that the high patient’s transaction focused on the weekend
and spread out to other days. Furthermore, the patients who did not book appointment
in advance takes time for waiting in turm. The result of the survey also claimed that
not affected to the central problem here. At the moment, the clinic is focusing on
building new location at 87 Tran Hung Dao Street, Ward 1 located near the current
location which supply full of facilities and machines.
Based on Picker view point, Luxford, Piper, Dunbar,and Poole gave patient-centred
communication and longer consultations in primary care increase patient satisfaction.
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Communication skills training for clinicians can lead to improved communication,
reduced anxiety and greater patient satisfaction (29).
Therefore, in this research, communication is the central cause need to focus on
researching.
3.2 Central cause validation
Communication is the degree to which the patient is heard, kept informed through
understandable terms, afforded social interaction and time during consultation and
provided psychological and non-technical information as Tucker defined (30). Ohtaki
S, Ohtaki T, Fetter (31) citied communication during history taking or discussion of
the management plan has a significant association with patient outcomes. The other
stated communication that achieves information exchange and negotiation of mutual
expectations, reassures patients and demonstrates positive affect from the practitioner
increases patient adherence (32). The basic elements of doctor-patient communication
are to build the relationship, create a path for the discussion between the doctor and
the patient, gather information about the patient’s problems and issues, and to
mutually decide the plan of action to handle them (33).
The Communication Assessment Tool (CAT) developed by Makoul (34) is used as
the scale to measure the communication between physicians and patients based on the
patient’s perception.
The CAT is a 15-item survey that is easily administered in a paper-and-pencil format
or via the phone or Internet. A 14-item version for residency programs is also
available; it omits an item on whether the doctor’s staff treated the patient with
respect. Makoul et al published data for practicing physicians across multiple different
specialties.
The CAT is a feasible tool to assess patient perceptions of physician communication,
and offers a rare but essential opportunity for providing physicians with systematic
feedback. The translation and cross-cultural adaptation of an instrument to assess
interpersonal and communication skills has useful implications for practice since there
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