[123doc] - assessment-of-outpatient-satisfaction-in-binh-dinh-provincial-general-hospital-in-2018.pdf

0000 VIETNAM NATIONAL UNIVERSITY, HANOI
VIETNAM JAPAN UNIVERSITY
NGUYEN NAM KHANH
ASSESSMENT OF INPATIENT
SATISFACTION IN
BINH DINH PROVINCIAL GENERAL
HOSPITAL IN 2018
MASTER’S THESIS
BUSINESS ADMINISTRATION
Hanoi, 2019

VIETNAM NATIONAL UNIVERSITY, HANOI
VIETNAM JAPAN UNIVERSITY
NGUYEN NAM KHANH
ASSESSMENT OF INPATIENT
SATISFACTION IN
BINH DINH PROVINCIAL GENERAL
HOSPITAL IN 2018
MAJOR: BUSINESS ADMINISTRATION
CODE: 60340102
RESEARCH SUPERVISORS:
ASSOC. PROF. DR. VU ANH DUNG
PROF. DR. HIROSHI MORITA
Hanoi, 2019

i
ACKNOWLEDGEMENT
First of all, I would like to give my sincere thanks to Vietnam Japan University,
Yokohama National University, Japan International Cooperation Agency (JICA)
with all the members, lecturers and assistants for giving me this opportunity to study
and research in an international academic environment. I have gained a lot of
knowledge and experience through classes and seminars in Vietnam and Japan.
Secondly, I want to express my deep and sincere gratitude to my two supervisors,
Associate Professor. Vu Anh Dung, Vietnam Japan University and Professor. Hiroshi
Morita, Yokohama National University. Their wide knowledge and critical thinking
have given me motivation, confidence and value to do my research. They also
encouraged and instructed me personally for my thesis. I also want to thank Professor.
Matsui, Associate Professor. Pham Thi Lien, Hanh sensei, Hino sensei for what all
of you have done with VJU students. You always support and share with us your
valuable knowledge and experience.
To Huong san and IPO’s staff, YNU. Thank you for your detailed caring to VJU
students in Vietnam as well as in Japan.
Finally, I would like to thank my family, friends and colleagues who supported and
encouraged me to finish my thesis.
Hanoi, 2019
Nguyen Nam Khanh

ii
ABSTRACT
Patient satisfaction is an important indicator used for measuring the quality of
healthcare facilities. Patient satisfaction has an effect on outcomes of medical service
providers and reflects efficiency of provided services. Therefore, patient satisfaction
will be an effective indicator to measure the success of medical service providers.
This research introduces how to assess patient satisfaction in public hospitals, taking
the case of Binh Dinh provincial general hospital.
In the strategy of Vietnam healthcare system for protecting, caring and improving
healthcare in the period 2011-2020, vision 2030. Some issues have been mentioned:
Health is the most valuable asset of individuals and all society; medical service is a
special social service without profits in public service providers; investing in health
is investing for the future and for good nature of society; improvement and
modernization of healthcare system towards Equity-Efficiency-Development.
Currently, medical services in public hospitals are considered not as good as in private
hospitals. Therefore, the objectives of this research are assessing current situation of
patient satisfaction in the hospital and providing some recommendations as the
background or reference for public hospitals to improve their medical services.

iii
TABLE OF CONTENTS
ACKNOWLEDGEMENT...............................................................................i
ABSTRACT.....................................................................................................ii
LIST OF FIGURES .......................................................................................vi
LIST OF TABLES ........................................................................................vii
CHAPTER 1: INTRODUCTION.................................................................. 1
1.1. Background .............................................................................................. 1
1.2. Research objectives................................................................................... 2
1.3. Research questions.................................................................................... 2
1.4. Introduction of Binh Dinh provincial general hospital................................. 2
1.4.1. Policies of Vietnam healthcare system towards patient satisfaction....... 2
1.4.2. Establishment and development process of the hospital ....................... 4
1.5. Structure of research ................................................................................. 5
CHAPTER 2: LITERATURE REVIEW ON PATIENT
SATISFACTION............................................................................................. 6
2.1. Hospital services....................................................................................... 6
2.2. Service quality.......................................................................................... 6
2.3. Customer satisfaction................................................................................ 8
2.4. Customer satisfaction and service quality................................................... 9
2.5. Overview of patient satisfaction...............................................................10
2.6. Role of patient satisfaction ......................................................................10
2.7. The relationship between service quality and patient satisfaction ..............11
2.8. Factors impacting patient satisfaction.......................................................11

iv
CHAPTER 3: RESEARCH METHODOLOGY .......................................16
3.1. Research design ......................................................................................16
3.2. Research process.....................................................................................17
3.3. Data collection........................................................................................17
3.4. Research model ......................................................................................20
CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH
DINH PROVINCIAL GENERAL HOSPITAL.........................................23
4.1. General information of researched patients...............................................23
4.2. Assessment of inpatient satisfaction.........................................................25
4.2.1. Inpatient satisfaction on accessibility.....................................................25
4.2.2. Inpatient satisfaction on Transparency on information, examination and
treatment procedures.........................................................................................27
4.2.3. Inpatient satisfaction on Facilities and equipment .................................29
4.2.4. Inpatient satisfaction on Medical staff’s behavior and professional
capacity.............................................................................................................31
4.2.5. Inpatient satisfaction on Results of service provision............................33
4.3. Summary of results on inpatient satisfaction.............................................35
4.3.1. Inpatient satisfaction in general and classified by factors......................35
4.3.2. Percentage of overall assessment of inpatient satisfaction.....................36
4.3.3. Classification of patients who will return or introduce to other patients
..........................................................................................................................36
4.3.4. Odds Ratio Analysis...............................................................................37
CHAPTER 5: RECOMMENDATIONS TO IMPROVE INPATIENT
SATISFACTION IN BINH DINH PROVINCIAL GENERAL
HOSPITAL ....................................................................................................40

v
5.1. Improving facilities in the hospital................................................................40
5.2. Investing more in medical equipment and information technology to improve
service quality.......................................................................................................40
5.3. Simplifying complicated administrative procedures .....................................41
5.4. Improving medical staff’s communication skills ..........................................41
5.5. Limitations of the thesis.................................................................................41
CONCLUSIONS ...........................................................................................42
LIST OF REFERENCES .............................................................................43
APPENDIX 1 .................................................................................................46
APPENDIX 2 .................................................................................................50
APPENDIX 3 .................................................................................................52
APPENDIX 4 .................................................................................................53

vi
LIST OF FIGURES
Figure 1. Research process........................................................................................17
Figure 2. Research model..........................................................................................22
Figure 3. Patient satisfaction by age .........................................................................24
Figure 4. Summary of inpatient satisfaction on Accessibility ..................................26
Figure 5. Summary of inpatient satisfaction on Transparency on information,
examination and treatment procedures .....................................................................28
Figure 6. Summary of inpatient satisfaction on Facilities and equipment................31
Figure 7. Summary of inpatient satisfaction on Medical staff’s behavior and
professional capacity.................................................................................................33
Figure 8. Summary of inpatient satisfaction on Results of service provision ..........35

vii
LIST OF TABLES
Table 4.1. Patient classification by sex .....................................................................23
Table 4.2. The total number of days of hospitalization ............................................24
Table 4.3. Patients using of health insurance card for this treatment .......................24
Table 4.4. Classification of inpatient satisfaction by accessibility ...........................25
Table 4.5. Classification of inpatient satisfaction by Transparency on information,
examination and treatment procedures .....................................................................27
Table 4.6. Classification of inpatient satisfaction by Facilities and equipment........29
Table 4.7. Classification of inpatient satisfaction by Medical staff’s behavior and
professional capacity.................................................................................................31
Table 4.8. Classification of inpatient satisfaction by Results of service provision ..33
Table 4.9. Inpatient satisfaction in general and classified by factors .......................35
Table 4.10. Percentage of overall assessment of inpatient satisfaction ....................36
Table 4.11. Classification of patients who will return or introduce to other patients
...................................................................................................................................36
Table 4.12. The relation between related factors and inpatient satisfaction.............37
Table 4.13. The relation between related factors and patient return.........................38

1
CHAPTER 1: INTRODUCTION
1.1. Background
Health is always among the most important issues and the most valuable asset of
individuals and all society. Investing in health is investing for development and
growth, reflecting the good society. With the development trend of health sector,
public hospitals gradually have to be autonomous in finance meaning that they must
cover all the costs for their operation such as salary, equipment, drugs…etc. In this
situation, to be survival in severe competition in market economy, public hospitals
need to attract more patients. Therefore patient satisfaction is one of the most
important issues for hospitals as well as a principal indicator reflecting quality and
efficiency of medical services.
For public hospitals, assessment of patient satisfaction will help improve quality of
services and reputation, so that hospitals can increase revenue and have effects on
other hospitals. Pollack (2008) there is a relationship between service quality and
patient satisfaction, level of satisfaction is a measurement for the suitability between
medical services provided with expectation from patients. Satisfied patients will lead
to improved financial outcomes, reduce management claims, retain patients and
succeed in a competitive environment.
In current circumstance, there is a difference of medical services between public and
private hospitals, services at private hospitals are considered better than at public
hospitals. Nowadays, patients do not only pay attention on quality of medical
treatment but also the services that they would receive from medical staff. With the
development of modern technology in medical treatment, medical services have been
highly focused on to increase the competitiveness.
Raising patient satisfaction in public health will play an important role for public
healthcare providers because patient satisfaction determines the survival and
development of public hospitals, according to Decree No 55/2012/ND-CP public
healthcare providers will be dissolved if the task is not completed in three consecutive
years.

2
With current situation and desire to contribute to improve the quality of medical
services and patient satisfaction in Binh Dinh provincial general hospital, the author
decided to choose the topic “Assessment of inpatient satisfaction in Binh Dinh
provincial general hospital in 2018”
1.2. Research objectives
- Assessing current situation of inpatient satisfaction in Binh Dinh provincial general
hospital.
- Analyzing the relation between related factors and inpatient satisfaction.
1.3. Research questions
- What is the current situation of inpatient satisfaction in Binh Dinh provincial general
hospital?
- What is the relation between related factors and inpatient satisfaction?
1.4. Introduction of Binh Dinh provincial general hospital
1.4.1. Policies of Vietnam healthcare system towards patient satisfaction
Satisfaction of patient is the result of medical services provided. The level of
satisfaction is a tool to assess the quality of healthcare services. Some studies have
indicated the relationship between quality of service and satisfaction, the higher the
quality of health services, the higher the level of satisfaction. Satisfaction plays an
important role deciding the choices of patients using medical services at health
facilities that helps increase revenue for hospitals. When patients are satisfied with
the services received, they will return in the future and become regular customers.
Besides that, they may also introduce the positive remarks about the service quality
to other patients that will help hospitals attract more patients therefore improving
satisfaction not only helps retain existing patients but also attracts new patients and
enhances the reputation for hospitals
Some studies have also indicated that there is a relationship between patient
satisfaction and the profit of hospital. The satisfaction will help increase profit for
hospitals and competition with other healthcare facilities

3
Patient satisfaction is also an important factor determining the survival and
development of public hospitals that is indicated in Decree No. 55/2012/ND-CP:
public healthcare providers will be dissolved if the task is not completed in three
consecutive years. Patient satisfaction has been identified as a significant evidence
reflecting the completion of the task.
Improving patient satisfaction will have a good effect on healthcare sector because it
brings not only benefits to service users but also benefits to healthcare facilities.
In the current context of Vietnam healthcare system, central hospitals are overloading
therefore the measurement of patient satisfaction is necessary, it will provide useful
evidence for reorganizing the process of delivering services that meets the demand of
service users.
Raising the quality of medical services and reforming administrative procedures in
the whole healthcare sector will make a contribution to implement the Resolution No
30/NQ-CP of the Government on protection, caring, and improvement of people’s
health. The Resolution No 30/NQ-CP regulating the program of administrative
reform on the period 2011-2020 with 5 objectives:
- Building and completing the institutional system of market economy towards
social orientation
- Creating a fair and ventilated business environment
- Developing a system of administrative procedures that is smooth, clean, and
strong from the central government to the local authorities
- Ensuring protection of democratic rights and human rights
- Building a team of officials and civil servants with quality, capacity and
qualifications
The program is divided into two phases with the following tasks:
- Phase I (2011 - 2015): ensuring personal satisfaction with services provided
by public facilities in the field of education and health care reaches more than
60% in 2015.

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- Phase II (2016 - 2020): ensuring personal satisfaction with services provided
by public facilities in the field of education and health care reaches more than
80% in 2020.
1.4.2. Establishment and development process of the hospital
From the first infirmary of 20 beds with less than 10 staff, established in April 1961
in the highland of Vinh Thanh (Ha Tien village). In 1969, the infirmary had an
outstanding growth and was eligible for being a hospital. Implementing the direction
of the Provincial Department of Health, hospital staff and local people build a new
100-bed provincial hospital, completed in October 1969, at O village - Vinh
Thanh. The hospital is made of bamboo, but it is tall and spacious in the dense forest
with 20 large and small houses
After the liberation of the South, on April 1975, the provincial health officer took
over the medical facility, repaired and brought the hospital back to normal operation
and transferred the hospital to the current Binh Dinh General Hospital.
Provincial General Hospital with a total area of more than 5 hectares is the highest
treatment level of the provincial health sector. From 1975 until now, the hospital has
experienced many historical periods and has always received investment in
construction and development, meeting the need of caring and protecting people's
health. Currently, Binh Dinh General Hospital is one of the large-scale provincial
hospitals in the Central Region, Central Highlands, with 1050 inpatient beds; the total
number of officials, employees nearly 1300 people; The hospital currently has 07
functional rooms, 33 clinical and subclinical departments. Many modern equipment
and facilities for diagnosis and treatment have been procured; officials and employees
are regularly trained with knowledge, professional and management skills that is the
basis for implementing the goal of constantly improving the quality of medical
examination and treatment at the hospital, facilitating officials and people in the
province have access to high quality of healthcare services.
Being a leading facility in the field of medical examination and treatment. With a
long tradition and a team of highly qualified professional staff in many specialized

5
areas. For many years, Binh Dinh General Hospital has affirmed its role in
implementing the functions and tasks of a provincial general hospital. The hospital is
planned by the Prime Minister to be a Regional Hospital under Decision No.
153/2006 / QD-TTg dated June 30, 2006 " approving the master plan for
development of Vietnam's health in the period up to 2010 and vision to 2020 ” . On
September 19, 2007, the Hospital was recognized by the Provincial People's
Committee of level I Hospital according to Circular No. 23/2005 / TT-BYT dated
August 25, 2005 of the Minister of Health.
Along with promoting the strength of the hospital in examination, treatment, caring,
protection and improvement of people's health in the province and the region. The
hospital has actively implemented social activities such as free medical examination
for people in remote and disadvantaged areas; coordination with charity
organizations to giving meals to serve the poor, participation in disease prevention,
humanitarian blood donation ... etc. The Hospital always sets priority target to
improve constantly the quality of medical examination and treatment. In order to
accomplish this goal, hospital leaders appreciate and focus on people as a key
factor. Therefore, even in difficult times, lack of human and budget, the hospital still
tries to prioritize investment in training and human resource development.
With a team of highly qualified professional and technical staff, and some modern
equipment, Binh Dinh General Hospital is always a reliable medical examination and
treatment place for patients and their relatives in the province and nearby provinces.
1.5. Structure of research
Chapter 1: Introduction
Chapter 2: Literature review on patient satisfaction
Chapter 3: Research methodology
Chapter 4: Results of inpatient satisfaction in Binh Dinh provincial general hospital
Chapter 5: Recommendations to improve patient satisfaction in Binh Dinh provincial
general hospital

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CHAPTER 2: LITERATURE REVIEW ON PATIENT SATISFACTION
2.1. Hospital services
According to an article on Encyclopedia of Surgery, hospital services is a term that
refers to medical and surgical services, the supporting laboratories, equipment and
personnel that make up the medical and surgical mission of a hospital or hospital
system. Hospital services cover a range of medical offerings from basic health care
or training and research for major medical school centers to services designed by an
industry-owned network of such institutions as health maintenance organizations
(HMOs). The mix of services that a hospital may offer depends almost entirely upon
its basic missions or objectives.
Hospital services define the core features of a hospital's organization. The range of
services may be limited in such specialty hospitals as cardiovascular centers, or
cancer treatment centers, or very broad to meet the needs of the community, or patient
base, as in full service health maintenance organizations (HMOs), rural charity
centers, urban health centers, or medical research centers. Hospital services are
usually the most general in large urban areas or underserved rural areas, broadly
encompassing many services ordinarily offered by other providers.
2.2. Service quality
Gronroos (1984) argues that customer perceived quality is influenced by a technical
and functional dimension. The functional quality is more important as long as the
technical quality is at a satisfactory level, a high level of functional quality may
compensate for temporary matters in technical quality in overall assessments of
service quality. Technical quality in the healthcare sector based on the basis of the
technical accuracy of the diagnoses and procedures. Functional quality refers to the
way in which the healthcare services delivered to the patients and it is usually the
main determinant of patients’ quality perceptions.

7
Quality is a term that we usually think of an excellent product or service that meets
our expectations. Quality is based on perceptions of individuals on products and
services, these perceptions have been created through past experience of customers.
Parasuraman, Ziethml, Barry (1985) Service quality is a type of attitude related to
satisfaction described as the difference between the customer’s expectations and
perception of services
Javetz and Stem (1996) were the first to observe the growing attention to
improvement of quality as a result of three important trends characterizing the
healthcare sector
- The market has become more competitive, healthcare insurers and providers
compete based on economic considerations.
- There has been a consumption growth of private healthcare services
- A marked growth of customers’ awareness with their rights in healthcare
sector
Hollis (2006) agreed that financial impact is a significant consideration but stressed
that the management of consumer perceptions of healthcare quality is also significant
with the following reasons:
- Evaluation of quality is related to satisfaction and service re-use intent
- Quality improvement methods require the identification and meeting of patient
expectations
Zineldin (2006) Patient satisfaction is an important health outcome and quality
measurement and he suggested reasons for the improvement of quality as followings:
- Patient dissatisfaction with high costs and poor quality
- Quality methods give managers ways to solve problems, influence the work,
improve relations with health workers, provide ways to reduce waste and save
Money
- Unnecessary drugs, surgery and laboratory wastes resources, and harms
patients
From the previous authors, quality is a crucial determinant of competitiveness and
long-term profitability in both service and manufacturing organizations. However, he

8
concluded that quality methods used in developed countries were not appropriate for
developing countries therefore the different reasons given for quality improvement
comparing to those of previous authors
Raja, Deshmukh and Wadhwa (2007) supported the argument that quality
management has emerged not only as the most important and long-term strategy for
ensuring the survival of organizations, but also leads to business excellence. The
authors concluded that declining reimbursement, new incentive structures, and
increasing competition are placing pressure on providers to deliver healthcare
services effectively and efficiently. The authors also stated that most healthcare
organizations are beginning to realize that quality is necessary for survival.
James (2005) argued that the healthcare industry is moving from competition based
on price to competition based on quality and performance.
It is obvious from all of the authors mentioned above that high quality of service is
vitally important for the survival of healthcare facilities.
2.3. Customer satisfaction
Wilson et al (2008) Customer satisfaction has been a great topic for organizations and
researchers because customer satisfaction will be an important factor to increase sales,
maximize profits, minimize costs, and lead to customer loyalty.
Customers play a significant role in the organizational process and are the first aspect
to be considered by managers. Customers are always trying to get maximum
satisfaction from products and services. Winning in today’s severe competition
market, it is necessary to build not only the products but also customer relationship
that means delivering superior value to the targeted customers. Most companies
adopts quality management programs which improves the quality of products and
marketing processes because quality has a direct impact on product performance and
on customer satisfaction, Kotler et al (2002).
Kotler & Keller (2009) it is termed satisfaction when a customer is contented with
products or services, satisfaction can be a person’ feelings of pleasure or
disappointment comparing a product’s perceived outcome with their expectations

9
Levy (2009) suggested three ways of measuring customer satisfaction
- A survey that customer feedback could be transformed into measureable data
- Focus group where discussions arranged by a trained moderator reveal what
customers think
- Informal measures like talking to customers or reading blocs
The National Business Research Institute suggested possible dimensions that can be
used in measuring customer satisfaction
- Quality of service
- Innocently
- Speed of service
- Pricing
- Complaints or problems
- Trust in your employees
- The closeness of the relationship with contacts in your firm
- Other types of services needed
- Your positioning in clients’ mind
2.4. Customer satisfaction and service quality
Cronin & Taylor (1992) customer satisfaction has been considered to be based on the
customer’s experience on a particular service encounter, the fact that service quality
is a determinant of customer satisfaction because service quality comes from results
of the services from providers.
Oliver (1993) suggested that service quality would be antecedent to customer
satisfaction regardless of whether these constructs were cumulative or transaction-
specific.
Wilson et al (2008) have been more precise about the meaning and measurement of
service quality and satisfaction. Service quality and satisfaction have certain things
in common; however, satisfaction is a broader term whereas service quality focuses
on dimensions of service.

10
2.5. Overview of patient satisfaction
Hulka et al (1970) attempted to undertake the initial steps in the conceptualization of
the patient satisfaction concept. These researchers defined "satisfaction" as the
patient's "attitudes toward physicians and medical care.” More specifically, judgment
concerning the quality of medical care received from physicians, nurses.
Researchers in the consumer satisfaction have the definition of satisfaction as a
cognitively based evaluation of product or service attributes. These researchers
contend that satisfaction is an emotional or affective response to a product or service
use (Oliver 1981).
Ross et al. (1987) argues that restricting patient satisfaction to perceptions of the
"quality" of health care received is an "inherent weakness." The researcher supports
his position by noting that a segment of "healthy but unhappy" patients have been
found in several empirical studies. Thus, Ross et al. suggest that the conceptualization
of the patient satisfaction should be enlarged to include other evaluations (e.g.,
waiting time, costs…etc.) in addition to purely quality perceptions.
Tam (2007) satisfaction is a process of comparing service perceptions with
expectations. The initial expectations of patients about services considered as a
determinant of satisfaction. If perceived care is lower than expectation, the outcome
will be dissatisfaction. When patients meet or exceed expectations, the result will be
satisfaction.
2.6. Role of patient satisfaction
Pollack (2008) shows that there is a close relationship between patient satisfaction
and profits of healthcare providers. Patient satisfaction will help to increase profits
and improve competitiveness with other hospitals.
Patient satisfaction plays an important role for public healthcare providers because
patient satisfaction determines the survival and development of public hospitals,
according to Decree No 55/2012/ND-CP public healthcare providers will be
dissolved if the task is not completed in three consecutive years. Therefore, patient
satisfaction will be the evidence of task completion of hospitals. Improving

11
satisfaction will benefit not only service users when they access high quality services
but also healthcare service providers.
In recent years, assessment of patient satisfaction to public healthcare services has
not been implemented uniquely and widely. Currently, there has not been a general
indicator reflecting patient satisfaction towards public medical services.
2.7. The relationship between service quality and patient satisfaction
Fornell, Johnson, Anderson and Bryant (1996) service quality is one of three
antecedents to patient satisfaction with expectation and perceived value.
Raja et al (2007) healthcare service quality is relating to activities, interactions, and
solutions to customer problems.
Badri, Attia and Ustadi (2008) patient satisfaction is considered the most crucial point
in the planning, implementation, and evaluation of service quality
Hollis (2006) argued that there was a strong link between service quality and
satisfaction, and it is believed that quality has been defined as perceived satisfaction.
Sailia, Mattila, Aalto and Kaunonen (2008) patient satisfaction is widely used as an
indicator in assessing quality of care.
2.8. Factors impacting patient satisfaction
Expectations are believed to be one of the primary determinants of patient satisfaction,
expectations reflect the levels of quality that patients expect to receive and it is the
result of previous experience
Marley, Collier and Goldstein (2004) differentiate process quality and technical
quality. Process quality refers to how healthcare services are delivered to patients and
technical quality refers to what patients receive.
Sofaer and Firminger (2005) identified seven dimensions:
- Patient-centered care
- Access
- Courtesy and emotional support
- Communication and information
- Technical quality

12
- Efficiency of care organization
- Structure and facilities
Attree (2001) researched the perceptions of doctors, nurses, managers, patients and
their relatives, the study showed the results of five dimensions
- Patient focus
- Availability and accessibility to patients
- Open communication and information flow
- Encouraging a close, sociable relationship
- Holistic care
Infante, Proudfoot, Davies, Bubner, Holton, Beilby and Harris (2004) researched the
perceptions of patients and the results showed seven dimensions:
- Trusts and believes patients
- Convenient consultation times
- Good interpersonal skills
- Caring and compassionate
- Clinical skills
- Good triage system
- Variety of clinical services
Andaleeb, Siddiqui and Khandakar (2007) researched patient satisfaction at public,
private, and foreign hospitals in Bangladesh. Doctors’ service orientation, nurses’
service orientation, and tangible evidence of facilities were the most significant
factors.
Carman (2000) nursing care was the most significant issue whilst physician care was
the third most significant.
Vukmir (2006) waiting time and the amount of caring were the most important
determinants in the emergency department.
Saila et al (2008) the reasons of patient dissatisfaction: having to wait for an
appointment, the length of waiting time, communication and information received,
duration of consultation, lack of reach ability, lack of continuity, not being able to
participate in and contribute to decision making

13
Tam (2007) identified factors of medical service that influenced patient satisfaction
including:
- Doctor’s technical quality
- Doctor’s interpersonal skills
- Quality of nurses
- Quality of support staff
- Efficiency of appointment system
- Waiting time
- Duration of consultation
- Physical environment
- Respect for patient’s privacy.
Bielen and Demoulin (2007) waiting time is not only a satisfaction determinant but
also moderates the satisfaction-loyalty relationship. Determinants of waiting time
include the perceived waiting time, information provided while waiting and waiting
environment.
Anderson, Barbara and Feldman (2007) patient satisfaction ratings were influenced
by a core of communication and follow-up care. The core qualities are the most
important including communication, access, inter-personal skills, care coordination
and follow up. The quality of medical care processes, quality of healthcare facilities
and quality of office staff followed in order of importance.
Saila et al (2008) the most important determinant was the actual consultation with the
doctor, effective communication was the key to patient satisfaction. The Professional
skills and competencies of staff members, protection of privacy, and perceived
usefulness of the visit were highly rated.
Germaine (13), expectations include the availability of professional care, the
individuality of treatment, the competence, experience, maturity, dependability,
knowledge, and skills of the nursing staff.
Tucker and Adams (2001) the most significant issue in patient assessment is the
interpersonal relation between patients and service providers.

14
Woolley et al. (1978) not only considered the importance of expectation of outcome
as a predictor of satisfaction in primary care, but also the level of communication
about this expected outcome between the patient and the general practitioner.
Perceived attribute performance: tangible and intangible value that patients receive
in the process of using services and the process has a direct impact on evaluating
patients’ satisfaction
Disconfirmation: customer dissatisfaction to services depends on the levels of
product quality. A product or service including many factors relating to examination
and treatment, facilities, medicine that is not recognized affecting directly to the
reduction of patient satisfaction
Attribution of cause: the process that individuals give causes of behaviors and events.
There are two types including external attribution (situational attribution) and internal
attribution
Equity: the beliefs that people value fair treatment. An individual feel satisfied if he
is treated fairly as others around him.
Summary of determinants from previous studies on patient satisfaction
Authors Year Contents
Attree 2001
- Patient focus
- Availability and accessibility
to patients
- Open communication and
information flow
- Encouraging a close, sociable
relationship
- Holistic care
Tucker & Adams 2001 - Interpersonal relation skills
Infante et al 2004
- Trusts and believes patients
- Convenient consultation times
- Good interpersonal skills
- Caring and compassionate
- Clinical skills
- Good triage system

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- Variety of clinical services
Sofaer and Firminger 2005
- Patient-centered care
- Access
- Courtesy and emotional
support
- Communication and
information
- Technical quality
- Efficiency of care
organization
- Structure and facilities
Vukmir 2006
- Waiting time and the amount
of caring
Tam 2007
- Doctor’s technical quality
- Doctor’s interpersonal skills
- Quality of nurses
- Quality of support staff
- Efficiency of appointment
system
- Waiting time
- Duration of consultation
- Physical environment
- Respect for patient’s privacy
Anderson, Barbara and
Feldman
2007
- Communication
- Follow-up care
Bielen and Demoulin 2007 - Waiting time
Andaleeb, Siddiqui and
Khandakar
2007
- Doctors’ service orientation
- Nurses’ service orientation
- Tangible evidence of facilities
Saila et al 2008
- Waiting for an appointment
- Waiting time and
communication
- Lack of reach ability
- Lack of continuity
- Lack of participation in
decision making

16
CHAPTER 3: RESEARCH METHODOLOGY
3.1. Research design
The research collected data via a questionnaire survey. Zikmund (2003) the survey is
accurate, quick and inexpensive assessing information about research subjects, a
questionnaire survey is a research technique in which information is gathered from a
sample of people participating in the study. Two major errors of the survey are
random sampling error and systemic error. There are respondent and administrative
errors in systemic errors. Non-response errors and response bias are in respondent
errors whereas data processing errors, sample selection errors, interviewer errors are
in administrative errors. These errors may occur in the study.
Zikmund (2003) business research provides information to help reduce uncertainty,
there are three main classes of business research based on function or purpose, namely
casual, exploratory and descriptive research. Descriptive research is implemented to
describe characteristics of a phenomenon or population.
Distinguishing descriptive research and exploratory research is that descriptive
research is based on previous awareness of the nature of the research matters. The
research implemented in this study can be best understood as mainly descriptive.
The questionnaire could be electronic or printed questionnaires. Pre-testing process
of the survey questionnaire is conducted by a trial run with a group of respondents
including patients in the hospital. The purpose of the test is detecting problems in the
questionnaire’s design and instructions. The questionnaire was tested for evidence of
potential misunderstandings, ambiguous questions, questions that means the same to
all respondents.

17
3.2. Research process
Figure 1. Research process
Source: Created by the author
3.3. Data collection
The method of data collection is questionnaire survey handed personally to patients
in the hospital. Zikmund (2003) suggested selecting relevant methods including speed
of data collection, cost, and anonymity.
+ Source of information: Primary data and secondary data
+ Primary data:
The primary data is collected through survey questionnaire, which is the main source
of information showing the findings of the research
+ Survey:
Zikmund (2003) two basic criteria of a questionnaire are relevance and adequacy. A
questionnaire is relevant if necessary data is collected and the information of data that
Primary data
collection
Survey questionnaire to
collect data of inpatient
satisfaction
Assessment
of inpatient
satisfaction in
Binh Dinh
provincial
general
hospital
Secondary data
collection
Books, reports,
newspapers, internet
Data
processing
and
analysis
Recommendations

18
is needed to solve the problems is obtained and the adequacy of a questionnaire is
decided by being reliable and valid.
Based on the Decision 4448/QD-BYT by the Ministry of Health, information of
patient satisfaction is collected in Binh Dinh provincial general hospital. The
questionnaire is based on 5 dimensions to evaluate inpatient satisfaction: (1)
Accessibility; (2) Transparency on information, examination and treatment
procedures; (3) Facilities and Equipment; (4) Medical staff’s behavior and
professional capacity; (5) Results of service provision.
- Respondents: Individual patients using medical services with stable
psychology, non-psychiatric diseases and a good health status that meets
requirements of the survey in the hospital.
- Sample size: 300 individual patients using medical services in the hospital
- Survey tools: The tool for information collection is survey questions based on
5-level scale of each question measuring from negative side to positive side.
The number of questions must fully cover 5 dimensions reflecting patient
satisfaction with medical services in the hospital.
+ Questionnaire distribution:
Questionnaire is delivered directly to patients using medical services in Binh Dinh
provincial general hospital. The questionnaire was delivered in different time and 300
valid questionnaires have been collected.
+ Scale:
Zikmund (2003) defines attitude as an enduring disposition to consistently respond
in a way to various aspects of the world including persons, events and objects. There
are three components: cognitive, behavioral and affective components. Direct verbal
statements relating belief, behavior or belief are used to assess behavioral intent.
Obtaining verbal statements generally requires that respondents perform a task, for
example, rating, sorting, ranking or making a choice. Rating is to estimate the
magnitude of quality or a characteristic that an object possesses. Quantitative scores
are used to estimate the strength of the belief or attitude. A Likert-type response scale
or multiple-response scale from very poor to very good was used. This scale is both

19
parallel and balanced so that responses can be quantified and the differences analyzed
appropriately. Patient responses were converted into scale for data analysis as
followings: very poor = 1, poor = 2, normal = 3, good = 4, and very good = 5.
+ Sample: Zikmund (2003) suggested that it is important to define carefully the target
population so that the proper source of data can be identified. In this research, the
target population can be identified as inpatients in the hospital.
The most common criteria of selecting a sample are resources, time, degree of
accuracy, need for statistical projections and advance knowledge of population
characteristics. There are several ways of taking a sample, there are two main groups
including probability and non-probability techniques.
In probability sampling, every element of the population has a selection of known
non-zero probability. In a non-probability sampling, the probability of any members
of population chosen is unknown. The ideal to obtain a probability sample by
ensuring that the projections of data would be appropriate statistically.
+ Secondary data:
From documents, reports such as: Jackie Tam (2007) "Linking quality improvement
with patient satisfaction: a study of a health service centre", Anderson, Barbara and
Feldman (2007) “What patients want: A content analysis of key qualities that
influence patient satisfaction”. Policies, regulations: Decision 4448/QD-BYT by the
Ministry of Health on defining methods to measure people’s satisfaction with public
health services; Decree No. 55/2012/ND-CP; Resolution No. 30c/NQ-CP of the
Government in the field of caring, protection and improvement of people's health.
Other articles on newspapers, books that are related to patient satisfaction.
+ Data analysis method:
The author applies different tools to analyze data: Stata software, Microsoft Office,
Graphs, Charts.
+ Research Scope
Patients using medical services in Binh Dinh provincial general hospital in 2018. The
research focuses on assessing inpatient satisfaction with 300 individual patients who
use medical services in the hospital

20
Timing: The primary data is collected in 2018
+ Research Schedule:
Time (2019) Contents
From March to April Data processing
April-May Data analysis and writing
June Final thesis presentation
3.4. Research model
In Vietnam, Decision 4448/QD-BYT by Ministry of Health approves the proposal
“Defining methods to measure people’s satisfaction with public health services”
giving some groups of criteria for measuring patient satisfaction including
Accessibility, Transparency on information and administrative procedures, Facilities,
Staff’s behavior and Results of service provision.
The author based on the proposal by Ministry of Health and the studies by Tam
(2007); Bielen and Demoulin (2007); Anderson, Barbara and Feldman (2007)…etc.
to develop the research model.
Based on previous studies, summary of factors that affect patient satisfaction in
chapter 2. These factors have been put into 5 groups.
The research model includes the following factors of patient satisfaction
1. Accessibility: Attree (2001) Availibility and accessibility; Sofaer and
Firminger (2005) Access…etc.
+ Distance from home to the hospital
+ Location, signboards and instruction to the hospital
+ Applying information technology for advertising services
+ Time of patient visit
2. Transparency on information, examination and treatment procedures: Attree
(2001) Open communication and information flow; Tam (2007) Waiting time,
Efficiency of appointment system; Saila et al (2008) Waiting for an
appointment…etc.
+ Applying information technology for dealing with administrative procedures

21
+ Regulations of the hospital, regulation on medical staff’s behaviors
+ The process and procedures of examination and treatment
3. Facilities and Equipment: Tam (2007) Physical environment; Andaleeb,
Siddiqui and Khandakar (2007) Tangible evidence of facilities; Sofaer and
Firminger (2005) Structure and facilities…etc.
+ Patient’s room, patient’s bed, canteen
+ The setup of departments, divisions
+ Environment, space and atmosphere of service provision rooms
4. Medical staff’s behavior and professional capacity: Sofaer and Firminger
(2005) Patient-centered care, Courtesy and emotional support; Infante et al
(2004) Caring and compassionate…etc.
+ Following regulations on communication
+ Serving behaviors
+ Knowledge and skills on technical and professional capacity
5. Results of service provision: Tam (2007) Doctor’s technical quality, quality of
nurses; Infante et al (2004) Convenient consultation times; Andaleeb, Siddiqui
and Khandakar (2007) Doctors’s service orientation; Tam (2007) Duration of
consultation…etc.
+ Applying information technology for service provision
+ Time of service provision
+ The trust on service quality, reputation of the hospital
+ Level of meeting patient’s expectation

22
Figure 2. Research model
Source: Bielen and Demoulin (2007); Tam (2007); Anderson, Barbara and
Feldman (2007) Decision No. 4448/QD-BYT by the Ministry of Health
Transparency on
information, examination
and treatment procedures
Facilities and Equipment
Medical staff’s behavior and
professional capacity
Results of service provision
Inpatient Satisfaction
Patient Return
Accessibility

23
CHAPTER 4: RESULTS OF INPATIENT SATISFACTION IN BINH
DINH PROVINCIAL GENERAL HOSPITAL
4.1. General information of researched patients
After collecting and inputting data into Excel, the data shows results as followings:
Table 4.1. Patient classification by sex
Sex n %
Male 149 49,67
Female 151 50,33
Total 300 100
Source: Data collected from the survey (2018)
Summary: There are 300 valid questionnaires that have been collected and the
percentage of male is approximately 49,67% compared to the percentage of female
is 50,33%. The scale of male and female is equal and ideal
27.33%
38.67%
34%
Age <36
Age 36-60
Age >60

24
Figure 3. Patient satisfaction by age
Summary: Patients aged from 36-60 have the highest percentage with 38,67%,
patients aged under 36 have the lowest percentage with 27,33% and patients aged
more than 60 accounts for 34%.
Table 4.2. The total number of days of hospitalization
Average days of hospitalization ± SD Min Max
7,22 ± 6,67 1 60
Table 4.3. Patients using of health insurance card for this treatment
Health insurance card n %
Yes 282 94,00
No 18 6,00
Total 300 100

25
Summary: Most of the patients used the health insurance card for this treatment with
the percentage of 94%; only 6% of patients did not use the health insurance card
4.2. Assessment of inpatient satisfaction
4.2.1. Inpatient satisfaction on accessibility
The first criteria to assess patient satisfaction is accessibility, accessibility is the first
approach of patients to the hospital.
Table 4.4. Classification of inpatient satisfaction by accessibility
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Signboards
and maps of
direction to
different
departments
of the
hospital are
clear and easy
to see and
find
2 0,67 1 0,33 42 14,00 132 44,00 123 41,00
Time of
patient visit is
listed clearly
1 0,33 1 0,33 22 7,33 152 50,67 124 41,33
The
buildings,
stairs and
patient rooms
are numbered
clearly and
easily able to
be seen
1 0,33 - - 47 15,67 121 40,33 131 43,67
The hallways
in the hospital
- - - - 40 13,33 145 48,33 115 38,33

26
are flat and
easy to move
Patients are
able to call
medical staff
for help when
needed
- - 2 0,67 23 7,67 141 47,00 134 44,67
Summary: Patients highly appreciated the item “Time of patient visit is listed clearly”
with the percentage of 41,33% very satisfied and 50,67% satisfied
The item “The buildings, stairs and patient rooms are numbered clearly and able to
be seen easily” that was evaluated very dissatisfied and normal has the percentage up
to 16%
Figure 4. Summary of inpatient satisfaction on Accessibility
72%
28%
Satisfaction
Dissatisfaction

27
4.2.2. Inpatient satisfaction on Transparency on information, examination and
treatment procedures
Table 4.5. Classification of inpatient satisfaction by Transparency on information,
examination and treatment procedures
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
The process
and procedures
of
hospitalization
are clear,
public and
convenient.
- - 1 0,33 32 10,67 118 39,33 149 49,67
Regulations
and necessary
information of
hospitalization
are announced
clearly
- - - - 28 9,33 134 44,67 138 46,00
The condition
of disease,
methods and
estimated time
of treatment
are explained
clearly
- - 2 0,67 36 12,00 115 38,33 147 49,00
Before testing
and using high
technology
equipment,
patients are
explained
clearly
- - 3 1,00 32 10,67 122 40,67 143 47,67

28
Updated
information of
drugs and cost
of treatment
are listed
clearly
- - 2 0,67 25 8,33 121 40,33 152 50,67
Summary: the item "Updated information of drugs and cost of treatment are public”
was highly evaluated with the percentage of 91% very satisfied and satisfied.
Patients evaluated the item “The condition of disease and methods, estimated time of
treatment are explained clearly” dissatisfied and normal with the percentage up to 12,
67%
80.67%
19.33%
Satisfaction
Dissatisfaction

29
4.2.3. Inpatient satisfaction on Facilities and equipment
Table 4.6. Classification of inpatient satisfaction by Facilities and equipment
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Patient rooms
are spacious,
clean and full
of equipment
such as fans,
heaters or air
conditioners
1 0,33 4 1,33 48 16,00 134 44,67 113 37,67
Patient beds
with pillows,
sheets are safe
and in good
condition
2 0,67 6 2,00 42 14,00 139 46,33 111 37,00
Toilets, bath
rooms are
convenient,
clean and in
good
condition
1 0,33 4 1,33 59 19,67 111 37,00 125 41,67
Patient rooms
are safe and
have good
security
- - 3 1,00 49 16,33 146 48,67 102 34,00
Clean clothes
are provided
for patients
1 0,33 - - 30 10,00 141 47,00 128 42,67
Hot and cold
water are
provided for
patients
3 1,00 4 1,33 46 15,33 159 53,00 88 29,33

30
Is there a
private area
for patients
when
necessary
such as
clothes
changing or
examination
3 1,00 8 2,67 51 17,00 146 48,67 92 30,67
Canteen of
the hospital
meets the
expectation of
patients for
meals and
other needs
- - 4 1,33 49 16,33 157 52,33 90 30,00
The
environment
in the hospital
campus is
green and
clean
- - - - 34 11,33 150 50,00 116 38,67
Summary: Patients evaluated the item “Clean clothes are provided for patients” with
the percentage of 89,67%. However, the item “Toilets, bath rooms are convenient,
clean and in good condition” was evaluated 21,33% very poor, poor and normal.

31
Figure 6. Summary of inpatient satisfaction on Facilities and equipment
4.2.4. Inpatient satisfaction on Medical staff’s behavior and professional capacity
Table 4.7. Classification of inpatient satisfaction by Medical staff’s behavior and
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Medical staff
(doctors,
nurses) has
good words,
behaviors and
communication
skills
- - 2 0,67 25 8,33 125 41,67 148 49,33
Serving staff
(security
guards,
receptionist…)
- - 3 1,00 31 10,33 132 44,00 134 44,67
58%
42%
Satisfaction
Dissatisfaction

32
has good
words,
behaviors and
communication
skills
Medical staff
respects, treats
and takes care
of patients
fairly
- - 2 0,67 27 9,00 138 46,00 133 44,33
Doctors and
nurses have a
good
cooperation
and the task is
completed
quickly
- - 1 0,33 23 7,67 143 47,67 133 44,33
Patients are
visited and
encouraged by
doctors at the
patient rooms
- - - - 25 8,33 135 45,00 140 46,67
Patients are
consulted by
doctors about
meals,
exercises and
prevention
from
symptoms
- - 1 0,33 26 8,67 145 48,33 128 42,67
Medical staff
do not have
suggestions of
tips
1 0,33 - - 23 7,67 136 45,33 140 46,67

33
Summary: Up to 92% of patients evaluated very good and good about the item
“Medical staff do not have suggestions of tips” and the item “Doctors and nurses have
a good cooperation and the task is completed quickly”
4.2.5. Inpatient satisfaction on Results of service provision
Table 4.8. Classification of inpatient satisfaction by Results of service provision
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Provision and
usage
instruction of
drugs are
explained
clearly
- - - - 17 5,67 130 43,33 153 51,00
81%
19%
Satisfaction
Dissatisfaction

34
Equipment
and medical
supplies are
complete,
modern and
meet your
expectation
- - 2 0,67 33 11,00 145 48,33 120 40,00
The result of
treatment
meets your
expectation
- - 1 0,33 28 9,33 142 47,33 129 43,00
Mr./Mrs.
evaluates the
level of trust
on quality of
medical
services
- - - - 28 9,33 143 47,67 129 43,00
Mr./Mrs.
evaluates the
level of
satisfaction
on fee of
medical
services
- - - - 32 10,67 128 42,67 140 46,67
Summary: Up to 94.33% patients evaluated very good and good with the item
“Provision and usage instruction of drugs are detailed”. However, 11.67% patients
evaluated dissatisfied and normal with the item “Equipment and medical supplies are
full, modern and meet your expectation”

35
Figure 8. Summary of inpatient satisfaction on Results of service provision
4.3. Summary of results on inpatient satisfaction
4.3.1. Inpatient satisfaction in general and classified by factors
Table 4.9. Inpatient satisfaction in general and classified by factors
Average Min Max
Accessibility 4,3 2,8 5
Transparency on information, examination and
4,4 2,8 5
Facilities and Equipment 4,2 2,3 5
Medical staff’s behavior and professional capacity 4,4 2,1 5
Results of service provision 4,4 2,8 5
Average point of inpatient satisfaction 4,3 2,9 5
83.67%
16.33%
Satisfaction
Dissatisfaction

36
In the table 4.9, All the factors have the point more than 4 and the average point of
inpatient satisfaction is 4,3.
4.3.2. Percentage of overall assessment of inpatient satisfaction
Table 4.10. Percentage of overall assessment of inpatient satisfaction
Average percentage of inpatient satisfaction ± SD Min Max
90,1 ± 10,24 50 100
Summary: Average percentage of inpatient satisfaction is 90,1% while the lowest
percentage of inpatient satisfaction is 50%
4.3.3. Classification of patients who will return or introduce to other patients
Table 4.11. Classification of patients who will return or introduce to other patients
n %
Never come back - -
Do not want to come back but there is no other choices 3 1,00
Want to move to another hospital 2 0,67
Maybe come back 109 36,33
Definitely come back or introduce to other patients 186 62,00
Total 300 100,00
Summary: The result shows that 62% of patients will come back for treatment at the
hospital and 36,33% maybe come back. Only 1% do not want to come back. With the
percentage of more than 90% of patients who may come back for the next treatment,

37
it is a signal for the hospital. However, the hospital needs to do more to retain the
other patients.
4.3.4. Odds Ratio Analysis
Table 4.12. The relation between related factors and inpatient satisfaction
General assessment of
inpatient satisfaction on
meeting expectation (%)
OR
(95% CI)
P
> 90% < 90%
Accessibility
Dissatisfaction 45,78 54,22 5,4
(2,99 -
9,76)
<0,05
Satisfaction 82,00 18,00
Transparency
on
information,
examination
and treatment
procedures
Dissatisfaction 60,24 39,76
5,07
(2,64 –
9,72)
<0,05
Facilities and
Equipment
(1,99 –
6,14)
<0,05
Satisfaction 66,36
33,64
Medical
staff’s
behavior and
professional
capacity
6,46
(3,32 –
12,62)
<0,05
Results of
service
provision
(4,50 –
19,83)
<0,05
Summary:
- Satisfied patients on “Accessibility” have the average percentage >90% are
5,4 times higher than Dissatisfied patients with CI 95%: 2,99-9,76 and
p<0,05
- Satisfied patients on “Transparency on information, examination and
treatment procedures” have the average percentage >90% are 5,07 times
higher than Dissatisfied patients with CI 95%: 2,64 – 9,72 and p<0,05

38
- Satisfied patients on “Facilities and Equipment” have the average
percentage >90% are 3,48 times higher than Dissatisfied patients with CI
95%: 1,99 – 6,14 and p<0,05
- Satisfied patients on “Medical staff’s behavior and professional capacity”
have the average percentage >90% are 6,46 times higher than Dissatisfied
patients with CI 95%: 3,32 – 12,62 and p<0,05
- Satisfied patients on “Results of service provision” have the average
percentage >90% are 9,34 times higher than Dissatisfied patients with CI
95%: 4,50 – 19,83 and p<0,05
Table 4.13. The relation between related factors and patient return
General assessment of
inpatient satisfaction
on patient return or
introduction to other
people (%)
OR
(95% CI)
P
Definitely Maybe
Accessibility
Dissatisfaction 63,16 36,84 2
(1,16 –
3,45)
<0,05
Transparency
on
information,
examination
and treatment
procedures
3,44
(1,82 –
6,55)
<0,05
Facilities and
Equipment
(1,37 –
3,77)
<0,05
Medical
staff’s
behavior and
professional
capacity
3,63
(1,91 –
6,97)
<0,05
Results of
service
provision
(1,95 –
7,86)
<0,05

39
Summary:
- Satisfied patients on “Accessibility” definitely come back to the hospital are
2 times higher than Dissatisfied patients with CI 95%: 1,16-3,45 and p<0,05
- Satisfied patients on “Transparency on information, examination and
treatment procedures” definitely come back to the hospital are 3,44 times
higher than Dissatisfied patients with CI 95%: 1,82 – 6,55 and p<0,05
- Satisfied patients on “Facilities and Equipment” definitely come back to the
hospital are 2,27 times higher than Dissatisfied patients with CI 95%: 1,37 –
3,77 and p<0,05
- Satisfied patients on “Medical staff’s behavior and professional capacity”
definitely come back to the hospital are 3,63 times higher than Dissatisfied
patients with CI 95%: 1,91 – 6,97 and p<0,05
- Satisfied patients on “Results of service provision” definitely come back to
the hospital are 3,88 times higher than Dissatisfied patients with CI 95%:
1,95 – 7,86 and p<0,05

40
CHAPTER 5: RECOMMENDATIONS TO IMPROVE INPATIENT
SATISFACTION IN BINH DINH PROVINCIAL GENERAL
HOSPITAL
After showing and summarizing the results at Chapter 4. Due to the limitation of time
and capacity, the author just suggests some recommendations to the problems with
my own expertise
5.1. Improving facilities in the hospital
Some patients evaluated normal with the facilities of the hospital such as signboards
and map of direction to different departments are not clear, buildings and rooms are
not numbered easily to been seen. Patient’s rooms are not spacious and clean. Toilets
and bathrooms are not in good condition. With these issues, the hospital should
consider more about improving facilities.
Besides those issues above, the hospital should provide hot and cold water for patients
as well as improve the quality of the canteen to provide better meals for patients.
Patients also want to have private areas in case of necessity such as clothes changing
or private examination.
5.2. Investing more in medical equipment and information technology to
improve service quality
The hospital should provide tools for online services so that patients can register and
manage their time and disease such as with electronic health records, patients can
follow their condition. Patients want to follow their health condition like manage their
bank account so it is very convenient to register just with electronic devices.
The hospital should also consider about how to invest in medical equipment to
diversity modern devices to improve medical services. It is difficult for the hospital
to buy directly the equipment therefore the hospital can cooperate with medical
equipment enterprises to have more modern equipment
With the development of advanced information technology, the hospital should help
patients to have a good experience with information about medical services such as
patients could have access to the social network channels of the hospital like

41
Facebook, Twitter to get more education and support for current treatment or in the
future. With the social network channels, patients could talk to doctors, ask questions
and give comments for the services.
5.3. Simplifying complicated administrative procedures
With the current modern technology, simplification of administrative procedures is
considered to be necessary, however, it can be complex to deal with and it needs the
participation of all levels of the hospital.
In the future, there should be more action plans to alleviate the burden of
administrative procedures at the hospital. The hospital should apply more information
technology to transfer from medical records in paper to electronic medical records.
5.4. Improving medical staff’s communication skills
Effective communication will create a good relationship with patients, this is very
important in delivering healthcare services because patients would be easy to
cooperate and be more satisfied. However, in public hospitals the relationship
sometimes is not good because there are some reasons for that such as patients’
anxiety and fear, staff’s fear of physical and verbal harassments…etc.
5.5. Limitations of the thesis
The scope of the research is quite narrow, only in Binh Dinh provincial general
hospital. The data was collected as the basis of the study and the results may not be
applicable to all public hospitals. For more information of patient satisfaction, other
studies need to be conducted in other hospitals in different provinces.
The research model has not indicated the relation between patient satisfaction and
patient return. The other variables that affect the relations in the model was not
explained.
The questionnaire survey was designed to assess only some factors of patient
satisfaction. Factors that affects patient satisfaction are always changing and there
may be some other factors that are not found in this research. The research has not
mentioned about other options for patients in case of dissatisfaction.

42
CONCLUSIONS
Patient satisfaction is the target of all hospitals because the success or failure
depended on patients, hospitals cannot survive and have no business without patients.
With the current trend of autonomy in finance, patients are becoming the central, and
hospital managers have to know how well they are doing with healthcare services and
it is necessary to communicate, attract and satisfy patients.
The research was implemented with 300 participants who are the inpatients in Binh
Dinh provincial general hospital. The percentage of female accounts for 50.33%
(151/300) and the percentage of male is 49.67% (149/300); most of the inpatients
have the health insurance cards for the treatment with the percentage of 94%
(282/300). Patients evaluated the most the item “Provision and usage instruction of
drugs are detailed” with 94.33%. The average point of inpatient satisfaction is 4.3/5
with min is 2.9/5 and max is 5/5. The average percentage of inpatient satisfaction is
90.1%, the percentage of patients definitely come back to the hospital is 62% and
36.33% may come back.
The hospital has a high rating result but the need of patients should be more evaluated.
With increasing choices of providers, patients will demand excellent services like
other markets. Patients who are satisfied with medical services that they receive will
come back but it is important that current patients will introduce the hospital to other
patients.
The hospital should not only focus on positive ratings but also on the negative ratings.
According to the result, the hospital still has some weaknesses that need to be
improved to make patients more satisfied.
Because of limited capacity and time limitation, there are still many issues needed to
discuss and do more researches. The author hopes that this thesis can be a good
document or background for reference in the future.

43
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46
APPENDIX 1
INPATIENT SATISFACTION SURVEY QUESTIONNAIRE
I am a student of MBA Program at Vietnam Japan University. I am doing my research
on inpatient satisfaction in the Binh Dinh provincial general hospital. In order to
analyze the factors affecting patient satisfaction and make assessments in the hospital,
I would like you to spend some of precious time and help me fill in this following
questionnaire. All of the information that you provide will be used for the purpose of
the research only.
Thank you very much for your help!
1. Name of hospital: ……………………. 2. Date of survey…………………..
3. Name of department….....4. Department code (filled in by the hospital)……..
PATIENT INFORMATION
A1. Sex: 1.Male 2. Female A2. Age ……
A3. Mobiphone: A4. Number of days for treatment …….days
A5. Do you use your health insurance card for this treatment? 1. Yes 2. No
EVALUATION OF USING MEDICAL SERVICES
Please tick the symbol (X) at the relevant box from 1 to 5 with the following
questions:
Very dissatisfied
or Very poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
2 3 4 5
1

47
A. Accessibility
Signboards and maps of direction to different
departments of the hospital are clear and easy to see
and find
Time of patient visit is listed clearly
The buildings, stairs and patient rooms are
numbered clearly and easily able to be seen
The hallways in the hospital are flat and easy to
move
Patients are able to call medical staff for help when
needed
B. Transparency on information, examination and treatment procedures
The process and procedures of hospitalization are
clear, public and convenient.
Regulations and necessary information of
hospitalization are announced clearly
The condition of disease, methods and estimated
time of treatment are explained clearly
Before testing and using high technology
equipment, patients are explained clearly
Updated information of drugs and cost of treatment
are listed clearly
C. Facilities and Equipment
Patient rooms are spacious, clean and full of
equipment such as fans, heaters or air conditioners
Patient beds with pillows, sheets are safe and in
good condition
Toilets, bath rooms are convenient, clean and in
good condition
Patient rooms are safe and have good security
Clean clothes are provided for patients
Hot and cold water are provided for patients
Is there a private area for patients when necessary
such as clothes changing or examination
Canteen of the hospital meets the expectation of
patients for meals and other needs
The environment in the hospital campus is green and
clean
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5

48
D. Medical staff’s behavior and professional capacity
Medical staff (doctors, nurses) has good words,
behaviors and communication skills
Serving staff (security guards, receptionist…) has
good words, behaviors and communication skills
Medical staff respects, treats and takes care of
patients fairly
Doctors and nurses have a good cooperation and the
task is completed quickly
Patients are visited and encouraged by doctors at the
patient rooms
Patients are consulted by doctors about meals,
exercises and prevention from symptoms
Medical staff do not have suggestions of tips
E. Results of service provision
Provision and usage instruction of drugs are
explained clearly
Equipment and medical supplies are complete,
modern and meet your expectation
The result of treatment meets your expectation
Mr./Mrs. evaluates the level of trust on quality of
medical services
Mr./Mrs. evaluates the level of satisfaction on fee of
medical services
G1 Overall evaluation, how many percentage does the
hospital meet your expectation before
hospitalization?
(fill in from 0% to 100% or more than 100% if the
hospital provides good treatment that exceeds your
expectation)
…………..%
G2 If you have the need for
treatment in the future,
do you want to come
back or introduce to
other patients?
1. Never come back
2. Do not want to come back but there is no other
choices
3. Want to move to another hospital
4. Maybe come back
5. Definitely come back or introduce to other
patients
6. Others (details)………………………………
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5

49
H Do you have any other
comments, please
specify?
THANK YOU VERY MUCH!

50
APPENDIX 2
GENERAL INFORMATION OF PATIENTS
Sex n %
Male 149 49,67
Female 151 50,33
Total 300 100
27.33%
38.67%
34%
Age <36
Age 36-60
Age >60

51
Average days of hospitalization ± SD Min Max
7,22 ± 6,67 1 60
Health insurance card n %
Yes 282 94,00
No 18 6,00
Total 300 100

52
APPENDIX 3
ASSESSMENT OF INPATIENT SATISFACTION
Average Min Max
Accessibility 4,3 2,8 5
Transparency on information, examination and
4,4 2,8 5
Facilities and Equipment 4,2 2,3 5
Medical staff’s behavior and professional capacity 4,4 2,1 5
Results of service provision 4,4 2,8 5
Average point of inpatient satisfaction 4,3 2,9 5
Average percentage of inpatient satisfaction ± SD Min Max
90,1 ± 10,24 50 100
n %
Never come back - -
Do not want to come back but there is no other choices 3 1,00
Want to move to another hospital 2 0,67
Maybe come back 109 36,33
Definitely come back or introduce to other patients 186 62,00
Total 300 100,00

53
APPENDIX 4
INPATIENT SATISFACTION BY EACH FACTOR
Accessibility
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Signboards
and maps of
direction to
different
departments
of the hospital
are clear and
easy to see
and find
2 0,67 1 0,33 42 14,00 132 44,00 123 41,00
Time of
patient visit is
listed clearly
1 0,33 1 0,33 22 7,33 152 50,67 124 41,33
The buildings,
stairs and
patient rooms
are numbered
clearly and
easily able to
be seen
1 0,33 - - 47 15,67 121 40,33 131 43,67
The hallways
in the hospital
are flat and
easy to move
- - - - 40 13,33 145 48,33 115 38,33
Patients are
able to call
medical staff
for help when
needed
- - 2 0,67 23 7,67 141 47,00 134 44,67

54
Figure 4. Summary of inpatient satisfaction on Accessibility
Transparency
on
information,
examination
and treatment
procedures
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
The process
and procedures
of
hospitalization
are clear,
public and
convenient.
- - 1 0,33 32 10,67 118 39,33 149 49,67
Regulations
and necessary
information of
hospitalization
are announced
clearly
- - - - 28 9,33 134 44,67 138 46,00
72%
28%
Satisfaction
Dissatisfaction

55
The condition
of disease,
methods and
estimated time
of treatment
are explained
clearly
- - 2 0,67 36 12,00 115 38,33 147 49,00
Before testing
and using high
technology
equipment,
patients are
explained
clearly
- - 3 1,00 32 10,67 122 40,67 143 47,67
Updated
information of
drugs and cost
of treatment
are listed
clearly
- - 2 0,67 25 8,33 121 40,33 152 50,67
80.67%
19.33%
Satisfaction
Dissatisfaction

56
Facilities and
Equipment
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Patient rooms
are spacious,
clean and full
of equipment
such as fans,
heaters or air
conditioners
1 0,33 4 1,33 48 16,00 134 44,67 113 37,67
Patient beds
with pillows,
sheets are safe
and in good
condition
2 0,67 6 2,00 42 14,00 139 46,33 111 37,00
Toilets, bath
rooms are
convenient,
clean and in
good
condition
1 0,33 4 1,33 59 19,67 111 37,00 125 41,67
Patient rooms
are safe and
have good
security
- - 3 1,00 49 16,33 146 48,67 102 34,00
Clean clothes
are provided
for patients
1 0,33 - - 30 10,00 141 47,00 128 42,67
Hot and cold
water are
provided for
patients
3 1,00 4 1,33 46 15,33 159 53,00 88 29,33
Is there a
private area
for patients
when
3 1,00 8 2,67 51 17,00 146 48,67 92 30,67

57
necessary such
as clothes
changing or
examination
Canteen of the
hospital meets
the
expectation of
patients for
meals and
other needs
- - 4 1,33 49 16,33 157 52,33 90 30,00
The
environment
in the hospital
campus is
green and
clean
- - - - 34 11,33 150 50,00 116 38,67
Figure 6. Summary of inpatient satisfaction on Facilities and equipment
58%
42%
Satisfaction
Dissatisfaction

58
Medical staff’s
behavior and
professional
capacity
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Medical staff
(doctors,
nurses) has
good words,
behaviors and
communication
skills
- - 2 0,67 25 8,33 125 41,67 148 49,33
Serving staff
(security
guards,
receptionist…)
has good
words,
behaviors and
communication
skills
- - 3 1,00 31 10,33 132 44,00 134 44,67
Medical staff
respects, treats
and takes care
of patients
fairly
- - 2 0,67 27 9,00 138 46,00 133 44,33
Doctors and
nurses have a
good
cooperation
and the task is
completed
quickly
- - 1 0,33 23 7,67 143 47,67 133 44,33
Patients are
visited and
encouraged by
doctors at the
patient rooms
- - - - 25 8,33 135 45,00 140 46,67

59
Patients are
consulted by
doctors about
meals,
exercises and
prevention
from
symptoms
- - 1 0,33 26 8,67 145 48,33 128 42,67
Medical staff
do not have
suggestions of
tips
1 0,33 - - 23 7,67 136 45,33 140 46,67
81%
19%
Satisfaction
Dissatisfaction

60
Results of
service
provision
Very
dissatisfied
or Very
poor
Dissatisfied
or Poor
Normal
Satisfied
or Good
Very
satisfied
or Very
good
n % n % n % n % n %
Provision and
usage
instruction of
drugs are
explained
clearly
- - - - 17 5,67 130 43,33 153 51,00
Equipment
and medical
supplies are
complete,
modern and
meet your
expectation
- - 2 0,67 33 11,00 145 48,33 120 40,00
The result of
treatment
meets your
expectation
- - 1 0,33 28 9,33 142 47,33 129 43,00
Mr./Mrs.
evaluates the
level of trust
on quality of
medical
services
- - - - 28 9,33 143 47,67 129 43,00
Mr./Mrs.
evaluates the
level of
satisfaction
on fee of
medical
services
- - - - 32 10,67 128 42,67 140 46,67

61
Figure 8. Summary of in patient satisfaction on Results of service provision
83.67%
16.33%
Satisfaction
Dissatisfaction

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