INTERNATIONAL SCHOOL – HANOI NATIONAL UNIVERSITY

MARKETING RESEARCH

“The factors effect on patient’s satisfaction

about the quality of medical service in hospital
in Hanoi”

Director: Assoc. Prof. Pham Thi Lien

Prepared by:
1. Nguyen Thi Oanh – IB2016A -16071091
2. Nguyen Thanh Van – IB2016A -16071133
3. Tran Thi Phuong Thanh – IB2016C - 16071110
4. Dang Thi Nga – IB2016C -1607108
5. Tran Thi To Linh – IB2016C – 16071060
6. Nguyen Thi Thanh Thuy – IB2016C – 16071117
Prepare for: BSA3012

May 19, 2019

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TABLE OF CONTENT

Contents
Abstract........................................................................................................................................................ 4
LISTS OF FIGURES .................................................................................................................................. 5
LISTS OF TABLES .................................................................................................................................... 9
CHAP 1: AN INTRODUCTION ............................................................................................................. 12
Background of the study .......................................................................................................................... 12
Research objectives and research question ............................................................................................ 14
Hypotheses ................................................................................................................................................. 14
Theoretical framework ............................................................................................................................. 15
Research methods: .................................................................................................................................... 16
Research findings ...................................................................................................................................... 16
Structure of the study ............................................................................................................................... 16
Chap 2: LITERATURE REVIEW .......................................................................................................... 17
2.1 Physical care facilities, medical equipment and hospital physical environment and
surroundings.............................................................................................................................................. 17
2.2. Procedures of admission to the hospital, waiting time, examination order, explanation about the
examination results and treatment process. ........................................................................................... 18
2.3. Doctors’ and medical staff’s care and attitude towards patients during admission procedures,
examination and treatment, and the medical personnel’s morality in interaction with patients. ..... 19
2.4. Good reputation of hospital, qualification of doctor....................................................................... 20
CHAP 3: QUESTIONAIRE AS A QUANTITATIVE RESEARCH METHOD ................................ 21
3.1 Survey design....................................................................................................................................... 21
3.2 Reliability and validity ....................................................................................................................... 21
3.3 Question design ................................................................................................................................... 21
3.4 Sample and Collect data. .................................................................................................................... 22
3.5 Measurement ....................................................................................................................................... 23
CHAP 4: DATA ANNALYSIS AND RESEARCH FINDINGS ........................................................... 27
4.1 Data analysis with IBM SPSS statistic .............................................................................................. 27
4.1.1 Measurement model......................................................................................................................... 27
4.1.2 Structural model .............................................................................................................................. 27
4.2 Research findings ................................................................................................................................ 27
4.2.1 Respondents’ characteristics ........................................................................................................... 27
4.2.2 Descriptive statistics of reality test ................................................................................................. 28

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4.2.3 Descriptive statistic of correlation analysis.................................................................................... 29

4.2.4 Descriptive statistic of regression analysis ..................................................................................... 30
Chap 5: RECOMMENDATION& CONCLUSION .............................................................................. 33
5.1 Conclusion ........................................................................................................................................... 33
5.2 Contribution and recommendation of the study .............................................................................. 33
5.3 Limitations of the study ...................................................................................................................... 34
REFERENCES .......................................................................................................................................... 35

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Abstract
Purpose: This study investigates factors impacting customer satisfaction on the
quality of health services in hospitals (Hanoi).Specially, the research focuses on
effects of tangible things which are physical care facilities, medical equipment and
hospital physical environment and surroundings; accessibility to healthcare service
which is procedures of admission to the hospital, waiting time, examination order,
explanation about the examination results and treatment process, etc.. attitude &
medical ethic that are doctors‟ and medical staff‟s care and attitude towards
patients during admission procedures, examination and treatment, and the medical
personnel‟s morality in interaction with patients and reliability which is good
reputation of hospital, qualification of doctor ( reputation, experience, professional
degree, study abroad).

Design/Methodology/Approach: The quantitative research method is applied

in this study. Survey questionnaire delivered to a sample of random 100 people
who used medical services in Hanoi hospital.

Findings: The study‟s result provided empirical evidence for the impact of for
dimensions of service quality „tangible‟, ‟accessibility to healthcare
services‟, ‟attitude and medical ethics‟ and „reliability‟) on patient satisfaction.
Satisfaction level of health services in Hanoi hospital reflects the trust of patients
about the quality of services, infrastructure, machinery and equipment, clean
hygiene, procedures and examination process, time to carry out. In addition, there
were also opinions on the attitudes and consciousness of doctors and nurses in the
hospital, the spirit of listening, the enthusiasm for medical examination and
treatment. Moreover, the expectation for more medical services is also measured
expectation of patient to Hanoi hospitals and decided to re-examine at these
hospitals as well as to introduce people like relatives and friends to see doctors.
Implication: The study helps to understand more about the factors affecting
customer satisfaction about health services in Hanoi hospitals. It provides people
including patients and doctors with information about hospitals. As the opinion of
the examiner, the two parties have made the right changes and decisions, the
hospital also brings trust benefits from patients.

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Originality/value: The study shows the satisfaction level of patients with health
services and that affects the decision to return or not, trust or cannot trust the
hospital.

Keywords: Service quality; patent satisfaction; hospital.

LISTS OF FIGURES
1. Figure 4.2.1 Respondents’ characteristics

Respondents‟ Percentage (%)

characteristics
Gender female 65.5
male 34.5
Age Under 20 years old 17.4
From 20- 39 years old 80.7
From 40- 59 years old 1.8
Income level Under 3 million 57.8
From 3 to 5 million 10.1
From 5 to 10 million 14.7
From to 10 million or 17.4
more
Health service Yes 92.7
No 7.3
Places of using medical Public hospital 73.4
service Private hospital/ 13.4
international hospital
Clinic 12.8
Medical service Medical examination 65.1
Impatient treatment 2.8
Outpatient treatment 3.8
Periodical health check 26.3
2. Figure 4.2.2 Descriptive statistics of reality test

Reality Test
DT1 0.92
DT2 0.92
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PT1 0.90
PT2 0.90
PT3 0.90
PT4 0.90
PT5 0.90
PT6 0.90
TC1 0.87
TC2 0.87
TC3 0.87
TC4 0.87
DD1 0.91
DD2 0.91
DD3 0.91
DD4 0.91
DD5 0.91
HL1 0.93
HL2 0.93
HL3 0.93

3. Figure 4.2.3 Descriptive statistic of correlation analysis

Correlations
DT PT TC DD HL
Pearson
1 .675** .610** .606** .712**
Correlation
DT
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
.675** 1 .828** .824** .787**
Correlation
PT
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
.610** .828** 1 .836** .814**
Correlation
TC
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
DD .606** .824** .836** 1 .759**
Correlation
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Sig. (2-tailed) .000 .000 .000 .000

N 109 109 109 109 109
Pearson
.712** .787** .814** .759** 1
Correlation
HL
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
**. Correlation is significant at the 0.01 level (2-tailed).

4. Figure 4.2.4 a) Regression analysis

Model R R Adjusted R Std. Error of the Estimate

Square Square
a
1 .866 .750 .740 .42057
Predictors: (Constant), DD, DT, TC, PT
5. Figure 4.2.4 b) Regression analysis

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Model R R Adjusted R Std. Error of

Square Square the Estimate

1 .712a .507 .503 .58213

a. Predictors: (Constant), DT
b. Dependent Variable: HL

6. Figure 4.2.4 b) Regression analysis

Mode R R Adjusted R Std. Error of the

l Squar Square Estimate
e
.71
1 .507 .503 .58213
2a
a. Predictors: (Constant), DT
b. Dependent Variable: HL
7. Figure 4.2.4 c) Regression analysis

Model R R Adjusted R Std. Error

Square Square of the
Estimate
.787
1 a .620 .616 .51143
a. Predictors: (Constant), PT
b. Dependent Variable: HL
8. Figure 4.2.4 d) Regression analysis

Model R R Adjusted R Std. Error

Square Square of the
Estimate
a
1 .814 .662 .659 .48222
a. Predictors: (Constant), TC
b. Dependent Variable: HL

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Model Summaryb
Mode R R Adjusted R Std. Error
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LISTS OF TABLES
1. Questionnaire

I. Personal information
1. Sex
 Male
 Female
2. Age
 Under 20 years old
 20-39
 40-59
 More than 60 years old
3. Income level ( per month)
 Under 3,000,000 VND
 From 3,000,000 VND to under 5,000,000 VND
 From 5,000,000 VND to under 10,000,000 VND
 More than 10,000,000 VND
4. Do you have state health insurance of
 Yes
 No
5. What medical service do you often you?
 Medical examination
 Inpatient treatment
 Outpatient treatment
 Periodical health check

6. Where do you usually use medial services?

 Public hospital
 Private hospital/ international hospital in Vietnam
 Clinic

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II, Satisfaction level

Please indicate the extent of your agreement on the following statements on a scale
of 1 to 5.

Strongly Disagree Neutral Agree Strongly

disagree agree
1 2 3 4 5

Quality of medical services components Agreement level

DT- Reliability
DT1:The hospital makes you feel secure when 1 2 3 4 5
choosing treatment there
DT2: You feel secure about the doctor expertise 1 2 3 4 5
and experience at the hospital
PT- Tangibles
PT1: The hospital have enough modern equipment 1 2 3 4 5
and machinery to serve your medical examination
and treatment
PT2: The patient room is clean and fully equipped 1 2 3 4 5
PT3: The hospital‟s environment is quiet, fresh and 1 2 3 4 5
clean, which is suitable for patients to treat and rest
PT4: Hospital rest room are clean 1 2 3 4 5
PT5: Hospital canteen and grocery are enough for 1 2 3 4 5
patients with variety items
PT6: Hospital parking is very convenient 1 2 3 4 5
TC- Accessibility to healthcare services
TC1: The hospital has specific advice on 1 2 3 4 5
procedures and treatment process, so you do not
encounter many difficulties in the process of
hospitalization - discharge.
TC2: You don‟t have to wait too long to turn on 1 2 3 4 5
service or get results
T3: All your questions and questions are always 1 2 3 4 5
answered by the hospital‟s staffs
TC4:Your doctors always know any changes in 1 2 3 4 5
your health
DD- Attitude and medical ethics
DD1: The staff of the hospital is always warm and 1 2 3 4 5
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considerate to serve, guide and help you when you

have a need
DD2: You feel free from discrimination if you 1 2 3 4 5
don‟t use health insurance or you are in difficult
circumstances (poor condition)
DD3: You can easily see your treating doctor when 1 2 3 4 5
you need
DD4: The doctor and the hospital staff always 1 2 3 4 5
visited and encouraged them during the treatment
DD5: Hospitals always receive all feedbacks from 1 2 3 4 5
patients (suggestion box, hotline ...) by positive
attitude

HL- Satisfaction

HL1: Overall medical service quality at the hospital 1 2 3 4 5

meets your demands
HL2: You are satisfied with the quality of service 1 2 3 4 5
of the hospital
HL3: You will continue to use the service in this 1 2 3 4
hospital (when you need) and recommend it to
friends and relatives

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2. Table 1.4: Theoretical framework

Tangible (1)

Accessibility to
healthcare service
(2) Customer’s satisfaction
Attitude & medical
ethic (3)

Reliability (4)

CHAP 1: AN INTRODUCTION

This study investigates factors impacting customer satisfaction on the quality of

health services in hospitals (Hanoi).This chapter consist of five sections. Initially,
the chapter elaborates background for the study (section 1.1) before the research
objectives and research questions are presented (section 1.2).Subsequently, a brief
description of the research method is provided (section 1.3), which is followed by a
presentation of research findings (section 1.4). The chapter closes with a
presentation of the thesis structure (section 1.5).

1.1 Background of the study

In recent years, healthcare has been seen operating as a commercial, for-profits
organization that is growing rapidly in both developed and developing countries.
Relationships between patients and hospitals are similar to those between
customers and service providers where hospitals strive to provide services that

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meet or exceed patients‟ expectations. In the past, people would go to hospital

when they had illnesses/diseases or in cases of emergency; but in modern time,
people tend to be more attentive to prevention and promoting health awareness
thus their visits to hospitals are not just to receive quality treatment but expect
more services that would ensure total quality healthcare experience. Regardless of
clinical factors, effectiveness and efficiency of therapy, nowadays, the quality of
healthcare is dependent upon other dimensions comprised of environment,
hygiene, attitude of staffs, facilities and material information, etc. by patients. On
the other hand, World Health Organization (WHO) has mentioned that patient is a
centered point in a healthcare system that anything affecting them will significantly
impact a success or a defeat of hospital or organization as well as to decisions of
policy-makers in making plans or strategies for their own system (WHO, 2006).
Consequently, it is obvious to recognize a crucial role of patient in healthcare at
this moment, hence, to deliver quality services will be revealed as a key factor in
searching for sustainable competitive advantage, differentiation and excellence
among competitors (Jabnoun, 2005).
However, how to realize that whether the quality of healthcare provided in a
certain hospital and whether a hospital met patient‟ expectations or not. Recently,
in the world, the concept of “patient‟ satisfaction” has been mentioned as a
valuable tool for assessing quality of healthcare, which concerns as regard
consumer-oriented in medical quality assurance (Donabedian, 2003). Moreover,
WHO also proclaims in “Assessment of Quality” document that satisfaction of
patient is one of nine crucial standards to evaluate the quality of healthcare services
(Donabedian, 2003).
Over the past years, the hospital system in Vietnam has been significantly
improved and developed. Much investment has been put in developing healthcare
infrastructure, facilities, and human resource training. However, service quality in
the healthcare system in general and in the public hospitals particularly have still
received much concern from the society and pressingly requires for improving
patients‟ satisfaction (Phung and Tran, 2012). Every year, many Vietnamese
patients, especially the wealthier people spend as much as US$ 2billion on
treatment abroad. These patients with better living standards seek for better service
quality abroad because they do not only care about having their diseases cured, but
also about how they are treated (Thanh Nien Daily, 2013).

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This study focuses on providing empirical evidence to confirm many factors affect
patient satisfaction in the context of the public hospitals specialize in Hanoi
hospital, Vietnam. The similarities and unique characteristics associated with the
research context are explored. It is expected to enrich our understanding of
healthcare service quality, attitude, medical ethic and its relationship with patient
satisfaction.

1.2 Research objectives and research question

Research on the factors affecting customer satisfaction on the quality of health

services in Hanoi hospital consists of four objectives. That evaluate based on
reliability, tangible means, accessibility to healthcare service and attitude &
medical ethic.
Research question: What factors affect customer satisfaction on the quality of
medical services in Hanoi hospital?

1.3 Hypotheses

H1: Reliability affects patient satisfaction. For patients who go to health checkups
which is an important decision because it relates to their physical condition. If they
know their own health status, they will make a decision as soon as possible if their
bodies get sick. Therefore, a prestigious hospital, highly qualified and experienced
doctors, modern equipment will bring peace of mind to patients about accurate
search results.

H2: Tangible means affect the satisfaction of patients. The society is growing, the
demand for human enjoyment is increasing and the patients also have their own
requirements when they are sick but the health sector has not met both in terms of
technical quality and functional quality. The rate of the patient's level of
satisfaction and satisfaction with facilities is only average.

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H3: Access to services also affects patient satisfaction. Administrative procedures

are always a concern for patients when visiting hospitals. Most patients are not
satisfied with the services such as hospitalization procedures, waiting time,
examination orders, explanation of examination results and treatment process. The
patient's satisfaction score on administrative procedures, reception and guidance of
the hospital only stops at the average level.
H4: The attitude and professional ethics of doctors and nurses affect the
satisfaction of patients. Health workers still work in the old way (subsidized
regime) do not really see patients as customers and it is not yet thought that
medical examination and treatment is a service activity. The nurse has more
satisfaction than the treating doctor, which depends a lot on the process of
explaining the disease, helping daily care and hygiene.

Hy5: Accessibility to healthcare service has the most influence on patient

satisfaction

1.4 Theoretical framework

Tangible (1)

Accessibility to
healthcare service (2)
Customer’s satisfaction
Attitude & medical
ethic (3)

Reliability (4)

(Table 1.4: theoretical framework)

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(1) Physical care facilities, medical equipment and hospital physical environment
and surroundings

(2) Procedures of admission to the hospital, waiting time, examination order,

explanation about the examination results and treatment process, etc.

(3) Doctors‟ and medical staff‟s care and attitude towards patients during
admission procedures, examination and treatment, and the medical personnel‟s
morality in interaction with patients

(4) Good reputation of hospital, qualification of doctor (reputation, experience,

professional degree, study abroad)

1.5 Research methods:

The quantitative method was employed in this study. We employed the scales
measuring healthcare service quality and patient satisfaction. These measures were
adopted and modified from past research while taking into account the suggestions
from our quantitative study. The main objectives of the quantitative study are to
gain overall understanding of patient perceptions of the current status of healthcare
service quality in Hanoi public hospitals. In this study, we discuss the measures
used, the questionnaire development, the sample, and the techniques used for data
analysis.

1.6 Research findings

Research to find out the satisfaction level of patients on the quality of services
in Hanoi hospitals based on reliability, quality and attitude.

1.7 Structure of the study

 Introduction
 Literature review
 Research method
 Data analysis and research finding
 Discuss and conclusion

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Chap 2: LITERATURE REVIEW

The health care delivery system in Vietnam faces four major challenges:
improving care facilities and environment, accessibility to healthcare service,
attitude and medical ethic. In Nepal, for example, the government made substantial
investments in healthcare to increase access. Yet, according to Lafond (1995),
utilization of the facilities remained low because of clients‟negative perceptions of
quality. Guldner and Rifkin (1993) also showed that in Vietnam and Uganda, poor
quality of services in the public sector led to greater use of private providers.

2.1 Physical care facilities, medical equipment and hospital

physical environment and surroundings.
In the research, we would like to prove the various elements of tangibles
associated with healthcare service quality in Vietnamese public hospitals,
especially those at district and lower levels are at not good status and there is a
strong need for improvement. The issues such as poor facilities, inadequacy of
patient beds, lacking of medical equipment, dirty toilet and shortage of water have
been frequently reported… According to Journal of Emerging Economies and
Islamic Research in Investigation in Vietnamese Public Hospitals (Nguyen Thanh
Cong and Nguyen Thi Tuyet Mai, 2010) show that:
 Emergency rooms in this hospital [a hospital at district level] should be
better equipped. Private clinics now are well equipped with all necessary
equipment, while here there is still a very old machine that has been used for
many years. (Male patient, 30). The room is not comfortable and not warm
enough. There are even not enough blankets. The mat is old and with foul
smell. There are even old blood marks on it. It is very uncomfortable. I do
not dare to use them. (Female patient, 25). The toilets here are very
uncomfortable, very unhygienic. It has very bad smell and also there is often
a shortage of water at the end of the day. (Male patient, 35).There is no
canteen in this hospital. I have to go and buy food outside. It is expensive
and not convenient at all. (Female patient, 40).
In Patient‟ Satisfaction and quality Of Healthcare: Case Of hospitals in Ho Chi
Minh City (Nguyen Thanh Luan, Touchanun Komonpaisarn Jiruth Sriratanaban
and H.A.T. Vy, 2014), they presented three important roles of patient in assuring
quality:

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 The environment of the hospital can also play a critical role in patient‟s
satisfaction. Above all, patients want to know whether the facility is clean,
sterile and safe, and that proper disease control procedures are followed
consistently. John Reiling has warned that to address the problems of errors
in healthcare, assurance of quality and serious safety issues, fundamental
changes of health care processes, culture, and the physical environment are
necessary and need to be aligned (John, 2008). Furthermore, in a study of
GUP IIoh in Nigeria, hospital environment is ranked 3rd importance to
impact to patient‟ satisfaction (Iloh, 2013).

2.2. Procedures of admission to the hospital, waiting time,

examination order, explanation about the examination results
and treatment process.
The patient‟s satisfaction has considerably impacted by process feature
following the research: Case Of hospitals in Ho Chi Minh City (Nguyen Thanh
Luan, Touchanun Komonpaisarn Jiruth Sriratanaban and H.A.T. Vy, 2014) shows
that includes convenience in moving and timeliness for treatment procedure.
 As indicated in a report in Canada, there appears to have been marginal
increases in satisfaction with “timeliness of access to care” since 2001. The
increases are slight at best however it is still the case that barely half of
Canadians (46 per cent) are satisfied in this regard (Stuart, 2007).
In Vietnam, currently, it is one of the factors causing patients‟ dissatisfactions.
When patients enter in a certain hospital, they usually get lost in a maze of clinic
rooms, laboratory rooms or drug store, etc… the arrangement of these facilities is
not conveniently and appropriately suitable for patients to find their ways while at
the hospitals. It will be very difficult for disabled patients or the elderly. Moreover,
waiting time at clinic room or wait time for doing and receiving test or wait time
for making payments cause tiredness, dissatisfactions and anxiety for patients who
already have problems of their own.

According to Journal of Emerging Economies and Islamic Research in

Investigation in Vietnamese Public Hospitals (Nguyen Thanh Cong and Nguyen
Thi Tuyet Mai, 2010) indicated that:

 In some big and well-known hospitals, patients are also not easy to access
adequately explanation about the examination results and treatment from the
doctors. The following excerpts provide some illustration for our

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interviewees‟ concerns. When I went to the hospital I had to wait over 20

minutes to register for examination. There were so many people but only one
medical doctor was there. (Male patient, 35). During my stay in hospital and
until I discharged from the hospital, the doctors did not give any instructions
on how to prevent illness. (Female patients, 55).

2.3. Doctors’ and medical staff’s care and attitude towards

patients during admission procedures, examination and
treatment, and the medical personnel’s morality in interaction
with patients.
In our qualitative study, many patients expressed their great concerns about the
attitude of some medical staff and doctors. In the context of healthcare services, it
seemed more painful for patients and their families to suffer bad attitude of
medical personnel expressed by impolite and bad words, cold faces and ignorance.
And in Journal of Emerging Economies and Islamic Research in Investigation in
Vietnamese Public Hospitals (Nguyen Thanh Cong and Nguyen Thi Tuyet Mai,
2010) expressed their interviews in the hospital as follows:
 An interviewee said that “I find that the doctors have treated relatively well,
but there are a number of nurses who are not friendly, often grumpy in my
20days of treatment at the hospital”.
 Another expressed that “When I am in the hospital (a hospital at provincial
level), I must try to endure my pain and do not dare to complain anything
about the difficulties. If I do that (the doctors and nurses) will hate me.”
(Female patient, 40).
Our study would point out the common phenomenon of receiving envelops and
non-transparent amount of money among medical staff has been noted with big
concerns, especially for poor patients due to ethical problems of a number of
doctors and medical staff. Psychology is one of the most important factors effect
on the patients‟ satisfaction and there are various matters related to patients‟
psychology such as a certain sympathetic action or a performance also affects
patient‟ feeling and results in good or bad satisfaction evaluation from patients
(Case Of Hospitals In Ho Chi Minh City, Nguyen Thanh Luan, Touchanun
Komonpaisarn Jiruth Sriratanaban and H.A.T. Vy, 2014)

Therefore, attitude is imperative which is showed off in service providers who

correctly interpret laboratory reports, diagnose the disease competently, provide
appropriate explanation to queries, courtesy and generate a sense of safety. Thus,
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the greater the perceived good attitude from the healthcare providers, the greater
the satisfaction of patients will be. Service related communication with nurses and
physicians than impressive technology or facility (Power, 2012).

2.4. Good reputation of hospital, qualification of doctor

Finally, patients can be evaluated of healthcare when they are educated about
the system of hospital and witnesses of system performance. But in Vietnam to
provide information and education in hospital is one of the compulsory
accreditations of quality. However, rarely hospitals actually consider and pay more
attention in this matter. To deliver quality services it is important, first, to help
customer having perception about hospital as well as doctor and according to Case
Of hospitals in Ho Chi Minh City (Nguyen Thanh Luan, Touchanun
Komonpaisarn Jiruth Sriratanaban and H.A.T. Vy, 2014) explained that

 Interpersonal skills, including expressing knowledge, skills and promptly

response of doctors and nurse. Patients are not scientists or professional who
can understand clearly about their illness, diagnosis and treatment therapies.
They will not know whether or not a therapy or treatment is appropriate for
their illness. But they themselves can quickly acknowledge or grasp their
illness conditions by observing physician‟s performance and gestures. J.D.
Power also mentioned that higher patient satisfaction is more influenced by
interpersonal skills of nurses and physicians (Power, 2012).

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CHAP 3: QUESTIONAIRE AS A QUANTITATIVE

RESEARCH METHOD
3.1 Survey design
Our survey questionnaire is design base on survey questionnaires and question
interview of 3 previous studies with the similar themes of Nguyen Thanh Cong,
Nguyen Thi Tuyet Mai( 2010), Dr. Rambha Pathak (2012), Nguyen Thanh Luan,
Touchanun Komonpaisarn, Jiruth Sriratanabanand H.A.T. Vy (2014). And some
questions are created by group of marketing research students to be more suitable
with this study in Hanoi.

We also train a group of 6 people to collect the data by 2 main ways are collect
directly by distributing directly questionnaires to patients at the hospital and collect
indirectly by sharing the questionnaire link on E-mail and Facebook.

3.2 Reliability and validity

The reliability of this survey questionnaire is ensured because almost of
question offering in this study is based on the success previous study of Nguyen
Thanh Cong, Nguyen Thi Tuyet Mai( 2010), Dr. Rambha Pathak (2012), Nguyen
Thanh Luan, Touchanun Komonpaisarn, Jiruth Sriratanabanand H.A.T. Vy (2014)
with the similar themes.
Moreover, In order to be suitable for the case under study, we have edited the
original questions from the references and asked some new questions. Therefore,
we also apply SPSS to measure the reliability of these questions

3.3 Question design

Our questionnaire include 2 main parts: the first part is personal information of
patient, and the second once is measure the “satisfaction level”. In the part 1, we
mention about the information about sex, age, income level, health insurance, what
medical service the patient use and where they use that. And the others part is the
self-worth of their satisfaction with the hospital's service through four main factors,

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the reliability ( the reputation of hospital and quality and experience of doctors ) ,
tangibility (physical care facilities ,equipment and technology, the convenience of
patient‟s room, environment and surroundings …) access to health care
services(procedures of admission to the hospital, waiting time, examination order,
explanation about the examination results and treatment process) and attitudes and
ethics of the hospital staff (doctors‟ and medical staff‟s care and attitude towards
patients during admission procedures, examination and treatment, and the medical
personnel‟s morality in interaction with patients.

Some question in this questionnaire is design based on the questionnaire of Dr.

Rambha Pathak‟s previous studies on “An Assessment of Patients Satisfaction with
Services Obtained from a Tertiary Care Hospital in Rural Haryana” and study on
“Service Quality and Its Impact on Patient Satisfaction: An Investigation in
Vietnamese Public Hospitals” of Nguyen Thanh Cong and Nguyen Thi Tuyet Mai.
And some questions measuring patients‟ perception of healthcare service quality
are newly developed.

3.4 Sample and Collect data.

The survey was conducted on a total of 110 people. The questionnaire given to
them is totally the same and that is done by them individually and independently.
After checking and removing the questionnaire answered incorrectly, the final
sample size of this study is 100 people. The main subjects of this survey are people
aged 18 to 70 who have or are using health services at hospitals in Hanoi.
Information was collected in two main ways: the first way was to distribute the
survey directly to the patients being treated in two major hospitals in Hanoi: Bach
Mai Hospital and K2 Tan Trieu Hospital (hospital for cancer patient) (40%), the
second way is to send randomly link of online survey via Email and Facebook
(60%)

A trained data-collection team of 6 people went to Bach Mai and K Tan Trieu
hospital to give questionnaire to the patients. In most cases the filling in the
prepared questionnaire. Necessary explanations were provided to the respondents
during the filling questionnaire. Each questionnaire took about 3-5 minutes of
survey participants.

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3.5 Measurement
We have four main factors to affect the satisfaction of customers when they use
medical service in hospital in Hanoi. Each factor we also measure by some smaller
question about specific component of service. Some measurement in this study is
based on the measurement questions of previous study and some once are newly
developed by our group of marketing research student to suitable with this study.

Factor Measurement questions Reference / newly

developing
Reliability The hospital makes you “Service Quality and Its
feel secure when choosing Impact on Patient
treatment there Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
You feel secure about the Newly development
doctor expertise and
experience at the hospital
Tangibles The hospital have enough “Service Quality and Its
modern equipment and Impact on Patient
machinery to serve your Satisfaction: An
medical examination and Investigation in
treatment Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
The patient room is clean “Service Quality and Its
and fully equipped Impact on Patient
Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
The hospital‟s environment “Service Quality and Its
is quiet, fresh and clean, Impact on Patient
which is suitable for Satisfaction: An
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patients to treat and rest Investigation in

Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
Hospital rest room are Newly development
clean
Hospital canteen and “Assessment of Patients
grocery are enough for Satisfaction with
patients with variety items Services Obtained From
a Tertiary Care Hospital
in Rural Haryana “ of
Dr. Rambha Pathak
(2012)
Hospital parking is very “Service Quality and Its
convenient Impact on Patient
Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
Accessibility to The hospital has specific “Patients‟ satisfaction
healthcare services advice on procedures and and quality of
treatment process, so you healthcare : case of
do not encounter many hospital in Ho Chi Minh
difficulties in the process City” of Nguyen Thanh
of hospitalization - Luan, Touchanun
discharge. Komonpaisarn, Jiruth
Sriratanabanand H.A.T.
Vy (2014)
You don‟t have to wait too Newly development
long to turn on service or
get results
All your questions and “Patients‟ satisfaction
questions are always and quality of
answered by the hospital‟s healthcare : case of
staffs hospital in Ho Chi Minh
City” Nguyen Thanh

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Luan, Touchanun
Komonpaisarn, Jiruth
Sriratanabanand H.A.T.
Vy (2014)
Your doctors always know “Patients‟ satisfaction
any changes in your health and quality of
healthcare : case of
hospital in Ho Chi Minh
City” Nguyen Thanh
Luan, Touchanun
Komonpaisarn, Jiruth
Sriratanabanand H.A.T.
Vy (2014)
Attitude and medical The staff of the hospital is Newly development
ethics always warm and
considerate to serve, guide
and help you when you
have a need
You feel free from “Service Quality and Its
discrimination if you don‟t Impact on Patient
use health insurance or you Satisfaction: An
are in difficult investigation in
circumstances (poor Vietnamese Public
condition) Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
You can easily see your “Service Quality and Its
treating doctor when you Impact on Patient
need Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
The doctor and the hospital “Service Quality and Its
staff always visited and Impact on Patient
encouraged them during Satisfaction: An
the treatment Investigation in
Vietnamese Public

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Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
Hospitals always receive “Service Quality and Its
all feedbacks from patients Impact on Patient
(suggestion box, hotline ...) Satisfaction: An
by positive attitude Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
Satisfaction Overall medical service “Service Quality and Its
quality at the hospital Impact on Patient
meets your demands Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
You are satisfied with the “Service Quality and Its
quality of service of the Impact on Patient
hospital Satisfaction: An
Investigation in
Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)
You will continue to use “Service Quality and Its
the service in this hospital Impact on Patient
(when you need) and Satisfaction: An
recommend it to friends Investigation in
and relatives Vietnamese Public
Hospitals” of Nguyen
Thanh Cong, Nguyen
Thi Tuyet Mai( 2010)

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CHAP 4: DATA ANNALYSIS AND RESEARCH

FINDINGS
4.1 Data analysis with IBM SPSS statistic

4.1.1 Measurement model

In this study to describe the general characteristics of respondents, we will use
descriptive analysis in IBM SPSS statistic. Secondly, to determine the reliability of
the variables that they have value for to evaluate whether or not, we used the
reality test in BM SPSS statistic. Thirdly, to measure the ratio of each independent
variable to the implant works independent variable for how we used regression
analysis .Finally, to measure the variables would impact the most satisfaction then
we use the correlation analysis IBM SPSS statistic.

4.1.2 Structural model

Firstly, the questions about gender, age, income lever per month, health
insurance, medical service, places for using medical services are to determine
respondents‟ characteristics. Secondly, the dependent variables are reliability
(DT1&DT2), tangibles (from PT1 to PT6), accessibility to healthcare service (from
TC1 to TC4), attitude and medical ethics( from DD1 to DD4), satisfaction( from
HL1 to HL2) in order to determine reality test, correlation analysis, regression
analysis in turn.

4.2 Research findings

4.2.1 Respondents’ characteristics

Respondents’ Percentage (%)
characteristics
Gender female 65.5
male 34.5
Age Under 20 years old 17.4

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From 20- 39 years old 80.7

From 40- 59 years old 1.8
Income level Under 3 million 57.8
From 3 to 5 million 10.1
From 5 to 10 million 14.7
From to 10 million or 17.4
more
Health service Yes 92.7
No 7.3
Places of using medical Public hospital 73.4
service Private hospital/ 13.4
international hospital
Clinic 12.8
Medical service Medical examination 65.1
Impatient treatment 2.8
Outpatient treatment 3.8
Periodical health check 26.3
(Figure 4.2.1 Respondents‟ characteristics)

Table of figures indicate that 65.5 % of the respondent is female, there is 34.5%
of male. The survey was made mainly the age is from 20 to 39 years old, under 20
years old accounted only for 17.4 %, and the rest is 1.8% from 40 to 59 years old.
The level of income of those surveyed ranged as follows under 3 million
accounting for 57.8%, from 3 to 5 million accounted for 10.1%, from 5 to 10
million accounting for 14.7% and from more than 10 million constituted 17.4%.
The questions about where people usually use medical services are answered as
follows public hospital accounted for 73.4%, private hospital international hospital
accounted for 13.4%, clinic accounted for 12.8. And finally the opportunity to
experience the service was when specified as Medical examination 65.1%,
impatient treatmen2.8%, outpatient treatment 3.8%, periodic health check 26.3%.

4.2.2 Descriptive statistics of reality test

Reality Test
DT1 0.92
DT2 0.92
PT1 0.90

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PT2 0.90
PT3 0.90
PT4 0.90
PT5 0.90
PT6 0.90
TC1 0.87
TC2 0.87
TC3 0.87
TC4 0.87
DD1 0.91
DD2 0.91
DD3 0.91
DD4 0.91
DD5 0.91
HL1 0.93
HL2 0.93
HL3 0.93
(Figure 4.2.2 reality test)

The reliability was determined based on Cronbach‟s Alpha result, which these
alpha variables was less than 0.5 would be eliminated and others with alpha more
than 0.7 is usable (Nunnally, 1978). As the result conducted, in the study of the
factors effect on patient‟s satisfaction about the quality of medical service in
hospital in Hanoi have 4 variables. Reliability (from DT1 to DT2) is 0.92,
tangibles (from PT1 to PT6) is 0.90, accessibility to healthcare service (from TC1
to TC4)is 0.87, attitude and medical ethics( from DD1 to DD4) is 0.91 satisfaction(
from HL1 to HL2)is 0.9. All variables are good and high reality

4.2.3 Descriptive statistic of correlation analysis

Correlations
DT PT TC DD HL
Pearson
1 .675** .610** .606** .712**
Correlation
DT
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109

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Pearson
.675** 1 .828** .824** .787**
Correlation
PT
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
.610** .828** 1 .836** .814**
Correlation
TC
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
.606** .824** .836** 1 .759**
Correlation
DD
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
Pearson
.712** .787** .814** .759** 1
Correlation
HL
Sig. (2-tailed) .000 .000 .000 .000
N 109 109 109 109 109
**. Correlation is significant at the 0.01 level (2-tailed).
(Figures 4.2.3 Correlation analysis)

-Red box: Pearson correlation coefficient

-Blue box: significant audit of Pearson. In this figure, the correlation is 0. So if this
sig is less than 5%, we can conclude that two variables are correlated with each
other. If this is greater than 5% sig, then the two variables are not correlated with
each other. In this table, green variables are independent variables, yellow
variables are dependent variables. So, it shows that reliability (DT) correlates with
satisfaction (HL) at 71.2%. Tangibles (PT) correlate with satisfaction (HL) at
78.7%. Accessibility (TC) to healthcare services correlates with satisfaction (HL)
at 81.4%. and attitudes and medical ethics(DD) correlates with satisfaction(HL) at
75.9%. This results indicate that accessibility to healthcare services have the most
correlation with satisfaction

4.2.4 Descriptive statistic of regression analysis

Model Summary
Mode R R Adjusted R Std. Error
l Square Square of the
Estimate

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1 .866a .750 .740 .42057

Predictors: (Constant), DD, DT, TC, PT
(Figure 4.2.4 a) Regression analysis)

In this table, we interest the value- Adjusted R Square (or R Square). Adjusted
R Square also known as R squared, it reflects the level of influence of the
independent variable, dependent variable, up. Specifically in this case, 4
independent variables take on 74% influenced the change of the remaining 26% is
due to turn out models and random error. Often this value from 50% or more is
usable research.
In the detailed results of each independent variable affect the satisfaction of
customers in hospital

Model R R Adjusted R Std. Error

Square Square of the
Estimate
a
1 .712 .507 .503 .58213
a. Predictors: (Constant), DT
b. Dependent Variable: HL
(Figure 4.2.4 b) Regression analysis)
The independent variable is reliability (DT) influenced at 50.3% the change of
satisfaction‟s customers (HL) when using medical services

Model R R Adjusted R Std. Error

Square Square of the
Estimate
a
1 .787 .620 .616 .51143
a. Predictors: (Constant), PT
b. Dependent Variable: HL
(Figure 4.2.4 c) Regression analysis)

The independent variable is tangibles (PT) influenced at 61.6% the change of

satisfaction of customers (HL) when using medical services

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Model R R Adjusted R Std. Error

Square Square of the
Estimate
a
1 .814 .662 .659 .48222
a. Predictors: (Constant), TC
b. Dependent Variable: HL
(Figure 4.2.4 d) Regression analysis)
The independent variable is accessability to healthcare services (TC) influenced at
65.9% the change of satisfaction‟s customers (HL) when using medical services

Model Summaryb
Model R R Adjusted R Std. Error
Square Square of the
Estimate
a
1 .759 .576 .572 .53979
a. Predictors: (Constant), DD
b. Dependent Variable: HL
(Figure 4.2.4 f) Regression analysis)

The independent variable is attitudes and ethics (DD) influenced at 57.2% the
change of satisfaction‟s customers (HL) when using medical services

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Chap 5: RECOMMENDATION& CONCLUSION

5.1 Conclusion
In this study focused on investing the factors effecting on patient‟s satisfaction
about the quality of medical service in hospital in Hanoi. The results of our search,
in line with the findings from the previous studies, confirmed the impact of
healthcare service quality on Vietnam patient satisfaction, lending support to all
the hypothesized relationships. In this study, among four dimensions the dimension
“accessibility to healthcare services” was found to have strongest influence
(81.4%) on the Vietnamese patient satisfaction, closely followed by
“tangibles”(78.7%), next followed by “attitudes and ethics” (75.9%) and finally by
“reliability” (71.2%). The findings suggest the importance of accessibility element
such as procedures and treatment process as patient‟s satisfaction predictors. This
study also provides strong evidence of the strong impact of tangible element and
attitudes and ethics of doctors

The findings from quantitative method suggest that four independent variables
take on 74% influenced the change of satisfaction the remaining 26% is due to turn
out models and random error. The results show that the level of satisfaction at
hospitals in Hanoi is at the acceptable level (around the average score)

5.2 Contribution and recommendation of the study

The research findings from this study contribute to better understanding of the
service quality dimensions and their impact on patient satisfaction in the context of
the hospitals in Hanoi. This research is meaningful since the ability to deliver
quality services and provide patient satisfaction, especially in the public units in
developing countries like Vietnam is limited (Chahal and Kumari, 2010). Several
managerial implications are offered to the public hospital administrators to
improve hospital management and quality control systems of healthcare services.
To deliver high quality of healthcare services and by doing so to enhance patient
satisfaction, it is important to introduce modern managerial practices in the
hospital with customer orientation. The service quality in the hospital can be
enhanced through various action programs pertaining to improving all the quality
dimensions of healthcare services. For instance, it is necessary for the hospital
managers to pay attention to the elements of hospital tangibles and be innovative in
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attracting and calling for investment to upgrade the hospital facilities equipment
and hospital environment. It is also very important to promote good spirit, medical
ethics and attitude of medical staff and doctors towards patients, as well as to
develop better and transparent hospital culture, and provide training medical staff
and physicians on ethics, communication, and skills/specialization. This study is
also expected to provide implications for policy makers in an attempt to develop
relevant strategies to improve the current status of healthcare service quality at the
public hospitals and enhance patient satisfaction.

5.3 Limitations of the study

In this study, because of time constraints and approach, the number of collected
samples is still limited. The number of samples collected was 109respondents and
the number of females was dominant and the age was mainly from 20-39.
Depending on the different range of age and income, there is a difference in
satisfaction of health services. The second limit of the study is the scope of the
study. Our research only examines the factors that affect the satisfaction of health
services in Hanoi. The different locations also cause the difference in the
satisfaction in experience service. So, the results of this study are only for
reference.

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