醫護人員及就醫民眾對中醫醫療服務品質期望與滿意度之探討-
以高屏地區中醫醫療院所為例

本研究目的在探討高屏地區之中醫醫護人員及就醫民眾，對於中醫醫療服務品質之期望認知及就醫民眾的「期望-滿意」，是否存在 PZB model中之缺口一及缺口五的落差，並分析影響醫護人員與就醫民眾之期望及落差的因素。研究方法：本研究為橫斷式研究設計，主要以高屏地區中醫醫療院所為研究範圍，以高屏地區中醫醫療院所之醫護人員及就醫民眾為主要研究對象，採立意隨機抽樣，以結構式問卷進行調查。問卷設計是參考相關文獻及蔡文正教授修訂之中醫醫療服務品質指標而制定。總計回收有效問卷醫護人員117份，就醫民眾497份，有效回收率分別為82.40%， 91.19%。統計方法除描述性統計外，就醫民眾期望-滿意以相依樣本t檢定，就醫民眾-醫護期望以獨立樣本t檢定分別進行差異性分析。另採用複迴歸分析找出影響期望及缺口落差之因素。研究結果：高屏地區就醫民眾對中醫醫療服務品質之期望與滿意度的差異性分析:22項指標其p值均小於0.01，表示就醫民眾之期望與滿意有顯著差異，存在落差，且皆為就醫民眾期望大於滿意。高屏地區就醫民眾與醫護人員中醫醫療服務品質之期望之差異性分析：22項指標中僅四項p值小於0.05有統計上明顯差異，表示就醫民眾與醫護人員對中醫醫療服務品質之期望認知無顯著差異；僅具有現代化中醫醫療設備及醫謢人員能滿足病患的特殊需求等二項指標呈現正落差，而具有專業形象穿著、具有整潔與舒適環境等二項，為負落差。影響中醫醫療服務品質之相關因素方面，影響就醫民眾期望之因子有宗教信仰、居住地區、醫院型態、就診原因。影響醫護人員期望之因子包括教育程度、執照取得、定期員工滿意度調查。影響就醫民眾期望-滿意落差之相關因子包括性別、初複診、推薦、醫院型態、就診原因。結論與建議：高屏地區就醫民眾對中醫醫療服務品質期望顯著高於滿意度，表示高屏地區的中醫醫療服務品質尚無法滿足就醫民眾的期望，仍有很大提升的空間，尤以有形性和可靠性構面落差最大。而在就醫民眾與醫護人員期望認知方面，醫護人員對於就醫民眾之期望大多有所了解，僅具有現代化中醫醫療設備及醫謢人員能滿足病患的特殊需求需要加強醫護人員的認知；且依據PZB模式推論，高屏地區之中醫醫療服務品質有可能存在內部服務傳遞及外部溝通之落差。建議醫療管理階層可定期使用服務品質指標進行施測，以充分了解就醫民眾的期望與感受，並針對醫療服務品質指標落差較大的項目進行改善將有效提昇醫療服務品質。

關鍵字

中醫醫療服務品質；缺口分析；服務品質；滿意度；中醫

並列摘要

The aim of this study is to investigate the expectations,satisfactions and the gap between expectations and satisfactions for the service quality of Chinese medicine from the medical practitioners and their patients in the Chinese-medicine hospitals in the Kaohsiung-Pingtung area. The first and fifth kinds of the gaps in the PZB model on the expectations between the medical practitioners and their patients are studied and analyzed, and the factors that contribute these gaps are indentified. Methods：This study was designed in the transverse type. The main studied objects are the medical practitioners and their patients in the Chinese-medicine hospitals in the Kaohsiung-Pingtung area. The objects were purposively and randomly sampled to conduct surveys by structural questionnaires. These questionnaires were designed according to relevant literatures and also the medical service quality indicators developed and revised by Professor Wen-Cheng Tsai (蔡文正). 117 valid questionnaires were collected from medical practitioners and 497 from their patients; the effective sample rate was 82.40% and 91.19%, respectively. The patients’ expectations vs. satisfactions were t-analyzed as dependent samples, while the expectations between the medical practitioners and their patients were t-analyzed as independent samples by statistical methods, in addition to descriptive statistics, to find their differences. Furthermore, multiple regression analyses are used to identify the factors that determine the gap in the expectations. Results：The analysis on the gaps between expectations and satisfactions from the patients of the Chinese-medicine hospitals in the Kaohsiung-Pingtung area gives the following result: The p-values of the all 22 indicators were less than 0.01, which indicate huge gaps between the expectations and satisfactions of the patients. In short, the satisfactions significantly fall short of the expectations for the patients. The analysis on the expectation gaps between the medical practitioners and their patients gives the following result: Among the p-values of 22 indicators, only four of them were less than 0.05 and signified the statistical different. In other words, there are no significant differences on the expectations between the medical practitioners and their patients. Positive gaps exist in two indicators: the modernization of medical facilities and the fulfillments of the patients’ special needs; while negative gaps exist in other two indicators: the professional images and dresses of the medical practitioners and the clean and comfortable medical environments. The factors contributing the overall service quality are summarized. The factors affecting the expectations of the patients are their religious belief, place of residence, type of hospitals, and the motivations of seeking medical treatments. The factors affecting the expectations of medical practitioners are their degrees of education, medical licenses, and regular surveys on employees’ satisfaction. The factors contribute the gaps between expectations and satisfactions are the patients gender, initial and return treatments, the recommendation of treatment, type of hospitals, and the motivations of seeking medical treatments. Conclusions and suggestions: For patients seeking the medical service of Chinese medicine in Kaohsiung-Pingtung area, their expectations on the service quality are significantly higher than their satisfactions. This certainly indicates that the service quality of Chinese-medicine hospitals in Kaohsiung-Pingtung area did not meets the expectations of the patients, and there is still much room for further improvements, especially, in the practice and reliability of the medical system where the largest gap exists. Although the medical practitioners are aware of their patients’ expectations, only those with modern facilities of Chinese medicine can meet the special needs of their patients. Based on PZB model inferences, the internal service delivery and external communication gap may exist within the service quality of Chinese medicine in the Kaohsiung-Pingtung area. It is recommended that the indicators of medical service quality should be regularly surveyed and monitored to fully understand the expectations and satisfactions of the patients, and immediate actions should be given to those parts of the services that fall short of the indicators in order to improve the overall quality of the medical services.