病人就醫選擇與滿意度模型探索

Medical Treatment Selection and the Exploration of Patient Satisfaction Models

侯宏彬(Hung-Pin Hou)

指導教授 ： 林欣美 ； 白炳豐

國立暨南國際大學/管理學院/國際企業學系/博士(2018年)

摘要

隨著醫療服務產業市場競爭的普遍化，病人的滿意度成為醫院管理者提升醫療服務品質努力的重點。因此，透過持續探索影響病人就醫滿意度的調查活動，成為醫院確保醫療服務品質普遍的做法。由於以病人為中心的醫療概念與重視病人權利規範的興起，使得過去十年來病人滿意度量測的模型趨於複雜化與多樣化。因此，需要更多樣化和特定的模型來識別不同病人在接受醫療服務時的期望與感受。
本文的研究目的是探討影響病人滿意度的機制，以及影響病人滿意度前因間複雜的關係，包含病人感受到的有形與無形的服務。透過縱斷面連續七年1,530件的調查資料，以結構方程式 (CB-SEM) 驗證本研究模型具有良好的適合度，確認醫療機構的硬體環境、醫療技術品質 (technical service quality) 及服務功能品質 (functional service quality) 對於病人就醫的滿意度皆有正向的影響；醫療機構員工的態度對於病人就醫滿意度僅具有正向間接的影響。此外，本研究發現醫療技術品質對病人就醫滿意度具有最高的解釋力，與服務功能品質共同為就醫環境與員工態度間接影響病人就醫滿意度的中介變項。
本研究另透過WEKA分類演算法探索影響病人就醫滿意度的關鍵因素，不同分類器 (Classifier) 產生決策樹的結果皆顯示護理師執行醫療照護時顧及病人的隱私，使病人感受到被尊重是最主要影響病人滿意度的原因。此外，本研究利用分群演算法產生之滿意度模糊矩陣，進一步探討影響不同類型滿意度病人的關鍵因素發現，影響真滿意 (True Satisfaction) 病人群滿意度的主要因素是寬敞舒適的就醫環境，影響假滿意 (Spurious Satisfaction or Latent Dissatisfaction) 病人群滿意度的關鍵因素是櫃台服務人員的態度，對於假不滿意(Spurious Dissatisfaction or Latent Satisfaction) 病人群最關心的是就醫等候時間，對於真不滿意 (True Dissatisfaction) 群的病人，造成他們不滿意的主要原因係醫師診療時讓病人感受不被尊重，未來將選擇尋找其他機構就醫，此為醫療機構失去其病人主要的原因。相同的，本研究以病人忠誠度模糊矩陣檢視亦發現，影響那些表示不滿意確願意持續就醫的假忠誠 (Spurious Loyal) 病人群滿意度主要的因素，仍然是醫師診療時的態度是否注重病人隱私及讓病人有被尊重的感受。
本研究總結了影響不同類型病人滿意度的各種因素，綜言之，醫護人員展現當 (accountability) 的態度是影響病人滿意度主要的關鍵因素，病人的滿意度僅是病人忠誠度的充分條件，並非必要條件。

關鍵字

病人滿意度 ； 潛在滿意 ； 虛假滿意 ； 有形品質 ； 無形品質 ； 當責 ； 模糊矩陣

並列摘要

In the increasingly competitive market of healthcare industries, hospital managers should effort on succeeding high ratings of patient satisfaction by improving both technical and functional service qualities. Consequently, aiming to explore the factors which influence patient satisfaction grows into popular activities that hospital to verify their service quality.
Due to the rising of patient-centric and patient rights norms, the measurement model of patient satisfaction have become complex increasingly in the past decades, thus, a more diverse and specific model is required for identifying both patients’ expectations and perceived values when they take medical service. The study purpose in this article is to explore the mechanism of patient satisfaction and the complex relationship between the antecedents not only for the tangible service quality presented but also for the professional intangible technical quality perceived. In a longitudinal section survey examined by CB-SEM for seven years with 1,530 samples, the results show the measurements of hospital physic environment, the technical service quality, and the functional service quality have positive direct effects on the patient satisfaction with the robustness of research model. The attitude of hospital staffs only shows indirect effect positive on the patient satisfaction. In addition, the technical service quality has the most explanatory power to patient satisfaction among other measurements of the research model. Both of the technical and the functional quality are regarded as the mediator effects on the patient satisfaction to the antecedent of environment and staff attitude in our research model. Furthermore, to address the key factors which could have an effect directly on the patient satisfaction by examining to the complex structure model involving many indicators with WEKA classification and clustered algorithms. The classified decision tree shows the privacy and the respect provided by nurses during medical services are the key factors affecting the patient satisfaction which perform as the strong predictors of patient satisfaction, which accuracy rate achieves as high as 87.6%. Moreover, in this study, we apply confusion satisfaction matrix to develop the further study to investigate the key factors that affect the different type of patients’ satisfaction. Results show the physic environment of spacious space is the root cause for the True Satisfaction group patients; the service attitude of front desk staffs is the main factor affecting the satisfaction of the Spurious Satisfaction (Latent Dissatisfaction) group patients; for the Spurious Dissatisfaction (Latent Satisfaction) group patients, the waiting time is the main reason which makes patient dissatisfied. Finally, the physician’s attitude that let the patient feels not respected will makes the patient feels stronger dissatisfy (True Dissatisfaction) and turns to others providers. Similarly, by confusion loyalty matrix, we also found those patients who unsatisfied but still continue visit clinic (Spurious Loyal) lay stress on the respect feeling and the privacy concerned, which are the main factors affecting the satisfied status, from doctors while visiting the clinic.
This study concludes the various factors which effect on the patient satisfaction for different patient types. In short, an accountability of medical staffs is the priority and the most important factors for patient satisfaction. We also assert that the satisfaction is a sufficient, but not a necessary antecedent factor for loyalty.

並列關鍵字

Patient Satisfaction ； Latent Satisfaction ； Spurious Satisfaction ； Tangible Quality ； Intangible Quality ； Accountability ； Confusion Matrix

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