顧客對不同醫療服務缺失之歸因、嚴重度認知 與行為反應之研究

The Client's Responses to Service Inadequacies. － A Questionaire Study with Scenario Simulation Techniques in Health Care Industry －

王莉華(Li-Hua Wang)

指導教授 ： 薛亞聖

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01099

摘要

醫療行業或產業如同其他行業或產業一般，有效的服務缺失補救可以增進服務對象的忠誠度及口碑，但有關醫療服務缺失、補救的研究卻相對缺乏，有待更多的研究投入，以供醫療管理及實務經營者的參採運用。
本研究目的在於探討顧客對不同型態醫療服務缺失的心理及行為反應，還有心理與行為反應間之相關性。心理反應方面透過歸因理論的三個構面（穩定性、控制性及責任歸屬）而以缺失的嚴重度作為測量項目，行為反應方面則透過「申訴行為」、「補救期望」與「補救預期效果」等作為測量指標，並參考一般醫療院所申訴之實例設計出如「手術紗布未取出」、「醫師沒有正確診斷病因」、「醫師沒有清楚解釋病情」、「病人就醫沒有隱私」、「電腦當機」、「藥名打錯」及「護士態度不耐煩」等七種不同的服務缺失模擬情境，編擬成結構式問卷。本研究之執行採角色扮演法，以立意取樣方式，針對北部某大醫學中心的住院病人或其親友共480人進行為期一週之斷面調查，共回收249份問卷，剔除2份無效之問卷，實得有效問卷247份，回收率51﹪。回收之問卷資料經整理及統計分析，獲致參考結果，進一步歸納結論如下：
一、顧客對不同的醫療服務缺失狀況會有不同之歸因及嚴重度認知。受訪者認為非醫療型缺失比醫療型缺失的發生頻率較為頻繁；嚴重度認知方面，醫療型較非醫療型嚴重度高。較重大的醫療型缺失及服務態度方面的缺失，控制性較高；責任歸屬方面難以醫療型或非醫療型服務缺失加以區分。
二、顧客對不同的醫療服務缺失有不同之行為反應。遭遇醫療型缺失之情況較希望得到實質補償，而非醫療型之缺失則實質補償的需求較低，但相對讓顧客遭受到實質損失情況（例如時間或金錢的損失）者，比未遭受實質損失者（例如服務態度不佳或沒有隱私），實質補償的需求較高。
三、嚴重度是預測顧客對服務缺失反應行為的最有效因素，其次是補救期望。因此嚴重度最有助於推測顧客是否會對缺失提出申訴，對補救效果的推測力則較低。無論是何種型態的服務缺失，嚴重度愈高之服務缺失愈可能被申訴；在某些情況下，嚴重度愈高者愈會要求實質之補償。
四、歸因理論中，穩定性及控制性兩個構面與服務對象之反應行為較有相關性，穩定性及控制性歸因可用來預測顧客之續診意願。在某些情況下，缺失發生愈頻繁，服務對象愈不會有續診之意願；缺失可控制性愈高，顧客也愈不會有續診意願。
五、人口學特性對歸因、嚴重度之認知，以及顧客行為反應的影響視情況而定。在某些缺失情況中，男性比女性較可能提出申訴；年齡愈大者認為缺失較少發生；教育程度愈高者補救效果愈差。
六、顧客對非醫療型服務缺失的認知差異較大。非醫療型缺失常涉及服務態度或隱私等，認知差異較大，傾向屬於仁智互見之問題。
七、與其他行業/產業相較，本研究結果與之有所差異：醫療服務缺失需要「說明解釋」及「道歉」的比例比一般行業/產業高，醫療缺失經補救後的再購買意願亦較一般產業為高。
根據研究結果及結論，提出以下建議：
一、醫療院所管理當局對服務之缺失應積極面對處理。本研究顯示無論服務缺失是否員工個人造成，顧客大都會認為醫療院所管理當局難逃其責，但經過補救後，再購買意願比一般行業/產業高，故醫院管理當局應該摒除規避的心態，宜以正面積極的態度鼓勵抱怨處理申訴，一方面藉以改進醫院之服務，一方面創造服務對象第二次滿意度，也增加顧客的忠誠度。
二、針對不同服務缺失研擬補救策略。本研究發現對不同類型的缺失，顧客會有不同的心理認知與行為，醫院管理當局可以根據此模式，從自己醫療院所最常發生的服務缺失案例著手，了解申訴者的心理認知及可能的行為反應，從而發展本身適用的補救策略，使缺失管理更臻完善。
三、運用顧客對缺失歸因及嚴重度之認知，妥善化解顧客對缺失的不滿。不常發生、無法控制、屬於員工責任、嚴重度輕等的服務缺失，顧客比較容易諒解，管理者可藉由溝通，並承諾未來注意及改善，取得顧客的諒解。若是缺失經常性發生、可控制而未予控制、大部分是醫療院所應負起責任、嚴重度高者，則管理者應該了解服務對象的憤怒與不滿，儘量給予適當對等的補償，以化解服務對象的怨憤。
四、盡量避免核心之關鍵缺失，且一旦發生，儘速因應處理。核心之關鍵缺失嚴重度高，不易補救。醫療院所應加強核心業務的管控，避免讓核心之關鍵業務發生缺失，一旦發生，必須知覺到其嚴重性，應以積極的態度處理，在顧客擴大憤怒前，即給予妥善的處理。
五、準備貼心禮物或優惠之後續服務，營造公平感受。本研究結果顯示，愈可能提出申訴者愈會要求實質補償，而結果也顯示有些受訪者希望得到慰問性的小禮物或優惠之後續服務以充補償，因此建議醫療院所管理當局能準備一些禮物或設計優惠之後續服務，在處理嚴重度不高的服務缺失時，提供或贈與申訴者以表達院方的誠意，提昇申訴者的滿意度。
六、對醫事人員進行專業及服務的教育訓練，提高顧客滿意度。本研究發現「經常發生」百分比最高的是「覺得醫師沒有清楚解釋病情」及「覺得醫師沒有正確診斷病因」，建議給予醫事人員服務的教育訓練，使醫事人員能給予病患滿意的解說，也使病患對自己的疾病狀況得到清楚的解答；並透過專業的教育訓練，提昇醫師的診察治療能力，或者延請專業能力強的醫療人員，以降低上述服務缺失的產生。

關鍵字

服務缺失補救 ； 服務缺失 ； 顧客抱怨行為 ； 顧客忠誠度 ； 歸因理論 ； 服務補救期望

並列摘要

In a service industry, an effective compensation system for the service inadequacies (deviation, failure or defect) is well known able to recover the loyalty of clients and to enrich reputation of the service providers. However, such studies in the health care industry are rare and the experience is limited. In Taiwan, the financial pressure to hospital management dramatically increases after introduction of the National Health Insurance and the hospital authority gradually puts a special emphasis to keep loyal clients. Hence, the compensation system for service inadequacies becomes more and more important in the aspect of client management for every hospital.
This study was aimed at investigating the psychosocial and behavioral responses of clients (patients or their family members) to service inadequacies in a medical center in the northern Taiwan. Through a well structured questionnaire, a survey with role-playing approach and scenario simulation technique was conducted. The seven scenarios designed in this study to represent service inadequacies could be divided into two groups: medical and non-medical inadequacies. The former group indicating dissatisfaction at the service results included: (1) leaving gauze in the abdomen in a surgical procedure; (2) inability to give a definite diagnosis; and (3) failure to explain the condition of a patient in detail. Scenarios included in the latter group suggestive of problems in the process of service delivery were: (1) disesteem of privacy when receiving medical care; (2) breakdown of computer system; (3) to misprint a prescribed drug; (4) impatience of nurse staffs.
A total of 480 questionnaires were issued, in National Taiwan University Hospital (NTUH), to 480 inpatients or their family members. Over one-half (249 copies) of the questionnaires were recovered, but 2 of them were practically invalid. After multiple and stepwise regression analysis, the author obtained several important findings and summarized some concrete conclusions as follows:
1. Most of the clients agree that the non-medical service inadequacies are less severe but occur more frequently than the medical service ones. The more severe the service inadequacies, the more easily to prevent its occurrence.
2. The clients usually require substantial compensations in medical service inadequacies. Moreover, they have a tendency to require more substantial compensation in service problems causing monetary or time loss than causing merely emotional upsets (e.g., disesteem of privacy or nurse’s impatience).
3. The severity of service inadequacies is the most important factor to predict whether the clients would lodge a complaint with the hospital authority. The more severe the service inadequacy, the more likely to propose a substantial compensation.
4. Under certain circumstances, if service inadequacies occur more frequently, the clients would be more likely to lose their inclinations to accept further medical service from this hospital. The more avoidable the service problem, the more likely to lose clients’ inclination to accept further service.
5. Considering the demographic data, it is found: the younger people usually percept more service inadequacies than the aged; males have a higher tendency to lodge a complaint then the females. The higher the client’s education level, the less effective the compensation system.
6. The clients have a great variability to percept non-medical service inadequacies, especially service problems involving the patient’s privacy.
7. As compared with other service industries, the clients require more explanation and apology for service inadequacies in the healthcare system. After adequate compensation for service problems, the clients’ inclinations to accept further service are stronger than those in any other kind of service industry.
Based on the findings in the present study, the author has proposed the following suggestions:
1. The hospital authority should actively handle service inadequacies in order to increase loyalty of clients and to strengthen their inclinations for further medical service.
2. In the face of different kinds of service inadequacies, the clients of a hospital usually percept and react differently. Hence, the hospital authority should design specific strategy/tactics in compensation system to each type of service inadequacies.
3. It is necessary to make good use of severity recognition and its cause attribution from the clients, in order to pertinently buffer their untoward feeling on the service inadequacies.
4. The hospital authority should try the best to avoid service problems involving their core competence. Once it occurs, handle it with care as soon as possible.
5. For the sake of sincerity of compensation or recovery from the service inadequacies, hospital authority could provide some benefit (e.g., small gifts or prioritized healthcare service later on) for those clients lodging a complaint against service problems.
6. As inability to give a definite diagnosis and failure to explain the condition of a patient in detail are the most frequently encountered service problems, the hospital authority should reinforce the concepts of customer service in on-job training for medical staff and/or personnel. Physicians should be trained to have better communication skills in confronting with patients.

並列關鍵字

customer attribution ； service recovery expectation ； customer loyalty ； service failure ； service recovery ； customer complaint behavior

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