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Nghien cu anh gia o tin cay va tnh gia tr cua thang o anh gia s hai long cua benh nhan tai Khanh Hoa
Le Tan Phung, Gerard FitzGerald

Chat lng hoat ong cua benh vien di s cam nhan cua benh nhan c anh gia bang s hai long cua benh nhan. Nhieu nghien cu s hai long cua benh nhan a c tien hanh, nhng viec s dung thang o co tnh gia tr va tin cay cha c c anh gia ay u. Nghien cu nay nham th nghiem mot thang o da tren thang o SERVPERF trong viec anh gia s hai long cua benh nhan thc hien tai benh vien a khoa khu vc thanh pho Cam Ranh va benh vien a khoa huyen Van Ninh thuoc tnh Khanh Hoa. Phan tch yeu to kham pha c s dung e xac nh cac yeu to cau thanh s hai long cua benh nhan. Phan tch o tin cay, phan tch tng quan va hoi quy nham khao sat o tin cay va tnh gia tr cua thang o. Ket qua cho thay co 5 yeu to cau thanh s hai long cua benh nhan, phu hp vi thang o SERVPERF. Thang o s dung a c khang nh tnh tin cay cao (alpha = 0,88) va gia tr hoi tu a c chng minh. T khoa: S hai long cua benh nhan, SERVPERF, phan tch yeu to kham pha, tnh tin cay, tnh gia tr

Study on reliability and validity of the scale for evaluating patient satisfaction in Khanh Hoa province
Le Tan Phung, Gerard FitzGerald

Hospital quality under patients perceptions has been assessed by patient satisfaction surveys. Many studies on patient satisfaction have been conducted. However, validity and reliability of some scales have not been evaluated thoroughly. This study aims to examine a SERVPERF-model scale in evaluating patient satisfaction at Cam Ranh City Regional Hospital and Van Ninh District Hospital of Khanh Hoa province. Exploratory factor analysis was used to explore factors relating to the construct of patient satisfaction. Reliability, correlation and regression analyses were used to examine the reliability and validity of the scale. The result revealed a five-factor construct of patient satisfaction, consistent with the construct of the original SERVPERF. The scale has been obtained a high internal consistency (alpha = 0.88) and a confirmed validity. Key words: Patient satisfaction, SERVPERF, exploratory factor analysis, reliability, validity
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Tap ch Y te Cong cong, 1.2014, So 30 (30)

Ngay nhan bai: 28.11.2013

Ngay phan bien: 13.12.2013

Ngay chnh sa: 22.12.2013

Ngay c chap nhan ang: 30.12.2013

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Tac gia Bac s, thac s YTCC, NCS ai hoc ky thuat Queensland (QUT) - Uc, S Y te Khanh Hoa Giao s, trng ai hoc ky thuat Queensland (QUT), Uc

1. at van e Nhieu nghien cu s hai long cua benh nhan a c thc hien t lau tai nhieu quoc gia khac nhau tren the gii. Mot so nghien cu da tren mot khung ly thuyet hoan chnh e xay dng thang o c anh gia o tin cay va tnh gia tr. Tuy nhien, mot so nghien cu c thc hien da tren nhng thang o cha c kiem nh ay u cac yeu to cau thanh s hai long cua benh nhan cung nh cha anh gia c o tin cay va tnh gia tr cua thang o s dung [8]. Hang nam, theo quy nh cua Bo Y te, cac benh vien trong toan quoc eu tien hanh cham iem benh vien, trong o co bo cau hoi anh gia s hai long cua benh nhan ieu tr noi tru. Tuy nhien, noi dung bo cau hoi va c mau yeu cau thay oi theo tng nam. Bo cau hoi cung cha c chnh thc kiem nh tnh gia tr va o tin cay. Thang o SERVPERF [2, 3], phan "cam nhan" (perception) cua thang o SERVQUAL, la thang o chat lng dch vu thong qua s anh gia cua khach hang a kiem nh o tin cay va gia tr trong nhieu nghien cu tren the gii, ke ca trong he thong benh vien. Muc tieu cua nghien cu nay nham anh gia o tin cay va tnh gia tr cua thang o SERVPERF co ieu chnh e ap dung trong cac benh vien cong lap tai Khanh Hoa noi rieng va Viet Nam noi chung. Nghien cu nay con nham xac nh cac yeu to cau thanh s hai long cua benh nhan tai cac benh vien cong lap, gop phan cai thien chat lng hoat ong benh vien. 2. Phng phap nghien cu 2.1. oi tng nghien cu Benh nhan u 18 tuoi tr len hoac ngi nha u 18 tuoi tr len cua benh nhan a tng ieu tr noi tru tai Benh vien a khoa khu vc Cam Ranh va

Benh vien a khoa huyen Van Ninh, a xuat vien trong vong 3 thang tnh en thi iem nghien cu (4/2012), nham han che nhng sai lech do nh lai.

2.2. Thiet ke nghien cu S dung thiet ke nghien cu cat ngang. 2.3. C mau va phng phap chon mau C mau tong cong cho 2 benh vien la 300 benh nhan. ay la c mau c xem la tot cho phan tch yeu to kham pha (Exploratory Factor Analysis) va ap ng c tieu chuan 5 - 10 oi tng cho moi bien so anh gia (items) trong thang o [3, 4, 7]. Do o, moi Benh vien chon 150 benh nhan. Chon oi tng nghien cu theo phng phap chon mau thuan tien (khong ngau nhien). Danh sach benh nhan a ieu tr noi tru tai 2 Benh vien noi tren c thu thap tren he thong may tnh lu tr cua Benh vien. Benh nhan c sap xep theo xa, phng ni ho c tru. Danh sach benh nhan c chuyen en Trung tam Y te huyen e chon la nhng benh nhan de tiep can, ong y tham gia nghien cu cho u so lng 150 benh nhan tai moi huyen. Cac benh nhan ong y tham gia nghien cu se c cung cap bo cau hoi e t ien hoac nh ngi nha oc giup va chon cau tra li. Bo cau hoi sau khi hoan thanh se c chuyen lai cho nghien cu vien chnh hoac qua ng bu ien nh vao phong b a dan san tem va ghi san a ch ngi nhan gi kem, hoac thong qua nhan vien tram y te vi phong b ng bo cau hoi a hoan thanh c dan kn. 2.4. Thang o s dung Thang o nay (sau ay goi tat la thang o PSS) s dung nhng noi dung cua thang o SERVPERF gom co 5 yeu to cau thanh s hai long vi 22 bien so anh gia, c o lng bang thang 5 iem cua
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Likert: Rat ong y, ong y, bnh thng, khong ong y va rat khong ong y. Tuy nhien, trc khi nghien cu nay c tien hanh, mot nghien cu nh tnh thong qua thao luan nhom a c thc hien nham tm hieu sau hn nhng yeu to anh hng en s hai long cua benh nhan. Ket qua thao luan nhom vi 4 nhom benh nhan ieu tr noi tru tai cac benh vien trong tnh, noi dung ve thu tuc hanh chnh noi len nh mot van e anh hng en s hai long cua benh nhan tai benh vien. Do vay, yeu to th 6 ve thu tuc hanh chnh c them vao thang o PSS vi 4 cau hoi. Cac cau hoi ve thu tuc hanh chnh c tham khao vi cac chuyen gia la lanh ao S Y te, cac chuyen gia cua S Y te ve to chc - hanh chnh, ieu dng trng cua S Y te va Benh vien a khoa tnh. Cuoi cung, thang o PSS bao gom 26 bien so anh gia, c gia nh o lng cho 6 yeu to: C s vat chat (Tangibles), s bao am chat lng (Assurance), S tin cay (Reliability), S cam thong (Empathy), s ap ng (Responsiveness), va thu tuc hanh chnh (Administrative procedures). Ngoai ra, thang o con c bo sung mot cau hoi phan anh s anh gia cua benh nhan ve mc o hai long noi chung cua benh nhan oi vi benh vien, s dung thang 5 iem cua Likert, xep t "Rat khong hai long" en "Rat hai long". Cau anh gia nay ong vai tro nh mot bien so phu thuoc trong moi lien quan vi thang o SERVPERF e anh gia tnh gia tr cua PSS.

- Phan tch o tin cay da tren ch so Cronbach alpha. ay la o tin cay anh gia tnh tng thch noi tai. - Phan tch tnh gia tr bang phng phap phan tch tng quan hoi quy a bien. - So lieu c nhap bang phan mem EpiData version 3.1, phan tch bang phan mem IBM SPSS version 19.0.

3. Ket qua Co 289/300 benh nhan tra li bo cau hoi (t le ap ng la 96,3%). Co 9 benh nhan di 18 tuoi, do o con lai 280 phieu c a vao phan tch. 3.1. Phan tch yeu to kham pha Phan tch so lieu trong (missing) trong 26 bien so anh gia cua thang o PSS cho thay khong co bien so anh gia nao co tren 5% so lieu trong. Do o, so lieu trong trong mau nghien cu nay la chap nhan c [5]. Trong trng hp nay, s dung ky thuat loai bo so lieu trong (listwise) e phan tch yeu to kham pha. Vi ky thuat nay, c mau con lai e phan tch yeu to kham pha la 242. Phan tch tng quan cho thay Barlett's test cho ket qua p < 0,001 chng to rang ma tran tng quan khong phai la ma tran n v (identity matrix); Kaiser-Meyer-Olkin (KMO) test bang 0.868 chng to rang c mau la u so vi so lng bien so cua thang o [7]. Nh vay thang o PSS phu hp cho phan tch yeu to kham pha. Ket qua phan tch yeu to kham pha bang phng phap phan tch thanh phan chnh va quay vong Direct Oblimin cho ket qua co 5 yeu to co gia tr eigen > 1 va t le phng sai trch xuat bang 5% tr len (tr yeu to 5 gan bang 5%) (Bang 1). Bieu o Scree (Hnh 1) cung cho thay 5 yeu to c trch xuat. Ket qua cho thay mac du a c them vao 1
Bang 1. Phan tch phng sai c trch xuat cua thang o PSS

2.5. Phng phap phan tch


- Phan tch yeu to kham pha (exploratory factor analysis) c s dung e xac nh cac yeu to lien quan en s hai long cua benh nhan thong qua thang o PSS s dung trong nghien cu nay. Tieu chuan e xac nh mot yeu to la co y ngha bao gom: gia tr eigen value > 1; phan tram phng sai c trch xuat (percent of extracted variance) t 5% tr len; va bieu o Scree [7]. He so tai (factor loadings) c chap nhan toi thieu bang 0.3 hoac tot hn la t 0.45 [5, 7]. S dung phng phap trch xuat thanh phan chnh (Principal component analysis), xoay vong theo phng phap Direct Oblimin la phng phap ma cac tac gia SERVPERF s dung trong tat ca cac nghien cu. Ma tran cau truc (structural matrix) se la c s chnh e xac nh yeu to. Ma tran mo hnh (pattern matrix) se ong vai tro tham chieu khi co bien so o lng tai ong thi tren nhieu yeu to.
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yeu to la thu tuc hanh chnh nh la yeu to th 6, nhng phan tch yeu to kham pha cho thay cac bien so anh gia ch tai tren 5 yeu to ma thoi, phu hp vi thang o SERVPERF.

trong yeu to "C s vat chat", nhng ket qua phan tch yeu to lai c tai len yeu to 2. ieu nay co the c giai thch nh la hau qua cua tnh trang "ong uc benh nhan" lam tang thi gian ch i, va do o anh hng en "s ap ng".
Bang 2. Ma tran cau truc cua thang o PSS

Hnh 1. Bieu o Scree cho phan tch yeu to kham pha cua thang o PSS

Ma tran cau truc va ma tran mo hnh c trnh bay tai Bang 2 va Bang 3. Bien so v20 "Ho ly luon luon lch s, nha nhan vi Ong (Ba)" tai tren 3 yeu to: 1, 4, va 5 trong ma tran cau truc, vi he so tai cao nhat thuoc ve yeu to 1 (0,479). Tuy nhien, trong ma tran mo hnh, bien so nay ch tai tren yeu to 5 vi he so tai la 0,336. Hn na, he so tai cua bien so nay vi yeu to 5 trong ma tran cau truc khac biet khong nhieu vi he so tai vi yeu to 1 (0,476 so vi 0,479). Do o, se hp ly e bien so v20 tai tren yeu to 5. ieu nay co the giai thch la, do ho ly ch la nhng ngi lam cac cong viec thong thng, khong lien quan en chuyen mon nh bac s hoac ieu dng, cho nen co the quan niem cua ngi benh cho rang ho ly khong ong gop trong van e bao am chat lng ieu tr (yeu to 1). Chnh v vay bien so nay c tai tren yeu to "s cam thong" (yeu to 5). Bien so anh gia v14 "cac khoa phong th sach se" tai co y ngha hn tren yeu to 1 (0,585) so vi yeu to 3 (0,478). Tuy nhien, y ngha cua bien so nay thuoc ve "C s vat chat" cho nen co the e bien so nay thuoc yeu to 3. Phan tch o tin cay tiep theo se giup khang nh la chon nay. Yeu to 2 (S ap ng) gom cac bien so anh gia lien quan en thi gian ch i, bao gom ca thi gian ch i ap ng t bac s, ieu dng, ke ca thu tuc hanh chnh. Bien so v21 "Benh vien tnh qua ong uc benh nhan" d kien ban au c at

3.2. Phan tch o tin cay


o tin cay c phan tch nh la bc cuoi cung e quyet nh cac bien so anh gia thuoc yeu to nao va xac nh thang o chnh thc. Ket qua (Bang 4) cho thay cac yeu to "bao am chat lng", "s ap ng" va "s tin cay" co ch so Cronbach's alpha cao (0,865; 0,810; va 0,726). Yeu to "s cam thong" co ch so Cronbach's alpha chap nhan c (0.624), va yeu to "c s vat chat" co Cronbach's alpha thap (xap x 0,6).
Tap ch Y te Cong cong, 1.2014, So 30 (30) 49

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Bang 3. Ma tran mo hnh cua thang o PSS

Bang 4. Phan tch o tin cay cua thang o PSS va tng yeu to

Co 3 bien so anh gia lam tang ch so Cronbach's alpha khi loai bo chung ra khoi thang o PSS. o la cac bien v21, v4, va v23 thuoc cac yeu to 2, 3, va 5. Tuy nhien, loai bo v21 ch lam tang ch so Cronbach's alpha cua yeu to 2 khong nhieu (t 0,810 len 0,813) cho nen khong can thiet loai bo bien so nay. Loai bo bien so v4 cung lam tang Cronbach's alpha cua yeu to 4 khong nhieu (t 0.726 len 0.796). Hn na, yeu to nay ch co 3 bien so anh gia, cho nen can gi lai v4 e am bao co toi thieu 3 bien so cho moi yeu to. S gi lai v23 cung c giai thch bang ly do tng t. Xet toan bo thang o, ch so Cronbach's alpha 0,88 cho thay thang o PSS co o tin cay cao. Viec loai bo v6 ch lam tang Cronbach's alpha khong ang ke (t 0,880 len 0,886). Do o, toan bo 26 bien so anh gia cau thanh thang o PSS c gi lai. Ket qua phan tch yeu to kham pha va phan tch o tin cay tren a xac nh thang o PSS chnh thc cung vi nhng yeu to cau thanh (Bang 4).
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3.3. Phan tch tnh gia tr Nh a noi tren, mot cau hoi nham anh gia s hai long noi chung cua benh nhan c s dung e khao sat tnh gia tr hoi tu (convergent validity) cua thang o PSS [6]. Bien so anh gia nay cung thuoc thang 5 iem cua Likert, goi la bien so "hai long". Neu s tng quan gia bien so "hai long" vi cac yeu to cau thanh thang o PSS la co y ngha, ta co the xac nh thang o PSS la co gia tr hoi tu. Ket qua phan tch Bang 5 cho thay ca 5 yeu to eu co moi tng quan co y ngha thong ke vi bien so "hai long". Hau het y ngha thong ke cua cac moi tng quan nay mc p < 0,001.

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Bang 5. Phan tch tng quan gia 5 yeu to cua thang o PSS va bien so "hai long"

benh nhan noi chung la yeu to "bao am chat lng" (=0,642, p <0,001) va yeu to "s cam thong" (=0,237, p <0,007). Cac he so hoi quy chuan hoa cho thay yeu to "bao am chat lng" co tac ong ln nhat en s hai long noi chung cua benh nhan (a chuan hoa = 0,448 so vi 0,191 cua yeu to "s cam thong").

e khang nh them tnh gia tr hoi tu nay, mot mo hnh hoi tuyen tnh c e ngh gia bien so phu thuoc la bien "hai long" va 5 bien so oc lap la 5 yeu to cua thang o PSS.
Bang 6. Mo hnh hoi quy tuyen tnh gia cac yeu to thang o PSS va bien so "hai long"

Ket qua tai Bang 6 cho thay mo hnh hoi quy la co y ngha thong ke vi p < 0,001 va R2 ieu chnh bang 0,377. ieu o co ngha la 37,7% bien thien phng sai cua s hai long noi chung cua benh nhan c giai thch bi 5 yeu to cau thanh cua thang o PSS. Ngoai ra, mo hnh hoi quy con cho thay co 2 yeu to co y ngha thong ke tac ong en s hai long cua

4. Ban luan - Thang o PSS 26 bien so phat trien t thang o SERVPERF a cho thay tnh gia tr va tnh tin cay trong viec o lng s hai long cua benh nhan oi vi 2 benh vien cua tnh Khanh Hoa. - Thang o PSS bao gom 5 yeu to cau thanh: S bao am chat lng, s ap ng, c s vat chat, s tin cay, va s cam thong, phu hp vi 5 yeu to cua cac thang o SERVPERF. - Khao sat s bo tai 2 benh vien Cam Ranh va Van Ninh trong nam 2012 cho thay 2 yeu to quan trong gop phan vao s hai long cua benh nhan la yeu to "bao am chat lng" va "s cam thong", trong o "bao am chat lng" co tac ong ln nhat. Do o, e cai thien s hai long cua benh nhan, can nghien cu cai thien cac bien so anh gia co lien quan. - Can co them nhieu nghien cu theo hng phan tch yeu to kham pha e khao sat ay u thang o PSS trc khi tien hanh cac phan tch khang nh (confirmatory factor analysis) nham ap dung thang o PSS tai cac benh vien cua Viet Nam trong khuon kho cua cong tac quan ly va anh gia chat lng benh vien.

Tai lieu tham khao Tieng Anh 1. Cronin, J.J. and S.A. Taylor, Measuring service quality: a reexamination and extension. The Journal of Marketing, 1992: p. 55-68. 2. Cronin, J.J. and S.A. Taylor, SERVPERF versus SERVQUAL: reconciling performance-based and perceptions-minus-expectations measurement of service quality. The Journal of Marketing, 1994. 58(1): p. 125-131. 3. DeVellis, R.F., Scale Development: Theory and Applications. 2012: SAGE Publications. 4. Floyd, F.J. and K.F. Widaman, Factor analysis in the development and refinement of clinical assessment

instruments. Psychological assessment, 1995. 7(3): p. 286. 5. Kline, R.B., Principles and practice of structural equation modeling. Third ed. 2011, New York: The Guilford Press. 6. Parasuraman, A., L.L. Berry, and V.A. Zeithaml, Refinement and Reassessment of the SERVQUAL Scale. Journal of Retailing, 1991. 67(4): p. 420. 7. Pett, M.A., N.R. Lackey, and J.J. Sullivan, Making sense of factor analysis: the use of factor analysis for instrument development in health care research. 2003, London: SAGE Publications. 348. 8. van Campen, C., et al., Quality of Care and Patient Satisfaction: A Review of Measuring Instruments. Medical Care Research and Review, 1995. 52(1): p. 109-133.

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