| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 93 === 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.
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