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KMID : 0614819960020010097
Journal of Korean Academy of Nursing Administration
1996 Volume.2 No. 1 p.97 ~ p.114
A Study on Quality Perceptions and Satisfaction for Medical Service Marketing
Yoo Dong-Keun

Abstract
INSTRODUCTION: Service quality is, unlike goods quality, an ab¡©stract and elusive constuct. Service quality and its requirements are not easily understood by c¡©onsumers, and also present some critical resear¡©ch problems. However, quality is very importa¡©nt to marketers and consumers in that it has m any strategic benefits in contributing to profita¡©bility of marketing activities and consumers¢¥ pr¡©oblem-solving activities. Moreover, despite the phenomenal growth of medical service sector.. few researchers have attempted to define and Inodel medical service quality. Especially, little research has focused on the evaluation of medic¡©al service quality and patient satisfaction from the perspectives of both the provider and the patient. As competition intensifies and patients are demanding higher quality of medical service, m¡©edical service quality and patient satisfaction has emerged as a critical research topic. The m¡©ajor purpose of this article is to explore the con¡©cept of medical service quality and its evaluati¡©on from both nurse and patient perspectives. This article attempts to achieve its purpose by (1)classfying critical service attibutes into three¡©categories (satisfiers, hygiene factors, and perfor mance factors), (2)measuring the relative import ance of need criteria, (3)evaluating SERVPERF model and SERVQUAL model in medical service sector, and (4)identifying the relationship betw¡©een perceived quality and overall patient satisf¡©action.

METHOD:
Data were gathered from a sample of 217 pati¡©ents and 179 nurses in Seoul-area general hospi¡©tals. From the review of previous literature. 50 survey items representing various facets of¢¥ the medical service quality were developed to form a questionnaire. A five-point scale ranging from " Strongly Agree"(5) to."Strongly Disagree"(1) acc¡©ompanied each statement (expectation statemen¡©ts, perception statements, and importance stat¡©ements).
To measure overall satisfaction, a seven-point scale was used, ranging from "Very Satisfied"(7) to "Very Dissatisfied" (1) with no verbal labels for scale points 2 through 6

RESULTS:
In explaining the relationship between perceiv¡©ed performance and overall satisfaction, only 31 variables out of original 50 survey items were proven to be statistically significant. Hence, a
penalty-reward analysis was performed on theses 31 critical attributes to find out 17 satisfiers, 8 hyg:Lene factors, and 4 performance factors in patient perspective.
The role(category) of each service quality attr¡©ibute in relation to patient satisfaction was com pared across two groups, that is, patients and nurses. They were little overlapped, suggesting that two groups had different sets of "perceived quality¢¥ attributes.
Principal components factor analyses of the patients¢¥ and nurses¢¥ responses were performed to ide:atify the underlying dimensions for the set of performance (experience) statements. 28 variab les were analyzed by using a varimax rotation of ter deleting three obscure variables. The number of factors to be extracted was determined by ev¡©aluating the eigenvalue scores. Six factors were¡©extracted, accounting for 57.1% of the total var¡©iance.
Reliability analysis was performed to refine the factors further. Using coefficient alpha, scor¡©es of .84 to .65 were obtained. Individual-item analysis indicated that all statements in each of the factors should remain.
On 26 attributes of 31 critical service quality attributes, there were gaps between actual pati¡©ents importance of need criteria and nurse per¡©ceptions of them. Those critical attributes could be classified into four categories based on the relative importance of need criteria and perceiv¡©ed performance from the perspective of patient. This analysis is useful in developing strategic plans for performance improvement.
OO top priorities(high importance and low perfo rmance)
(in this study)- more health-related informati¡©
on
accuracy in billing
- quality of food
- appointments at my convenience
- information about tests and treatments
- prompt service of business office
-adequacy of accommodations (elevators, etc)
¨Ï current strengths(high importance and high performance)
¨Ï unnecessary strengths(low importance and high performance)
¢ç low priorities(low importance and low perfor mance)
While 26 service quality attributes of SERPE¡©RF model were significantly related to patient satisfation, only 13 attributes of SERVQUAL m¡©odel were significantly related. This result sugg¡©ested that only experience-based norms(SERVP¡©ERF model) were more appropriate than expect¡©ations to serve as a benchmark against which service experiences were compared(SERVQUAL model). However, it must be noted that the deg¡©ree of association to overall satisfaction was not consistent.
There were some gaps between nurse percetio¡©ns and patient perception of medical service per¡©
formance. From the patient¢¥s viewpoint, "person¡©al likability", "technical skill/trust", and "cares about me" were most significant positioning fact¡©ors that contributed patient satisfaction.

DISCUSSION:
This study shows that there are inconsistenci¡©es between nurse perceptions and patient perce¡©ptions of medical service attributes. Also, for se¡©rvice quality improvement, it is most important for nurses to understand what satisfiers, hygiene factors, and performance factors are through two -way communications.
Patient satisfaction should he measured, and problems identified should be resolved for survi¡©val in intense competitive market conditions. Hence, patient satisfaction monitoring is now becoming a standard marketing tool for healthc¡©are providers and its role is expected to increase.
KEYWORD
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