Public health service quality at Thai Nguyen national general hospital

Establishing appropriate mechanisms for implementing patient‘s rights: Have effective feedback mechanisms, for capturing complaints, and for gathering general satisfaction data; analyses this information regularly in a meaningful way to identify areas for improvement, examine the extent to which the patient can participate in treatment decision making. - Applying total quality management, continuous quality improvement in which emphasizes in taking care of staffs, teamwork, empowerment, leadership commitment, using good and appropriate tools and methods to improve the process. - Cooperation in quality improvement. This cooperation is reflected in two aspects: Cooperation within the hospital and cooperation with external partners. - Measuring and comparing quality indicators.

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of demographics on quality was supported by many researchers including Webster et al., 1989 found that consumer demographic characteristics have a significant effect on their consumers‘ expectations and perceptions of quality for professional services and not for non-professional services. Katherine & Hathcote (1994) findings also indicated that race, marital status and income yielded significant differences. As mentioned previously, nearly all patients using public service of hospitals in Thainguyen are usually paying for their medical services through insurance with partially or fully covered, only small percentage used their own pockets to pay for their health services. Thus it comes to notice that demographic characteristics do not have an impact on the overall perceived service quality of the hospital. 5.2. Conclusions Improving the quality of healthcare is an important and leading activity in the direction of the field of medical examination and treatment of the hospital. This activity always gets the attention of the board of directors of the hospital. However, in addition to investments in infrastructure and enhance the responsibility of every staff, the hospital needs to consider the strengthening of human resources and finance, improve patient safety and patient satisfaction. In the previous period, in order to improve quality, the hospital has established a quality management unit to cover and supervise the quality of activities in the hospital. Thereby, the hospital made a fundamental change in the quality management; this is also an important step in changing and improving the quality of hospital, contributing to improve patient satisfaction. Quality management is one of the indispensable activities and becoming increasingly more important in health facilities in the current period, when the patient's expectations are higher and higher. 110 The research results showed that, majority of patients were satisfied with the attitude of nurses and doctors. The care and positive attitude of nurses help patients reduce fatigue and trust in hospital. Some advantages should continue to develop to get better quality in terms of facilities, quality of doctors, consulting hours, attitude of almost doctors and nurses. All components reflect health service quality meet the expectation of patients when they visit to hospital. Patients are quite satisfied with the quality of medical services and will continue to use the services of hospital. Besides it, they also reveal their willingness to recommend friends and relatives using the health care services of hospital. Through testing the difference of demographic variables, the result showed that: ANOVA analysis showed that there is no difference in overall level of perceived service quality by ages, occupations, genders, educational level and income. The majority of patients and their relatives have high satisfaction rate with the medical services when visiting and being treated at the Thai Nguyen national hospital, in which, Responsiveness and Reliability criteria reached highest-level. Low satisfaction rate of the patients related to the tangible, garage item and noisy environment landscape. The problem posed is has to build a hospital environment that not only concentrate on specialization, investing modern facilities and equipment but also other important factors such as: clean green beautiful environment; positive attitude, attentiveness of medical staffs even from security guards, vehicle custodian; can tin of patients;Doing well these things, the hospital will attract more patients and not only meet national standards but also international standards. Following an extensive literature review and completion of the qualitative and quantitative phases of the research, many factors were identified for healthcare service quality. These researchers have included some of the original 10 dimensions that were identified by Zeithaml et al. (1989) and others that they thought proved relevant to healthcare from the works of Brown & Swartz (1989), Joby (1992), Walbridge & Delene (1993), Woodside et al. (1989) and Carmen (1990). Additional factors were included from the results of the qualitative research (in-depth interviews with patients and experts and pilot study). This resulted in formulation of a wide-ranging model containing a broad array of constructs and sub-constructs thought to affect healthcare service quality in the public healthcare sector in Vietnam. The model was tested and showed significance for 5 modified factors of SERVQUAL model to assess health service quality. The 5 constructs affected 111 healthcare service quality was identified through factor analysis and multi variables regression. The model suggests that there are five major factors for service quality that include Reliability, Assurance (Security), Empathy, Responsiveness and Tangibility. Several sub-constructs including nursing tangibles, hospital premises and employees‗ tangibles as well as room and housekeeping courtesy were found to have a more significant impact on overall service quality than others. In addition, eight different scales to be tested and Weighted SERVQUAL was identified as the ideal method for measurement of healthcare service quality among the tested methods in the current research settings. The effect of moderating variables (demographics) was also tested through ANOVA analysis. Although age, gender, occupation, income and education did not have a significant on variables of the research. Finally, correlation between overall consumer satisfaction on one hand and behavioral intentions to return and recommend were established. As a conclusion, through the above research, the researcher was able to provide a model for healthcare service quality in Thai Nguyen National Hospital. A valid and reliable scale that will enable healthcare marketers and managers to evaluate the level of healthcare service quality in their organizations, to pinpoint the weak areas and upgrade the quality of the service provided was also established. The author, based on the synthesis of some service quality models, along with additional, certain adjustments to suit the circumstances, the characteristics of a public hospital in Thai Nguyen National Hospital, has strongly inherited the results of this study to test the quality of public hospital services in Thai Nguyen city. This is new to the topic. 5.3. Policy recommendations In order to improve quality of the hospital, the following measures should be noted: Includes solutions in building infrastructure systems, hospital equipment; Construction quality management system; Management of hospital human resources; Building health financing; Reform of the administrative organization of medical apparatus; Diversifying the type of medical examination and treatment; promote the development of health information; Hospital participation and implementation of international cooperation projects; Application of information technology in the medical field. For the detail solutions, the hospital should: - Increasing the main resources: finance facilities, equipment and manpower. - Reforming of the organization, financial mechanism. - Developing operational standards, professional guidelines and monitoring the 112 implementation; implementing the mechanism of clinical testing and feedback; having quality plans for ongoing staff training and professional development. - Establishing appropriate mechanisms for implementing patient‘s rights: Have effective feedback mechanisms, for capturing complaints, and for gathering general satisfaction data; analyses this information regularly in a meaningful way to identify areas for improvement, examine the extent to which the patient can participate in treatment decision making. - Applying total quality management, continuous quality improvement in which emphasizes in taking care of staffs, teamwork, empowerment, leadership commitment, using good and appropriate tools and methods to improve the process. - Cooperation in quality improvement. This cooperation is reflected in two aspects: Cooperation within the hospital and cooperation with external partners. - Measuring and comparing quality indicators. - Calibration: Using comparative information on quality with additional methods to help service providers decide how to improve quality. From the results of research about the patient satisfaction in the quality of medical services in Thainguyen National Hospital, may propose measures to improve the quality of health care services of the hospital, as follows: In Tangibility aspect - The hospital should pay attention in buying more modern and adequate medical equipment to meet the increasing needs of patients; build a more beautiful and cleaner hospital landscape that can reduce medical features. Especially, the hospital should build some lakes for conditioning the environment, build flower gardens, landscaped garden, medicinal gardens; Designing hospital rooms with sound-proof glass for patients that need quiet; limiting the number of patient‘s relatives visiting them in the room; prohibiting hawkers from selling in hospital; prohibiting playing, running around and loud quarrel in the hospital; Building and expanding the covered garage, opening more parking ticket gates to the patient. - It is necessary to clean hospital room regularly in order to make patients feel airy and comfortable for living during treatment time in hospital. Allocating sufficient hospital beds per room, with sufficient fans or air conditioners to help patients avoid hot and stifling atmosphere at noon or overcrowded situation when relatives visit patients. Beside it, the hospital should allocate sufficient lamps to ensure standard lighting. - The hospital should arrange more guiding counters to help patients performing the necessary procedures and arising requirements. At the outpatient department: Adding 113 photocopiers to perform services for patients when they have need; Arranging priority areas for the disabled persons and children under 3 years old; Separating examination rooms for people who have contributed to the revolution using health insurance card; Wi-Fi and a number of modern amenities should be equipped at waiting room; adding examination rooms for special patients in the rush hour; At labor ward, providing patients at the optional rooms more serving equipment appropriate with service price. - The hospital can add planned patient beds for cardiology ward to avoid many people lying on a bed, cramped room, beds blocking the aisle. Supplementing, replacing and repairing the equipment and facilities do not meet the requirements. Applying flexible procedures with severe patient cases need to emergent treatment; - Hospital needs to propose health insurance agencies to add a list of drugs to patients using health insurance. Currently, there are many drugs used in treatment but not being listed, patients have to buy outside. In Reliability Aspect - Training and development are vital cogs in the wheel when it comes to aiming for service excellence. Therefore, the board of directions of the hospital should take care of providing appropriate and continuous training for young doctors and new staffs. Creating opportunities for them to gain experience. Arrange them under management of experienced doctor. Allow them exposuring to patients via tasks from simple tasks to complex tasks, avoiding too hard tasks will cause anxiety for patients - The hospital should strictly comply the necessary treatment services for health status of each patient, provide consulting information about the disease and what services patient will be provided during treatment in hospital, it will help the patient have enough prepare for psychology and finance. - Hospital can public the information about specific working schedules of the medical staffs and doctors. Limit to change that schedules and ensure patients easily meet your treating doctor. - Always raise up attitude and medical ethics, improve communication skills for medical staffs, regular visits and encourage the health situation of the patient. Always be friendly, considerate with patients irrespective of whether or not patients use health insurance and disadvantaged persons. 114 In Empathy Aspect - After treatment time at hospital, doctors need to contact with patients to ask them about the changes of their health, encourage them, adjust prescription if necessary. - The hospital need to strengthen and attract more good doctors, accurate diagnosis for patients. Medical staffs need to listen to patient‘s comments, react to patients requests. Make sure that medical staffs always value patient‘s comments. - There should be a link between the outpatient department and expertised wards to facilitate the patients and their families, avoid trouble for patients and patiens have to take a long time to implement admistrative procedures - The hospital should reduce the number of patients per room to make hospital room really be a place that patient can take a rest and get health medical care. At the Odontology ward, need to pay attention to the attitude of the nurses. Ensure that they are really gentle, professional and effective. - The hospital's fee of people without health insurance card is higher than the average income of people in Thai nguyen and in particular and the region of northern mountainous area in general. In Assurance aspect - Supplement more types of services on-site to serve the needs of patients and their families, avoid the exclusive situation with high-value services that damages to the financial of patients and their family. - The price of optional room is quite high, the number of bed is not respond to the number of patient so the patient still lie transplant. Patients wish the hospital reduce the price of optional room for patients who have long treatment time. Curently, the price of optional room is two hundred thoundsan per day is not a small amount of expense if patient has a long treatment time, not to mention the medical bills. - Hospital should have a policy to reduce fees for highland peoples, the poor, disabled people and people who have contributed to the revolution. - The hospital should build working hours of the hospital ensures 24/24, ready to meet the need for care and medical treatment of the patient all the time. - The hospital need strengthen manpower and improving administrative procedure in order to shorten the waiting time of patients at reception area and improve working process ensuring the connection between wards, departments and units, minimize shorten the waiting time of patients. 115 Other recomendations - The hospital may develope a plan to evaluate and improve quality according to SERVQUAL model: The way to apply this model including 8 steps: - Step 1: Begining step: Determine the necessary và determination to apply the method assessing the quality of services by SERVQUAL model. - Step 2: Establish specialized unit have responsible to manage and assess health service quality. - Step 3: Raise up awareness and training skills to apply methods: Need to train quality specialized team with basic skills such as identify patient‘s requirements, standardized services, create assessment standards and the way to control quality. - Step 4: Conduct standardization services to have a standard set of service, supplying process and quality service control. - Step 5: Creating regulations on quality assessment in order to have standard rugulations (or procedures) on assessment, how to conduct assessment (both internal assessment and assessment of the patients). - Step 6: Creating annual assessment programme and assessment plan for each stage: The annual assessment programme needs to have assessment cycle which is able to assess fully and control comprehensively processes and parts that affect quality. Assessment plan for each stage is necessary to determine the questions, specify how to score and assess and things to tasks required for both assessment experts and assessmented parts - Step 7: Issuing and appling the regulations of new health service fee, coinciding with control the quality management in order to match between quality and fee of using services in which the assessment of service quality following the SERVQUAL is an important content. - Step 8: Maintaining and improving: perform the assessment (especially gathered from the patients), result analysis, continue to improve quality while implementing standardized services and processes that are consistent with patient‘s requirements. In conlusions, the research has some implications as follow: First, the research results will give to reader an overview of factors affecting the quality of service of public hospitals in the city. Second, this study helps to identify the scale used to measure quality of hospital services in the city, from which the Board of Directors can review the quality of services that they are providing hospitals, thereby building held up for his consistent policy to improve service quality, meet better to the needs of the people. 116  Limitations Firstly, the sample selected for this study is from Thai Nguyen city. Hence the conclusions drawn are mostly applicable to the health care sector in this city. So the results of the study cannot be generated to other countries or healthcare system. Secondly, the author tried to cover quite large number of respondents, but the author only concentrated on patients and their relatives, there is a need of asking other stake holder which have relate benefit in health sector such as medical staff, policy maker, manager, to get qualitative information to analyses the quality of health services in public hospital. Thirdly, the research only standing on the patient‘s side to assess and view the health care services quality, it did not standing on the providers‘ point of view to assess the quality and quality management. Finally, the research only studied on public health services sector, did not study the private sector. So that the research hasn‘t got the comparison between the quality of health care services in public and private sector. The author only assess the patient satisfaction at a point of time, do not have the assessment at different time of using service of patient.  Scope for future research The future research may cover wider range with the comparisons of different hospitals or in different countries. The researcher could also add more dimensions to measuring the outcome of healthcare services or develop a new scale for evaluating the quality of services in health care sector. 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Dang Anh Tuyet (2012), the case study of the quality of medical services in Tien Giang, Institute of Sociology, Institute of Politics - National Administration, Ho Chi Minh City. 121 APPENDIX Appendix 1: Questionnaire TABLE SURVEY OF PATIENTS’ SATISFACTION OF HEALH CARE SERVICES AT THAI NGUYEN NATIONAL HOSPITAL QUESTIONNAIRE Dear Respondents, I am Nguyen Thi Lan Anh, a researcher of the joint doctorate program between Central Philippine University and Thai Nguyen University of Economic Business Administration. I am conducting a survey on patients‘ satisfaction with health care services of Thai Nguyen National Hospital in Thai Nguyen Province. You have been selected as a respondent of this study, so may I request you to answer this questionnaire as honestly as possible. There are no rights or wrong answers, all we are interested in are the numbers that strongly shows your expectations, perceptions with of the services offered. Please be assured that any information you provide will be treated with utmost confidentiality and will be used for academic purpose only. Respondent’s identification Respondent No. ................ Category: Patient or Relative of patient Using services at Department: Using Health Insurance Card: Yes No Time duration of treatment in TN hospital: ..(days) Number of using hospital‘ service:(times) * General Information of respondent 1. Name (optional): .................................................Phone number:. 2. Resident: Thai Nguyen province: 1- Urban ; 2 - Rural or Others: .. 3. Gender: Male or Female 4. Age: Under 18 From18 - Under 30 From 30 - Under 60 Over 60 5. Ethnic: Kinh Ethnic minority 6. Occupation: Student Worker Famer Retire Self business Public servant Others 7. Monthly income: 122 ≤ 2.0 million VND; From 2.1 – under 5 million VND; From 5 - under 10 million VND; ≥10 million VND. 8. Education level: Secondary school and lower; High school; Diploma level; University graduate; Post-graduate. 9. The reason why you choose Thainguyen National General Hospital: High quality doctor; Modern facility and equipment; Good reputation of Hospital; Good attitude of doctor; Right line of treatment; Reasonable fee. PART 1: EXPECTATIONS This survey deals with your opinions of patients at Thai Nguyen National Hospital. Please show the extent to which you think health care service should be. Please rate on a scale of 1 -5 your experience to the statement on the left regarding the quality of care you received during your most recent hospital visit. Highly Satisfied Satisfied Neutral Dissatisfied Highly dissatisfied 1 2 3 4 5 1 2 3 4 5 A. Tangible (TAN) TAN1 Thai Nguyen National Hospital has modern equipment TAN 2 The physical facilities at the hospital are visually appealing. TAN 3 Employees are neat appearing at hospital TAN 4 Materials associated with the health care service are visually appealing and clean TAN 5 Parking facilities enabled patients to access hospital without undue effort B Reliability (REL) REL6 Health care service of Thai Nguyen National 123 hospital have reliable REL 7 The nurses and doctors treated patients with dignity and respect REL 8 High quality of doctor and medical staffs REL 9 The hospital provides services at the time they promise to do so REL10 The hospital keeps patient‘s information and complains on record and keep it secret. REL11 Patients were informed of any risks associated with the procedure for any procedures of tests that were recommended to patients‘ related health issues C Responsiveness (RES) RES12 Employees of hospital tell patients exactly when services will be performed RES 13 If patients had pain while at the hospital, staffs did everything they could to control the pain RES 14 Employees of hospital always be willing to help patients. RES 15 Employees of hospital have hotline respond to customers‘ requests RES 16 Employees of Thai Nguyen C hospital will give prompt service to patients D Assurance (ASS) ASS17 Employees of hospital have the knowledge to answer customers‘ questions quickly and exactly ASS 18 Employees of hospital always polite and friendly and gets on well with patients ASS 19 The fees applied were reasonable in relation to what other hospital charge for similar services ASS 20 Customers (patients and their family) of TN National General hospital feel comfortable in health care services E Empathy (EMP) 124 EMP21 Hospital give patients individual attention EMP22 Employees of hospital understand the needs and wants of patients EMP23 All procedures of health care service in hospital are easy and convenient for patients EMP24 Health service in hospital have operating hours and communication space convenient to all their customers EMP25 No discrimination between HIC and paired fee patients PART 2: PERCEPTIONS 1 2 3 4 5 A. Tangible (TAN) TAN1 Thai Nguyen National Hospital has modern equipment TAN2 The physical facilities at the hospital are visually appealing. TAN3 Employees are neat appearing at hospital TAN4 Materials associated with the health care service are visually appealing and clean TAN5 Parking facilities enabled patients to access hospital without undue effort B Reliability (REL) REL6 Health care service of Thai Nguyen National hospital have reliable REL7 The nurses and doctors treated patients with dignity and respect REL8 High quality of doctor and medical staffs REL9 The hospital provides services at the time they promise to do so REL10 The hospital keeps patient‘s information and complains on record and keep it secret. 125 REL11 Patients were informed of any risks associated with the procedure for any procedures of tests that were recommended to patients‘ related health issues C Responsiveness (RES) RES12 Employees of hospital tell patients exactly when services will be performed RES13 If patients had pain while at the hospital, staffs did everything they could to control the pain RES14 Employees of hospital always be willing to help patients. RES15 Employees of hospital have hotline respond to customers‘ requests RES16 Employees of Thai Nguyen C hospital will give prompt service to patients D Assurance (ASS) ASS17 Employees of hospital have the knowledge to answer customers‘ questions quickly and exactly ASS18 Employees of hospital always polite and friendly and gets on well with patients ASS19 The fees applied were reasonable in relation to what other hospital charge for similar services ASS20 Customers (patients and their family) of TN National General hospital feel comfortable in health care services E Empathy (EMP) EMP21 Hospital give patients individual attention EMP22 Employees of hospital understand the needs and wants of patients EMP23 All procedures of health care service in hospital are easy and convenient for patients EMP24 Health service in hospital have operating hours and communication space convenient to all their 126 customers EMP25 No discrimination between HIC and paid fee patients Overall Patient Satisfaction (SAT) SAT26 Overall, I am satisfied with hospital service SAT27 I should definitely choose this hospital again if I need it in the future SAT28 I should recommend this hospital to a friend or relative Recommend for Health care service of hospital Thank you for your support! 127 Appendix 2:FOCUS GROUP DISCUSSION The following section lists the five features concerning hospitals and services of hospital. We would like to know how important each feature is when evaluating a Hospital's service quality. Please allocate a total of 100 points among the five features according to how important each feature is to you. The more important the feature, the more points you should allocate to it. Please ensure that the sum of points you allocate to the five features add up to 100. Thank you for your support! SERVQUAL IMPORTANCE WEIGHTS 1. TANGIBLE: The appearance of Thai Nguyen National Hospital physical facilities, equipment, personnel, and communication materials. 2. RELIABILITY: Thai Nguyen National Hospital ability to perform the promised healthcare service dependably and accurately. 3. RESPONSIVENESS: Thai Nguyen National Hospital‘s staff‘s willingness to help customers and provide prompt services. 4. ASSURANCE: The knowledge and courtesy of the healthcare service employees and their ability to convey trust and confidence. 5. EMPATHY: The caring, individual attention the health care service provides to patients. Total .points . points ... points ... points ...points 100 points 128 Appendix 3: RESULTS OFQUANTITATIVE ANALYSIS 3.1.TEST OF RELIABILITY 3.1.1. TANGIBLE Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .761 .768 5 Item Statistics Mean Std. Deviation N A_1 3.6812 .72372 367 A_2 3.6785 .78938 367 A_3 3.6894 .72162 367 A_4 3.6785 .77188 367 A_5 3.7493 .72605 367 Inter-Item Correlation Matrix A_1 A_2 A_3 A_4 A_5 A_1 1.000 .097 .914 .246 .492 A_2 .097 1.000 .146 .274 .193 A_3 .914 .146 1.000 .316 .576 A_4 .246 .274 .316 1.000 .724 A_5 .492 .193 .576 .724 1.000 Inter-Item Covariance Matrix A_1 A_2 A_3 A_4 A_5 A_1 .524 .056 .477 .138 .259 A_2 .056 .623 .083 .167 .110 A_3 .477 .083 .521 .176 .302 A_4 .138 .167 .176 .596 .406 A_5 .259 .110 .302 .406 .527 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted A_1 14.7956 4.753 .589 .838 .697 A_2 14.7984 5.681 .221 .085 .825 A_3 14.7875 4.539 .675 .857 .667 A_4 14.7984 4.768 .526 .560 .720 A_5 14.7275 4.456 .702 .659 .656 129 3.1.2. RELIABILITY Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .843 .841 6 Item Statistics Mean Std. Deviation N B_6 3.5095 .83260 367 B_7 3.5640 .95277 367 B_8 3.5668 .95258 367 B_9 3.3815 .80060 367 B_10 3.3869 .82160 367 B_11 3.3161 .88295 367 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted B_6 17.2153 12.913 .314 .146 .871 B_7 17.1608 9.824 .796 .997 .780 B_8 17.1580 9.822 .796 .997 .780 B_9 17.3433 10.931 .739 .790 .797 B_10 17.3379 11.284 .639 .746 .815 B_11 17.4087 11.767 .485 .258 .844 Inter-Item Correlation Matrix B_6 B_7 B_8 B_9 B_10 B_11 B_6 1.000 .291 .289 .195 .146 .338 B_7 .291 1.000 .998 .631 .537 .401 B_8 .289 .998 1.000 .633 .539 .400 B_9 .195 .631 .633 1.000 .863 .416 B_10 .146 .537 .539 .863 1.000 .347 B_11 .338 .401 .400 .416 .347 1.000 130 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted B_6 17.2153 12.913 .314 .146 .871 B_7 17.1608 9.824 .796 .997 .780 B_8 17.1580 9.822 .796 .997 .780 B_9 17.3433 10.931 .739 .790 .797 B_10 17.3379 11.284 .639 .746 .815 B_11 17.4087 11.767 .485 .258 .844 3.1.3. ASSURANCE Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .763 .757 5 Item Statistics Mean Std. Deviation N C_12 3.5232 .89558 367 C_13 3.5041 .84243 367 C_14 3.4986 .89588 367 C_15 3.5068 .89280 367 C_16 3.5804 .71169 367 Inter-Item Correlation Matrix C_12 C_13 C_14 C_15 C_16 C_12 1.000 .370 .914 .320 .504 C_13 .370 1.000 .347 .422 .167 C_14 .914 .347 1.000 .349 .428 C_15 .320 .422 .349 1.000 .022 C_16 .504 .167 .428 .022 1.000 131 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted C_12 14.0899 5.306 .770 .853 .626 C_13 14.1090 6.660 .441 .241 .751 C_14 14.1144 5.391 .744 .839 .637 C_15 14.1063 6.756 .373 .247 .777 C_16 14.0327 7.365 .366 .280 .770 3.1.4. RESPONSIVENESS Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .704 .700 4 Item Statistics Mean Std. Deviation N D_17 3.5259 .83879 367 D_18 3.7330 .74627 367 D_19 3.5259 .93432 367 D_20 3.6403 .77270 367 Inter-Item Correlation Matrix D_17 D_18 D_19 D_20 D_17 1.000 .561 .626 .149 D_18 .561 1.000 .457 .203 D_19 .626 .457 1.000 .214 D_20 .149 .203 .214 1.000 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted D_17 10.8992 3.206 .625 .488 .552 D_18 10.6921 3.656 .551 .343 .608 D_19 10.8992 2.987 .596 .419 .567 D_20 10.7847 4.454 .226 .060 .781 132 3.1.5. EMPATHY Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .719 .733 5 Item Statistics Mean Std. Deviation N E_21 3.3106 .93882 367 E_22 3.6621 .81667 367 E_23 3.5940 .80046 367 E_24 3.5313 .80196 367 E_25 3.4632 .88283 367 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted E_21 14.2507 6.729 .183 .040 .792 E_22 13.8992 5.615 .574 .390 .634 E_23 13.9673 5.545 .615 .663 .619 E_24 14.0300 5.324 .685 .699 .590 E_25 14.0981 5.908 .423 .276 .694 3.1.6. SATISFACTION Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items .981 .981 3 Item Statistics Mean Std. Deviation N F_26 3.5068 .59537 367 F_27 3.5341 .61254 367 F_28 3.5395 .61221 367 133 Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item- Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted F_26 7.0736 1.462 .954 .912 .974 F_27 7.0463 1.410 .965 .931 .966 F_28 7.0409 1.422 .954 .912 .974 3.2. RESULTS OF EFA KMO and Bartlett's Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .759 Bartlett's Test of Sphericity Approx. Chi-Square 6317.134 df 171 Sig. .000 Total Variance Explained Component Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative % 1 6.054 31.863 31.863 6.054 31.863 31.863 3.200 16.842 16.842 2 2.594 13.651 45.514 2.594 13.651 45.514 3.085 16.235 33.077 3 1.928 10.149 55.663 1.928 10.149 55.663 2.669 14.049 47.125 4 1.607 8.458 64.121 1.607 8.458 64.121 2.279 11.996 59.121 5 1.308 6.886 71.007 1.308 6.886 71.007 2.258 11.886 71.007 6 .959 5.048 76.056 7 .835 4.393 80.449 8 .742 3.905 84.353 9 .605 3.184 87.537 10 .528 2.777 90.315 11 .482 2.537 92.852 12 .436 2.296 95.148 13 .309 1.628 96.777 14 .179 .940 97.716 15 .165 .868 98.585 16 .117 .613 99.198 17 .079 .415 99.613 18 .072 .379 99.992 19 .001 .008 100.000 134 Rotated Component Matrix(a) Component 1 2 3 4 5 B_8 .826 B_7 .826 B_9 .700 B_11 .641 B_10 .626 E_24 .762 E_22 .728 E_23 .720 E_25 .655 A_5 .846 A_3 .812 A_1 .774 A_4 .663 D_17 .860 D_19 .809 D_18 .752 C_12 .902 C_14 .874 C_16 .649 Component Score Coefficient Matrix Component 1 2 3 4 5 A_1 -.125 .120 .317 -.037 -.056 A_3 -.125 .100 .326 .000 -.042 A_4 .183 -.192 .295 -.007 -.098 A_5 .061 -.110 .374 .023 -.114 B_7 .290 -.027 -.021 -.011 -.046 B_8 .289 -.026 -.021 -.012 -.045 B_9 .210 .101 -.053 -.040 -.065 B_10 .181 .100 -.061 -.018 -.053 B_11 .277 -.172 .063 -.089 .056 C_12 .013 -.055 -.110 -.045 .475 C_14 .021 -.071 -.122 -.004 .461 C_16 -.162 .086 -.011 -.007 .326 D_17 -.046 -.038 -.032 .414 -.013 D_18 -.028 -.039 -.021 .356 -.002 D_19 -.082 -.004 .040 .394 -.057 E_22 -.077 .280 -.036 -.031 .036 E_23 -.074 .271 -.011 .066 -.058 E_24 -.043 .271 -.024 .059 -.043 E_25 -.040 .263 .003 -.169 .017 135 Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. 3.3. RESULTS OF REGRESSION ANALYSIS Variables Entered/Removed a Model Variables Entered Variables Removed Method 1 Factor5, Factor4, Factor1, Factor3, Factor2 b . Enter a. Dependent Variable: SuHaiLong b. All requested variables entered. Model Summary b Model R R Square Adjusted R Square Std. Error of the Estimate Durbin-Watson 1 .829 a .686 .682 .33566 1.932 a. Predictors: (Constant), Factor5, Factor4, Factor1, Factor3, Factor2 b. Dependent Variable: SuHaiLong ANOVA a Model Sum of Squares df Mean Square F Sig. 1 Regression 89.035 5 17.807 158.049 .000 b Residual 40.673 361 .113 Total 129.709 366 a. Dependent Variable: A b. Predictors: (Constant), Factor5, Factor4, Factor1, Factor3, Factor2 Coefficients a Model Unstandardized Coefficients Standardized Coefficients t Sig. 95.0% Confidence Interval for B B Std. Error Beta Lower Bound Upper Bound 1 (Constant) -.224 .145 -1.543 .124 -.509 .061 Factor1 .153 .034 .153 4.554 .000 .087 .219 Factor2 .298 .030 .360 9.958 .000 .239 .357 Factor3 .126 .028 .154 4.472 .000 .071 .182 Factor4 .242 .027 .286 9.119 .000 .190 .294 Factor5 .236 .032 .258 7.325 .000 .173 .300 136 a. Dependent Variable: SAT Coefficient Correlations a Model Factor5 Factor4 Factor1 Factor3 Factor2 1 Correlations Factor5 1.000 -.037 -.116 -.095 -.433 Factor4 -.037 1.000 -.032 -.134 -.190 Factor1 -.116 -.032 1.000 -.367 -.076 Factor3 -.095 -.134 -.367 1.000 -.144 Factor2 -.433 -.190 -.076 -.144 1.000 Covariances Factor5 .001 -3.127E-5 .000 -8.701E-5 .000 Factor4 -3.127E-5 .001 -2.825E-5 .000 .000 Factor1 .000 -2.825E-5 .001 .000 -7.653E-5 Factor3 -8.701E-5 .000 .000 .001 .000 Factor2 .000 .000 -7.653E-5 .000 .001 b. Dependent Variable: SAT Residuals Statistics a Minimum Maximum Mean Std. Deviation N Predicted Value 2.4127 5.0546 3.5268 .49322 367 Std. Predicted Value -2.259 3.098 .000 1.000 367 Standard Error of Predicted Value .021 .075 .041 .011 367 Adjusted Predicted Value 2.4259 5.0563 3.5276 .49330 367 Residual -1.36625 .73570 .00000 .33336 367 Std. Residual -4.070 2.192 .000 .993 367 Stud. Residual -4.133 2.202 -.001 1.002 367 Deleted Residual -1.40897 .74230 -.00084 .33932 367 Stud. Deleted Residual -4.229 2.213 -.002 1.006 367 Mahal. Distance .483 17.219 4.986 3.203 367 Cook's Distance .000 .089 .003 .008 367 Centered Leverage Value .001 .047 .014 .009 367 c. Dependent Variable: SAT 137 3.4. RESULTS OF DISCRIMINANT ANALYSIS In terms of Income Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 df2 Sig. .248 3 363 .863 ANOVA SuHaiLong Sum of Squares df Mean Square F Sig. Between Groups .230 3 .077 .215 .886 Within Groups 129.478 363 .357 Total 129.709 366 In terms of age groups Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 df2 Sig. .664 4 362 .617 ANOVA SuHaiLong Sum of Squares df Mean Square F Sig. Between Groups .537 4 .134 .376 .826 Within Groups 129.172 362 .357 Total 129.709 366 In terms of Occupation Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 df2 Sig. .895 8 358 .521 138 ANOVA SuHaiLong Sum of Squares df Mean Square F Sig. Between Groups 4.242 8 .530 1.513 .151 Within Groups 125.467 358 .350 Total 129.709 366 In terms of Gender Test of Homogeneity of Variances SuHaiLong Levene Statistic df1 df2 Sig. 1.739 1 365 .188 3.5. TEST OF CORRELATIONS Correlations F_26 F_27 F_26 Pearson Correlation 1 .949 ** Sig. (2-tailed) .000 N 367 367 F_27 Pearson Correlation .949 ** 1 Sig. (2-tailed) .000 N 367 367 **. Correlation is significant at the 0.01 level (2-tailed). Correlations F_26 F_28 F_26 Pearson Correlation 1 .934 ** Sig. (2-tailed) .000 N 367 367 F_28 Pearson Correlation .934 ** 1 Sig. (2-tailed) .000 N 367 367 **. Correlation is significant at the 0.01 level (2-tailed).

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