46 Dinh Hong Diem Thuy et al.

Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

Evaluation of patient satisfaction and the service quality of the

outpatient care at the Heart Institute of Ho Chi Minh City
Dinh Hong Diem Thuy1, Tran Thi Thanh Phuong2*, Nguyen Huu Khanh1,
Nguyen Truong Vien3
1
Heart Institute of Ho Chi Minh City, Department of Planning and Administration, Vietnam
2
University of Economics Ho Chi Minh City, School of Management, Vietnam
3
University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
*
Corresponding author: [email protected]

ARTICLE INFO ABSTRACT

DOI:10.46223/HCMCOUJS. Background and aims: Research on patient satisfaction with

econ.en.11.1.1307.2021 the outpatient service quality at the hospitals has been undertaken in
both developed countries and developing countries. However, there
remains a paucity of studies evaluating patient satisfaction at the
cardiovascular related services. This study assesses the levels and
determinants of patient satisfaction with outpatient care at the Heart
Institute of Ho Chi Minh City, Vietnam in 2018.
Methods: A cross-sectional descriptive survey was conducted
at the Heart Institute of Ho Chi Minh City from June to November
2018. Patients and relatives were face to face interviewed on
Received: November 5th, 2020
satisfaction questionnaires of Vietnam’s Ministry of Health.
Revised: January 21st, 2021
Results: Satisfaction of patients and relatives about the quality
Accepted: February 5th, 2021
of outpatient care was high, reaching the average 87.3 percent of
patients’ expectation with the minimum of 50 to 100. The booking
appointments via phone/online services, long times waiting, and
toilet/drinking water facilities are also the lowest level of
satisfaction. “The transparency of the information”, “the behavior
and competence of medical staff and service staff”, and “the quality
of the medical infrastructure and facilities” are three dimensions that
Keywords: impacted patient satisfaction.
patient satisfaction, treatment Conclusions: Overall most of the patients positively evaluated
and care, quality of
the outpatient services at the Heart Institute of Ho Chi Minh City but
healthcare, cardiology
services, medical outcomes there are still some aspects of healthcare services that need to
study, outpatient department, improve such as the booking services, the toilet and drinking
healthcare services facilities, the long waiting times and more transparent information.

1. Introduction
The patient has been regarded as consumers and patient satisfaction is one of the important
factors that determine the quality of health care facilities (Gogoi & Choudhury, 2015; Mitropoulos,
Vasileiou, & Mitropoulos, 2018; Sitzia & Wood, 1997). Many studies have considered patient
satisfaction as a quality measurement tool for healthcare providers (Bird et al., 2018; Hoang, Dao,
Wall, Nguyen, & Byass, 2006; Singh & Kumar, 2015). In Vietnam, before 2015 due to the poor
infrastructure, the public hospitals in Vietnam did not place the emphasis on patient satisfaction as
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 47

a measure of the quality of care. Historically, hospital managers have focused on the outcome of
surgeries and treatment as a measure of “patient satisfaction” but ignored the patient’s perspective
of quality of care.
Hospitals in Vietnam granted their self-governance in 2016. In response to the levels of
increased competition, the hospital managers started to pay attention to patient’s perspectives and
inputs towards care quality. Since 2016, the public hospitals in Vietnam has circulated
questionnaire every six months to assess patient perspectives of quality of care during their
treatment with the hospitals (Nguyen & Mai, 2014). These findings guided the top management
identify areas of concern and improve the services.
Research on patient satisfaction with the outpatient service quality at the hospitals have
been undertaken in both developed countries (Gogoi & Choudhury, 2015; Kulkarni, 2018;
Stefanovska & Petkovska, 2014) and developing countries (Ho, 2015; Nguyen & Mai, 2014;
Pham, Le, Bui, & Ly, 2011; Tran & Nguyen, 2012). These studies examined various dimensions
of healthcare services including “the medical infrastructure and the facilities”, “the accessibility to
healthcare services” and “the attitude and the competence of medical staff”. However, there
remains a paucity of studies evaluating patient satisfaction at the cardiovascular related services.
Cardiovascular diseases (CVDs) have become a chronic disease that requires so much care in
Vietnam. In Viet Nam, CVDs were responsible for 31% of total deaths in 2016 - equivalent to
more than 170,000 (WHO, 2016). In 2016, it represented about 12 percent of all new cancer cases
and 25 percent of all cancers in women (WHO, 2016). This study focuses on providing empirical
evidence to evaluate the out-patient satisfaction towards the quality of cardiovascular care and
treatment at the Heart Institute of Ho Chi Minh city (CMI) in Vietnam. In this study, the patient’s
satisfaction is assessed in terms of two objectives:
i) To assess patient satisfaction regarding the services provided in the outpatient
department;
ii) To assess the patient satisfaction among different socio-demographic characteristics of
patients.
2. A literature review of patient satisfaction towards outpatient care and service
quality
Patient satisfaction is considered an important component in evaluating the quality of
healthcare as well as the health care system (Sitzia & Wood, 1997; Williams, 1994) (Kulkarni,
2018). Patient satisfaction is achieved when the patient’s perception of the quality of care and
services that they receive in hospitals has been positive, satisfying and meets their expectations
(Singh & Kumar, 2015).
Many previous studies have developed and applied patient satisfaction as a quality
improvement tool for healthcare provides (Al-Abri & Al-Balushi, 2014; Batchelor, Owens, Read,
& Bloor, 1994; Cronin & Taylor, 1992; Olusina, Ohaeri, & Olatawura, 2002; Williams, 1994).
The patient satisfaction measurement serves three purposes (Kulkarni, 2018) that (a) to reflect the
quality of healthcare services from the patient’s perspectives, (b) to identify problem areas in
healthcare organizations and generate ideas for solutions, and (c) to evaluate healthcare. In an
extensive electronic search of the literature, we found that tools developed to measure patient
satisfaction have generally taken one of two forms: episode-specific or general (Kulkarni, 2018).
The SERVQUAL scale (Parasuraman, Zeithaml, & Berry, 1988) has widely used to measure the
quality of medical services (Bird et al., 2018). Patient assessment of hospital outpatient care
48 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

includes various dimensions of quality of services such as tangibles, responsiveness,

communication, attitude, clinical and comforting skill, amenities, food services.
The majority of studies had been conducted in India. These studies found that the highest
percentages of the patients were not satisfied with the cleanliness of the hospital, the washroom
facility and the waiting area. A study was undertaken to assess patient satisfaction with health care
services at the outpatient department of Maharaja Aggarsain General Hospital, Hisar (Singh &
Kumar, 2015). The study randomly recruited 100 respondents irrespective of age, gender,
education, income. This study found that there was a fair level of patient satisfaction about the
hospital structure, hospital process and hospital performance. The overall mean responses were
2.73 (±0.57), 2.176 (±0.93), and 2.607 (±0.76). However, the study found that most patients were
not happy with the cleanliness of the washroom facility and waiting area.
Another cross-sectional study of patient satisfaction was carried out in an outpatient
department of a tertiary care hospital in Maharashtra (Kulkarni, 2018) during December 2017. A
100 randomly patients of all ages were selected, a majority of patients belonged to the age group
15-45 years with a mean age of 42.9 (±19.53). The study found that the overall satisfaction level
was 73% excellent to good, 22% average. 68% of respondents were unsatisfied with the toilet
facility and 56% were unsatisfied with the drinking water facility and 50% were not satisfied
regarding convenience to reach pharmacists. The most frequent explanation for the variation and
low-quality care in the developing world was the lack of resources (Olusina et al., 2002) (Sachdeva
& Kaur, 2018).
According to our search, there is only one study from Australia evaluating patient
satisfaction with cardiology quality care (Stefanovska & Petkovska, 2014). The study used a
specially developed “Medical Outcomes Study, Patient Satisfaction Questionnaire” (MOS PSQ-
III) and found that patients positively evaluated financial accessibility and quality of health
services, even though some aspects of health care needed improvement such as the accessibility
of healthcare services. This study also found that gender, age and education were the
socioeconomic determinants of satisfaction with healthcare quality. Study contexts in Australia
and Vietnam have many differences in service needs, expectations, socio-cultural characteristics
and languages, and MOS PSQ-III is an unpopular questionnaire in Vietnam. These can create
barriers to apply similar studies in Vietnam. Using a popular questionnaire help increase the
comparability and applicability of study results in Vietnam.
In 2005, the Ministry of Health (MOH) in Vietnam initiated the development of a patient
satisfaction survey for outpatient and inpatients based on specific criteria within the five
dimensions of service quality: 1) Accessibility 2) Transparency 3) Quality of infrastructure 4)
Behaviour and competence of staff, and 5) Outcome of service delivery. The scale consists of 32
items across these five dimensions, and each item is used to measure the customer expectation and
the customer perception of the service provided. The surveys have been standardized and validated
and can be used in the health-care setting as quality-improvement tools.
The outpatient department at Heart Institute of Ho Chi Minh City (CMI) has received
300,357 check-ups in 2018 according to the annual report of the Institute. The Heart Institute is
well-known for its band of doctors and professionals in treating patients with cardiovascular
diseases. However, the effectiveness of the health system depends upon many factors not only
having professional doctors. The CMI has circulated the MOH survey to evaluate
patient satisfaction towards health service quality annually since 2016.
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 49

3. Research methodology
3.1. The setting
The Heart Institute of Ho Chi Minh City was founded in early 1992 by Professor Alain
Carpentier, a well-known French cardiac surgeon and late Professor Duong Quang Trung who was
at the time director of the Department of Health of Ho Chi Minh City. This is a non-profit
organization and is the cooperation of Viet-French relations. The Institute laid the foundation for
developing cardiac surgery and treating advanced cardiovascular pathologies for the country.
According to the annual report, the CMI has implemented cardiac surgery for more than 32.748
patients with congenital heart disease. Coronary angioplasty and treatment of congenital heart
disease by cardiac catheterization was for more than 32,500 patients, examination and treatment
of 3 million cardiovascular patients.
3.2. Study design, sampling and data collection
A cross-sectional study was conducted at the CMI among patients attending the outpatient
department (OPD) during the period from 1/1/2018 to 30/12/18. Our sample comprised 401 new
patients with cardiovascular diseases for all ages attending the outpatient department. A simple
random sampling technique was used to select patients attending different specialty departments
of the Institute. The respondents were interviewed at the exit point of the outpatient department
after taking informed consent. Patients not willing to participate and follow-up patients were
excluded from the study. The patients and accompanying persons either parents or relatives for
pediatric age less than 15 years were interviewed at the exit point of the hospital after taking
informed consent. The data were collected based on the Ministry of Health (MOH) questionnaire
and without interference from staff. The ethical committee at the CMI approved the methodology
and data collection procedure of the study. The patients were told that the purpose of the study
was to assess the patient satisfaction of services provided by the hospital so as to bring further
improvement in services. The patients were also told that the investigator was not part of the
treatment team and they were free to give their responses. The patient’s respondents were then
submitted to the MOH online portal.
3.3. Instruments of collecting data for service quality and patient satisfaction
This study employed the scales designed by MOH to suit reality to measure the quality of
medical examination and treatment services in Vietnam. The questionnaire used in our study
consists of two main parts of which the first part is about personal information of the patient, and
the second part includes questions about the patient’s evaluation of healthcare service quality,
his/her satisfaction with the healthcare services and the intention of coming back to the Institute.
or introducing the treatment to others.
The MOH scale is a self-report questionnaire that consists of 32 statements which cover
the experiences of patients in the outpatient department the following five domains (see Table 3):
Accessibility to services (first five items of Table 3), Transparency of information (10 items),
Medical infrastructure and facilities (8 items), Competence of medical and non-medical staff (4
items) and Outcome of service delivery (4 items). The validity and reliability of the questionnaires
were determined by the Ministry of Health in Vietnam.
Patient satisfaction was classified according to Likert scale, with 5 levels: Level I: Very
unhappy, very bad, very disagree. Level II: Not satisfied, not good, disagree. Level III: Acceptable.
Level IV: Satisfied, good, agree. Level V: Very satisfied, very good, very agree. There is the
question for a patient to rate from 1 to 5 to whether “I would definitely return to the Institute
50 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

again”. The patients choose whether they would like to come back or introduce services to others.
The patients were also told that the investigator was not part of the treatment team and they were
free to give their responses.
In addition, this study employed a one-item scale ranging from 0 to 100 measuring overall
patient satisfaction score with the quality of healthcare services at the Institute. The respondents
were asked to indicate their level of agreement with the statement “Overall I am satisfied with the
quality of healthcare services in the hospital”. Although a multiple-item measure like a 5-point
Likert scale would often be desirable, the literature has suggested that employing single-item
measures of global satisfaction (Olusina et al., 2002).
3.4. Data analysis
The proportion of respondents answering each item was recorded. The total score for each
domain and overall MOH scale was obtained by taking averaging the scores of the constituent items.
In order to test the proposed hypotheses, we ran multiple linear regression analyses using the
overall patient satisfaction score and the patient satisfaction for the outcome of service delivery as
two dependent variables. The independent variables were the four dimensions of service quality
(i.e., accessibility to healthcare services, transparency of information, the competence of healthcare
staff, the medical infrastructure and facilities and the outcome of health service delivery).
Multivariable logistic regression (Sitzia & Wood, 1997) was employed to test the
differences of dissatisfaction proportion between each patient’s characteristics group.
Dissatisfaction in this study was defined as the total score for the overall MOH scale lower than 4.
All of our hypothesis tests were acceptable at type I error proportion less than 0.05.
4. Results
4.1. Characteristics of patients
The results presented in Table 1 are for 401 completers. Out of 401 respondents, there were
155 males (38.7 %) and 246 females (61.3%). A majority of patients belonged to the age group
18-59 years with a mean age of 51.85± 22.3. The sample covered a wide range of ages from 15-
92 years. 91.8 % of respondents were patients themselves and 8.2% of respondents were
accompanying persons either parents or relatives for pediatric age less than 15 years of age. Nearly
half of patients held health insurance (45.6%). About more than half of patients (65.6%) live less
than 200 km from home to the Institute.
Table 1
The socio-demographic characteristics of patients (N= 401)
Socio-demographic variable Frequency %
Response types:
Patients 365 91.8
Relatives 36 8.2
Gender:
Male 155 38.7
Female 246 61.3
Age range (years) Mean (SD): Range: 15-92
51.85± 14.9
<18 8 2.0
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 51

Socio-demographic variable Frequency %

18-59 214 53.4
≥60 179 44.6
Insurance:
Yes 183 45.6
No 218 54.4
Distance from home to the Institute:
<200 263 65.6
≥ 200 138 34.1
Source: The researcher’s data analysis

4.2. Patients’ satisfaction with service quality

Satisfaction was adequate for all the domains of healthcare services relating to the
accessibility of healthcare services, transparency of information, the quality of facilities, the
competence of medical staff, and the outcome of service delivery. The distribution of patient
respondents was similar across five domains. More than half of the patient’s responses were
attributable to the score of 4 or 5 indicating that patient was satisfied or extremely satisfied with
the services.
Regarding the accessibility of healthcare services, Table 2 indicates that the respondents
were satisfied with the clear diagrams, signs showing directions to the departments and rooms in
the hospital, clear blocks and stairs to find, and the flat pathways to move around. The patients
were well-informed about the time to visit. However, about 30% of respondents were not satisfied
with booking services via phone, and website as the CMI has not presently implemented the
booking via online services.
Table 2
Distribution of responses from the respondents according to the accessibility of healthcare services
(n= 401) (%)
Frequency (%) Mean ± SD
Items of care
1 2 3 4 5
1. Diagrams, signs showing directions to the
departments and rooms in the hospital are clear 0.3 2.0 8.7 57.1 31.9 4.18 ± 0.69
and easy to understand and easy to find
2. Time to visit patients is clearly informed 0.3 1.0 10.7 55.3 32.7 4.19 ± 0.68
3. Blocks, stairs and rooms are clearly numbered
0.3 1.2 13.4 52.4 32.7 4.16 ± 0.71
and easy to find
4. The pathways in the hospital are flat and easy to
0.3 0.7 13.9 52.4 32.7 4.16 ± 0.70
move around
5. Customers can find out information and register
for examination by phone, the website of the 0.3 1.7 25.7 51.1 21.2 3.91 ± 0.74
hospital conveniently
Accessibility of healthcare services (Average) 4.12 ± 0.58
Note: 5=Strongly Agree, 4=Agree, 3=Neither Agree nor Disagree, 2=Disagree, 1=Strongly Disagree
Source: Primary data
52 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

Regarding the transparency of information and procedures for medical examination and
treatment, Table 3 shows that most of the respondents were satisfied with the well-informed
processing of consultation, the clear quoted price of consultation, the welcomed spirit of the staff.
However, with a regard to the waiting times, about 35% of patients were not happy with the waiting
time for the registration, to see the doctors, to get the investigation check from OPD and time taken
in getting the results from investigations. One explanation for the long waiting times was the lack
of doctors speciliased in heart problems against the number of patients visiting the Institute.
Table 3
Distribution of responses from the respondents according to the transparency of information and
procedures for medical examination and treatment (n= 401) (%)
Items of care Frequency (%) Mean ± SD
1 2 3 4 5
6. The medical examination process is clearly and
0.5 1.0 8.5 49.9 40.1 4.28 ± 0.70
publicly available and easy to understand
7. The procedures and procedures for the medical
examination have been reformed to be simple and 0.5 1.0 15.9 48.9 34.7 4.15 ± 0.75
conveniently
8. Prices of medical services are clearly and
0.3 0.3 10.2 51.8 37.4 4.26 ± 0.67
publicly listed
9. Medical staffs welcome and guide patients to
0.5 0.7 13.0 56.4 29.4 4.13 ± 0.69
make affable procedures
10. Assess the lining up in the order first after the
procedures for registration, payment, examination, 0.5 1.2 17.0 52.6 28.7 4.08 ± 0.74
testing, screening
11. Assess the waiting time for registration
0.5 5.0 29.7 41.9 22.9 3.82 ± 0.86
procedures
12. Assess the waiting time for the doctor's turn to
0.5 5.3 28.9 46.1 19.2 3.78 ± 0.83
see
13. Assess the time to be examined and advised by
0.3 2.0 26.4 49.6 21.7 3.91 ± 0.76
a doctor
14. Assess waiting time for testing and screening 1.0 8.0 29.9 42.9 18.2 3.69 ± 0.89
15. Assessing the waiting time for receiving results
0.7 6.2 25.5 48.9 18.7 3.79 ± 0.84
of tests and screenings
B. Transparency of information and 3.99 ± 0.59
procedures for medical examination and
treatment (Average)
Note: 5=Strongly Agree, 4=Agree, 3=Neither Agree nor Disagree, 2=Disagree, 1=Strongly Disagree
Source: Primary data
Regarding the quality of the medical infrastructure and facilities, Table 4 shows that most
of the respondents were satisfied with the conditions of the waiting room, the patient’s privacy
was kept confidentially when the investigation has taken, the CMI ensures the security to prevent
theft, and creates the green campus surrounding the Institute. However, 54.1 % of patients were
not happy with the toilet and drinking water facility in OPD.
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 53

Table 4
Distribution of responses from the respondents according to the quality of the medical
infrastructure and facilities (n= 401) (%)

Items of care Frequency (%) Mean ± SD

1 2 3 4 5
16. Having clean, cool lounge / lounge in the
0.7 1.3 20.5 46.4 31.2 4.06 ± 0.79
summer; Airtight and warm in winter
17. The waiting room has enough seats for the
0.0 4.5 22.2 44.4 28.9 3.98 ± 0.83
patients and relatives and is in good use
18. The waiting room has full fan (air conditioner)
0.0 1.2 25.2 44.4 29.2 4.01 ± 0.77
in regular operation
19. The waiting room has facilities to help patients
feel comfortable such as television, pictures, 0.0 2.0 23.7 50.9 23.4 3.96 ± 0.74
leaflets, drinking water ...
20. The CMI guarantees privacy for the patient’s
0.0 1.7 18.5 53.4 26.4 4.04 ± 0.72
medical examination, screening, procedures
21. The toilets are convenient, in good use, clean 10.0 13.7 30.4 28.4 17.5 3.30 ± 1.19
22. The environment campus surrounding the CMI
0.3 1.7 11.0 51.1 35.9 4.21 ± 0.72
is green, clean and beautiful
23. Medical examination and treatment area ensures
0.3 2.5 16.2 55.6 26.4 4.05 ± 0.73
security, order and prevents theft for people

C. The quality of the medical infrastructure and 3.95 ± 0.65

facilities (Average)
Note: 5=Strongly Agree, 4=Agree, 3=Neither Agree nor Disagree, 2=Disagree, 1=Strongly Disagree
Source: Primary data

Regarding the behavior, professional competence of medical and service staff, Table 5
shows that most of the respondents were satisfied with doctor and nurse attitude and
communications with an average score of 4.20 ± 0.60 (out of 5). The patients felt satisfied with
the doctor’s explanation and the doctor’s professional care. The patients were respected by the
doctors and nurses, and service staff.
Table 5
Distribution of responses from the respondents according to the behavior, professional competence
of medical and service staffs (n= 401) (%)
Items of care Frequency (%) Mean ± SD
1 2 3 4 5
24. Doctors and nurses have the polite words,
attitudes and communication 0.3 0.3 13.0 52.8 33.6 4.19 ± 0.68
25. Service staff (nurse, guard, accountant ...)
have the right words, attitudes and
communication 0.0 1.5 14.2 54.1 30.2 4.13 ± 0.70
54 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

Items of care Frequency (%) Mean ± SD

26. Be respected by medical staff, treat them
fairly, care and help 0.0 0.5 12.2 54.1 33.2 4.20 ± 0.66
27. Professional qualifications of doctors and
nurses meet expectations 0.0 0.3 9.5 51.6 38.6 4.29 ± 0.64
D. Behavior, professional competence of
4.20 ± 0.60
medical and service staff
Note: 5=Strongly Agree, 4=Agree, 3=Neither Agree nor Disagree, 2=Disagree, 1=Strongly Disagree
Source: Primary data

Regarding the service delivery outcomes, Table 6 shows that the respondents expressed
high satisfaction towards the outcomes of consultations, examinations and medication. The
invoices and the outcomes were delivered in full and clear in detail. The respondents expressed
trust in the quality of healthcare and satisfaction with the price of healthcare.
Regarding the one-item scale of overall patient satisfaction (Table 6), the average score of
overall patient satisfaction level was 87.3 with a minimum of 50 to 100. The distribution of overall
satisfaction level was divided as follows: 73% of respondents selecting between 70 points to 100
points (good to excellent), 22% selecting between 50 points to 70 points (average) and 5%
choosing less than 50 points (poor service). In this study, 94% of respondents answered “yes” to
the question: “would you recommend this hospital to friends and family?”

Table 6
Distribution of responses from the respondents according to the outcome of service delivery (n=
401) (%) and the one-item scale of patient satisfaction level (0-100)
Items of care Frequency (%) Mean ± SD
1 2 3 4 5
28. The results of the examination met the
0.3 0.3 8.7 48.8 41.9 4.32 ± 0.66
expectation of patients
29. Invoices, receipts, prescriptions and
medical examination results are provided 0.3 0.7 10.0 46.1 42.9 4.31 ± 0.70
and explained in full, clear, transparent
30. Assess the level of trust in the quality of
0.3 0.3 8.0 50.3 41.1 4.32 ± 0.65
health services
31. Assess the level of satisfaction with the
0.0 0.0 10.0 49.4 40.6 4.31 ± 0.64
price of medical services
E. The outcome of service delivery 4.31 ± 0.61
F. One-item scale of overall satisfaction 87.3 ± 11.72
level (0 -100) Range: 50 - 100
Note: 5=Strongly Agree, 4=Agree, 3=Neither Agree nor Disagree, 2=Disagree, 1=Strongly Disagree
Source: Primary data
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 55

4.3. The association of service quality and patient satisfaction

The results of multiple regression analysis with the overall patient’s satisfaction as a
dependent variable presented in Table 7. These results showed that patients’ satisfaction at the
outpatient services was explained significantly by three components of healthcare services. The
regression results confirmed the positive impact of “the transparency of information”, “the
competence of medical staff”, and “the outcome of service delivery” on the patient satisfaction: β
= 3.10 (p <0.05); β = 2.79 (p < 0.05) and β = 6.05 (p < 0.001) respectively. The regression model
was found to be significant (F = 40.22, p < 0.001), accounting for 33% of the variance in the data.
In the table above, the variable “the outcome of service delivery” had the strongest relationship
with the dependent variable, since its standardized beta is the highest (0.312) following by the
“transparency of the information”. All of the variables have the variance inflation factor (VIF)
lower than 4 indicating that there are no collinearity issues. The general rule of thumb is that VIF
exceeding 4 warrants further investigation (Williams, 1994).
The second regression analysis with the outcome of service delivery as a dependent
variable is presented in Table 8. These results confirmed the positive impact of “transparency of
information” (β = 0.12, p <0.05), and “the competence of medical and service staff” (β = 0.61, p
<0.05). In addition, the study found a significant impact on the quality of the medical infrastructure
and facilities for the “outcome of service delivery” (β = 0.17, p <0.05).
Table 7
The association of Service Quality and patient Satisfaction (n=401)

Unstandardized beta (B) Standardized

Service quality dimensions P-values VIF
beta (SE B) beta (β)

Constant 32.6095 (4.1284) <0.0001***

A: Accessibility of healthcare
0.5329 (1.2110) 0.026 0.6601 2.14
service

B: Transparency of information 3.1057 (1.2757) 0.158 0.0154* 2.50

C: The quality of the medical 0.5883 (1.1617)

0.032 0.6128 2.45
infrastructure and facilities

D: Competence of medical and

2.7861 (1.3569) 0.142 0.0407* 2.86
service staff

E: Service delivery outcome 6.0516 (1.2483) 0.312 <0.0001 *** 2.48

Adjusted R2 = 0.33; F (5, 395) = 40.22; p<0.001

SE: Standard errors are reported in parentheses.
*, **, *** indicates significance at the 90%, 95%, and 99% level, respectively
VIF: Variance inflation factor
Source: The researcher’s data analysis
56 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

Table 8
The association of Service Quality and the outcome of service delivery (n=401)
Unstandardized beta Standardized
Service quality dimensions P-values VIF
(B) beta (SE B) beta (β)
Constant 0.94061 (0.15933) <0.0001
A: Accessibility of healthcare service -0.08653 (0.04856) -0.083 0.07 2.12
B: Transparency of information 0.12010 (0.05100) 0.12 0.02* 2.47
C: The quality of the medical infrastructure
0.16883 (0.04599) 0.18 0.000275*** 2.36
and facilities
D: Competence of medical and service staff 0.61458 (0.04505) 0.60 <0.0001*** 1.95
Adjusted R2 = 0.593; F (4, 396) = 146.7; p<0.001
Sig.: Significance test of Multivariable Linear regression
Standard errors are reported in parentheses
*, **, *** indicates significance at the 90%, 95%, and 99% level, respectively
Source: The researcher’s data analysis

4.4. Differences in patient satisfaction according to the socio-demographic

characteristics of patients
The multivariable logistic regression was applied to examine the patient satisfaction
according to different socio-demographic characteristics of patients. The “outcomes of service
delivery” were categorized to “dissatisfaction” for the responses that were rated for 1,2,3 according
to Likert scale and for 4 and 5 for the “satisfaction”. Table 9 showed that there were no significant
differences between patient satisfaction between gender, age groups, and having insurance or not,
or the distance from home to hospital.
Table 9
Comparison of mean satisfaction scores according to the socio-demographic characteristics of
patients (n =401)
Dissatisfaction Satisfaction
Patient’s characteristics OR (95% CIs) p- value
n(%) n(%)
Patients 175 (48.9) 183 (51.1) 1
Response type
Relative 17 (53.1) 15 (46.9) 1.18 (0.57 - 2.44) 0.646
Male 8 (34.8) 81 (38.9) 1
Gender
Female 15 (65.2) 123 (61.1) 0.55 (0.15 - 1.76) 0.335
<18 0 8 (2.1) 1
Age groups
18-59 14 (60.9) 200 (52.9) 0.91 (0.27 - 2.93) 0.874
(years)
≥60 9 (39.1) 170 (45.0) 1.61 (0.37 - 6.95) 0.522
Yes 15 (65.2) 168 (44.4) 1
Insurance
No 8 (34.8) 210 (55.6) 2.53 (0.82 - 8.48) 0.115
Distance from home <200 15 (65.2) 248 (65.5) 1
to hospital ≥ 200 8 (34.8) 130 (34.4) 1.02 (0.40 - 2.41) 0.969

Note: 95% CIs: 95% confidence intervals

OR: Odds ratios of demographic characteristics of respondents
Source: The researcher’s data analysis
Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59 57

5. Discussion
The analysis reveals that patients are satisfied with the outpatient facilities provided at the
Heart Institute of Ho Chi Minh City in Vietnam. The degree of patient satisfaction for the service
quality was at an acceptable level (around the score of four) ranging from the accessibility of
healthcare services (4.12 ± 0.58), the transparency of information and procedures for medical
examination and treatment (3.99 ± 0.59), the quality of the medical infrastructure and facilities
(3.95 ± 0.65), the behavior, professional competence of medical and service staffs (4.20 ± 0.60),
the outcome of service delivery (4.31 ± 0.61). Most of the patients were not happy with the booking
services via phone, and website and online services, the long waiting times to get registered, to see
the doctors, to do the investigations and receive the results, and also the condition of toilet and
drinking water facility in OPD. These issues have also been encountered from studies in
developing countries (Kulkarni, 2018; Singh & Kumar, 2015).
These findings are in line with the reports in the literature from Vietnam which have shown
that the majority of patients (80% or more) expressed satisfaction with their care, with a few
responding negatively to any given items (Nguyen & Mai, 2014). However, this positive
appreciation might have resulted from patients being unwilling to express dissatisfaction for fear
of displeasing staff and experiencing even worse service in the future (Batchelor et al., 1994).
Further study on this topic may be desirable to confirm the results.
In addition, this study focused on investigating the relationship between service quality and
patient satisfaction at the Heart Institute of Ho Chi Minh City. The findings indicated that three
service quality dimensions, “the transparency of information”, “the competence of medical staff”
and “the quality of the medical infrastructure and facilities” significantly determined the patient
satisfaction and the outcome of service delivery. The results of our research, in line with the
findings from previous studies, confirmed the impact of “competence of professional staff” and
“facilities and tangibles” on Vietnamese patient satisfaction (Nguyen & Mai, 2014). The
importance of tangible elements such as booking facilities, electronic medical equipment and
infrastructure influence patient satisfaction. Our study also provides empirical evidence for the
strong impact of competence of medical staff and doctors and the transparency of information to
improve patient satisfaction. Of the socio-demographic assessed, the results of our study could not
demonstrate the noted differences in satisfaction be-tween age groups, gender and having
insurance or not and distance from home to hospital.
Implications
The findings from this study contribute to a better understanding of the quality of outpatient
services provided by the Heart Institute of Ho Chi Minh City and their impact on the level of
patient satisfaction with cardiovascular diseases.
Several managerial implications are offered to the administrators at the Heart Institute of
Ho Chi Minh City to enhance patient satisfaction. It is necessary for the managers to pay attention
to improve the elements of facilities and services, especially the bed, water drinking and toilet
conditions. The CMI should consider implementing electronic booking to reduce the waiting time
for registration and the consultation. It is also very important to continue to promote an attitude of
medical staff and doctors towards patients, as well as provide training to medical staff and
physicians to enhance the speed of the process but still ensures the quality of communication,
skills/specialization and transparent culture.
Recommendations to the Institue:
58 Dinh Hong Diem Thuy et al. Ho Chi Minh City Open University Journal of Science, 11(1), 46-59

1. Improve the technical quality of care to book an appointment, make more investment
to the system infrastructure to reduce the waiting times;
2. The physical environment should be improved to cleanliness;
3. Enhance the inter-professional and inter-departmental collaborations. Accessibility/
convenience should be arranged to increase more medical staff to minimize waiting times;
4. Continue to improve the medical and services staff’s manner, in which providers
interact personally with patients and respond promptly to patient’s questions and requests.
Limitations of the study and future research directions
The major limitations of the study are the fact that it was cross-sectional and conducted at
a single center. A study conducted in other parts of Vietnam and across time intervals could be
further extended. Despite the limitations, the findings have presented the patient view regarding
the quality of healthcare services from the top of the national centre that is specialized in treating
cardiovascular diseases and remains as the model for medical practice in the nation. Hence, the
findings of this study can be considered as representative of the patient satisfaction toward the
cardiology outpatient services in Vietnam and can help the managers enhance the patient
satisfaction level by concentrating on the factors identified as determinants of satisfaction in
patients.
Conclusion
Overall most of the patients positively evaluated the transparency of information regarding
disease conditions and the competence of medical staff at the Heart Institute of Ho Chi Minh City
but there are still some aspects of healthcare services that need to improve such as the medical
infrastructure, electronic facilities to reduce the waiting times and enhance more transparent
information to patients. This study provides empirical evidence to help healthcare managers make
policies and develop action plan programs to improve the quality of service for patients with
cardiovascular diseases.

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