Evaluation Research On Service Quality And Ability Of Long-term Care Facilities

[Purpose]In this paper,the evaluation index system of service quality and capability evaluation of long-term care facilities is theoretically constructed.Through a comprehensive understanding of the status quo of the service quality and ability of the long-term care facilities in Hubei Province,the service quality and ability of sample institutions are evaluated by using the index system.Based on the analysis of the evaluation results and the empirical study,a strategic study on the improvement of the service quality and ability of the long-term care facilities is carried out.[Methods](1)Literature analysis: A systematic literature review is conducted to analyze the evaluation of the long-term care facilities at Domestic and foreign,the relevant policy documents on the integration of medical care and the regulatory documents of the old-age care institutions,which provides the basis for constructing the index system of the long-term care facilities.(2)Delphi method: On the basis of literature analysis and empirical research,the first draft of the evaluation index system of service quality and ability of the long-term care facilities is designed.Through two rounds of expert consultation,the representativeness,accessibility and sensitivity of the indicators are evaluated according to the expert's opinions,and the weights of the indicators are determined.The index system of service quality and ability evaluation of the long-term care facilities is preliminarily established(3)Descriptive statistical analysis: A simple descriptive analysis is made on the situation of the medical and nursing care institutions,the needs of the elderly and the situation of institutional nursing staff in the investigated areas.(4)DEA data envelopment analysis: DEA data envelopment analysis is used to analyze the input and output efficiency of pension institutions,and explore the optimal development plan.(5)Non-parametric test: Chi-square test,correlation test,Kruskal-Wallis test,Mann-Whitney test are used to analyze the influencing factors of the needs of the elderly,job satisfaction and its influencing factors,turnover intention and related factors.(6)Automatic linear model method: The automatic linear model method is used to explore whether factors such as the endowment of pension object satisfaction will have an impact on the degree of demand of pension object and the degree of impact.(7)Binary Logistic regression analysis: Using the method of binary Logistic regression test,the relevant factors affecting job satisfaction of maintenance staff are determined.[Results](1)Constructing the evaluation Index System of Service Quality and Ability of Long-term Care FacilitiesThe evaluation index system of service quality and ability of long-term care facilities has identified a total of 7 primary indicators,including basic requirements,endowment function,medical function,endowment service,medical health care service,spiritual and cultural service and service provision dimensions;there are 14 secondary indicators,including medical and nursing integration,human resources,living room,activity venues,medical rehabilitation facilities,personal hygiene,health management,medical care,preventive health care,rehabilitation,psychosocial,cultural entertainment,service quantity and service quality dimensions.There are 41 tertiary indicators.The weights of indicators are determined by product method.The correlation coefficient of retest reliability method is r=0.83(simple correlation coefficient r>0.7).The reliability of the two parts of the split-half reliability scale is 0.823 and 0.817 respectively,and the correlation coefficient between the two parts is 0.715.According to the results of expert consultation,the scale S-CVI/Ave is 0.9288 and I-CVI is 0.8235.It can be seen that the index system has good reliability and validity.(2)Empirical Study on Demanders of Service Quality and Ability of Long-term Care FacilitiesThe demand degree of the elderly is significantly correlated with gender,education level,marital status,income,type of pension insurance and type of medical security.From the point of view of health status,whether the elderly suffer from chronic disease,hypertension,cerebrovascular disease,diabetes mellitus,ischemic heart disease,gastrointestinal disease,cataract in the past year is significantly related to the degree of demand.In terms of satisfaction evaluation of medical and health service utilization,whether the elderly are satisfied with convenience and waiting time,service attitude of medical and nursing staff,technical level and service price are significantly related to the degree of demand.(3)Empirical Study on Providers of Service Quality and Ability of Long-term Care FacilitiesThe variables of employment time and marital status are the influencing factors of job satisfaction of maintenance personnel,and the employment time and working intensity are the influencing factors of maintenance personnel's turnover intention.Difference test of related variables of job satisfaction between nurses and nursing workers is performed,and it shows that the differences between them are not fully taken into account in terms of salary,monthly income,gender and other factors,and that the failure to give higher treatment to nurses is also a major factor in the low level of personnel structure and high turnover rate.The educational level and training mode of the staffs should be further improved.The facilities generally only pay attention to the material needs and physical diseases of the elderly,but few pay attention to the spiritual needs of the elderly.Especially for the elderly who live for a long time,their emotional demands can not be satisfied,and the quality of life needs to be improved.The research on the input and output efficiency of pension institutions shows that two-thirds of the pension institutions belonging to the supporting-radiation mode have increasing returns on scale,which indicates that the supporting-radiation mode is a pension mode with optimal allocation of resources.(4)Evaluation of Service Quality and Ability of Sample Long-term Care FacilitiesTaking the 15 long-term care facilities as the research object,the service quality and ability of these institutions are evaluated by using the index system designed in this study.The results show that the first and second facilities ranked in the comprehensive evaluation score are the two institutions in Wuhan,whose scores are higher in structural,procedural and outcome indicators than other institutions.The two facilities have beautiful environment,large building area,complete supporting facilities,high quality of nursing staff service and high level of medical service.The 3rd-6th ranked institutions are the municipal institutions in Yichang and Xiangyang,which have advantages in building area,supporting facilities and the number of nurses compared to the lower ranked institutions.Most of the institutions ranked 7-15 are at the district and county level.Compared with the higher institutions,these institutions have relatively low scores in building area,living environment,supporting facilities,medical level and quality of nursing staff.The evaluation results are in accordance with the prediction of the service quality and ability of these facilities.(5)Analysis on Policy Environment and Operation of the Construction of Long-term Care FacilitiesThrough the analysis of the current situation,it is found that in terms of policy,there are still some problems,such as the difficulty of policy supervision and the imperfection of financing system.In terms of operation,there are some problems,such as the lack of competitiveness for the medical-care combined institutions,ineffective integration of medical endowment resources,insufficiency of total resources,structural imbalance of service objects,the lack of professional maintenance personnel and the lack of enthusiasm for the service subjects.[Conclusions](1)There are still some problems in the long-term care facilities,such as poor quality of personnel,inadequate investment in medical and health care,and inadequate integration ability of medical and nursing resources.It is necessary to establish an evaluation system of service quality and ability of relevant institutions to improve the service quality and ability of the long-term care facilities.The evaluation framework and indicators of service quality and capacity of long-term care facilities based on expert consultation method are reasonable,and the results of comprehensive evaluation are robust and sensitive.It can provide a basis and guidance for the evaluation of service quality and ability of large sample long-term care facilities in the future,and also help to provide a tool support for the dynamic management of access and withdrawal of long-term care facilities.(2)The establishment of the evaluation system for the service quality and capacity of the long-term care facilities should fully consider the factors related to the status of the institution and demand-related factors,and factors related to the nursing staff.It is recommended that exploring individualized services,improving service system construction,and strengthening the talent team should be taken as strategies to improve the service quality and ability of internal factors in long-term care facilities,and improving the government management mechanism,exploring the establishment of payment system,and strengthening safeguard measures should be taken as strategies to improve the service quality and ability of external factors in long-term care facilities.[Innovation and deficiency]Innovation:(1)Based on the background of the accelerated aging process in China,this paper explores the construction of the evaluation index system of service quality and ability of long-term care facilities from the perspective of institutional capacity enhancement.It is expected to provide policy reference for standardizing the service quality of long-term care facilities and defining the evaluation criteria of long-term care facilities.(2)From the perspective of providers and demanders of integrated medical and nursing services,the DEA method,non-parametric test,automatic linear modeling and binary logistic regression are used to quantitatively analyze the input and output efficiency of the pension institutions,the factors affecting the job satisfaction and turnover intention of the maintenance staff,the factors affecting the demand of the pension objects and the strength of the influence,and to conduct a comprehensive investigation and analysis of the status quo of the long-term care facilities.It is expected to provide a certain reference for refining and analyzing the health aging planning of China within the provincial scope.Deficiency:(1)Restricted by objective conditions,the evaluation index system of service quality and ability of the long-term care facilities is only validated in a small scale(15 institutions),and its scientificity and practicability need to be further validated.(2)Because of the small sample size,the index system constructed is too detailed and complex,and its application in practice is not easy.