A Strategy Research For Non-technical Needs Towards Outpatient Clinic Service Based On KANO Model

BackgroundIn 2014, the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine jointly proposed a plan to further improve the medical services in three years. The starting point of the plan was to improve the patients’ experience in medical treatment process. It stressed to adopt effective measures, such as improving the medical environment, quality, safety, optimizing processes, providing technological support, improving doctor-patient communication, to establish an affordable and masses satisfying medical services.The patients experience is one of the core competences of good medical services. Improving the patients’experience, we must identify the real demands of the patients. With the medical model changes to bio-psycho-social, the connotation of medical services from the development of "meet the technical specifications" to "meet the demand of patients". In addition to the technical care, patients pay more attention to the non-technical medical services.ObjectivesUsing the traditional satisfaction survey alone is not enough to grasp the demands of patients. KANO model provides an effective approach to categorize customer characteristics, establish the individual service features for customers’ satisfaction and create the appropriate prerequisite for service improvement activities. This study which combines the KANO model with the patient satisfaction evaluation is armed at:1. Evaluating the outpatient satisfaction of the surveyed hospital;2. Analyzing the demands of the outpatients towards the non-technical service;3. Analyzing the demands of the medical personnel towards the non-technical service;4. Analyzing the cognitive differences between the outpatients and the medical personnel;5. Concluding the importance matrix of the service projects based on the patient satisfaction evaluation and the patient demands analysis, additionally, proposing the strategies to improve the quality of non-technical service.Methods1. Literature analysisThis study uses the library and database, such as CNKI Database, VIP Chinese Journal Database, WanFang Database, ScienceDirect, PubMed, to gather materials about the non-technical service and the evaluation system of medical. By comparing, I select the most suitable method in this study.2. Semi-structured interviewUsing semi-structural interview syllabus, this research conducts an in-depth interview among 10 medical staffs from Nanfang Hospital and Guizhou Provincial People’s Hospital.3. Questionnaire surveyThe study employs questionnaire survey as methodology, and examines 200outpatients and 200 medical staffs from Guizhou Provincial People’s Hospital. For outpatients, investigates their satisfaction status and potential demands for non-technical service, and provide the strategies for the improvement of non-technical service. For medical staffs, investigates their potential demands for non-technical service, and analyzes the cognitive differences between the outpatients and the medical staffs.4. KANO modelKANO model have developed a useful diagram for characterizing customer’s requirements. According to the KANO model, a customer’s attributes can be effective categorized into different types. KANO classifies the quality attributes into five categories, described bellow:Attractive quality attributes, Must be quality attributes, One-dimensional quality attributes, Indifferent quality attributes, Reverse quality attributes. According to customer’s answer of pair combinations, the customer requirements can be classified into different categories.5. Matrix Analysis of ImportanceThe matrix analysis of importance is a method which combined with the results of specific evaluation and the results of customer’s satisfaction for further subdivided the importance of each items. Using KANO model we can get the Satisfaction Index (SI) and the Dissatisfaction Index (DSI) which can be combined with the customer satisfaction to subdivide the service items.Result1. The reliability and validity analysis of the questionnaireThe criterion of reliability, namely an estimate of the internal consistency and homogeneity, is evaluated using Cronbach’s α statistic. The value of Cronbach’s a for all questions is 0.962, and the value of Cronbach’s a for six dimensions exceed 0.8, indicating reasonable internal reliability.It’s viewed as the best protocol of employing factor analysis in construct validity assessment. The value of KMO is 0.905 and P value for Bartlett’s test of sphericity less than 0.001. The cumulative contribution rate is 70.636%.2. The result of the outpatient satisfaction(1) Characteristics of the sampleTwo hundred questionnaires were distributed to outpatients, who subsequently visited the outpatient of the studied hospital for treatment. After removing incomplete samples,186 questionnaires were further analyzed.(2) Analysis of service satisfactionThe dressing of medical staff, the inventory of charges and ambient lighting are the top three service elements in this satisfaction survey. On the contrary, the environment of waiting area, registration time and waiting time get the low assessment in this survey. It’s worth mentioning that socio-demographic characteristics produce an effect on patients’ satisfaction which concentrated in gender and age.3. Analysis of service attributes from the perspective of outpatients(1) Characteristics of the sampleTwo hundred questionnaires were distributed to outpatients, who subsequently visited the outpatient of the studied hospital for treatment. After removing incomplete samples,186 questionnaires were further analyzed.(2) Analysis of service attributesThe attribute of each service element was derived according to the relative frequency of participant answers. From the patient’s perspective, most service elements were classified as one-dimensional attributes (13elements). Moreover,6 elements were classified as must-be attributes, the remaining were classified as attractive attributes.(3) The SI and DSI of the service elementsThe top three elements of SI are:indoor green (0.75), moral encouragement (0.73), waiting time (0.70), medical staff (0.70). The top three elements of DSI are: Bathroom cleanliness (0.91), guiding-nurse (0.88), medical staff (0.88),4. Analysis of service attributes from the perspective of medical staff(1) Characteristics of the sampleTwo hundred questionnaires were distributed to the medical staff. After removing incomplete samples,182 questionnaires were further analyzed.(2) Analysis of service attributesThe attribute of each service element was derived according to the relative frequency of participant answers. From the perspective of medical staff, most service elements were classified as one-dimensional attributes (20elements). Only 4 elements were classified as attractive attributes. It’s worth mentioning that none of the elements were classified as must-be attributes.(3) The SI and DSI of the service elementsThe top three elements of SI are:waiting of dispensary (0.81), moral encouragement (0.73), waiting time (0.70), medical staff (0.70). The top three elements of DSI are:Bathroom cleanliness (0.91), guiding-nurse (0.88), medical staff (0.88),5. The comparative study of non-technical needs between outpatients and medical staffAccording to the result,13 elements existed differences among 24 elements, and the difference was statistically significant (P<0.05). The main difference between patients and medical staff lies in the dimension of environment. Moreover, the dressing of medical staff, explanation, medical expense existed differences.Strategies1. Provide personalized service based on the Socio-demographic differences;2. Determine the service quality attributes for identifying key drivers and enhancing service quality of outpatient;3. Applying matrix analysis of importance to determine the weakness of medical service;4. Envisage the cognitive differences between patients and doctors, take effective measures to build a harmonious relationship;5. Explore a unified evaluation system to assess patients’satisfaction.Conclusion1. KANO model analysis has a reference value to enhance medical servicesThe KANO model has attracted considerable attention among marketing practitioners and researchers interested in identifying key drivers of customer satisfaction and dissatisfaction. Accordingly, it has also been adopted to identify patient requirements or enhance their satisfaction with healthcare services. Such a model may prove useful in identifying drivers of patient satisfaction for application to outpatient services and clarify where there is room for improvement.2. Cognitive differences exist between patients and medical staffPhysician-patient relationship is the most basic one in medical practice. Because of the different structure of knowledge, information mastery, mental role of medical service, the expectations and needs of medical service are obviously different. It is one of the major causes of the conflict between physician and patients. It is important to envisage the cognitive differences and take effective measures to build a harmonious relationship;3. Applying periodic testing for continuous improvementKano postulated that successful quality attributes follow a life-cycle such as the following:indifferent quality-attractive quality-one dimensional quality-must be quality. It is not reasonable to use one-time result to make long-term improvements. Medical institutions must apply periodic testing to identify the key drivers which effect patient satisfaction.