DEVELOPMENT OF AN INTERACTIVE MULTIMEDIA E-LEARNING …umkeprints.umk.edu.my/5041/1/PHD...
Transcript of DEVELOPMENT OF AN INTERACTIVE MULTIMEDIA E-LEARNING …umkeprints.umk.edu.my/5041/1/PHD...
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ACKNOWLEDGEMENTS
First and foremost I would like to thank Allah SWT for making this journey possible
and blessing me with family, friends and colleagues who have helped me in their
different ways in completing this thesis. My deepest and sincerest thanks to my
distinguish supervisor, Prof. Dr. Razli Che Razak, UMK’s Registrar (January 2012-
January 2015), who invaluable advice and critical evaluation over numerous meetings
regarding this thesis is greatly appreciated. Thanks for his constant and abundant
resource for guidance, support, enthusiasm and learning. Your deep and insightful
views over our numerous discussions have definitely helped to shape this thesis.
I must also thank the academicians and practitioners who at various stages were
involved in discussing and commenting on this research. My special thanks and sincere
gratitude to A/Prof.Dr.Mohammad Ismail, Prof.Dr.Murali Sambasivan, A/Prof.Dr.
Nizar Abdul Jalil (MD), A/Prof.Dr.Mohammad Iqbal Omar (MD), Dr.Abdul Aziz
Abdullah, Prof.Dr.Harshita Aini Haroon, Prof.Dr.Abdul Hamid Adom,
Prof.Dr.Mohd.Yusoff Mashor, Prof.Dr.Sazali Yaacob, Dr. Abd. Rahim Romle,
Sharmini Abdullah, Nur Syuhadah Kamaruddin, Dr. Syed Zulkarnain Syed Idrus,
Hafizah Abdul Rahim, and others who always support me with deepest motivation ever
after to complete this study. A special thanks to Prof. T.Ramayah for his valuable
comments and suggestions especially with regard to the research findings.
Thank you also for Ministry of Health (MOH) Malaysia, in specific, National Medical
Research Register (NMRR), Institute for Health Behavioural Research (IHBR) and
Medical Research Ethics Commitee (MREC) for the approval letter in conducting this
research. Thank you for Ministry of Higher Education (MOHE), Malaysia for giving me
the great opportunity till the end to finish this study.
Last but not least, my very special heartfelt thanks are reserved for my beloved
charming and tremendous husband, Ruslizam Daud (PhD) and my greatest children
Afifah An-Nur (2000), Afif Al-Ikhlas (2003), Afif Luqman (2007) and Afifah As-Syura
(2008) whose prayers and support helped to encourage me and make things just that bit
easier. Thanks for all your sacrifices and patience especially during the dreadful
moments. Thanks to stood with me with your full understanding and constant
encouragement during the study. I wish to express my sincere gratitude to my caring
and loving mother Hjh.Che Esah Hj.Nor and my great father Hj.Nordin Hj.Ismail and
my siblings Hjh.Norshazwani, Mohd Shahril, Mohd Hafiz, and Nailul Amal for their
golden advice whenever I needed them. I am also deeply indebted to my late mother and
late father-in-law and families for their continual supports and assistance.
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TABLE OF CONTENTS
PAGE
THESIS DECLARATION ii
ACKNOWLEDGEMENT iii
TABLE OF CONTENTS iv
LIST OF TABLES xi
LIST OF FIGURES xx
LIST OF ABBREVIATIONS xxiii
DEFINITION OF TERMS xxvi
ABSTRACT xxviii
ABSTRAK xxix
CHAPTER I INTRODUCTION 1
1.1 Chapter Overview 1
1.2 Motivation of the Study 1
1.2.1
Non-linearity Behaviour of Patient Service Fulfilment
2
1.2.2 Local Healthcare Service Provider Constraints and Limitations 5
1.2.3 Rising Complaints Frequency 8
1.2.4 Levels of Compliments and Complaints 11
1.3 Problem Statements 12
1.4 Research Questions 16
1.5 Research Objectives 17
1.6 Significance of the Study 18
1.7 Research Scope 20
1.8 Thesis Organization 21
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CHAPTER II LITERATURE REVIEW 22
2.1
Introduction
22
2.2
Malaysian Healthcare System
22
2.2.1 Public Healthcare Admission 24
2.2.2 Healthcare Capacity and Constraint 26
2.3 Complaints and Compliments in Healthcare Service 29
2.3.1
Complaints through Public Complaints Bureau (PCB)
31
2.3.2 Complaints through Ministry of Health, Malaysia 33
2.3.3 Complaint Issues in Malaysia Healthcare Service Delivery 37
2.3.4 Complaint based on Healthcare Service Delivery
Department
42
2.4
Non-Linear Relationship in Service Satisfaction Model
44
2.5
Quality Function Deployment
49
2.5.1 QFD definition 49
2.5.2 History of QFD 52
2.5.3 QFD General Framework 53
2.5.4 General QFD Research Classification 56
2.5.5 QFD Application in Product Development 59
2.5.6 QFD Application in Services 62
2.5.7 Integrated QFD in New Service Development 63
2.5.8 QFD Application in Healthcare Services 64
2.6 Patient Satisfaction Model in Healthcare 69
2.6.1
Integrated Patient Satisfaction Model in Healthcare
74
2.6.2 QFD in Services and Healthcare Services 79
2.6.3 The Development of Kano-QFD Model 83
2.6.4 Kano-QFD in Healthcare Service 87
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2.7 Patient Dissatisfaction Model in Healthcare 88
2.8 Kano-QFD Non-Linear Methodological Assumption 90
2.9 Proposed Concept of Kano-QFD Service Satisfaction Model 94
2.9.1 Conventional Kano Questionnaire Design 97
2.9.2 Kano-Service Satisfaction (Kano-SS) 99
2.9.3 Kano-Services Satisfaction Evaluation Table Development 106
2.10 Summary 114
CHAPTER III RESEARCH METHODOLOGY 115
3.1 Introduction 115
3.2 Research Design 115
3.3 Development of Kano-QFD Model Integration 117
3.3.1 Kano-QFD Phase I 117
3.3.2 Kano-QFD Phase II 121
3.3.3 Kano-QFD Phase III 122
3.4 Sampling Design 124
3.4.1 Population Definition 125
3.4.2 Sampling Frame and Respondents 127
3.4.3 Sampling Technique 128
3.4.4 Sample Size 129
3.5 Research Instrument Design 133
3.5.1 Questionnaire Design and Development of Kano-SS
Questionnaire
133
3.5.2 Service Variable Measurement 137
3.5.3 Pilot Survey: Phase 1 138
3.5.4 Pilot Survey Reliability Testing 140
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3.5.5 Service Variable Construct Validity by Exploratory Factor
Analysis (EFA)
142
3.5.6 Kano-QFD Instrument 143
3.6 Data Analysis: Phase 1, 2 and 3 147
3.6.1 Berger’s Coefficient and Kano Attribute Category 149
3.6.2 Kano’s Statistical Significant 149
3.6.3 Patient’s Attributes into QFD (Step 1) 151
3.6.4 Service Compliment and Service Complaint Indexes (Step 2) 152
3.6.5 Defining the Healthcare Service Attributes (Step 3) 153
3.6.6 Relationship Matrix between Patient’s Attributes and Service
Attributes (Step 4)
154
3.6.7 Correlation Matrix of Service Attributes (Step 5) 154
3.6.8 Calculation of Prioritized Patient Attributes by Compliment
and Complaint Indexes
155
3.7 Summary 156
CHAPTER IV RESULTS AND DISCUSSION 157
4.1 Introduction 157
4.2 Profile of Respondents 157
4.3 Instrument Reliability 160
4.4 Construct Validity using Confirmatory Factor Analysis (CFA) 161
4.5 Non-linear Kano Quality Attributes of Phase I 163
4.5.1 Data Analysis Berger’s Mass Coefficient and Kano Attribute
Category
163
4.5.2 Data Analysis Kano’s Statistical Significant 189
4.5.3 Data Analysis Kano Quality Attributes Grid Mapping 201
4.5.4 Data Analysis Service Complaint Index and Service 215
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Compliments Index
4.5.5 Data Analysis of Service Gap and Service Effective 225
4.6 Non-linear Kano Quality Attributes Analysis of Phase 2 and 3 248
4.6.1 Kano-QFD HOQ for Doctor Care 250
4.6.2 Kano-QFD HOQ for Nurse Care 255
4.6.3 Kano-QFD HOQ for Surgery Care 259
4.6.4 Kano-QFD HOQ for Doctor Attitude and Personality 263
4.6.5 Kano-QFD HOQ for Nurse Attitude and Personality 266
4.6.6 Kano-QFD HOQ for Appointment 270
4.6.7 Kano-QFD HOQ for Medical Communication 273
4.6.8 Kano-QFD HOQ for Admission 278
4.6.9 Kano-QFD HOQ for Discharge 281
4.6.10 Kano-QFD HOQ for Mortuary 285
4.6.11 Summary of Kano-QFD HOQ and Service Prioritization 287
4.7 Comparison of Kano-QFD Satisfaction Model with Other Models 291
CHAPTER V CONCLUSION AND RECOMMENDATIONS 300
5.1 Introduction 300
5.2 Addressing the Research Questions 301
5.3 Contribution of Present Kano-QFD Satisfaction Model and Comparison 314
5.3.1 Theoretical Contribution 314
5.3.2 Methodological Contribution 318
5.3.3 Managerial Contribution 320
5.4 Limitations and Recommendations 321
5.4.1 Limitations 321
5.4.2 Future Research 321
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REFERENCES 324
APPENDIX - A 366
A.1 Letter from Director General of Health Malaysia 366
A.2 Institute for Health Behavioural Research (IHBR) and National
Institute of Health (NIH) Approval for Research
A.3 Official Approval Letter from Medical Research & Ethics Committee
(MREC), MOH, Malaysia
368
369
A.4 National Medical Research Register (NMRR) High Level Workflow 370
APPENDIX - B Kano-QFD Questionnaire 371
APPENDIX - C Exploratory Factor Analysis (EFA) for Pilot Survey 386
C.1 Measurement model for Doctor Care 386
C.2 Measurement model for Nurse Care 387
C.3 Measurement model for Surgery Care 388
C.4 Measurement model for Doctor Attitude and Personality 389
C.5 Measurement model for Nurse Attitude and Personality 390
C.6 Measurement model for Appointment 391
C.7 Measurement model for Medical Communication 392
C.8 Measurement model for Admission 393
C.9 Measurement model for Discharge 394
C.10 Measurement model for Mortuary 395
Table C.1 Summary of Exploratory Factor Analysis (EFA) 396
APPENDIX - D Reliability Test Results for Pilot Survey 397
Table D.1 Cronbach’s α for Kano-Q and Kano-SS (N = 50) 412
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APPENDIX - E Confirmatory Factor Analysis (CFA) for Data Analysis 413
E.1
Measurement model for Doctor Care
413
E.2 Measurement model for Nurse Care 414
E.3 Measurement model for Surgery Care 415
E.4 Measurement model for Doctor Attitude and Personality 416
E.5 Measurement model for Nurse Attitude and Personality 417
E.6 Measurement model for Appointment 418
E.7 Measurement model for Medical Communication 419
E.8 Measurement model for Admission 420
E.9 Measurement model for Discharge 421
E.10 Measurement model for Mortuary 422
Table E.1 Summary of Confirmatory Factor Analysis (CFA) 422
APPENDIX - F
Reliability Test Results for Data Analysis
423
Table F.1
Cronbach’s α for Kano-Q and Kano-SS (N=300)
438
APPENDIX - G
Demographic Data
439
APPENDIX - H
QFD House of Quality for Data Analysis
H.1
QFD HOQ of Doctor Care
442
H.2 QFD HOQ of Nurse Care 443
H.3 QFD HOQ of Surgery Care 444
H.4 QFD HOQ of Doctor Attitude and Personality 445
H.5 QFD HOQ of Nurse Attitude and Personality 446
H.6 QFD HOQ of Appointment 447
H.7 QFD HOQ of Medical Communication 448
H.8 QFD HOQ of Admission 449
H.9 QFD HOQ of Discharge 450
H.10 QFD HOQ of Mortuary
451
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LIST OF TABLES
NO. PAGE
1.1
Development of non-linear satisfaction model in service due to
inaccuracy and deficiency of linear relationship between service
delivery and customer expectation
4
1.2
Summary of healthcare system for 2011-2015 Country Health Plan
6
1.3
Area of concern that affects the healthcare service delivery
6
1.4
Public Complaint Report and Total on Malaysian Healthcare
Services which adapted from Public Complaints Bureau (PCB) (i-
Aduan) through MESRA Programme, Mobile Complaints Counter
(MCC) and Integrated Mobile Complaints Counter (IMCC)
10
2.1
Number of inpatient beds, bed occupancy rate (BOR) and total
admission to MOH hospitals and institutions, 2007-2011
26
2.2
Summary of healthcare capacity and constraints
28
2.3
Category of complaints in Year 2008
35
2.4
Summary of service delivery variables in healthcare
40
2.5
Kano evaluation (KE) table
49
2.6
QFD penetration
50
2.7
QFD advantages
51
2.8
QFD disadvantages
51
2.9
QFD research classification
56
2.10
QFD top 10 articles most published
58
2.11
QFD research classification by publications
59
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2.12 Conventional QFD for new product development 60
2.13
QFD integration for new product development
61
2.14
QFD research classification in product development
63
2.15
Conceptual requirements
64
2.16
Operational requirements
65
2.17
Selected operational requirements for design process
65
2.18
Important parameters for new service design
66
2.19
QFD advantages in healthcare service
67
2.20
QFD drawbacks in healthcare service
67
2.21
QFD possible problem arise in implementations
67
2.22
Stakeholders target for hospitals
68
2.23
QFD research classification in services
68
2.24
Respondents number for satisfaction model in healthcare
71
2.25
Summary of satisfaction measurements in healthcare
73
2.26
Summary of previous study on satisfaction model in healthcare
78
2.27
QFD basic for new service development
80
2.28
QFD extension for new services development
81
2.29
Kano-QFD research model and objectives (1998-2011)
85
2.30
Expression of conventional Kano Answer
97
2.31
Seven point service satisfaction scale
101
2.32
Assumption of CIT and ACC
103
2.33
New Kano-SS equivalence scale assumptions
104
2.34
Importance scale and satisfaction scale reference
107
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2.35 Refined KQA by Yang (2005) 108
2.36
Refined KQA by Shahin & Nekuie (2011)
108
2.37
Comparison of satisfaction impact k
111
2.38 Proposed satisfaction impact coefficient μ
112
2.39
Refined Kano evaluation (KE) table (Kano et al., 1984) with service
satisfaction scale and proposed satisfaction impact coefficient μ
112
3.1
Population description
125
3.2
Survey population
126
3.3
Sample size of the survey (N=300)
130
3.4
Sampling size summary sources of service variable
132
3.5
Sub-variable of personal details, and visiting history
135
3.6
Main sources of service attributes based on complaints local
healthcare, Malaysia Public Complaints Bureau, Ministry of Health
and published satisfaction model
138
3.7
Cronbach’s alpha for pilot survey Kano-Q and Kano-SS
(N = 50)
141
3.8
Summary of Exploratory Factor Analysis (EFA)
143
3.9
Summary of frequency agreement for functional question
144
3.10
Summary of frequency agreement for dysfunctional question
146
3.11
Main sources of service attributes based on complaints local
healthcare, Malaysia Public Complaints Bureau, Ministry of Health
155
4.1
Demographic profile of respondents (N=300)
158
4.2
Cronbach’s α for Kano-Q and Kano-SS (N=300)
160
4.3
Summary of Confirmatory Factor Analysis (CFA) results
162
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4.4 Kano-SS KQA for Doctor Care 164
4.5
Kano-SS KQA for Nurse Care
167
4.6
Kano-SS KQA for Surgery Care
170
4.7
Kano-SS KQA for Doctor Attitude and Personality
173
4.8
Kano-SS KQA for Nurse Attitude and Personality
176
4.9
Kano-SS KQA for Appointments
177
4.10
Kano-SS KQA for Medical Communication
179
4.11
Kano-SS KQA for Admission
182
4.12
Kano-SS KQA for Discharge
184
4.13
Kano-SS KQA for Mortuary
185
4.14
Summary of overall service index for mass survey
187
4.15
Summary of KQA for data analysis (N = 300)
188
4.16
KQA Kano-SS statistical significant for Doctor Care
191
4.17
KQA Kano-SS statistical significant for Nurse Care
191
4.18
KQA Kano-SS statistical significant for Surgery Care
192
4.19
KQA Kano-SS statistical significant for Doctor Attitude and
Personality
193
4.20
KQA Kano-SS statistical significant for Nurse Attitude and
Personality
194
4.21
KQA Kano-SS statistical significant for Appointments
195
4.22
KQA Kano-SS statistical significant for Medical Communication
196
4.23
KQA Kano-SS statistical significant for Admission
198
4.24
KQA Kano-SS statistical significant for Discharge
199
4.25
KQA Kano-SS statistical significant for Mortuary
200
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4.26 Summary of KQA significant for data analysis (N = 300) 200
4.27
Summary of KQA for data analysis (N=300)
214
4.28
Doctor Care SCi and SCa Index
216
4.29
Nurse Care SCi and SCa Index
217
4.30
Surgery Care SCi and SCa Index
218
4.31
Doctor Attitude and Personality SCi and SCa Index
219
4.32
Nurse Attitude and Personality SCi and SCa Index
220
4.33
Appointment SCi and SCa Index
220
4.34
Medical Communication SCi and SCa Index
221
4.35
Admission SCi and SCa Index
222
4.36
Discharge SCi and SCa Index
223
4.37
Mortuary SCi and SCa Index
223
4.38
Summary of KQA, SCi and SCa
224
4.39
Service Gap and Service Effective for Doctor Care
226
4.40
Service Gap and Service Effective for Nurse Care
228
4.41
Service Gap and Service Effective for Surgery Care
231
4.42
Service Gap and Service Effective for Doctor Attitude and
Personality
233
4.43
Service Gap and Service Effective for Nurse Attitude and
Personality
235
4.44
Service Gap and Service Effective for Appointment
237
4.45
Service Gap and Service Effective for Medical Communication
240
4.46
Service Gap and Service Effective for Admission
243
4.47
Service Gap and Service Effective for Discharge
245
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4.48 Service Gap and Service Effective for Mortuary 247
4.49 Prioritized patient attributes ( ) index by compliments for Doctor Care
251
4.50 Prioritized patient attributes ( ) index by complaints for Doctor Care and minimum improvement required
251
4.51 Prioritized service attributes ( ) index by compliments for Doctor Care
253
4.52 Prioritized service attributes ( ) index by complaints for Doctor Care
253
4.53 Prioritized patient attributes ( ) index by compliments for Nurse Care
256
4.54 Prioritized patient attributes ( ) index by complaints for Nurse Care and minimum improvement required
256
4.55 Prioritized service attributes ( ) index by compliments for Nurse Care
258
4.56 Prioritized service attributes ( ) index by complaints for Nurse Care
259
4.57 Prioritized patient attributes ( ) index by compliments for Surgery Care
260
4.58 Prioritized patient attributes ( ) index by complaints for Surgery Care and minimum improvement required
261
4.59 Prioritized service attributes ( ) index by compliments for Surgery Care
261
4.60 Prioritized service attributes ( ) index by complaints for Surgery Care
262
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4.61 Prioritized patient attributes ( ) index by compliments for Doctor Attitude and Personality
263
4.62 Prioritized patient attributes ( ) index by complaints for Doctor Attitude and Personality and minimum improvement
required
264
4.63 Prioritized service attributes ( ) index by compliments for Doctor Attitude and Personality
265
4.64 Prioritized service attributes ( ) index by complaints for Doctor Attitude and Personality
266
4.65 Prioritized patient attributes ( ) index by compliments for Nurse Attitude and Personality
267
4.66 Prioritized patient attributes ( ) index by complaints for Nurse Attitude and Personality and minimum improvement required
267
4.67 Prioritized service attributes ( ) index by compliments for Nurse Attitude and Personality
268
4.68 Prioritized service attributes ( ) index by complaints for Nurse Attitude and Personality
269
4.69 Prioritized patient attributes ( ) index by compliments for Appointment
271
4.70 Prioritized patient attributes ( ) index by complaints for Appointment and minimum improvement required
271
4.71 Prioritized service attributes ( ) index by compliments for Appointment
272
4.72 Prioritized service attributes ( ) index by complaints for Appointment
273
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4.73 Prioritized patient attributes ( ) index by compliments for Medical Communication
274
4.74 Prioritized patient attributes ( ) index by complaints for Medical Communication and minimum improvement required
276
4.75 Prioritized service attributes ( ) index by compliments for Medical Communication
277
4.76 Prioritized service attributes ( ) index by complaints for Medical Communication
278
4.77 Prioritized patient attributes ( ) index by compliments for Admission
279
4.78 Prioritized patient attributes ( ) index by complaints for Admission and minimum improvement required
279
4.79 Prioritized service attributes ( ) index by compliments for Admission
280
4.80 Prioritized service attributes ( ) index by complaints for Admission
281
4.81 Prioritized patient attributes ( ) index by compliments for Discharge
282
4.82 Prioritized patient attributes ( ) index by complaints for Discharge and minimum improvement required
283
4.83 Prioritized service attributes ( ) index by compliments for Discharge
284
4.84 Prioritized service attributes ( ) index by complaints for Discharge
284
4.85 Prioritized patient attributes ( ) index by compliments for
285
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Mortuary
4.86 Prioritized patient attributes ( ) index by complaints for Mortuary and minimum improvement required
286
4.87 Prioritized service attributes ( ) index by compliments for Mortuary
286
4.88 Prioritized service attributes ( ) index by complaints for Mortuary
287
4.89
Summary of prioritized service attributes categories in ranking
290
4.90
Comparison of non-linear satisfation model using Kano and Kano-
QFD based on Kano Quality Attribute satisfaction impact
292
4.91
Service gap comparison of present non-linear satisfaction model
with other models for Tangibility and Reliability
294
4.92
Service gap comparison of present non-linear satisfaction model
with other models for Responsiveness
296
4.93
Service gap comparison of present non-linear satisfaction model
with other models for Assurance
297
4.94
Service gap comparison of present non-linear satisfaction model
with other models for Empathy and Accessibility
298
5.1
Average of service satisfaction index
302
5.2 Summary of , , , and
304
5.3
Summary of satisfaction gap and service effective
306
5.4
Summary of prioritized patient attributes and service attributes based
on complaint and compliment (Top Rank)
310
5.5
Summary of modified Kano-QFD Model with statistical approach
312
5.6
Summary of effective service attribute
313
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LIST OF FIGURES
NO. PAGE
1.1
Complaints frequency received by public hospital from year 2000 –
2014 based on Malaysian Public Complaints Bureau
9
2.1
Complaints frequency received by public hospital from year 2000 –
2014 based on government, state and public health sector
32
2.2
Complaints frequency received by public hospital from year 2005 –
2008 by Ministry of Health
33
2.3
Complaints fraction received by public hospital for 2008
34
2.4
Complaints frequency resources in public hospital (2006 – 2008)
36
2.5
Complaint frequency resources based on health institution, clinic and
hospital from year 2006 - 2008
37
2.6
Distribution of complaints by department
42
2.7
Classification of complaints
44
2.8
Kano’s model of customer satisfaction
46
2.9
Example of functional and dysfunctional form in Kano questionnaire
48
2.10
Basic components of QFD or HOQ
54
2.11
Eight steps of QFD diagram for mechanical design process
55
2.12
Nine steps QFD model
55
2.13
Summary of general Kano-QFD integration model
84
2.14
QFD research problem and issues
93
2.15
Preliminary concept of Kano-QFD integration
96
3.1
Research design
116
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3.2 Kano-QFD integration framework 118
3.3
Questionnaire design in Phase 1
134
3.4
Sample of Kano-Q (DCK 1-2) questions
136
3.5
Sample of Kano-SS (DCQ3-11) question
137
3.6
Phase I Kano-QFD Step 1 flow chart for pilot survey
139
3.7
Data analysis framework of phase 1, 2 and 3
148
3.8
Kano-QFD Step 1 and 2
152
3.9
The flow of information from Kano-QFD Step 1 to Step 2
153
3.10
Service attributes category and elements
156
4.1
Service satisfaction and service dissatisfaction index for Doctor Care
166
4.2
Service satisfaction and service dissatisfaction index for Nurse Care
169
4.3
Service satisfaction and service dissatisfaction index for Surgery Care
172
4.4
Service satisfaction and service dissatisfaction index for Doctor
Attitude and Personality
174
4.5
Service satisfaction and service dissatisfaction index for Nurse
Attitude and Personality
175
4.6
Service satisfaction and service dissatisfaction index for Appointment
178
4.7
Service satisfaction and service dissatisfaction index for Medical
Communication
181
4.8
Service satisfaction and service dissatisfaction index for Admission
183
4.9
Service satisfaction and service dissatisfaction index for Discharge
185
4.10
Service satisfaction and service dissatisfaction index for Mortuary
186
4.11
Grid mapping for Kano-SS Doctor Care
203
4.12
Grid mapping for Kano-SS Nurse Care
204
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4.13 Grid mapping for Kano-SS Surgery Care 205
4.14
Grid mapping for Kano-SS Doctor Attitude and Personality
207
4.15
Grid mapping for Kano-SS Nurse Attitude and Personality
208
4.16
Grid mapping for Kano-SS Appointment
209
4.17
Grid mapping for Kano-SS Medical Communication
210
4.18
Grid mapping for Kano-SS Admission
211
4.19
Grid mapping for Kano-SS Discharge
212
4.20
Grid mapping for Kano-SS Mortuary
213
4.21
Chart of service gap and service effective for Doctor Care
227
4.22
Chart of service gap and service effective for Nurse Care
229
4.23
Chart of service gap and service effective for Surgery Care
232
4.24
Chart of service gap and service effective for Doctor Attitude and
Personality
234
4.25
Chart of service gap and service effective for Nurse Attitude and
Personality
236
4.26
Chart of service gap and service effective for Appointments
238
4.27
Chart of service gap and service effective for Medical Communication
241
4.28
Chart of service gap and service effective for Admission
244
4.29
Chart of service gap and service effective for Discharge
246
4.30
Chart of service gap and service effective for Mortuary
247
5.1
Mapping of satisfaction and dissatisfaction coefficient and service
satisfaction scale
303
5.2 Relationship of satisfaction gap and service effective with Kano
Model
307
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LIST OF ABBREVIATIONS
A Attractive Attribute
ACC Analysis of Complaints and Compliments
ADMK Admission Kano
ADMQ Admission Question
AHP Analytical Hierarchical Process
ALOS Average Length of Stay for Acute Care
ANN Artificial Neural Network
ANP Analytical Network Process
APDK Attitude and Personality Doctor Kano
APDQ Attitude and Personality Doctor Question
APNK Attitude and Personality Nurse Kano
APNQ Attitude and Personality Nurse Question
APPK Appointments Kano
APPQ Appointments Question
BOR Bed Occupancy Rate
CA Customer Attribute
CD Customer Dissatisfaction
CFA Confirmatory Factor Analysis
CIT Critical Incident Technique
CKA Customer Kano Attribute
CKAD Customer Kano Attribute Dysfunctional
CKAF Customer Kano Attribute Functional
CKAS Conventional Kano Answer Scheme
CKQ Conventional Kano’s Questionnaire
CPD Complainant Personal Details
CQI Continuous Quality Improvement
CS Customer Satisfaction
CVI Clinical Visit Information
DC Degree of Confidence
DCK Doctor Care Kano
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DCQ Doctor Care Question
DISCK Discharge Kano
DISCQ Discharge Question
DP Desired Precision
ED Extent of Dissatisfaction
ES Extent of Satisfaction
FMEA Failure Mode Effect Analysis
HC Healthcare Customer
HSP Healthcare Service Provider
HSV Healthcare Service Variables
HOQ House of Quality
I Indifferent Attribute
IMCC Integrated Mobile Complaints Counter
IOP Inpatients and Outpatients
KAS Kano Answers Scale
KE Kano Evaluation
KEA Kano Evaluation Answer
KGM Kano Grid Mapping
KQ Kano Question
KQA Kano Quality Attribute
KSAS Kano Satisfaction Answer Scheme
KSS Kano Statistical Significant
M Must be Attribute
MCC Mobile Complaints Counter
MDCOMK Medical Communication Kano
MDCOMQ Medical Communication Question
MODM Multi Objective Decision Making
MOH Ministry of Health
MORTK Mortuary Kano
MORTQ Mortuary Question
O One dimensional Attribute
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PA Patient Attribute
PACap Prioritized Patient Attributes Index by Complaints
PACip Prioritized Patient Attributes Index by Compliments
PCA Patient Care Attributes
PCB Public Complaints Bureau
PD Patient Dissatisfaction
Pi Performance Index
PS Patient Satisfaction
PSA Prioritized Service Attribute
QA Quality Attribute
QBD Quality Benchmarking Deployment
QCC Quality Control Circle
QFD Quality Function Deployment
QI Quality Improvement Index
R Reversed Attribute
SACap Prioritized Service Attributes Index by Complaints
SACip Prioritized Service Attributes Index by Compliments
SCa Service Complaints
SCi Service Compliments
SCK Surgery Care Kano
SCQ Surgery Care Question
SD Service Dissatisfaction
SDDM Service Design Decision Making
SS Service Satisfaction
SV Service Variables
TQM Total Quality Management
TV True Variability
UQ Ultimate Question
USDF Uncertainty Service Delivery Feedback
VOP Voice of Patient
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DEFINITION OF TERMS
Attractive Attribute (A) These attributes provide satisfaction when achieved fully, but do not cause dissatisfaction when not fulfilled. These are attributes that are not normally expected. Since these
types of attributes of quality unexpectedly delight
customers, they are often unspoken. It can be neither
explicitly expressed nor expected by the customer and by
fulfilling these requirements, the more customer satisfaction
can be achieved.
Average Length of Stay
for Acute Care (ALOS)
Bed Occupancy Rate
(BOR)
Average length of stay is computed by dividing the number
of days stayed (from the date of admission in an in-patient
institution) by the number of discharges (including deaths)
during the year.
The total beds available in the hospital by number of days in
the year it would be available
Customer Attribute Customer attributes includes the way the business is working and the way the customers are buying the products and the regular occasional shoppers form family status- like
children's and adults.
Customer
Dissatisfaction
Confirmatory Factor
Analysis
Critical Incident
Technique
Continuous Quality
Improvement
One with the ability, means and desire to buy that does not
for a reason of dissatisfaction
Is a special form of factor analysis, most commonly used in
social research. It is used to test whether measures of a
construct are consistent with a researcher's understanding of
the nature of that construct (or factor). As such, the
objective of confirmatory factor analysis is to test whether
the data fit a hypothesized measurement model. This
hypothesized model is based on theory and/or previous
analytic research.
A set of procedures used for collecting direct observations
of human behaviour that have critical significance and meet
methodically defined criteria. These observations are then
kept track of as incidents, which are then used to solve
practical problems and develop broad psychological
principles. A critical incident can be described either as one
that makes a significant contribution positively or
negatively to an activity or phenomenon.
Is a process to ensure programs are systematically and
intentionally improving services and increasing positive
outcomes for the families they serve. Is a cyclical, data-
driven process, it is proactive and ongoing process that
involves the Plan, Do, Study, and Act cycle.
http://en.wikipedia.org/wiki/Factor_analysishttp://en.wikipedia.org/wiki/Constructhttp://en.wikipedia.org/wiki/Procedure_(term)http://en.wikipedia.org/wiki/Human_behaviorhttp://en.wikipedia.org/wiki/Psychological
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Customer Satisfaction The number of customers or percentage of total customers,
whose reported experience with a firm, its products, or its
services (ratings) exceeds specified satisfaction goals.
Degree of Confidence Is a type of interval estimate of a population parameter and is used to indicate the reliability of an estimate.
Failure Mode Effect
Analysis
Is often the first step of a system reliability study. It involves reviewing as many components, assemblies, and
subsystems as possible to identify failure modes, and their
causes and effects.
House of Quality Is a diagram, resembling a house, used for defining the relationship between customer desires and the firm/product
capabilities.
Indifferent Attribute These attributes refer to aspects that are neither good nor bad, and they do not result in either customer satisfaction or
customer dissatisfaction.
Kano Model A theory of product development and customer satisfaction developed in the 1980s by Professor Noriaki Kano which
classifies customer preferences into five categories; Must be
Attribute, One dimensional Attribute, Indifferent Attribute,
Attractive Attribute and Reversed Attribute
Must be Attribute These attributes are taken for granted when fulfilled but result in dissatisfaction when not fulfilled. An example of
this would be package of milk that leaks. Customers are
dissatisfied when the package leaks, but when it does not
leak the result is not increased customer satisfaction.
One dimensional
Attribute
These attributes result in satisfaction when fulfilled and dissatisfaction when not fulfilled. These are attributes that
are spoken of and ones which companies compete for. An
example of this would be a milk package that is said to have
10% more milk for the same price will result in customer
satisfaction, but if it only contains 6% then the customer
will feel misled and it will lead to dissatisfaction.
Quality Control Circle Is a management approach that involves input from a number of different sources within the structure of a
company. Is to identify the presence of specific performance
issue within the company, determine the origins of the
issue, and then develop a process that helps to correct or
resolve the problem without triggering additional issues
elsewhere within the operational structure.
Reversed Attribute These attributes refer to a high degree of achievement resulting in dissatisfaction and to the fact that not all
customers are alike. For example, some customers prefer
high-tech products, while others prefer the basic model of a
product and will be dissatisfied if a product has too many
extra features
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http://en.wikipedia.org/wiki/Customer_satisfactionhttp://en.wikipedia.org/wiki/Noriaki_Kano
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xxviii
Development of Kano Model and Quality Function Deployment Integration to
Assess Customer Satisfaction and Dissatisfaction of Service at Local Public
Hospital
ABSTRACT
The intensifying patient complaints on service delivery performance of local public
healthcare institution are critical and incrementally raised. New methodologies are
needed to address the complexity of patient expectation before the quality of service
delivery can be improved. This issue needs to be solved instantly by establishing the
service satisfaction model to understand the nature of patient’s expectation towards
service delivery. As a result, the developed service satisfaction model has contributed to
be inaccurate to understanding of patient’s behavior towards healthcare service. The
non-linear assumption should be considered for better accuracy since the non-linear
patient’s expectation remains undefined. This thesis aims to develop the non-linear
service satisfaction model that assumes patients are not necessarily satisfied or
dissatisfied with good or poor service delivery. With that, compliment and compliant
assessment is considered, simultaneously. Non-linear service satisfaction instrument
called Kano-Q and Kano-SS is developed based on Kano model and Theory of Quality
Attributes to define the unexpected, hidden and unspoken patient satisfaction and
dissatisfaction into service quality attribute. A new Kano-Q and Kano-SS algorithm for
quality attribute assessment is developed based satisfaction impact theories and found
instrumentally fit the reliability and validity test. The results were also validated based
on standard Kano model procedure before Kano model and Quality Function
Deployment (QFD) is integrated for patient attribute and service attribute prioritization.
An algorithm of Kano-QFD matrix operation is developed to compose the prioritized
complaint and compliment indexes. Finally, the results of prioritized service attributes
are mapped to service delivery category to determine the most prioritized service
delivery that need to be improved at the first place by healthcare service provider. The
results of this study indicate that the new satisfaction model is significantly effective in
differentiating Kano dimensions and provides more accurate prioritization of the
dimension and attribute compared to the traditional Kano approach. Although the new
methodology evaluates the Kano methodology with QFD integration, the methodology
is limited to a particular service industry that always encountered high dissatisfaction
which expected to compose the Must-be, Attractive and One-dimensional quality
attribute by ranking. As a conclusion, the new non-linear Kano-QFD service satisfaction
model has been developed, tested and validated with Kano model to facilitate the
analysis and decision making for better service delivery improvement. Comparison with
other models has shown well agreement in terms of Kano quality attributes satisfaction
impact and service gaps in healthcare service. As for future work, the comparison study
on linear and non-linear patient expectation based on Kano-QFD integration is
essentially recommended.
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Pembangunan Model Kano dan Integrasi Pertukaran Fungsi Kualiti untuk
Menilai Kepuasan dan Ketidakpuashatian Pelanggan Perkhidmatan di Hospital
Awam Tempatan
ABSTRAK
Pertambahan aduan pesakit terhadap prestasi penghantaran servis yang dilaporkan oleh
institusi kesihatan tempatan adalah pada tahap kritikal dan meningkat naik. Kaedah baru
diperlukan bagi mengetengahkan kehendak pesakit yang kompleks sebelum kualiti
penghantaran servis boleh dipertingkatkan. Isu ini perlu diselesaikan dengan segera bagi
membangunkan satu model kepuasan servis untuk memahami kehendak pesakit
terhadap penghantaran servis. Model kepuasan servis terdahulu adalah berdasarkan
andaian perhubungan lelurus. Hasilnya, model kepuasan servis yang dibangunkan juga
menyumbang kepada ketidaktepatan pada pemahaman kelakuan pesakit terhadap servis
kesihatan. Satu andaian ketaklelurusan perlu dipertimbangkan bagi ketepatan terbaik
kerana ketaklelurusan kehendak pesakit masih belum ditentukan. Tesis ini bertujuan
untuk membangunkan model kepuasan servis ketaklelurusan yang mengandaikan para
pesakit tidak semestinya berpuashati atau tidakberpuashati dengan kebagusan atau
ketakbagusan servis kesihatan. Oleh yang demikian, aduan dan pujian perlu disekalikan
dalam pembangunan model. Satu pengalatan kepuasan ketaklelurusan servis dinamakan
Kano-Q dan Kano-SS telah dibangunkan berasaskan model Kano dan Teori Sifat
Kualiti bagi mengenalpasti kepuasan dan ketakpuasan pesakit yang tak terjangka,
tersembunyi dan tak dinyatakan kepada sifat kualiti servis. Instrumen tersebut telah
digunakan untuk mengukur sepuluh pembolehubah aduan terbanyak dalam servis
kesihatan. Satu algoritma Kano-Q dan Kano-SS bagi penilaian sifat kualiti telah
dibangunkan berdasarkan teori impak kepuasan dan instrumen didapati mematuhi ujian
kebolehpercayaan dan kesahan. Keputusan juga disahkan berasaskan prosedur piawai
model Kano sebelum model Kano dan Quality Function Deployment (QFD)
diintegrasikan untuk sifat bagi pesakit dan keutamaan servis. Satu algoritma bagi
operasi matrix Kano-QFD dibangunkan bagi terbitan keutamaan indeks aduan dan
pujian. Walaupun metodologi baru membentuk kaedah untuk integrasi Kano-QFD,
metodologi tersebut terhad kepada industri perkhidmatan yang selalu mengalami
ketidapuashatian yang tinggi yang mana darjah sifat kualiti adalah Mesti, Menarik and
Satu-Dimensi. Kesimpulannya, satu ketaklurusan model Kano-QFD telah dibangunkan,
diuji dan disahkan untuk menyokong pembuatan keputusan bagi penambahbaikan
penghantaran servis. Perbandingan dengan model-model lain daripada literasi
menunjukkan ciri-ciri persamaan dalam bentuk sifar kualiti Kano. Sebagai cadangan
kajian pada masa hadapan, perbandingan kajian antara lelurus dan ketidak lelurusan
berdasarkan integrasi Kano-QFD perlulah dibangunkan.