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Analysis of importance level and quality achievement aspect in
48
Vol. 45. No. 1 March 2012
Research Report
Analysis of importance level and quality achievement aspect in
dental health service (A case study on Waru Sidoarjo Community
Dental Health Service)
Taufan Bramantoro and Retno Palupi
Department of Dental Public Health
Faculty of Dentistry, Airlangga University
Surabaya - Indonesia
abstract
Background: Patients as customers of health services actually have expectation and assessment of health services perceived.
During the initial interview conducted at Waru Sidoarjo Community Dental Health Service (Waru Sidoarjo CDHS), it is known that
one hundred percent of initial respondents were not satisfied with dental care service provided. All of those respondents assessed
that Waru Sidoarjo CDHS still has not met their expectations of service quality factors considered to be important for them. It is even
known that there is usually a gap between the expectations of quality dental care service and the assessment of services perceived. As
a result, further researches are needed to be conducted regarding the level of importance and achievement-related with factors that
affect the quality of health services. Purpose: The purpose of this study was to determine the level of importance and achievement of
the quality aspects of the health service provided by Waru Sidoarjo CDHS. Methods: This study can be considered as a descriptive
observational study. The instrument used in this study was measurement instruments of service quality. Respondents in the study
were 200 patients who visited to dental care services in Waru Sidoarjo CDHS in July 2011. Results: All of the attributes had a mean
value of dominant importance and assessments at four. The attributes of the appearance feasibility of medical staffs had the highest
interest, about 4.780. Meanwhile, the mean value of the lowest importance was on the attributes of the service suitability, about 4.595.
During the observation of the service value, it is also known that the highest mean value was on the non-discriminative services,
about 4.600. Conclusion: It can be concluded that there were attributes considered to be important for patients, but still not being
fully met by health services provided by the service provider or Community Dental Health Care. Those attributes involving waiting
room comfort, service readiness and service preparation attributes which not only had high importance value, but also had a large
percentage of respondents who were not satisfied.
Key words: The expectations of patients, the assessments of patients, the satisfactory of patients, dental care service
abstrak
Latar belakang: Pasien sebagai pengguna jasa pelayanan kesehatan, memiliki harapan dan penilaian terhadap pelayanan
kesehatan yang diterima. Pada wawancara awal yang dilakukan pada pasien Balai Pengobatan Gigi Puskesmas Waru Sidoarjo,
didapatkan bahwa seratus persen responden awal merasa tidak puas dengan pelayanan kesehatan gigi. Seluruh responden awal menilai
pihak BPG Puskesmas belum memenuhi harapan mereka terhadap faktor kualitas pelayanan yang mereka nilai penting. Terdapat
kesenjangan antara harapan mereka terkait kualitas pelayanan kesehatan gigi yang mereka nilai penting dengan penilaian mereka
terhadap pelayanan yang diterima, sehingga diperlukan penelitian lebih lanjut mengenai tingkat kepentingan dan pencapaian terkait
faktor yang berpengaruh terhadap kualitas pelayanan kesehatan. Tujuan: Tujuan penelitian ini adalah untuk mengetahui tingkat
kepentingan dan pencapaian aspek kualitas pelayanan yang diberikan Balai Pengobatan Gigi Puskesmas Waru Sidoarjo. Metode:
Penelitian ini merupakan penelitian deskriptif observasional. Instrumen yang digunakan pada penelitian ini adalah instrumen pengukuran
kualitas pelayanan jasa. Responden pada penelitian adalah 200 pasien yang berkunjung dan mendapatkan pelayanan kesehatan gigi
di Balai pengobatan Gigi Puskesmas Waru Sidoarjo pada bulan Juli 2011. Hasil: Seluruh atribut memiliki rerata nilai kepentingan
dan penilaian yang dominan pada nilai 4. Atribut kelayakan penampilan staf medis memiliki nilai kepentingan tertinggi sebesar 4,780.
Rerata nilai kepentingan terendah pada atribut kesesuaian layanan sebesar 4,595. Pada pengamatan nilai penerimaan layanan, rerata
nilai tertinggi pada atribut layanan yang tidak diskriminatif sebesar 4,600. Rerata nilai terendah didapatkan pada atribut kesiapan
layanan sebesar 4,200. Kesimpulan: Disimpulkan bahwa terdapat atribut yang dinilai penting tetapi belum sepenuhnya terpenuhi oleh
Bramantoro and Palupi: Analysis of importance level and quality achievement
49
pelayanan kesehatan yang diberikan oleh penyedia layanan atau Puskesmas. Atribut kenyamanan ruang tunggu, kesigapan layanan,
dan kesiapan layanan, memiliki nilai kepentingan yang tinggi, tetapi memiliki nilai persentase yang besar pada jumlah responden
yang merasa tidak puas.
Kata kunci: Harapan pasien, penilaian pasien, kepuasan pasien, pelayanan kesehatan gigi
Correspondence: Taufan Bramantoro, c/o: Departemen Ilmu Kesehatan Gigi Masyarakat, Fakultas Kedokteran Gigi Universitas
Airlangga. Jln. Mayjend. Prof. Dr. Moestopo No. 47 Surabaya 60132, Indonesia. E-mail: [email protected]
introduction
Waru Sidoarjo Community Dental Health Service (Waru
Sidoarjo CDHS) is a governmental organization that works
to provide community health services. Thus, it is always
required to constantly improve the quality of its health care
services. One of the services organized by the Waru Sidoarjo
CDHS is dental and oral health care. As a service provider
organization, it has to pay attention to interaction between
structure, process, and outcome; since these three components
will affect the health service quality assessment.1
The structure of the Public Health Center also involves
physical facilities, supplies and equipment, organization
and management, finance, human resources, and resource
sharing. The existence of the structure is actually supported
by a process, namely as a professional activity carried out by
medical and nonmedical resources including the assessment
of patients, diagnose, treatment plans, treatment indications,
and so on. The final results of the patients’ activity in terms
of changes in health status and satisfactory actually involve
both positive and negative outcomes, which could impact the
short and long term development of health care service.1,2
Patient as an individual has different individual
expectation and assessment of the health services perceived.
The patient will be satisfied when his expectation of the
health services is provided. It means that the satisfactory
of the patients at Waru Sidoarjo CDHS can have an
implication towards the improvement of dental health care
services.3,4
During the initial interview conducted at Waru Sidoarjo
CDHS, it is known that one hundred percent of the initial
respondents were not satisfied with dental care services
perceived. All of the respondents even stated that the BPG
still had not provided their expectations of service quality
factors. This condition was actually related to the gap
between their expectations of dental care service quality
considered to be important for them and their assessment
of the dental care services perceived. Therefore, further
researches are needed regarding the level of the importance
and achievement of related factors that affect the quality
of health services. The purpose of this study, thus, was to
determine the level of the importance and achievement of
the aspects of service quality provided by Waru Sidoarjo
CDHS.
materials and methods
This study is considered as a descriptive observational
study. The instrument used in this study was an instrument
of service quality measurement, questionnaire, consisting
of five aspects of the observations, namely: a) reliability,
the ability to deliver promised services immediately,
accurately, and satisfying, b) assurance or insurance includes
knowledge, compensation, decency and trustworthiness,
free from danger, and risk or doubt, c) tangibles or
physical evidence includes physical facilities, equipment,
as well as personnel and means of communication, d)
empathy includes relationships, good communication, as
well as attention and understanding of customer needs, e)
responsibility or responsiveness, the desire of staffs to assist
customers and provide a responsive service.
The respondents in the study were 200 patients who
visited Waru Sidoarjo CDHS in July 2011. The respondents
then answered 22 questions by circling items based on
Likert scale score of 1 to 5 concerned with the service
quality problems that have been adapted to the condition
of the dental health services. The questionnaire consisted
of column values of expectations and judgments. The
data of the respondents’ response were then recapitulated.
Afterwards, the comparison of the expectation of the
respondents and the assessment of the respondents was
conducted. The result was then classified into three groups:
the value of the assessment of the respondents was smaller
than the value of the expectation of the respondents; the
value of the assessment of the respondents was the same
as the value of the expectation of the respondents; and
the value of the assessment of the respondents was higher
than the value of the expectation of the respondents. The
mean value of the expectations and assessments of the
respondents was then calculated for each topic of questions
in order to know the importance of the service quality
provided by Waru Sidoarjo CDHS.
50
results
Based on the recapitulation result of the expectation
and assessment of the patients in Waru Sidoarjo CDHS,
it is known that more than 50% of respondents in each
attribute of health care service quality aspects had the
same expectation value as the assessment one concerned
with dental care services received. The highest mean
value was obtained from the attribute of the appearance
feasibility of the medical staffs, about 4.780. Meanwhile,
the lowest mean value was obtained from the attribute of
the dental care service suitability, about 4.595. Based on the
observation results on the value of the dental care services,
the highest mean value was obtained from the attribute of
the non-discriminatory services, about 4.600. Meanwhile,
the lowest mean value was obtained from the attribute of
the service readiness, about 4.200.
The attribute of the service readiness on responsiveness
aspects had the highest mean value of the expectation,
about 4.775. It means that the aspect of the service quality
had high level of importance. It was contradicted with the
percentage of the dissatisfaction value. Compared to the
other aspects of the service quality, the aspect of the service
readiness had the largest percentage of the dissatisfaction
value, about 39.5%.
The largest percentage value on the service satisfactory
was obtained from the attribute of the non-discriminatory
service, about 78.5%. This was consistent with the highest
mean value of the service reception obtained from the
attribute of the non-discriminatory service. It was also
followed by other five attributes on the aspect of assurance,
which were the attribute of the hospitality services by
medical staffs, the attribute of the medical staffs’ skills, the
attribute of the reasonable and affordable rates, the attribute
of the medical staffs’ thoroughness, and the attribute of the
medical staffs’ knowledge, so the aspect of assurance had
the highest percentage of the satisfactory of the patients,
above 70%, than the aspect of dental service quality.
Based on the results, it can be indicated that there were
some attributes that were considered to be important for
the patients or had high expectation value, but still not
being fully met by the dental care services provided by the
service providers or the Public Health Center. The attributes
of waiting room comfort, service readiness, and service
preparation actually obtained high interest value from the
respondents, but there still was a large percentage of the
number of the respondents who were not satisfied.
discussion
The characteristics of services involved can be related
with an activity with intangible elements. In the service
process, there are aspects of interaction between service
users and service providers although sometimes parties
involved are not always aware of the interaction, and do
not result in the transfer of owner.1,4,5
Dent. J. (Maj. Ked. Gigi), Vol. 45. No. 1 March 2012: 48–51
Quality improvement efforts that have impacts on
improving the utilization of services require both of the
focus on how to provide needs, demands, and expectations
of service users, as well as the integration of all activities of
the organization in order to meet the needs, demands, and
expectations in providing services. Both of them can actually
be related with the orientation of the long-term achievement
of organizational goals. The process of fulfilling the needs
of service users is actually more complicated than the
process of purchasing goods. The first stage in the process
of fulfilling the needs of service users is concerned with how
the customers identify the various alternatives, consider the
risks and the advantages, and then make a purchase decision.
The next stage is the interaction between service users and
service providers. An the last stage is about the assessment
of the service users on the services perceived.5,6
Based on the observation results of the value of
importance and achievement of the service quality of Waru
Sidoarjo CDHS, it is known that there were some attributes
including the comfort of waiting room, the readiness of
service, and the preparation of service obtaining high
importance value from the respondents, but they still
obtained a large percentage of the number of respondents
who felt unsatisfied. Those patients of CDHS felt that the
dental care service perceived still had not optimally met
their expectation considered to be important for them.
The service quality perceived by service users (perceived
service quality) is actually the difference of the expectations
or wishes of the service users (expected service) and the
reality of the service they received (perceived service).
Based on this difference between the expectations and the
reality, the satisfactory of the service users then can be
obtained. This condition will finally trigger the loyalty of
the service users to the service providers. The level of the
ability of the service providers in fulfilling the expectations
and needs of the service users is considered as the basis of
the service quality.7,8
Waru Sidoarjo CDHS actually requires efforts to
increase the satisfactory of patients with quality of
dental care provided. These efforts, therefore, require a
fundamental understanding of the expectations of patients.
The expectations of patients are greatly influenced by
experiences and taste. The expectations of service users
are believed to have a major role in determining the quality
of service and customer satisfaction. Basically there is a
close relationship between the determination of quality and
customer satisfaction. In evaluating process, it is known
that customers will usually use their expectations as a
standard or reference. The components of the expectations
of patients can become the basic ingredient in the process of
mutual interaction between the needs and the providing of
the needs of patients. Knowing the needs of service users,
therefore, can help service providers understand how and
why customers react to product delivery. The expectations
of patients, however, will continue to evolve to keep pace
of time progress. The development of the expectations
of patients improves as much information perceived by
Bramantoro and Palupi: Analysis of importance level and quality achievement
patients, and patients become more experienced, and
will affect the level of the perceived satisfactory of the
patients.9,10
Based on the results of the study, it can be concluded
that there are attributes that are considered important or
have a high expectation value by the respondents, but they
are not fully provided by health services conducted by
service provider or health center. Those high interest value
attributes include waiting room comfort, service readiness,
and service preparation. However, in this study it is known
that there are still a large percentage of respondents who
were not satisfied with the services.
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