運用PZB模式評估偏鄉公立地區醫院復健醫療服務品質

Applying the PZB Model in Evaluating the Service Quality of Rehabilitation in a Rural Local Hospital

10.6315/TJPMR.202106_49(1).0007

陳冠伯(Guan-Bo Chen)；劉亦修(I-Hisu Liou)；盧惠雯(Hui-Wen Lu)；李建輝(Chien-Hui Li)；陳思宇(Ssu-Yu Chen)；段生輝(Sheng-Hui Tuan)

PZB模式（PZB model） ； SERVQUAL量表（SERVQUAL questionnaire） ； 復健（rehabilitation） ； 醫療服務品質（medical service quality） ； 病患滿意度（patient satisfaction） ； PZB model ； SERVQUAL questionnaire ； rehabilitation ； medical service quality ； patient satisfaction

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

73 - 89

繁體中文

目的：在復健領域的文獻，鮮少有醫療品質之研究，更遑論是醫療資源相對缺乏之偏鄉地區，是故本研究以PZB服務品質缺口模式為基礎，來探討偏鄉地區公立醫院復健服務品質，希望了解復健治療師與接受復健治療的病人或其家屬，兩者間是否對於復健服務品質上有認知的差距。方法：本研究於民國2020年7月至9月在台灣南部某偏鄉公立地區醫院門診進行，問卷發放對象分為兩群。群組一為病人及其家屬，針對於接受常規復健超過1個月之病人隨機發送問卷；群組二為復健治療人員，針對於本科提供復健服務超過1個月的所有治療師，包含物理治療師生、職能治療師、語言治療師以及實習物理治療師全部發放問卷。該問卷共30題，改編自22題的SERVQUAL量表，內容包括五個構面，分別為（1）有形性（2）可靠性（3）反應性（4）確實性（5）關懷性。我們使用配對T檢定來分別檢驗群組一及群組二組內針對復健品質期望值與滿意度之差異，使用獨立T檢定來檢驗群組一及群組二針對復健品質期望值、滿意度是否存在組間差異。結果：發現病人及其家屬組有效問卷共99份，復健治療人員組有效問卷為27份，回收率為97.2%，量表內容效度指標為0.94，量表五大構面的Cronbach's α係數為0.854-0.929，具高信度。組內分析發現，病人及其家屬組在有形面問題七題中有六題之期望值與滿意度有顯著差異，其餘構面則皆無顯著差異；復健治療人員組在有形面及確實性兩大構面有部分問題之期望值與滿意度有顯著差異，其餘構面則皆無顯著差異。組間比較發現在五大構面中無論期望值或滿意度皆有部分題目病人及其家屬與復健治療人員認知呈現顯著差異，且復健治療人員組的分數皆較低。結論：本研究結果顯示偏鄉公立地區醫院之病人及其家屬對於復健醫療品質中期望與實際滿意度之品質缺口皆出現在有形性之構面，在復健專業度、熱忱、信賴程度等方面則無差異，代表本院復健醫療服務之軟體方面現階段符合民眾之預期，未來有待改善本院復健之硬體設備及環境以提升復健服務之品質。

Background: Previous studies on rehabilitation have rarely focused on the medical service quality. Not to mention studies about the medical service quality of rehabilitation in the rural public hospital. The expectations and needs of the patients and their caregivers should be emphasized. We applied the concept of Parsuraman,-Zeithaml,-Berry (PZB) service quality gap model and expected zone of tolerance to determine the difference in the medical service quality between the expectations and satisfaction of patients and their caregivers who received rehabilitation in a rural local public hospital in southern Taiwan. Methods: We used a 30-item structured questionnaire, modified from the 22- item SERVQUAL instrument, with high validity and reliability that compromised five dimensions: (1) tangibles, (2) reliability, (3) responsiveness, (4) assurance, and (5) empathy. The questionnaire was given randomly to two groups from July to September in 2020 at the rehabilitation department of Ci-Shan hospital. Group one was the patients or their caregivers who received regular rehabilitation at the target hospital for at least 1 month. Group 2 was therapists who provided regular medical service in the rehabilitation department for at least 1 month. The paired t- test was used to analyze the gap in service quality between the expectation and satisfaction scores of the two groups. The independent t-test was used to compare the expectation and satisfaction scores between the two groups. Results: A total of 99 patients (or their caregivers) and 27 therapists were enrolled in this study. The effective response rate was 97.2 %. The content validity index was 0.94, and the Cronbach's alpha for internal reliability was 0.854-0.929. Intragoup analysis found only significant differences between the expectation and the satisfaction scores in the tangible aspect in the group 1 and in the tangible and the assurance in the group 2. Intergroup analysis observed several significant differences in both the expectation and the satisfaction scores between the group 1 and the group 2. Meanwhile, all the scores of these significant items were lower in the group 2. The service quality gap in the scores of the patients' parents was influenced by traits, such as age and education level. The patients' parents focused more on the cleanliness of the therapeutic environment, rehabilitation in sessions being completed on schedule, therapists possessing sufficient expertise, and accommodations of the individualized needs of patients. In addition, the study showed aspects requiring urgent improvements in our hospital, including procuring additional therapy equipment, maintaining clean environment, and scheduling individualized rehabilitation times. Conclusion: Our study observed that the medical service quality gap in the scores of the patients and their caregivers presented in only the tangible aspect, which meant that the rehabilitation we currently provided could meet their expectations except for the hardware. To enhance the medical service quality, we need to improve the environment and equipment of in the rehabilitation department in the near future. Applying the PZB model may offer a method for evaluating health care service quality in rehabilitation field.

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