73

STUDENTS SATISFACTION LEVELS TOWARDS SERVICES PROVIDED BY

HEALTH CENTER UNIVERSITI MALAYSIA TERENGGANU (UMT)

Wan Muhamad Amir W Ahmad1, Nor Azlida Aleng

2, Nurfadhlina Abdul Halim

3, Mohd Pouzi Hamzah

4,

Norizan Mohamed5 and Zalila Ali

6

1,2,3,4,5 School of Informatics and Applied Mathematics

Universiti Malaysia Terengganu (UMT) 21030 Terengganu, Malaysia 6School of Mathematics Sciences, Universiti Sains Malaysia (USM)

11800 Minden, Pulau Pinang, Malaysia

Abstract

The purpose of this study is to investigate customer’s satisfaction towards Students Health Center services. To achieve the objective, we have designed questionnaires and distributed to 318 respondents. We employed five different methods which are structural equation modelling, Mann-Whitney U Test, Kruskal-Wallis H, Friedman test and Ordinal Regression. The statistical analyses reveal that service counter, treatment rooms, pharmacy counter and waiting hall have a relationship with a total score of satisfaction

level of students. Results of Mann Whitney U test 0000384 .p,.Z prove that

the score between male and female is highly significantly different. The mean rank

score for male students 87184.M is higher compared to female 41142.M

students. This indicated that males were more satisfied with the university health center services. According to correlation analysis the result obtained was between independent variable gender and dependent variable satisfaction level have negative correlation

0002270 .p,.r . This research also investigates the satisfaction level towards

health center services which is based on ethnic factors namely Malay, Chinese and Indian. Results from Kruskal-Wallis H shows that the three independent groups are not

significantly different 050290323162 .p,.df,N . Malay student’s

mean rank is 170.32 while Chinese and Indian students mean ranks are only 148.43 and 155.51 respectively. We conducted the statistical Friedman Test to determine the differing level of satisfaction among students towards four dependent variables namely service counter, treatment room, waiting hall and pharmacy counter. Results of Friedman test showed that the data of four dependent are significantly different

23162 df,N 0006558 .p,. . Service counter mean rank is 3.28 while

treatment room, waiting hall and pharmacy counter mean ranks are only 3. 27, 1.24 and 2.21 respectively. As a conclusion, to maintain a good performance of the UMT Health Center has to improve the efficiency of existing services as a guarantee for customers continue to use this service to make the best health center Keyword : Mann-Whitney U Test, Kruskal-Wallis H, Friedman test and Ordinal Regression.

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1. Introduction to Health Center and Services

Based on the World Health Organization (WHO), health is a point or situation at which an individual is perfect in terms of well-being physical, mental and social, and not merely free of disease or infirmity (official records of the world health organization, 1948). According to the dictionary, health is in relation to healthiness, freshness, good body condition and others. In this paper, we will discuss all the general information about health services and the center of Health of Universiti Malaysia Terengganu (UMT). A health center is a health care organization providing patient treatment by expert staff and equipment. The health center is usually funded by the public sector, by health organizations, health insurance companies, or charities, including direct charitable donations (Parakoyi, 2001). According to Schneider and Garrett (2009), today the health center is largely staffed by professional physicians, surgeons, and nurses, whereas in the past, this work was usually performed by the founding religious orders or by volunteers. In accord with the original meaning of the word, health center was originally placed on hospitality. Some patients go to a health center just for diagnosis, treatment or therapy and then leave (outpatients) without staying overnight; while others are admitted and stay overnight or for several days or weeks or month (inpatient). Health center usually are distinguished from other types of medical facilities by their ability to admit and care for inpatient while others are often described as clinics. The best-known type of health center is the general health center, which is set up to deal with many kinds of diseases and injuries, and normally has an emergency department to deal with immediate and urgent threats to health. The efficiency of health centers often depends on their services towards the customer or patient. So that, health center management must make sure that the services provided are

always perfectly reaches their customer needs. Service revolution is a phenomenon that has significant influences in the management of an organization. Service management, as the concept of management theory and practice, has confidently developed in the manufacturing industry sector at the beginning of the past century and later became the field of service quality began to be addressed (Lagrosen, 2003). In the other word, service sectors are the sectors which strives the economic development of the country nowadays. Sectors based on the service are a key to organizations in various fields such as banking, healthcare, hospitality, and telecommunications (Schneider & Garrett, 2009). Services of management in both manufacturing and service organizations have changed the way organizations accomplish and operate existing resources. In service, the customer often plays a role as co-productions, which provides input directly or indirectly in the form of time, energy, physically and mentally (Parasuraman, 2002). Services are not only seen in the depiction of the service providers, but also based on the performance of the regulars (Hill, 1995). Studies of the excellence of services have been growing briskly by past few decades. Measurement of service efficiency based on the range of service industries has been broadly carried out, such as in the health sector (Ritchie, 2002), tourism industry (Atilgan et al., 2008), banking (Spathos, 2004; Broderick & Vachira Pornpuk, 2002), hotels (Kayaman & Arasli, 2007), education (Hill, 1995), telecommunications (Leisen & Vance, 2001) and many other activities A) Universiti Malaysia Terengganu Health Center and its Service Facilities The Student Health Unit has been established with the founding of the University Putra Malaysia (UPM), a branch in Terengganu on 1996 and known as Terengganu University College in 2000. This Unit operates with two nurses who assisted the Locum Medical Officer.

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The locum Medical officer only worked for three hours every day of the academic semester. Beginning in May 2001, KUT named as KUSTEM of a fully autonomous University College. The Student Health Unit is internally named as the Student Health Center. It is still operating with the same workforce and placed under the administration of the Dean of Student Affairs. In April 2003, a medical officer was appointed permanently as head of the center. 1.1 Patient Satisfaction According to Buttle (1996), the service existing to customers is a key differentiator between organizations with other organizations. Health organizations such as clinics or hospitals are specially created to bump into the needs of the community in assisting and solving many health problems. Hereford, the health surveillance services cannot be equated with another field of services even core businesses for all of these facilities are based on services. In the current health care setting, patient satisfaction is considered as one of the main indicators to ascertain their service efficiency. Assessment of patient satisfaction is a useful parameter to predict the availability of health care services (Illana, 2003). Nowadays, the health care sectors are making continuous efforts to ensure a higher consumer satisfaction. By doing so, one can identify the deficiencies in the delivery of health care services and intervene them to enhance patient satisfaction. However, it is hard to identify a single factor that is directly associated with a low or high level of patient satisfaction. A variety of factors might be involved in the patient’s satisfaction process. Some of these are; patient demographics, health status, characteristics of the health care provided such as technical expertise, interest in patient oriented care and waiting time (Hall and Dornan, 1998). There are numerous ways to measure the excellence of the services of the organization.

According to Gronroos (1983), quality of services is based on the perception and appraisal of the handler. Consumers will evaluate the level of existing services based on the ability of services to meet the requirements of consumers. In the other words, service quality is an abstract and elusive nature. This existence of invisible features, intangibility, heterogeneity and inseparability of production and consumption that make it unique and in terms of medicine, quality is where health services to individual or population likely improve the health and consistent with current knowledge professionals (berry et al., 1985). When we discuss about the excellence of services, customer fulfillment should also be observed. Doherty and Wright in 1998 states that an organization without customer satisfaction may not be cognizant of the true potential of the services performed. It is the best indicator to forecast the future of the organization. Furthermore, the patient’s satisfaction level is found to directly associate with the patient expectations (Hall and Dornan, 1998). In this way, one can define patient satisfaction as the sum of the patient expectation and perceptions towards the treatment or pharmaceutical service provided to them. If the perceived expectations are met, it will result in a satisfied patient. Otherwise, a poor satisfaction level can be seen if there is a higher variation in the expectance against perception rate (Ikegami and Kawakita, 1987). In the study of customer satisfaction, if the patient or customer consummation levels are high, then this will give a positive portrait of the health organization in being able to comprehend and provide what is needed by the customer. Measurement of customer satisfaction is a technique to determine the effectiveness of the organization in offering services. The results of the experiment (Haliza et al., 2003) conducted in three private clinics in Seremban, found that as a whole shows that

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only 19.4% in total of 206 respondents were satisfied with the services provided by the private clinics. This shows that more than 80% of the consumers are not gratified with the service provided. Moreover, Desatnick (1987) states that service is the new standard by which customers are measuring an organization’s performance. Satisfaction is the difference between how customers expect to be treated and how they perceive being treated Davidow and Uttal (1990). Finally, according to Sanders (1995), if you are in business to serve customers, act on that belief, and customers will respond. The key of Sanders’ advice is that if we treat our customers with the respect and care they deserve and respond accordingly, we will always provide services that optimize our efforts and exceeds their expectations. Some basic principles and techniques for customer service in health care have been described. While they may seem either obvious or superfluous to some, their absence can, in essence, put us out of business in today’s competitive, cost-conscious, and customer-oriented environment. Customer satisfaction denotes to a service that provides the requirements, customer demand or desire (Lebow, 1983). To get information on how to develop or improve services of the existing health services, the view of customers is necessary. Many studies have been done in Malaysia showed high level of customer gratification which is about 70% to 80% as the study in an outpatient clinical Dungun Hospital (1994), Maternal and Child Health Clinic (KKIA) Muar, Johor (1995). Continuing the previous studies (Lebow, 1983) showed that although the overall satisfaction is very high, but there is dissatisfaction with certain aspects of the health care. Study by those of Wright et al., (2006) at the clinics of primary health care in the Lembah Klang showed the following aspects of care has the lowest level of satisfaction, that is a description of health and follow-up treatment and waiting

time. Study more about the quality of the results, especially in terms of changes in health status and changes in attitudes, knowledge and practices related to the health of the patient needs to be done. So the organizations offering services need to focus on the interest in the services offered to ensure that all parties gain and achieve aims that have been set. 2. Materials and Methods

2.1 Study Area This research was conducted on the campus of Universiti Malaysia Terengganu, which is situated on the shores of the South China Sea. 2.1 Sample Size Determination The target populations were students of University Malaysia Terengganu. Data from 331 respondents (students) were collected. The calculation of sample size was performed by using single proportion formula,

)1(

2

ppz

n

. In this case, the

anticipated population proportion 21.0p ,

level of significances )05.0%(5 and

absolute precision %5 .

So the calculation is as follows sample size,

)p(pz

1

2

=

)21.01(21.005.0

96.12

= 255 Students The requirement sample size at the analysis stage is )25.0255(255 = 318 students.

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Figure1. Conceptual framework of method in analyzing satisfaction level with UMT Health Centre

Section I : Structural Equation Modelling of Students Satisfaction level with UMT Health Centre services

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Figure 2. Conceptual framework of Students Satisfaction level with Universiti Malaysia Terengganu Health

Centre services

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Figure 3. Structural Equation Modelling of Students Satisfaction level with Universiti Malaysia Terengganu

Health Centre services Based on the previous research, some literature background and the corresponding theoretical perception, we come out one theoretical model as shown in Figure 2. There are five variables have been identified and used as shown in the Figure 2. The structural equation modeling was used to estimate multiple and dependence relationships and used to represent the unobserved concept in this relationship (Hall and Dornan, 1998). Amos version 8 was used to measure the model fit. In this case the model construction based on the suggestion proposed by Amos. Figure 3 shows the structural equation for five latent variables namely; student

information, counter service, treatment room, pharmacy counter and waiting hall are used to observe the relationships. The first latent variable consists of eight indicators which are gender, race, age, education, faculty, field, year and status. From the model we can see that, there are four major factors that contributing to the score of satisfaction level toward health center services. Under the factor of “counter service” there are nine items from ten items that contributed much to this dimension. The Table 1 below summarizes the items from A1 to A10.

Table 1. Service of Counter

Question A1 Hospitality, courteous and prudent

Question A2 Time taken to be treated

Question A3 Management of health records

Question A4 The ability of staff to communicate with patients

Question A5 Staffs all well-dressed and attractive

Question A6 Cleanliness of counter

Question A7 Patient's foyer

Question A8 Staffs are always on duty at the service counter

Question A9 Collaboration of service staff

Question A10 Overall service counter role

Table 2. Service of Counter

No Service Aspects Satisfaction Levels

1 2 3 4 5 6 7 8 9 10

1

Hospitality, courteous and prudent

0.9%

2.2%

4.4%

11.9

%

12.9

%

11.3

%

19.2

%

21.1

%

9.1%

6.9%

2 Time taken to be treated

0.6%

1.9%

3.1%

11.9%

15.7%

11.9%

18.9%

23.3%

8.8% 3.8%

3 Management of health records

0.6%

2.2%

4.4%

9.1% 12.3%

11.6%

17.3%

26.4%

11.3%

4.7%

4 The ability of staff to communicate with patients

0.3%

2.2%

3.5%

10.4%

10.4%

10.7%

18.6%

23.6%

15.1%

5.3%

80

5 Staffs all well-dressed and attractive

0.3%

1.9%

3.8%

8.8% 9.4% 9.7% 16.7%

23.9%

17% 8.5%

6 Cleanliness of counter

0.6%

0.9%

2.5%

7.9% 9.1% 8.5% 20.1%

23.9%

16.7%

9.7%

7 Patient's foyer

0.9%

1.9%

1.9%

8.2% 8.5% 9.8% 15.8%

27.1%

17.7%

8.2%

8 Staffs are always on duty at the service counter

0.3%

2.2%

3.8%

7.5% 8.8% 12.6%

16.7%

23% 16.7%

8.5%

9 Collaboration of service staff

0.3%

1.9%

3.8%

6.3% 8.2% 11.0%

20.8%

21.7%

16% 10.1%

10 Overall service counter role

0.3%

1.6%

2.2%

8.2% 8.2% 8.2% 17.3%

25.8%

19.5%

8.8%

Table 2 shows the frequency value of student’s satisfaction level with service counter of the UMT Health Centre. The highlighted data portraits obtained frequency value of each item in the research. According to the results, students highly satisfied with patient’s foyer (27.1%), management of health record (26.4%) and cleanliness of service counter (23.9%). These three items indicate that the UMT Health Centre is very clean, the patient’s foyer is very comfortable and management of the patient’s health records areoveryoefficient. Figure 3 shows the structural equation modelling of

students' satisfaction level towards UMT Health Centre services. Under counter service factor, there are six items that contribute most of the service counter. Question A1,

001.0,85.0 p Question A2

0010860 .p,. , Question A3

001.0,87.0 p Question A4

001.0,89.0 p , Question A5

001.0,86.0 p and the last is the

Question A6 001.0,86.0 p .

Table 2. Waiting Room

Question D1 Environments of waiting hall are attractive

Question D2 Cleanliness of health center

Question D3 Comfortable of waiting hall

Question D4 Adequate seating facilities

Question D5 Health centers adhere to existing regulations

Question D6 The overall conditions of waiting hall satisfied

Under the factor of “Waiting Room”, there are five questions given to the respondents. From Figure 3 we can see clearly there are five of the six items have a strong relation to the factor of “Waiting Room”. Environments of waiting hall

are attractive 0010940 .p,. and

Cleanliness of health center

0010960 .p,. were the highest

component that contributed to the score of satisfaction through the item of “Waiting Room”. For the “Treatment Room” there ten items tested. Out of ten, only four item were

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contributed more to the service counter. Time

taken to be treated 0010900 .p,. ,

Management of health records

0010920 .p,. , The ability of staff to

communicate with patients

0010920 .p,. and the item of all

staffs are well-dressed and attractive

0010890 .p,. .

Table 3. Ttreatment Room.

Question B1 Hospitality, courteous and prudent

Question B2 Time taken to be treated

Question B3 Management of health records

Question B4 The ability of staff to communicate with patients

Question B5 All staffs are well-dressed and attractive

Question B6 Cleanliness of counter

Question B7 Patient's foyer

Question B8 Staffs are always on duty at the service counter

Question B9 Collaboration of service staff

Question B10 Overall service counter role

Table 4. Pharmacy Counter.

Question C1 Hospitality, courteous and prudent

Question C2 Staffs all neat and attractive

Question C3 Pharmacists services

Question C4 Time taken to get the medicines

Question C5 Description about the medicines are clear

Question C6 Pharmacies’ environment

Question C7 Effectiveness of medicines

Question C8 Overall Pharmacy counter services

According to the service of “Pharmacy Counter”, only for items that have a strong relationship with the

score of the pharmacy counter. Pharmacists' services 0010930 .p,. , time taken to get the

medicines 0010930 .p,. , description about the medicines are clear 0010920 .p,.

and pharmacy environment 0010900 .p,.

Section II : satisfaction level between male and female students. Mann-Whitney U

Table 5. Mean rank

Gender N Mean Rank Sum of Ranks

Satisfaction level with UMT Health Centre services

Male 128 184.87 23663.00

Female 190 142.41 27058.00

Total 318

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Table 6. Test Statistics

Satisfaction level with UMT Health Centre services

Mann-Whitney U 8913.000

Wilcoxon W 27058.000

Z -4.038

Asymp. Sig. (2-tailed) 0.000

The Mann-Whitney U test used to analyze the differences of satisfaction level with UMT health center services between two male and female students. The values of mean rank determine the level of male and female student’s gratification towards UMT health center services. The mean ranking of male customers is higher than the female customers indicated that they were more satisfied with the university health center services. Male students mean rank is 184.87 while female students mean rank is only 142.41. Results of Mann Whitney U test showed that the data of two independent

groups are significantly different at p <0.05.

Therefore, 0H is rejected and 1H is accepted,

which stated that the satisfaction level between male students and female students has significant differences. The journal published by Steven on 2006, titled “Patient Satisfaction of Female and Male Users of Veterans Health Administration Services” results also show that's significant differences between female and male reporting of satisfaction were found in the unadjusted analyses with males showing greater levels of satisfaction than females (p <0.05).

Figure 4: Satisfaction level with Universiti Malaysia Terengganu Health Centre services According

to Gender The box plot graph illustrates the level contentment of male and female students of Universiti Malaysia Terengganu with its health center. Median value (which represents the line in the box plot) of male students is higher and shows that they satisfied more than female students with the UMT health center.

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Section II : Satisfaction level between counter service, treatment room service, waiting hall and pharmacy counter. Friedman test

Table 7. Mean Rank

Mean Rank

Service of counter 3.28

Service in treatment room 3.27

Comfort of waiting hall 1.24

Service at pharmacy counter 2.21

Table 8. Test Statistics

N 318

Chi-Square 558.566

df 3

Asymp. Sig. 0.000

a. Friedman Test

The Friedman test used to analyze the differences of satisfaction level of students with UMT health center services between four dependent variables namely service counter, treatment room, waiting hall and pharmacy counter. Table 7 listed the values of mean rank of gratification towards service counter, treatment room, waiting hall and pharmacy counter of the UMT Health Centre. The mean ranking of the service counter is higher than the other three aspects, indicated that students were more satisfied with the service counter of the University Health Centre. Service counter mean rank is 3.28 while treatment room, waiting hall and pharmacy counter mean ranks are only 3.27, 1.24 and 2.21 respectively. Results

of Friedman test showed that the data of four dependent are significantly different since Chi-Square is more than the critical value (558.566 > 7.82) at p <0.05. Since the p< 0.05, we accept

1H , which state that there is a high sibetween

thedifference betweentin UMT Health Centre of UMT Health Centre. Due to the results of the Friedman test, we only can conclude that there is a significant difference between the four aspects of the UMT Health Centre, and it does not show which spouse of aspects causes the result of the condition. So that, the multiple comparison among the four aspects done by using the Wilcoxon T test.

Table 9: Paired comparison analysis

Paired Asymp. Sig. (2-tailed)

Treatment Room - Service counter 0.552 Pharmacy Counter - Service counter 0.000 Waiting Hall - Service counter 0.000

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Pharmacy Counter - Treatment room 0.000 Waiting Hall - Treatment room 0.000 Waiting Hall - Pharmacy counter 0.000

Based on the results of the above analysis, the significant difference between five pairs contributed to the Friedman results which are pharmacy counter and service counter (p <0.05), waiting hall and service counter (p <0.05), pharmacy counter and treatment room (p <0.05), waiting hall and treatment room (p <0.05). And waiting hall and pharmacy counter (p <0.05) except treatment room with service counter (p <0.552). Section III : Respondents’ level of satisfaction towards race

Table 10: Mean rank

Race N Mean Rank

Satisfaction level towards UMT Health Center Services

Malay 114 170.32

Chinese 105 148.43

Indians 97 155.51

Total 316

Table 11: Test Statistics

Satisfaction level with UMT Health Centre services

Chi-Square 3.290

df 2

Asymp. Sig. 0.193

The Kruskal-Wallis H test used to analysis the differences of satisfaction level with UMT health center services between three independent variables namely Malay’s, Chinese and Indian’s students. The values of mean rank determine the level of Malay, Chinese and Indian student’s gratification towards UMT health center services is given in the Table 10. The mean ranking of Malay customers is higher than the other two race’s customers, indicated that they were more satisfied with the university health center

services. Malay student’s mean rank is 170.32 while Chinese and Indian students mean ranks are only 148.43 and 155.51 respectively. Results of Kruskal-Wallis H test showed that the data of three independent groups are not significantly different since Chi-Square is less than the critical value (3.290 < 5.99) at p < 0.05. Results that obtained by (Azimatun, Salmiah & Ahamad, 2007; Doherty and Wright, 1998) also proved that there is a no significant difference between ethnic origin toward satisfaction level.

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Section IV : Ordinal regression toward total score of satisfaction level.

Table 4.9: Parameter Estimates

Estimate Std. Error Wald df Sig.

Service Counter .147 .014 110.822 1 0.000

Treatment Rooms .137 .014 98.617 1 0.000

Pharmacy Counter .166 .018 86.032 1 0.000

Waiting Hall .168 .020 68.655 1 0.000

In the parameter estimates table we see the coefficients, their standard errors, the Wald test and associated p-values. Service counter, treatment rooms, pharmacy counter and waiting hall are statistically significant. So for the counter service, we would say that for a one unit increase in counter, we expect a 0.15 increase in the ordered log odds of being at a higher level of satisfaction, given all of the other variables in the model are held constant. For treatment room, we would say that for a one unit increase in treatment room, we would expect a 0.14 increase in the log odds of being at a higher level of satisfaction, given that all of the other variables in the model are held constant. For the pharmacy counter, we would say that for a one unit increase in pharmacy counter, we would expect a 0.17 increase in the log odds of being at a higher level of satisfaction, given that all of the other variables in the model are held constant. Besides that, for the waiting hall, we would say that for a one unit increase in the waiting hall, we would expect a 0.17 increase in the log odds of being at a higher level of satisfaction, given that all of the other variables in the model are held constant. Conclusion Customer satisfaction has always been a hot topic among service operators because the level of satisfaction can determine the growth of a business. In this study the purpose was to

measure the students' satisfaction level with the UMT Health Centre. The respondents were only from UMT students. There are 318 students were chosen to ascertain the satisfaction level with the UMT Health Centre. We had used structural equation modelling, ordinal regression, correlation analysis, Mann-Whitney U test, Kruskal-Wallis H and Friedman test to evaluate the student’s satisfaction level toward UMT Health Centre. According to structural equation modelling, we can say that service counter, treatment room, pharmacy counter and waiting hall have a relationship with a total score of satisfaction level of students. Based on correlation analysis results, we can conclude that there is a negative correlation between independent variable gender and dependent variable satisfaction level. This shows that, satisfaction level with the UMT Health Centre was not influenced by gender of the students. Results of Mann Whitney u test showed that the data of two independent groups are significantly different. The mean ranking of male customers is higher than the female customers indicated that males were more satisfied with the university health center services. Male students mean rank is 184.87 while female students mean rank is only 142.41. The Kruskal-Wallis H test used to analysis the differences of satisfaction level with UMT health center services between three independent variables namely Malay’s, Chinese and Indian’s students. The mean ranking of Malay customers is higher

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than the other two race’s customers, indicated that they were more satisfied with the university health center services. Malay student’s mean rank is 170.32 while Chinese and Indian students mean ranks are only 148.43 and 155.51 respectively. Results of Kruskal-Wallis H test showed that the data of three independent groups are not significantly different. Moreover the Friedman test indicated that, students were more satisfied with the service counter of the University Health Centre. Service counter mean rank is 3.28 while treatment room, waiting hall and pharmacy counter mean ranks are only 3. 27, 1.24 and 2.21 respectively. References

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