Hospital Quality Scale of the International Hospital Quality Assessment Organization (Jcaho)

or increase the patient's SHL. This finding has important implications for policy makers (Mosadeghrad, 2011).

2.1.6. Price and perceived price:

Price is the actual amount that a buyer has to pay to obtain a product or service that they want and is measured in terms of money.

According to Zeithaml (1988): Perceived price is the comparison between what customers receive (benefits) and what they give up (sacrifice) to get the product or service. The sacrifice here is not only the monetary price but also includes non-monetary opportunity costs called behavioral prices, which are the time and effort spent to get the service.

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According to Corin & Taylor (1992): Customers do not necessarily buy a service with the best quality, they only buy the service that provides them with a higher level of satisfaction. Therefore, factors such as customer price perception do not affect service quality but it will have an impact on customer satisfaction.

According to Anderson & ctg (1994): Perception of price plays an important role in customer satisfaction because when evaluating the value of a service, customers often think about price.

According to Oliver (1997): Customers often evaluate price and quality by a concept of reasonableness, thereby forming a level of satisfaction or dissatisfaction. Even when customers highly appreciate the ability and reliability, customers can still be dissatisfied if they perceive the price as high.

2.2. Some theoretical models and scales:

2.2.1. Hospital quality scale of the Joint Commission on Accreditation of Hospitals (JCAHO)

JCAHO (Joint Commission on Accreditation of Healthcare Organizations) was established in 1951, is an organization with affiliated agencies in countries other than the United States and has the function of conducting certification of medical facilities. The organization's members include international experts in general fields (medicine

health, care, administrative management, public management) from Western Europe, the Middle East, Latin America, the Asia-Pacific region, North America, Central Europe, Eastern Europe and Africa. The organization has now guided and assessed public and private hospitals and management apparatus in over 40 countries, nearly 100 hospitals in the world have been granted the organization's international standard JCI certification.

The hospital quality standards of the Joint Commission on Accreditation of Hospitals (JCAHO) include the following 9 components:

(1) Efficacy: The effectiveness of the treatment in relation to the patient's condition.

(2) Appropriateness: The appropriateness of a particular procedure, test, or service relative to the patient's needs.

(3) Effectiveness: Represents the level of care required to achieve the desired output.

(4) Respect & Care: Level of service delivery with respect and sensitivity to patient needs and expectations.

(5) Safety: Level of risk and interventions to minimize risk to patients and others.

(6) Continuity: Relates to overtime and the level of patient care provided by the staff.

(7) Efficiency: The relationship between output and resources provided to patients.

(8) Timeliness: Patient care at the time it is needed and useful.

(9) Availability: The level of availability of necessary procedures, tests and services.

The JCAHO scale is complete, comprehensive, and has many standards to measure different aspects of service quality. However, it was developed quite specifically for the licensing and certification process for hospitals, so it is difficult to forcefully apply it to a topic with a customer-based perspective such as this study.

The author's research is ongoing. From the basic theory of the JCAHO model, in 2001, Victor Sower et al. researched and developed it into the KQCAH scale which is currently very popular, applied by many authors at home and abroad.

2.2.2. KQCAH (Key Quality Characteristics Assessment For Hospital) scale by Victor Sower and colleagues

Using data collected from 12 hospital administrators, 100 staff and 23 customers (patients) in the US, the KQCAH scale was designed to capture the multidimensional perspectives of patients and providers. The study points out the need to build a theoretical foundation in the healthcare field to produce scales that are tested and have reliable value while adding to the treasure trove of quality research in the world. The study inherits past achievements to build a detailed service quality model including 75 questions tested by 663 patients. Separate, combine and remove (Effective factor) observed variables in the factors of the JCAHO scale based on focus group discussions and surveys. The KQCAH scale contains key quality characteristics contributed by both service providers (including hospital administrators, nurses, doctors, staff) and patients.

The KQCAH scale has the advantage of being designed to provide a way to measure “the right thing, the right way” to help managers make decisions and policies to improve quality to satisfy customers. The scale includes 8 factors:

(1) Respect and care;

(2) Effective and continuous;

(3) Suitable;

(4) Information;

(5) Effectiveness;

(6) Meals;

(7) First impression;

(8) Employee diversity.

Sower et al. (2001) compared their own JCAHO model and their empirical model with the following results:

Figure 2.1: Theoretical model and empirical model in hospital service quality research

Source: Sower et al. (2001)

This is an interesting reference source for policy makers or those who want to research in the health sector because it provides a comprehensive picture describing the quality of health services. However, to apply in Vietnam or more specifically for this topic, the KQCAH scale still reveals some inappropriate points such as the Meal factor being excluded from most domestic studies because health care facilities often do not have meal services for outpatients; the First Impression factor, Staff Diversity are excluded in quality measurement research.

service of Le Van Huy and Nguyen Dang Quang (2013); Nguyen Thi Minh Hong (2014); the factors of Information, Performance, and Employee Diversity were eliminated in the model of Dao Khanh Uyen (2013) due to insufficient reliability. Some other factors affecting customer satisfaction such as technical quality, facilities, equipment, and tangible means have not been mentioned. Thus, although quite comprehensive and reliable (for some countries with the same research conditions), this should only be considered a useful source of information when considering building a model for a research project. Moreover, there are still some traditional models that meet the need to become a scale for measuring the quality of medical examination and treatment services, and on the other hand, are popular and have been tested for accuracy many times in the country, especially in Ho Chi Minh City. That is the model of service quality components of Parasuraman et al. (1988).

2.2.3. SERVQUAL model of Parasuraman et al.

Parasuraman et al. (1985) defined service quality as the difference between customers' expectations of a service and their perceptions of the service outcome as shown by the five-gap model of service quality. In which, the fifth gap is considered the true measure of service quality and is specified by five components in the SERVQUAL scale, as follows:

(1) Tangibles: Shown through physical means, equipment, appearance, and staff uniforms.

(2) Reliability: Demonstrated through the level of trust in the ability to perform the expected service, on time and appropriately.

(3) Responsiveness: Demonstrated through the willingness to provide prompt service and customer support.

(4) Assurance: Also known as service capacity, expressed in the professional knowledge and service style and attitude of employees to convey trust and credibility.

(5) Empathy: Showing concern.

Figure 2.2: SERVQUAL model

Source: Parasuraman et al. (1988)

According to Parasuraman et al. (1994): SERVQUAL is considered a complete scale of service quality, this scale has value and reliability that it can be applied to different types of services.

According to Laith Alrubaiee (2011): SERVQUAL scale is the best known and most widely accepted

The SERVQUAL scale was originally developed by Parasuraman et al. (1988) and later revised by Parasuraman et al. (1991, 1994), which consists of 22 items measuring five dimensions of service quality, namely tangibles, reliability, responsiveness, assurance, and empathy, as follows:

Tangible components:

(1) XYZ Company has modern equipment.

(2) XYZ Company has very attractive facilities.

(3) XYZ company employees' uniforms are neat and beautiful.

(4) XYZ Company has facilities appropriate to the types of services provided.

(5) XYZ Company has convenient operating hours for all customers.

Reliability components:

(6) When XYZ company promises to do something by a certain time, it does so.

(7) When you have a problem, XYZ company will show sympathy and concern for you.

(8) XYZ Company provides reliable service.

(9) The service was provided by XYZ company at the time the company promised.

(10) XYZ Company always ensures accuracy and clarity.

(11) The customer is informed by XYZ company exactly when the service will be performed.

Response components:

(12) You will receive prompt service from the employees of XYZ company.

(13) XYZ Company has a team of employees who are always ready to help customers.

(14) XYZ Company has a staff that never seems too busy to respond to customer requests in a timely manner.

Guaranteed ingredients:

(15) You have complete confidence in the employees of XYZ company.

(16) When you deal with employees of XYZ company you will feel safe.

(17) The employees working in XYZ company are very polite.

(18) Employees are always fully supported by XYZ company to do their jobs well.

Understanding Components:

(19) XYZ Company always shows you personal attention.

(20) Employees of XYZ company always show you personal attention.

(21) XYZ Company has a staff that is always attentive to your special needs.

(22) XYZ Company has your best interests at heart.

Source: Bui Thanh Trang and Nguyen Dong Phong (2012)

According to Laith Alrubaiee (2011): In the healthcare industry, the SERVQUAL scale is widely applied, is a consistent and reliable model

According to Lim et al. (1999): One of the advantages of SERVQUAL analysis is the ability to determine the relative weight of the five aspects in influencing the patient's overall perceived quality.

Scientists adjusted the original 22 observation variables into a new scale to suit the research conditions (subjects: Public or private health care facilities, inpatients or outpatients; research environment, ...).

According to Hong Qin and Victor R.Prybutok (2009): Despite theoretical and empirical controversies, most studies on service quality in the industry still consider SERVQUAL to be a reliable and effective measure of perceived service quality.

In the US, to measure service quality in the emergency health care industry, two authors Hong Qin and Victor R.Prybutok, based on the research results of Babakus and Mangold, 1992; Lam, 1992; Taylor and Cronin, 1994, affirmed that the SERVQUAL scale and all five components of service quality are completely suitable for application. On the other hand, they also support the arguments about technical quality should be added to the model.

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