Satisfaction with the Spirit, Service Attitude, and Expertise of Medical Staff

Regarding drug quality, the hospital always ensures drug quality in prescriptions, instructions for drug use in treatment and ensures drug quality in the hospital. Drug quality assurance in the hospital is carried out through checking the quality of imported drugs, ensuring storage conditions in the warehouse and performing periodic inventory and comparison on a monthly, quarterly and annual basis.

- Check the quality of medicine before entering: before entering medicine stored in the hospital warehouse, always check the sensory quality, batch number and expiry date of the medicine.

- Ensure storage conditions: drugs are stored in accordance with the conditions stated on the label as recommended by the manufacturer, the hospital's drug storage warehouse is well-ventilated, avoiding the impact of environmental factors, the hospital always carries out import and export activities to ensure the FIFO (First In - First Out) or FEFO (First Expired - First Out) principle, according to the recommendations of the Ministry of Health, the drug storage warehouse at the hospital must comply with the principle of "Good Storage Practice" (GSP).

- Inventory reconciliation: the hospital's inventory department has the function of inventory reconciliation and evaluation of drug quality periodically every month, quarter and year for drugs stored in the warehouse to control deviations and losses. At the same time, this work also aims to evaluate the quality of drugs in terms of sensory to ensure that drugs are preserved according to the manufacturer's recommendations, contributing to improving the effectiveness of treatment at medical examination and treatment facilities.

The hospital selects and builds a hospital drug list based on the list of modern medicines covered by health insurance according to Circular 40/2014/TT-BYT, the results of drug supply bidding, the actual needs of the hospital and hospital regulations. Including the following groups of drugs:

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- Anesthetics

- Non-steroidal anti-inflammatory pain reliever and fever reducer

- Anti-allergy drugs, used in cases of hypersensitivity

- Antidote, used in cases of poisoning

- Anticonvulsants, antiepileptics

- Antiparasitic and antibacterial drugs (antibiotics)

- Cardiovascular drugs

- Digestive drugs

- Hormone and endocrine drugs

- Urinary drugs

- Respiratory drugs

- Eye, ear-nose-throat drugs

- Antipsychotic drugs

- Minerals and vitamins

- Blood and blood products

- Electrolyte balancing and adjustment solution

- Serum, immune globulin

- Oriental medicine

- Cancer treatment drugs

- Other special drug groups

The hospital, based on the functions and tasks of the pharmacy department and the characteristics of the hospital's professional activities, develops a process for dispensing medicine in the hospital from the pharmacy department to the hands of health insurance patients as follows:

- The Pharmacy Department approves the medicine before dispensing.

- Dispensing drugs to clinical departments:

 The head of the pharmacy department or the pharmacist authorized to approve the medication receipt during office hours;

 The pharmacy department ensures the timely and complete dispensing of drugs and chemicals (mixing, sterilization) according to the drug and chemical receipt form of the clinical and paraclinical departments;

 The clinical department receives medicine from the pharmacy department according to the regulations of the hospital director.

- Dispense prescription drugs to outpatients with health insurance cards

- Refuse to dispense medication if errors are found in the prescription or medication receipt, notify the prescribing physician and the approving physician; coordinate with the clinician in adjusting the prescription or replacing the medication.

- Check and compare when dispensing medicine:

 Form of medicine receipt or prescription;

 Check the drug name, concentration (content), dosage form, dosage, route of administration, and interval between doses on the prescription and the drug to be delivered;

 Drug label;

 Drug quality;

 Quantity, number of drugs in the prescription, drug receipt with the number of drugs to be delivered.

- After dispensing, the medicine must be tracked daily on the warehouse card.

- Dispense drugs according to the principle of first in, first out, drugs with shorter expiry dates are issued first. Only drugs within their expiry date and meeting quality standards are dispensed.

- Enter into the import and export tracking book or warehouse card.

CHAPTER 5. DISCUSSION

5.1 Characteristics of research subjects

The study was conducted on 400 subjects aged 16 to over 60 years old. The statistical results showed that the majority of the study participants were female, accounting for 63.5%, higher than male, which was 36.5%. This result is similar to the study of Ngo Thi Thuy Nhi (2015) where female patients accounted for 62.8%, higher than male patients, which was 37.2%, and the study of Le Quang Trung (2013) where the proportion of female patients was higher than male patients, which was 61%. However, this result was higher than the study of Tran Thi Kim Thoa (2015) where female patients accounted for 53.3% and male patients accounted for 46.7%. And the proportion of this study was also completely different from the study of Nguyen Le Kim Huynh (2014) where male patients accounted for 56.2%, higher than female patients, which was 43.8%. The higher proportion of female patients than male patients may have many causes. It may be because men are the main breadwinners of the family, and going to the hospital for medical examination and treatment takes a lot of time, so they often just buy medicine near home to take. It may also be because men always think they are healthy, so they take illness lightly. In addition, women are more susceptible to diseases than men because they have to go through childbirth, premenopause, menopause, etc.

In this study, the age group with the highest percentage is 36 - 60 years old 50.25%, followed by the age group from 16 - 35 years old accounting for 34.25%, the lowest is in the age group over 60 accounting for 15.5%. This result is similar to the result of the study by Ngo Thi Thuy Nhi (2015) with the highest percentage of people in the age group from 35 - 60 years old. This result shows that middle-aged patients have a greater need for medical examination and treatment than younger patients. Patients over 60 years old only account for a relatively small percentage because they may choose to go to private clinics to be examined faster, without having to wait long, leading to fatigue.

The educational level of the subjects was mainly primary and secondary, accounting for 34.1% and 31% respectively. The lowest percentage of patients who had not attended primary school was 4.75%. This result is quite similar to the study by Ngo Thi Thuy Nhi (2015) with the percentage of subjects with primary and secondary education being 36.5% and 37.2%, the lowest illiteracy rate was 3.3%. However, this result is different from the result of Phan Thi Ngoc Phuong (2013) with the highest educational level being high school, accounting for 33.5%. The explanation for this result is that the patients were mainly elderly, so during the war they did not have many opportunities to study, and most of the people in this area worked in the fields and gardens to make a living, so they did not care much about education.

Farmers accounted for the highest proportion among the research subjects 35.25%, followed by housewives at 18.75% and the lowest was retired at 1.5%. This proportion is suitable

with the local economic structure, with the majority of natural land area being agricultural land. This result is similar to the study of Tran Thi Kim Thoa (2015) and Ngo Thi Thuy Nhi (2015).

The majority of the research subjects are married (76%), followed by single (19.75%), the divorce rate is very low (1%). According to the above results, the age group that goes to the doctor is mainly from 36 to 60 years old, most of the subjects in this age group are married, so the highest rate of being married is reasonable. In addition, the research subjects are also students in the age group of 16 to 35 years old, which explains why the single rate is second in the survey rate. This rate is similar to the study of Ha Thi Thuy (2012).

The proportion of patients coming for medical examination and treatment under health insurance is mainly in the group of voluntary health insurance participants, accounting for 73%, the remaining are patients participating in compulsory health insurance, accounting for 27%. This difference is explained by the fact that people use health insurance for medical examination and treatment provided free of charge to the poor or voluntarily to reduce medical examination and treatment costs due to having to treat chronic diseases. In addition, the current Health Insurance Law stipulates that participating in voluntary health insurance in the form of the whole household will reduce costs, which partly increases the proportion of voluntary subjects.

The majority of the research subjects had visited Cao Lanh District Hospital many times, accounting for 86.75%, the rest were the first time, accounting for 13.25%. This result is similar to the study of Ha Thi Thuy (2012) and higher than the study of Phan Thi Ngoc Phuong (2013). This result may be due to the fact that the age of the patients coming for examination is mainly between 36 - 60 years old, most of them have chronic diseases, requiring many re-examinations. On the other hand, Cao Lanh District General Hospital is the main hospital serving the medical examination and treatment for people in the area. The hospital always strives to improve the quality of service, so it receives the trust of patients.

The reasons for patients coming to the hospital for medical examination and treatment are to continue treatment as scheduled (re-examination) and to have health problems, accounting for 52% and 37.5% respectively, while health check-ups only account for a low percentage of 8.25%. This result is similar to the research of Ngo Thi Thuy Nhi (2015) and Phan Thi Ngoc Phuong (2013), but different from the research of Le Quang Trung (2013). This shows that people do not really care about their own health. People's awareness of regular health check-ups to screen for diseases is still low. The district's health sector needs to have educational and propaganda measures to further raise people's awareness of regular general check-ups, helping to prevent and treat diseases well.

5.2 Patient satisfaction

5.2.1 Satisfaction with administrative procedures

Table 4.9 shows that 38.5% of patients felt that the waiting time for medical examination was too long.

is fast (<30 minutes); 39.25% is moderate (30 - 45 minutes), 15% wait long (46 - 75 minutes) and 7.25% wait too long (> 75 minutes). From there, it is concluded that 77.75% of patients feel satisfied with the waiting time for medical examination, the rate of dissatisfaction is 22.25%. This result is higher than the study of Ngo Thi Thuy Nhi (2015), only 44.2% of patients are very satisfied and satisfied, 23.8% of patients have no opinion and up to 32% of patients are very dissatisfied and dissatisfied. Patient dissatisfaction with waiting time for medical examination may be due to patient overload leading to long waits for medical examination. The number of patients is increasing while the hospital's payroll and staff do not increase. Waiting time for hospital fee payment procedures has a high satisfaction rate of 96%.

of which 73% of patients surveyed said it was fast (<30 minutes), 23% said it was moderate (30

– 45 minutes); only 4% of patients were dissatisfied with this issue, of which 3.25% of patients felt it was long (46 - 75 minutes), 0.75% felt it was too long (>75 minutes). This result is higher than the study by Phan Thi Ngoc Phuong (2013) with 58.6% of patients rating the waiting time to pay as fast, 37% as moderate and 37.4% as long. This shows that Cao Lanh District General Hospital has done well in collecting hospital fees, shortening the waiting time of patients, also contributing a small part to patient satisfaction with the quality of service of the hospital.

Regarding the waiting time for receiving medicine, 33.75% of patients felt it was fast (<30 minutes); 40.25% rated it moderate (30-45 minutes); 23% considered it long (46-75 minutes) and 3% considered it too long (>75 minutes). This result is quite similar to the study by Phan Thi Ngoc Phuong (2013) with the waiting time for receiving medicine being fast at 35.8%, moderate at 44.5% and long at 19.8%. Usually, the waiting time for receiving medicine is one of the longest waiting stages, because it has to go through many stages before the medicine reaches the patient such as checking the prescription, preparing the medicine, checking the medicine a first time, checking the medicine a second time. Therefore, it is quite time-consuming, making patients wait a long time, sometimes up to hours if the number of patients becomes overloaded.

The level of people's satisfaction with the waiting time for medical examination, waiting time for hospital payment procedures, waiting time for medicine is a subjective opinion, emotional in nature of patients, this opinion is influenced by many factors such as the number of patients increasing while the number of medical staff does not change, so the waiting time is long, besides, the psychology or health of patients is not good, which increases the feeling of waiting longer. Therefore, the survey on patient waiting time is only relative, based on these opinions alone, it is not possible to evaluate the quality of hospital service.

87% of patients were satisfied with administrative procedures, of which 2% were very satisfied, 85% were satisfied; only 13% of patients were dissatisfied with this issue, of which 6.25% had no opinion, 6.25% were dissatisfied and 0.5% were very dissatisfied.

The reason why patients are not satisfied and very dissatisfied is because they think the procedure is not scientific, causing patients to waste time. This result is higher than the study by Ngo Thi Thuy Nhi (2015).

The seriousness and orderliness of the administrative procedure place satisfied patients at a fairly high rate of 89.5%, of which 1.5% were very satisfied and 88% were satisfied. The rate of dissatisfaction was low at 9.5%, of which 7.25% of patients had no opinion and 2.25% were dissatisfied. A minority of these subjects were dissatisfied because a few employees still used their phones while working, affecting the quality of work and wasting time for both the hospital and patients.

The rate of patients who were generally satisfied with administrative procedures was high at 84.8%, while the rate of those who were dissatisfied was low at 15.15%. This rate is higher than the study by Ngo Thi Thuy Nhi (2015), with a rate of satisfaction of 52.5% and dissatisfaction of 47.5%. This shows that Cao Lanh District General Hospital has done a good job with administrative procedures, simplified administrative procedures, saved time, and made patients feel more comfortable when coming to see a doctor.

5.2.2 Satisfaction with the spirit, service attitude and expertise of medical staff

The level of satisfaction with the attitude of staff when receiving health insurance patients is 85.25% (1% of patients are very satisfied, 84.25% are satisfied), only 14.75% are dissatisfied (6.75% have no opinion, 6.75% are dissatisfied and 1.25% are very dissatisfied). This result is similar to the study of Phan Thi Ngoc Phuong (2013) and higher than the study of Ngo Thi Thuy Nhi (2015). The figure of 85.25% of patients satisfied with the attitude of staff when receiving patients is a remarkable figure showing the progress of the hospital in the process of receiving patients. Although only 14.75% of patients are dissatisfied because the staff often raise their voices and have a bad attitude towards patients when receiving patients, the hospital still needs to pay more attention to improve the work of receiving patients.

Regarding the attitude of staff when patients ask for instructions, the satisfaction and very satisfaction of patients is 87% (85.75% are satisfied), 13% are dissatisfied, thinking that medical staff explain carelessly, a few even bully patients (of which 6.75% of patients have no opinion, 5.25% are dissatisfied and 1% are very dissatisfied). In the study of Phan Thi Ngoc Phuong (2013), the percentage of patients satisfied with this issue is 61.8%, lower than our study. Explaining the attitude that makes patients dissatisfied, may be because the number of patients is overloaded, causing great pressure on medical staff, the hospital needs to come up with a solution to overcome this problem.

86.75% of patients were satisfied with the service attitude of the clinic nurses, this number is higher than the study of Le Quang Trung (2013) when only 58.1% of patients were satisfied. A small percentage of patients (3.75% were dissatisfied and 1.25% were dissatisfied)

(very dissatisfied) think that the nursing service attitude is grumpy. Although it only accounts for a low percentage, it also affects the patient's choice to come to this hospital or another medical facility, so the hospital staff needs to change their attitude for the better when serving patients.

Most patients were satisfied with the doctor's attitude during treatment, with 91.25% satisfied (of which 8.5% were very satisfied and 82.75% were satisfied), 7% had no opinion, and only 1.75% were dissatisfied and very dissatisfied. This is a remarkable figure. This result is higher than the study by Ha Thi Thuy (2012) with patient satisfaction of 83.6%. Doctors with good communication skills with patients will be the key to a better patient-doctor relationship, thereby making the process of exchanging and treating diseases easier. Thereby also contributing significantly to improving the quality of hospital services.

Satisfaction with the doctor's professional qualifications is quite low at 55.75% (4% very satisfied, 51.75% satisfied); 22.75% of patients have no opinion; 21.5% of patients are dissatisfied, they evaluate that the doctor only records the symptoms they declare and prescribes medicine without examining them further. Cao Lanh District General Hospital is a district-level hospital, so the professional qualifications of the doctors are limited. On the other hand, due to lack of human resources, a doctor has to serve many patients in one day, leading to the service attitude and professional quality not meeting the best needs of the patients. It is recommended that in the coming time, the hospital pay more special attention to this issue.

The satisfaction rate for the fee collectors is very high, accounting for 92.25% (5% very satisfied, 87.25% satisfied), 9.75% have no opinion and 2.5% are dissatisfied and very dissatisfied because the staff miscalculated their money. Previously, the staff received many complaints from the people about their service attitude, but today the staff has learned many lessons from their predecessors, as well as complied with the hospital's regulations, so the fee collectors have a more gentle attitude towards patients.

Regarding the service attitude of the drug dispensing staff, 83% of patients were very satisfied and satisfied, 7% had no opinion and 10% were dissatisfied and very dissatisfied. This rate is higher than the study by Ngo Thi Thuy Nhi (2015) with the rate of very satisfied and satisfied accounting for 69.5%. This result is good news for the hospital, because it has somewhat corrected the service attitude of the drug dispensing staff, a stage that many people complain about the most because of the behavior. The remaining 10% of patients felt not really comfortable with the drug dispensing staff, possibly because the drug dispensing area is a place where many patients gather at the same time, leading to patients talking privately with each other, causing disorder, noise, confusion in calling out the name of the drug, causing difficulties for the drug dispensing staff. For that reason, the staff cannot speak softly and kindly.

With patients, patients need to sympathize with staff and must be aware of maintaining order so that staff can work better.

In general, the satisfaction rate with the spirit, service attitude and expertise of medical staff is quite high at 82.4%, only 17.6% of patients are dissatisfied. This result is due to the fact that in recent years, the hospital has continuously adjusted and changed the style and service attitude of medical staff towards the people. In particular, the hospital applies the "6 Know" motto issued by the People's Committee of Dong Thap province to implement standards of conduct, which are: "Know how to greet - know how to smile - know how to listen - know how to guide - know how to thank - know how to apologize". Thereby, creating a change in awareness as well as actions of medical staff to increasingly improve the quality of service of the hospital.

5.2.3 Satisfaction with hospital facilities and equipment

The rate of satisfaction and very satisfied with the spacious, clean, airy waiting room and lobby, with enough chairs for patients accounted for 68%, 9.25% had no opinion, 22.75% of patients were dissatisfied because they found that the waiting room was not really spacious, during rush hour it was often very cramped, lacking chairs for patients, leading to psychological discomfort for patients. The hospital should pay attention to this issue, need to plan repairs to make the waiting room more spacious, this also contributes to making patients feel better served when coming to see a doctor. Compared with the results of Tran Thi Kim Thoa (2015), this satisfaction result was lower, with the result of up to 92.8% of patients satisfied.

The waiting room and lobby have a numbering area, with staff guiding to ensure fairness for patients in the order of arrival for examination. The patient satisfaction rate is quite high at 86% (of which 1.5% are very satisfied, 84.5% are satisfied), only 14% of patients are dissatisfied (7.75% have no opinion, 5.75% are dissatisfied and 0.5% are very dissatisfied). The dissatisfied people think that the numbering is not really transparent, there are still shortcomings such as when the patient is a relative or acquaintance of the medical staff, they will let these people take the number in front of them even though they arrived later, causing frustration for the patient. The hospital needs to overcome these cases by replacing manual numbering with a numbering machine to make the numbering more fair, transparent and save medical staff time.

64.25% of patients were satisfied with the aisles in the department, the corridors were flat, spacious, and easy to walk, the remaining 35.75% were not satisfied (7.75% had no opinion, 28% were not satisfied) because they found that during rush hour the aisles in the department and the corridors were very narrow, they had to jostle each other to walk, especially when there were patients in wheelchairs, causing narrow aisles and traffic congestion.

The satisfaction rate for spacious and clean medical clinics is very high (accounting for

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