Faculty of Nursing, Praboromarajchanok Institute of Health Workforce Development, Boromarajonani College of Nursing, Yala 95000, Thailand.
Faculty of Nursing, Praboromarajchanok Institute of Health Workforce Development, Boromarajonani College of Nursing, Khonkaen 40000, Thailand.
Int J Environ Res Public Health. 2024 Aug 12;21(8):1053. doi: 10.3390/ijerph21081053.
Following the transfer of hospital services to provincial government oversight, it is essential to understand how such changes impact service quality and efficiency. This study, conducted from 1 March 2023 to 31 March 2024 at sub-district health-promoting hospitals in Thailand, aims to identify the factors affecting hospital service quality post-transfer and evaluate the role of professional nurses in maintaining service standards under new governance. Utilizing a mixed-methods design based on the Global Fund-HSS framework (2012), which categorizes factors into accessibility, processes, productivity, and outcomes, we collected data from 340 nurses and 400 patients through structured questionnaires. These questionnaires were divided into seven sections, capturing metrics such as the personal data of nurses, hospital service activities, and leadership qualities. We employed a Likert scale to gauge the perceptions and expectations of service quality and conducted paired -tests to compare performance metrics before and after the administrative transfer. One-way ANOVA was used to assess variability among different service units, and binary logistic regression helped identify the key determinants of service quality. The analysis revealed a significant correlation between the attitudes and competencies of healthcare teams and the levels of service quality. Notably, service units transferred less than 50% exhibited minimal changes, indicating that the degree of transfer significantly impacts service outcomes. Despite these variations, the fundamental mission of promoting health remained consistent. The study emphasizes the critical role of nurses and recommends further research to identify additional factors that could improve service quality in transferred healthcare facilities, potentially contributing to enhanced healthcare delivery across restructured health systems.
在医院服务向省政府监管转移后，了解这些变化如何影响服务质量和效率至关重要。本研究于 2023 年 3 月 1 日至 2024 年 3 月 31 日在泰国的社区卫生促进医院进行，旨在确定影响转移后医院服务质量的因素，并评估专业护士在新治理下维持服务标准的作用。本研究采用基于全球基金健康促进医院框架（2012 年）的混合方法设计，将因素分为可及性、流程、生产力和结果四个类别，通过结构化问卷从 340 名护士和 400 名患者收集数据。这些问卷分为七个部分，涵盖了护士的个人数据、医院服务活动和领导素质等指标。我们采用李克特量表来衡量服务质量的感知和期望，并进行配对检验比较行政转移前后的绩效指标。单因素方差分析用于评估不同服务单位之间的变异性，二元逻辑回归用于确定服务质量的关键决定因素。分析结果显示，医疗团队的态度和能力与服务质量水平之间存在显著相关性。值得注意的是，转移比例低于 50%的服务单位变化最小，这表明转移程度对服务结果有重大影响。尽管存在这些差异，促进健康的基本使命仍然保持一致。该研究强调了护士的关键作用，并建议进一步研究确定可能改善转移医疗机构服务质量的其他因素，这可能有助于改善重组后的卫生系统中的医疗服务提供。
