108
i
PZB Kano
Kano
Kano
Kano
Kano
LINGO
Kano
ii
A Model to Maximize Hospital Service Quality Under Budget Constraint
Student : Wei-Kuo Chang Advisor : Dr. Chiu-Chi Wei
Abstract
The development of education and economy in Taiwan has made people
become more aware of medical knowledge, which in turn leads to their higher
expectations of medical quality. Under such a circumstance, the customers
(patients) satisfaction level becomes an important indicator to evaluate the
service quality of a hospital and a main factor for whether or not the patients will
visit the hospital. To strengthen the competitiveness of the hospitals, in addition to
making efforts to improve both of the service and medical quality, the top priority
of the hospital management is to build a comprehensive model to measure the
service quality.
PZB and Kano models are commonly used to measure service quality. These
two models, by using questionnaires and statistical analysis, can help clarify the
customers demands and therefore provide the hospital managers a way to
measure and improve the service quality. Given the fact that there are few
mathematical models for service quality evaluation, this study aims to develop a
new research dimension in applying Kano graphical model; that is the Kano
model will be modified and enforced to become a mathematical and scientific
model.
In the current medical environment, the implementation of global budget
and the criteria set by hospital accreditation program have forced the hospital
managers to tightly control cost and fiercely improve quality. Thus, the top
concern for the hospital managers is how to maximize service quality under a
limited budget. This study uses the mathematical Kano model to develop a model
that can maximize the service quality under a limited budget.
In this study, the curves representing the Must-Be element, One-Dimensional
element and Additional element are fist transformed into formula and then derive
iii
a mathematical model which can measure the levels of customers satisfaction.
In the end, a model to maximize service quality under limited budget is
established on the basis of the mathematical formula derived. To verify the
validity and reliability of the model, an example is adopted and solved using
LINGO to assess its effectiveness. The result of the case study shows that the
maximum service quality can be achieved when all budgets are used only to
improve Additional element.
Keyword: medical service quality, Kano model, mathematical model, quality
element, optimization quality model
iv
!
-
95 5
v
...................................................................................................................... i
Abstract ................................................................................................................... ii
.................................................................................................................... iv
..................................................................................................................... v
................................................................................................................... vii
.................................................................................................................. viii
......................................................................................................... 1
1.1 ...................................................................................................... 1
1.2 ...................................................................................................... 3
1.3 ...................................................................................................... 3
1.4 ...................................................................................................... 4
1.5 ...................................................................................................... 6
1.6 ...................................................................................................... 7
1.7 ...................................................................................................... 7
1.8 ...................................................................................................... 7
1.9 ...................................................................................................... 8
................................................................................................. 9
2.1 .......................................................................................... 9
2.1.1 .......................................................................................... 9
2.1.2 ........................................................................................ 10
2.1.3 .....................................................................11
2.1.4 ........................................................................................ 13
2.2 ........................................................................................ 18
2.2.1 ........................................................................................ 19
2.2.2 ................................................................................ 20
2.2.3 ................................................................................ 20
2.2.4 ................................................................................ 24
vi
2.3Kano31
2.3.1 .................................................................................... 32
2.3.2 Kano ............................................................................... 41
2.4 .................................................................... 42
2.4.1 ........................................................................ 43
2.4.2 .................................................... 47
2.4.3 ............................................................................ 53
............................................................................................... 61
3.1 Kano 61
3.2 .................................................................................... 70
3.2.1 ........................................................ 70
3.2.2 ........................................................ 72
3.3 ........................................................ 76
3.3.1 Kano .......... 76
3.3.2 Kano ............................... 76
............................................................................................... 78
4.1 ............................................................................................................ 78
4.2 .................................................................................................... 80
4.3 .................................................................... 80
........................................................................................... 85
5.1 ............................................................................................................ 85
5.2 ............................................................................................................ 87
............................................................................................................... 89
....................................................................................................................... 95
vii
1.1 .................................................................................................. 5
2.1 14
2.2 15
2.3 16
2.4 16
2.5 17
2.6 17
2.7 25
2.8 26
2.9 PZB 29
2.10 31
2.11 Herzberg 33
2.12 Kano 34
2.13 45
2.14 ACSI 55
2.15 ECSI 55
3.1 62
3.2 63
3.3 65
3.4 68
viii
2.1 SERVQUAL 30
2.2 Schvaneveldt 35
2.3 Schvaneveldt
Kano 36
2.4 Schvaneveldt 37
2.5 40
4.1 83
1
1.1
Chase 59
2
Tomes67
1998 58.5% TQMTotal Quality Management
CQIContinuous Quality Improvement
84.6%
QC-Quality Circle5SSeiri-Seiton-Seiso-Seiketsu-
Shitsuke-Bench Marketing
BPR-Business Process Reengineering
P.Z.B
Kano
Must-Be Elements
One-Dimensional ElementsAttractive Elements
3
Tenner
DeTorol66
Base Quality ExpectationImplicit Need
Optional Expectation
Explicit NeedUnarticulated
ExpectationLatent Need
Delight Results Kano model
1.2
Kano Kano l984
Kano
1.3
4
1984
Kano
Kano
Kano
Kano
Kano Kano
Kano
Kano
1.4
Kano
1.1
Kano
5
Kano
Kano
1.1
LINGO
LINGO
Kano
LINGO
6
1.5
Kano
7
LINGO
1.6
Kano
1.7
Kano
1.8
Kano
8
Kano 5
Kano
Kano 5
1.9
Kano
LINGO
Kano
9
Kano
2.1
2.1.1
American Marketing Association, AMA
Juran 44work
performed for someone elseBuell26
Kolter
47
Lovelock51
ISO
10
2.1.2
47
Intangibility
Inseparability
Heterogeneity
11
Perishability
services pecificationservice delivery
2.1.3
Parasuraman, Zetihaml, Berry58
12
King27
13
2.1.4
Service Process Matrix
Schmenner 611986
Service Process matrix2.1
14
:
:
:
2.1
61
Classifying Service for Strategic Insights
Lovelock51 Sasser Chase
Nature of the Service Act
2.2
15
2.2
51
Relationship with Customers
2.3
Customization and Judgment
2.4
16
AAA
2.3
51
2.4
51
Nature of Demand and Supply
2.5
17
2.5
51
Method of Service Delivery
2.6
AAA
2.6
51
18
2
2.2
19
2.2.1
Deming29
Garvin34
Transcent or Philosophic Approach
Product-Based Approach
User-Based Approach
Manufacturing-Based Approach
Value-Based Approach
20
Olshavsky55
2.2.2
Levitt49Sasser
60
Gronroos36
Garvin34
Parasuraman, Zetihaml, Berry57
1988
Binter24
PZB
2.2.3
Sasser, Olsen, Wyckoff60
Sasser, Olsen, Wyckoff
21
Gronroos36
Gronroos Technical Quality
FunctionaL QualityCorporate Image
Technical Quality
Functional Quality
Corporate Image
Noriaki Kano9
Must-be Quality Element
Attractive Quality Element
22
One-Dimensional Quality Element
Indifferent Quality Element
Reverse Quality Element
19
Internal Quality
Hardware Quality
Software Quality
23
Time Promptness
Psychological Quality
Heskett39
Heskett
Haywood-Farmer37
Haywood-Farmer 3P
Physical FacilitiesProcess and Procedures
Peoples Behavior and Conviviality
Professional Judgment
24
Parasuraman, Zetihaml Berry57
Parasuraman, Zetihaml Berry
AccessCommunication
CompetenceCourtesyCredibility
ReliabilityResponsivenessSecurity
TangiblesUnderstand/Knowing
1988 1985
Reliability
Tangibles
Responsiveness
Assurance
Empathy
2.2.4
25
Sasser, Olsen, Wyckoff60
Level of MaterialFacilities
Personnel2.7
2.7
60
1.
2.
3.
1.
2.
3.
1.
2.
3.
26
Service Package
2.8
36
Gronroos 1982 36
Technical QualityFunctional Quality
How
What
27
Corporate Image1984
Gronroos 2.8
PZB
Parasuraman, Zetihaml Berry57 1985
2.9
Gap
1-Consumer Expectation-
Management Perception Gap
28
2-Management Perceptio-
Service Quality Specification Gap
3-Service Quality
Specification-Service Delivery Gap
4-Service Delivery-External
Communication Gap
5-Expected Service-Perceived
Service Gap
5
29
5 1 2 3 4
5 = f 1 2 3 4
2.9 PZB
57
PZB
Parasuraman 1985
22 SERVQUAL
22
4
1
5
3
2
30
22
2.1 SERVQUAL
SERVQUAL PZB
Tangibles
Reliability
Responsiveness
Assurance
Empathy
/
56
PZB
Weiner 1985 69 PZB
Booms Bitner 1981 P
Marketing Mix
2.10
31
2.10 PZB
69
Boulding 25 Teas65
ExpectationShouldWill
Perception of Service Quality
Prior Expectation-WillShould
Actual Delivered Service-
Prior Expectation
2.3 Kano
32
Kano Kano
2.3.1
1959 Frederick Herzberg
Motivation-Hygiene Theory
Two-Factor Theory of Job Attitudes
Herzberg
Motivator Factors Hygiene
Factors
M-H Motivator-Hygienetheory
Frederick Herzberg38 1959
-
Motivation-Hygiene TheoryTwo-Factor
Theoryof Job Attitudes
Hygiene FactorsMaintance Factors
Zero Condition
MotivatorsSatisfiers
NosatisfactionNo Dissatisfaction
33
Dual-Continuum2.11
2.11 Herzberg
38
Herzberg
:
Herzberg
20
Kano
9Herzberg M-H
Motivato-Hygiene theoryM-H
;
M-H Attractive Quality
34
Must-be Quality
1984
2.12
2.12 Kano
9
Attractive Elements
One-Dimensional Elements
Must-be Elements
Indifferent Elements
35
Reverse Elements
SchvaneveldtEnkawa Miyakawa
2.2 Schvaneveldt
/
62
36
2.3 Schvaneveldt
Kano
Schvaneveldt
62
SchvaneveldtEnkawa Miyakawa62
PerformanceAssuranceCompleteness
Ease of Use /Emotion/Environment
2.2 2.3
37
Schvaneveldt
2.4
2.4 Schvaneveldt
--------------- ------------------ ------------------------
() / ()
()
/ () )
() / ()
/ () ()
()
/ ()
/ () ()
() / ()
()
/ ()
62
Matzler
Matzler 53 Kano
Kano
38
+47
High-Vision
-21
Weihrich Heinz R-S factors
Weihrich Heinz68Frederick Herzberg
Reliability Factors/R-Factor
Salability Factor/S-factorReliability
R-Factor S-factor
Weihrich Heinz
Comfort
SafetyEase of Use
Swan Combs
Swan Combs64 Herzberg M-H
Instrumental DimensionPhysical
Expressive DimensionPsychological
the Critical Incident Method
Herzberg
39
Maddox52 Swan and Combs
1
2.5
Kano 16 Kano
40
2.5
1
Kano ?
InovationCustomefocus Joiner43
Kano
Matzler Hinterhuber53 Kano
Must-BeOne-Dimensional
41
Attractive
Kano
Customer Segments
Differentiation
Kano Quality Function Deployment
Kano
Kano
2.3.2 Kano
18 1999
Kano
42
2.4
Disconfirmation
Disconfirmation
Asymmetric Gain-Loss
43
2.4.1
Quality of Medical Care
Fisher32
Fisher
Fisher
44
5
45
Donabedian30
Donabedian Structure
ProcessOutcome
Donabedian
21
2.13
21
46
2.13
10
47
2.4.2
Fletcher 33
Donabedian30--
48
Structure
Process
Outcome
Donabedian
Linn 50
49
Kenia 46
James40
500
Physician Service
QualityNurse Service Quality
Clinics Service Quality Compared to Competitor
Facilities/OperationqualityTechnical/Other Staff
Service Quality
PZB
SERVQUAL 3
50
12
15
51
22
6
52
4
8
11
53
7
17
13
2.4.3
Oliver54
54
ExpectationDimensions
14
PZB
1970
ACSI ECSI1989
Fornell
Swedish Customer Satisfaction
Barometer SCSB1996 Fornell SCSB
American Customer Satisfaction Index ACSI
SEM, Structural Equation Model
ACSI
ACSI
ACSI
ACSI
55
2.14
2.14 ACSI
35
+
-
2.15 ECSI
45
1999 European Customer Satisfaction
Index ECSI2.15 1999 12
SEM, Structural Equation Model
+
+
+
+
+
+
+
56
ECSI ACSI ECSI ACSI
Churchill28
Kotler48
Perceived
Oliver54
1.Assimilation Theory
Cognitive Dissonance Theory
57
2.Contrast Theory
3.Assimilation-Contrast Theory
4.Generalized Negativity Theory
5.Adaptation Level Theory
6.Opponent Process Theory
Opposition
Emotion
58
Threshold
7.Comparison Level Theory
1.Equity Theory
Input/Outcome
2.Attribution Theory
59
CSI
Solomon63
Oliver54
Engel 31
Anderson 23
60
Donabedia
Admitting Services
Admitting Attitudes
Nursing Services
Nursing Attitudes
Physician Communication
Physician Attitudes
Housekeeping Service
John42
61
Kano
LINGO
3.1 Kano
Kano Must-be Elements
One-Dimensional ElementsAttractive Elements
3.1 3.1 x
y
62
x
x 3.1 x
3.1 x
x 3.1 x
3.1
63
Kano
imy
im
x
3.2
3.2
x 3.2 a1
f(a1) b1
f(b1) a1
b1 3.2 a1b1f(b1)f(a1)
1n
3.2
y = fx= -pqx , 0
64
imy = f
imx = -pq imx , 0
65
imS i
mTS
mTS
mTS
1m
y =2m
y = =1nm
y
a1 = a2 = =1n
a = a b1 = b2 ==1n
b = b
im
x im
S
1m
S =2m
S ==1nm
S 1n
TSm
TSm==
1
1
n
imi
S = 1n Sm= 1n mb
a
x dxpq m = 1n [(-pqb/ln q)+(pqa/ln q)] 3-5
ioy
iox
3.3
c1 d1
f(c1)f(d1)
66
3.3
y = fx= rx , r>0 3-6
oi iox
ioy = f (
iox ) =
iorx , r>0 3-7
oi
iox
ioy
r
c1 d1
c1d1f(c1)f(d1)
ioS
ii
i
i
oo
d
c
dxrx= , r>0 3-8
ic
id
ioS
3-8
2n ci
di 2n
67
i
i
i
ii o
n
i
n
i
d
cooo dxrxTS
= =
==2 2
1 1S , i =1,2,, 2n 3-9
oTS 2n
ioS i
oTS
oTS
oTS
1o
y = 2o
y = = 2no
y
c1 = c2 = = 2nc = c d1 = d2 = = 2nd =d
io
x io
S
oS = 1oS = 2oS == 2noS 2n
oTS
===
2
1
n
ioo i
STS 2n =oS 2n od
codxrx = 2n (r/2)(d2-c2) 3-10
3.4
x y
y
e1
f(e1) f1 f(f1)
68
e1 f1
e1f1f(f1)f(e1)
iay
ia
x
3.4
3.4
y = fx= st x , t > 1 3-11
aiia
x
iay = f
iax = stxai , t >1 3-12
oi
iax
iay
e1 f1
f(e1)
f(f1)
69
st
e1 f1
e1f1f(f1)f(e1)
iaS
i
i
i
aa
f
e
x dxst i= 3-13
ie
if
iaS
3-12 3n e1 f1 3n
i
i
i
ia
i a
n
i
f
e
xn
iaa dxstSTS
==
==33
11
,i=1,, 3n 3-14
TSa 3n
iaS i
TSa
TSa
70
1a
y =2a
y ==3na
y
e1 = e2 = = 3n
e = e f1 = f2 = =3n
f = f
ia
x ia
S
aS = 1aS = 2aS == 3naS n
TSa
== =
3
1
n
iaa i
STS 3n =aS 3n af
e
x dxst a = 3n [(stf/ ln t)-(ste- ln t )] 3-15
3.2
3.2.1
Kano
71
Kano
TSm
TSo TSa
TSm
TSo
TSaTSmTSo TSa
Max W1TSm + W2TSo + W3TSa 3-16
s.t. W1 + W2 + W3 = 1
0W1 1
0W2 1
0W3 1
TSm
TSo
TSa
W1
W2
W3
72
W1W2W3
0 1 1
W1 W2
W3
TSm TSo
TSa
3.2.2
Max CmTSm + CoTSo + CaTSa 3-17
s.t. Cm + Co + Ca B
0Cm B
0Co B
0Ca B
Cm= k1ba, a b b1
Co= k2dc, c d d1
Ca= k3fe, e f f 1
TSm
73
TSo
TSa
Cm
Co
Ca
B
b1
d1
f1
a
b
c
d
e
f
b-a
d-c
f-e
k1 k2 k3CmCoCa
b-ad-cf-e
74
CmTSm Cm
TSmCoTSo Co
TSoCaTSa Ca
TSa
B
CmCo Ca
TSm TSo TSa
Cm Co Ca B 0
0
Cm C oCa
Cm C oCa
b-a d-c f-e
k1 k2k3
75
3-5
1TSm==
1
1
n
imi
S = 1n Sm= 1n mb
a
x dxpq m
3-10
2 od
coo
n
ioo dxrxnSnSTS i ===
=22
1
2
3-15
3 af
e
xa
n
iaa dxstnSnSTS ai ===
=33
1
3
Cm
TSm==
1
1
n
imi
S = 1n Sm = 1n mb
a
x dxpq m , ab b1, bR 3-18
CO
o
d
coo
n
ioo dxrxnSnSTS i ===
=22
1
2
, cd d1, dR 3-19
Ca
a
f
e
xa
n
iaa dxstnSnSTS ai ===
=33
1
3
, ef f1, f R 3-20
76
3.3
PZB Kano
3.3.1 PZB
PZB
Parasuraman, Zetihaml, Berry
PZB
PZB
PZB
PZB
PZB
3.3.2 Kano
Kano
77
Kano
Kano
Kano
Kano
Kano
Kano
Kano
78
LINGO
4.1
GDP
1999
1.3 GDP 14%Health Care
Financial Agency, HCFA 2008 2.1 GDP
16.2% 1999 NHE5,049
4.75%GDP5.44%
22,9413.91% 7,657
50.1% GDP 43.73%
2800
53.23%
68.4%
Monopsony
Marketpower
Monopoly
CT MRI
79
10.18%12.68%
Freedom of Choice
1993 1994
2543
1995 2000
141 1980 83568,382
82 2000 669
114,179171
80
Kano
4.2
A 500
2
5 4 3
5/35/2 5A 500
4.3
Kano
A
Max CmTSm+CoTSo+CaTSa
s.tCm+Co+Ca 5
0Cm 5
0Co 5
0Ca 5
81
Cm=k1b-a,ab b1
Co=k2d-c,cd d1
Ca=k3f-e,e f f1
k15/3k25/2k35
Cm=5/3*b-2,2 b 5, bR
Co=5/2*d-2,2 d 4, d R
Ca=5*f-2,2f 3 , f R
TSm==
1
1
n
imi
S = =mSn1 1n mb
a
x dxpq m , ab b1, b R
o
d
coo
n
ioo dxrxnSnSTS i ===
=22
1
2
, cd d1, d R
a
f
e
xa
n
iaa dxstnSnSTS ai ===
=33
1
3
, e f f1, f R
TSm = 1n *-pqb/ q--pqa/ q, 01
pqrst p=3q=1/2 r=5s=6t=7,
1n 2n 3n 1 a=2
c=2e=2 TSmTSoTSa
82
TSm=-3/1/2b/ 1/2--3/1/22/ 1/2 3-31
TSo=5/2d2-22 3-32
TSa=[6*7f/ 7]-[6*72/ 7] 3-32
3-313-323-33
Cm Co Ca
LINGO 3-313-32
3-33
=4532.607
Cm=0
Co=0.4233713*10-3
Ca=4.999624
TSm=0
TSo=0
TSa=906.5214
b=2
d=2
f=3
Cm=0
Co=0.4233713*10-3Ca=4.999624 Cm=0
a=2b=2TSm=0
Co=0.4233713*10-3 0
83
c=2d=2TSo=0 Ca=4.999624
500 e=2f=3
TSa=906.5214 500
4532.607
ki
ki ki
ki
ki pqrs t
ki
p=3q=1/2 r=5s=6t=7
ki
4.1
No. k1 k2 k3 p q r s t Cm Co Ca TSm TSo TSa
1 5/3 5/2 5 3 1/2 5 6 7 0 0.42x10-3 4.999624 0 0 906.5214 4532.607
2 5 5/3 5/2 3 1/2 5 6 7 2.4956 0.41x10-2 2.5 1.848 257.671 906.517 2271.944
3 5/2 5 5/3 3 1/2 5 6 7 3.2948 0.42x10-1 1.6667 1.516 73.9798 906.516 1518.971
4.1
k15/3k25/2k35
Cm=0Co=0.42*10-3Ca=5
0TSm=0 0
TSo=0 906.5214TSa=906.5214
4532.607
k15k25/3k35/2
Cm=2.4956Co=0.41x10-1Ca=2.5
84
1.848TSm=1.848
257.671TSo=257.671
906.517TSa=906.517
2271.944
k15/2k25k35/3
Cm=3.2948Co=0.42x10-1Ca=1.6667
1.516
TSm=1.516 73.9798TSo=73.9798
906.516TSa=906.516
1518.971
500
ki ki
ki ki
85
Kano
Kano
5.1
PZB Kano
Kano
86
Kano
Kano
3-1
3-63-11
3-3 1n
3-43-8
2n 3-9
3-13 3n
3-14
3-16
0 1 1
3-17
3-183-193-20
0
LINGO
87
0
Kano
5.2
88
Kano
89
1. (1998)
511-519
2. (1991)
3. 1983
4. 1985
5. (1978) 11 2 106-109
6. 1991
7. 1999
8. 1995
9. (1984)
AttractiveQualityandMust-beQuality
33-41
10. (1995) 28
4 12-16
11. 1996
12. 1987
13. 1999
14. (1995)-
15. 1988
90
16. (2001) KANO
18 2 71-80
17. 1999
149-157
18. (1998) Kano
19. (1986)
20. (1996)
21. (1995)
13 1 35-53
22. 1988
23. Anderson, E. W., Class, F. N., & Donald, R. L. (1994). Customer satisfaction,
market share, and profitability: Findings from Sweden, Journal of Marketing
Research, Vol. 60 No. 7, pp. 56-68.
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Encounter: Diagnosing Favorable and Unfavorable Incidents, Journal of
Marketing Vol. 54, January, pp. 71-84.
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(1993), A Dynamic Process Model of Service Quality: From Expectation to
Behavioral Intentios, Journal of Marketing Research, Vol. 30, No. 2, pp.
7-27.
26. Buell, V. P. (1984), Marketing Management: A Strategic Planning Approach,
Mc Graw-Hill, NewYork.
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95
LINGO
Max=x4*x1+x5*x2+x6*x3;
x1=(-3*0.5^b)/-0.6931-(-3*0.5^2)/-0.6931;
x2=5*(d^2-4)/2;
x3=(6*7^f)/1.9459-294/1.9459;
x4=5*(b-2)/3;
x5=5*(d-2)/2;
x6=5*(f-2);
x4+x5+x6=0;
x4=0;
x5=0;
x6=2;
b=2;
d=2;
x
96
LINGO
Local optimal solution found at step: 6
Objective value: 4532.607
Variable Value Reduced Cost
X4 0.0000000 0.0000000 X1 0.0000000 0.0000000 X5 0.4233713*10-3 0.0000000 X2 0.0000000 0.0000000 X6 4.999624 0.0000000 X3 906.5214 0.0000000 B 2.000000 0.0000000 D 2.000000 0.0000000 F 3.000000 0.0000000 X 3.000000 0.0000000
Row Slack or Surplus Dual Price1 4532.607 1.000000 2 0.0000000 0.0000000 3 0.0000000 0.0000000 4 0.0000000 5.000000 5 0.0000000 0.0000000 6 0.0000000 0.0000000 7 0.0000000 -2058.0118 0.0000000 0.0000000 9 0.0000000 0.0000000
10 5.000000 0.0000000 11 0.0000000 0.0000000 12 5.000000 0.0000000 13 5.000000 0.0000000 14 0.0000000 2964.533 15 0.0000000 0.0000000 16 3.000000 0.0000000 17 0.0000000 0.0000000 18 2.000000 0.0000000 19 1.000000 0.0000000 20 0.0000000 0.0000000
