physicians in tqm: a survey in taiwan fenghueih huarng department of business adm,southern taiwan...

Physicians in TQM: A Survey in Taiwan

Fenghueih Huarng

Department of Business Adm,Southern Taiwan Univ. of Technology

Huei-min Hsei

Center for Hospital Development, Kaohsiung Medical Univ.

Research Model

H1: A hospital-physician TQM relationship is positively related to physician’s personal medical quality. H1a: A hospital-physician TQM relationship is positively related to physician’s personal medical quality taking physician’s personal value as a moderating variable. H2 : An altruism physician has better personal medical quality than an egoism physician in TQM culture. H3 : Physician’s effort in advanced study is positively related to medical quality.

•Physician-hospital TQM relationship

•Physician’s professional advanced study

Physician’s personal value

Medical quality

Qualitative results—interviewing 22 doctors(most lasting at least 2 hours)

•NHI reimbursement rules

•Hospital cost policy

•Hospital payment policy about physicians

•Patients’ attitude

•The prevention of mal-practice suits

•Physicians’ professional ability

Medical Quality

Physician’s personal value

Literature Review

Some successful TQM cases in clinical Dept. (Hart & Masfeldt,1992, Dieter & Gentile,1993; Nathanson,1994;

Healey,etc,1994) Low acceptance in clinical Dept. for TQM (Zabada, Rivers & Munchus,1998; Lewis & Lamprey, 1992; Socha,

1993; Gerber,1992) Building a supported and cooperation culture to physicians help (Johnson,1992; Nathanson,1994; Boerstler,etc,1996;

Massarweh,1998) Top management leadership help clinical involvement in TQM (Weiner,Shortell & Alexander,1997) Physician-hospital relationship is emphasized (Berry,1999; Dahill & Kalman,2001; Budetti,etc,2002)

Personal cooperative, organizational collectivistic values or organizational individualistic value contribute separately to cooperative behavior (Chatman & Barsade,1995)

Congruence between personal values and organizational culture outperform than either characteristic alone (Chatman,1991)

Factors on physician utilization , medical quality or length of stay: specialty, age, sex, experiences, type of training, years of practices

(Eisenberg,1985;Salem-Schatz,Avorn & Soumerai,1993;Shi,1996;

Ely,etc,1996)

Literature Review

Research Method

Literature review and 22 physicians 302 copies sent to 11 hospitals ( 5 major hospital center, 5 regional, 1 local ) 222 returned samples, 73.5% returned rate 21 items for physicians’ personal values (1:highly disagree, 3:indifferent, 5:highly agree) 24 items for physician-hospital TQM relationship (1:highly disagree, 3:indifferent, 5:highly agree) 13 items for physician’s effort on clinical medical quality in two years (1:highly disagree, 3:indifferent, 5:highly agree) 5 items for professional advanced study relative to other physicians (1:none, 2:low, 7:high) 99(chief) residences vs. 123 senior attendings

Departments Numbers Percentage(%)

Urology 53 23.9

Orthopedics 37 16.7

Stomach and intestines surgery 13 5.9

General surgery 61 27.5

Nerve surgery 15 6.8

Chest surgery 5 2.3

Others 36 16.2

Missing value 2 0.9

Total 222 100

Table1. Types of physician's department

Rank Numbers Percentage(%)

Full time senior attending physician 123 55.4

Chief residence physician 23 10.4

Residence physician 66 29.7

Others 10 4.5

Total 222 100.0

Table2.Types of physician's rank

Years Numbers Percentage(%)

Below 2 years 39 17.6

3~5 years 42 18.9

6~10 years 66 29.7

11~15 years 30 13.5

Above 16 years 33 14.9

Missing value 12 5.4

Total 222 100.0

Table3. # of years after graduation

Years Numbers Percentage(%)

Below 2 years 29 23.6

3~5 years 28 22.8

6~10 years 33 26.8

11~15 years 16 13.0

Above 16 years 15 12.2

Missing value 2 1.6

Total 123 100.0

Table4. # of years with the title of senior attending physicians

Variables # of items Cronbach's α

Physician's personal value 21 0.7897

Hospital and physician TQM relationship 24 0.9357

Medical quality 13 0.8871

Physician's professional study 5 0.7690

Variables # of items Cronbach's α

Physician's personal value 21 0.7840

Hospital and physician TQM relationship 24 0.9307

Medical quality 13 0.8866

Physician's professional study 5 0.7611

Table6. N=123(senior attending physician samples)

Table5. N=222(total samples)

Senior attending Residence p-value

(SD) (SD) (sig.)

C1: Good Interaction between physician and patient 4.50 ( 0.63 ) 4.35 ( 0.66 ) 0.085 （+）C2: Physicians should be mainly responsible for medical quality 3.36 ( 1.18 ) 2. 90 ( 1.15 ) 0.004 （**）C3: Willing to assist new colleagues to adjust to the work environment 4.21 ( 0.56 ) 4.23 ( 0.53 ) 0.689

C4: Make constructive suggestions that can improve the medical quality of the company 3.60 ( 0.71 ) 3.35 ( 0.77 ) 0.014 （*）C5: Treating more patients can elevate my performance 3.70 ( 0.96 ) 3.14 ( 1.04 ) 0.000 (***)

C6: Instead of make-up treatments, we should improve in advance 4.59 ( 0.51 ) 4.42 ( 0.59 ) 0.026 (*)

C7: To reduce the length of stay can reduce the waste of cost 3.92 ( 0.86 ) 3.93 ( 0.86 ) 0.914

C8: Taking care of patients at all costs is the calling of doctors 3.73 ( 1.02 ) 3.26 ( 1.09 ) 0.001 (***)

C9: Use position power to pursue selfish personal gain 3.11 ( 1.04 ) 3.45 ( 0.98 ) 0.014 (**)

C10: Willing to coordinate and communicate with colleagues 4.25 ( 0.61 ) 4.27 ( 0.57 ) 0.868

C11: Being a good person comes before being a good doctor 4.21 ( 0.74 ) 4.10 ( 0.90 ) 0.310

C12: Taking protective diagnosis to avoid malpractice suit 3.72 ( 0.85 ) 3.88 ( 0.86 ) 0.186

C13: Tries hard to self-study to elevate the quality of work outputs 4.14 ( 0.63 ) 4.19 ( 0.71 ) 0.622

C14: Willing to cover work assignments for colleagues when needed 4.11 ( 0.46 ) 3.98 ( 0.68 ) 0.119

C15: Reinforce legal concepts to avoid malpractice suits 4.26 ( 0.056 ) 4.26 ( 0.55 ) 0.974

C16: Treating patients as family 4.14 ( 0.57 ) 3.78 ( 0.79 ) 0.000 (***)

C17: Open-minded for advice when treating a tough case 4.32 ( 0.59 ) 4.30 ( 0.58 ) 0.780

C18: Answer patients’ and their family’s questions in detail 4.36 ( 0.55 ) 4.17 ( 0.74 ) 0.033 (*)

C19: Reducing tests can reduce cost 4.21 ( 0.72 ) 4.18 ( 0.63 ) 0.747

C20: Complies with hospital rules even when nobody watches and no evidence can be traced 4.29 ( 0.52 ) 4.13 ( 0.66 ) 0.044 (*)

C21: Feel uncorrelated if others use illicit tactics to seek personal influence 2.40 ( 0.99 ) 2.48 ( 0.87 ) 0.496

Table7. Comparison of physician's personal value between senior attending and residence physicians

*** : up to p<=0.001 ** : up to p<=0.01* : up to p<=0.05 + : up to p<=0.1

ItemX X


(SD) (SD) (sig.)H1: Most physicians involve in elevating professional skills 3.99 ( 0.73 ) 3.84 ( 0.81 ) 0.136H2: Individual department is systemized 3.83 ( 0.75 ) 3.73 ( 0.87 ) 0.395H3: Physicians are empowered fully in clinical decisions 3.82 ( 0.82 ) 3.42 ( 0.96 ) 0.002 (**)H4: Paramedics coordinate with physicians in testing 3.79 ( 0.84 ) 3.76 ( 0.75 ) 0.763H5: Individual department encourage team work and discussions 3.89( 0.74 ) 3.55 ( 0.97 ) 0.005 (**)H6: The head of hospital would communicate with physicians about medical quality 3.52 ( 0.88 ) 3.05 ( 1.11 ) 0.001 (***)H7: Hospital encourage physicians to study and learn 3.75 ( 0.81 ) 3.54 ( 1.04 ) 0.009 (**)H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients 3.61 ( 0.87 ) 3.32 ( 1.01 ) 0.020 (**)H9: Hospital would organize medical seminars and conferences to improve medical quality 3.92 ( 0.74 ) 3.66 ( 0.86 ) 0.020 (**)H10: Hospital evaluates patients’ satisfaction periodically 3.66 ( 0.84 ) 3.42 ( 0.84 ) 0.048 (*)H11: Nurses coordinate with physicians in treating patients 3.98 ( 0.60 ) 3.71 ( 0.87 ) 0.010 (**)H12: Hospital encourage physicians to involve in improving medical quality 3.62 ( 0.77 ) 3.46 ( 0.84 ) 0.135H13: Physicians’ practice is respected and autonomous 3.55 ( 0.94 ) 2.90 ( 1.03 ) 0.000 (***)H14: The head of hospital clearly understand the fundamental principles of medical quality 3.79 ( 0.78 ) 3.15 ( 0.99 ) 0.000 (***)H15: Customers’ complaints are the beginning of improvement for medical quality 3.68 ( 0.84 ) 3.40 ( 0.92 ) 0.019 (*)H16: Hospital would communicate with physicians about patients’ responses 3.62 ( 0.87 ) 3.32 ( 0.92 ) 0.016 (*)H17: Department chair encourage an organizational culture with trust and commitment 3.75 ( 0.76 ) 3.39 ( 1.06 ) 0.005 (**)H18: Administrative department do their best to support medical affairs 3.38 ( 0.97 ) 3.08 ( 1.09 ) 0.033 (*)H19: Hospital would interfere with physicians’ decisions in medicinal prescription 2.94 ( 1.02 ) 3.53 ( 0.99 ) 0.000 (***)H20: Use clinical path analysis and evidence based medicine to improve medical quality 3.89 ( 0.64 ) 3.89 ( 0.73 ) 0.970H21: Department chair would communicate with physicians about medical quality 3.76 ( 0.79 ) 3.59 ( 0.93 ) 0.168H22: The head of hospital would support the implementation of quality planning 3.69 ( 0.80 ) 3.31 ( 0.92 ) 0.001 (***)H23: Individual department tries to build some clinical quality indicators 3.53 ( 0.87 ) 3.39 ( 0.87 ) 0.234H24: Each department has the same target in elevating medical quality 3.28 ( 0.93 ) 3.12 ( 1.04 ) 0.001 (***)


Item

Table8. Comparison of physician and hospital TQM relationship between senior attending and residence physicians

XX


(SD) (SD) (sig.)

Q1: Observe the repeated patient’s recovering situations after surgery 4.17 ( 0.46 ) 3.93 ( 0.62 ) 0.001 (***)

Q2: Patients show their affirmative about treatment to physicians directly 3.93 ( 0.52 ) 3.81 ( 0.57 ) 0.125

Q3: Patients show their affirmative about treatment to hospital 3.74 ( 0.56 ) 3.69 ( 0.61 ) 0.561

Q4: Repeated visit rate of patients after surgery 4.14 ( 0.50 ) 3.75 ( 0.70 ) 0.000 (***)

Q5: Do best to prevent malpractice suits 3.97 ( 0.59 ) 3.83 ( 0.74 ) 0.145

Q6: Explain patient’s conditions to patient himself/ herself orally 4.10 ( 0.56 ) 4.04 ( 0.59 ) 0.476

Q7: Tell patients the truth about after-effects and syndromes 3.98 ( 0.72 ) 4.05 ( 0.65 ) 0.413

Q8: Illustrate the functions of medicine and instruct patients how to take medicines 3.75 ( 0.72 ) 3.78 ( 0.77 ) 0.726

Q9: Both oral and written form of communication to understand patients’ life quality after surgery 3.76 ( 0.71 ) 3.80 ( 0.70 ) 0.616

Q10: The accuracy of decisions about the requirements of tests 3.87 ( 0.51 ) 3.80 ( 0.61 ) 0.393

Q11: Self assessment about the surgery conditions and results 3.92 ( 0.44 ) 3.72 ( 0.75 ) 0.022 (*)

Q12: Discuss the factor incurring syndromes and the corresponding treatments 4.00 ( 0.49 ) 3.94 ( 0.61 ) 0.357

Q13: The degree of consistence between diagnosis and pathology 4.02 ( 0.49 ) 3.96 ( 0.57 ) 0.361


Item

Table9. Comparison of medical quality between senior attending and residence physicians

XX


(SD) (SD) (sig.)

Q14a: Participate clinical medical seminars 4.30 (1.21) 3.87 (1.43) 0.015 (*)

Q14b: Participate regular meeting within hospital 4.73 (1.14) 4.71 (1.13) 0.888

Q14c: Doing up-to-date literature review about professional clinics 4.57 (1.03) 3.94 (1.26) 0.000 (***)

Q14d: Publishing clinical research results in journals 2.94 (1.61) 2.46 (1.76) 0.043 (*)

Q14e: To learn by observation from other hospitals domestically and abroad 3.31 (1.64) 1.97 (1.82) 0.000 (***)

Table10. Comparison of professional advanced study between senior attending and residence physicians

Item


X X

Results

Factor Analysis — Table11, physician’s personal values, 7 variables

(Fsce1-Fsce7)

— Table12, physician-hospital TQM relationship, 5 variables

(Fshe1-Fshe5)

— Table13, medical quality, 2 variables (Fsqe1-Fsqe2)

— Table14, professional advanced study (Fsq141)

Item Loading

C15: Reinforce legal concepts to avoid malpractice suits 0.746

C13: Tries hard to self-study to elevate the quality of work outputs 0.668

C14: Willing to cover work assignments for colleagues when needed 0.631

C16: Treating patients as family 0.658

C11: Being a good person comes before being a good doctor 0.582

C20: Complies with hospital rules even when nobody watches and no evidence can be traced 0.565

C18: Answer patients’ and their family’s questions in detail 0.512

C8: Taking care of patients at all costs is the calling of doctors 0.470

C2: Physicians should be mainly responsible for medical quality 0.769

C3: Willing to assist new colleagues to adjust to the work environment 0.628

C17: Open-minded for advice when treating a tough case 0.572

C1: Good Interaction between physician and patient 0.800

C10: Willing to coordinate and communicate with colleagues 0.718

C6: Instead of make-up treatments, we should improve in advance 0.482.

C7: To reduce the length of stay can reduce the waste of cost 0.737

C19: Reducing tests can reduce cost 0.719

C9: Use position power to pursue selfish personal gain 0.788

C5: Treating more patients can elevate my performance 0.739

C12: Taking protective diagnosis to avoid malpractice suit 0.584

C21: Feel uncorrelated if others use illicit tactics to seek personal influence 0.816

C4: Make constructive suggestions that can improve the medical quality of the company 0.713

Extraction Method: Principal Component Analysis.

Rotation Method: Equamax with Kaiser Normalization.

(Fsce5) emphasizing on understanding medical cost

(Fsce6) pursue individual benefit

(Fsce7) emphasizing public benefit

Table11. Factor analysis for physician's personal value

(Fsce1) elevating physician’s own professional ability

(Fsce2) emphasizing professional ethics

(Fsce3) emphasizing cooperation among colleagues to be responsible for medical quality

(Fsce4) emphasizing communication and coordination

Item Loading

H7: Hospital encourage physicians to study and learn 0.807

H10: Hospital evaluates patients’ satisfaction periodically 0.721

H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients 0.701

H22: The head of hospital would support the implementation of quality planning 0.685

H6: The head of hospital would communicate with physicians about medical quality 0.679

H14: The head of hospital clearly understand the fundamental principles of medical quality 0.576

H12: Hospital encourage physicians to involve in improving medical quality 0.556

H16: Hospital would communicate with physicians about patients’ responses 0.439

H11: Nurses coordinate with physicians in treating patients 0.762

H15: Customers’ complaints are the beginning of improvement for medical quality 0.679

H4: Paramedics coordinate with physicians in testing 0.557

H9: Hospital would organize medical seminars and conferences to improve medical quality 0.519

H13: Physicians’ practice is respected and autonomous 0.507

H21: Department chair would communicate with physicians about medical quality 0.828

H23: Individual department tries to build some clinical quality indicators 0.735

H24: Each department has the same target in elevating medical quality 0.688

H17: Department chair encourage an organizational culture with trust and commitment 0.558

H18: Administrative department do their best to support medical affairs 0.459

H1: Most physicians involve in elevating professional skills 0.869

H2: Individual department is systemized 0.809

H5: Individual department encourage team work and discussions 0.587

H19: Hospital would interfere with physicians’ decisions in medicinal prescription 0.743

H20: Use clinical path analysis and evidence based medicine to improve medical quality 0.599

H3: Physicians are empowered fully in clinical decisions 0.508



(Fshe4) using team work to elevate medical profession

(Fshe5) fully empowering physicians in clinical decisions

Table12. Factor analysis for physician - hospital TQM relationship

(Fshe1) hospitals encouraging physicians to promote their medical skill with customer orientation in mind

(Fshe2) supporting from all other departments

(Fshe3) hospital actively communicating with physicians about medical quality

Item Loading

Q7 : Tell patients the truth about after-effects and syndromes 0.803

Q6: Explain patient’s conditions to patient himself/ herself orally 0.746

Q10: The accuracy of decisions about the requirements of tests 0.665

Q8: Illustrate the functions of medicine and instruct patients how to take medicines 0.645

Q12: Discuss the factor incurring syndromes and the corresponding treatments 0.614

Q5: Do best to prevent malpractice suits 0.597

Q9: Both oral and written form of communication to understand patients’ life quality after surgery 0.596

Q13: The degree of consistence between diagnosis and pathology 0.727

Q4: Repeated visit rate of patients after surgery 0.725

Q3: Patients show their affirmative about treatment to hospital 0.684

Q2: Patients show their affirmative about treatment to physicians directly 0.644

Q1: Observe the repeated patient’s recovering situations after surgery 0.617

Q11: Self assessment about the surgery conditions and results 0.423



(Fsqe2) patient’s affirmation and treatment accuracy

Table13. Factor analysis for efforts in elevating medical quality

(Fsqe1) prevention of malpractice

Item Fsq141

Q14c: Doing up-to-date literature review about professional clinics 0.757

Q14e: To learn by observation from other hospitals domestically and abroad 0.756

Q14d: Publishing clinical research results in journals 0.727

Q14a: Participate clinical medical seminars 0.721

Q14b: Participate regular meeting within hospital 0.653



Table14. Factor analysis for professional advanced study

Results

Cluster Analysis

— using factor scores of physician personal values

— two groups: altruism vs. egoism

Altruism Egoism p-value

(SD) (SD) (sig.)

C1: Good Interaction between physician and patient 4.81 (0.39) 4.25 (0.69) 0.000 (***)

C2: Physicians should be mainly responsible for medical quality 3.00 (1.23) 3.69 (1.01) 0.001 (***)

C3: Willing to assist new colleagues to adjust to the work environment 4.37 (0.56) 4.08 (0.54) 0.005 (**)

C4: Make constructive suggestions that can improve the medical quality of the company 3.83 (0.69) 3.45 (0.66) 0.002 (**)

C5: Treating more patients can elevate my performance 3.46 (1.14) 3.89 (0.75) 0.020 (*)

C6: Instead of make-up treatments, we should improve in advance 4.94 (0.23) 4.28 (0.48) 0.000 (***)

C7: To reduce the length of stay can reduce the waste of cost 4.30 (0.71) 3.63 (0.84) 0.000 (***)

C8: Taking care of patients at all costs is the calling of doctors 3.76 (1.10) 3.66 (0.97) 0.608

C9: Use position power to pursue selfish personal gain 2.87 (1.13) 3.28 (0.94) 0.038 (*)

C10: Willing to coordinate and communicate with colleagues 4.56 (0.50) 4.01 (0.59) 0.000 (***)

C11: Being a good person comes before being a good doctor 4.44 (0.77) 4.05 (0.67) 0.004 (**)

C12: Taking protective diagnosis to avoid malpractice suit 3.52 (1.00) 3.88 (0.70) 0.029 (*)

C13: Tries hard to self-study to elevate the quality of work outputs 4.31 (0.54) 4.00 (0.66) 0.006 (**)

C14: Willing to cover work assignments for colleagues when needed 4.20 (0.49) 4.03 (0.43) 0.043 (*)

C15: Reinforce legal concepts to avoid malpractice suits 4.44 (0.50) 4.09 (0.55) 0.000 (***)

C16: Treating patients as family 4.39 (0.49) 3.94 (0.56) 0.000 (***)

C17: Open-minded for advice when treating a tough case 4.44 (0.63) 4.22 (0.54) 0.039 (*)

C18: Answer patients’ and their family’s questions in detail 4.59 (0.53) 4.17 (0.48) 0.000 (***)

C19: Reducing tests can reduce cost 4.48 (0.63) 4.00 (0.70) 0.000 (***)

C20: Complies with hospital rules even when nobody watches and no evidence can be traced 4.44 (0.60) 4.18 (0.42) 0.009 (**)

C21: Feel uncorrelated if others use illicit tactics to seek personal influence 3.78 (0.98) 3.45 (1.00) 0.072 (+)

Table15. Comparison of physician's personal value between altruism and egoism physicians

*** : up to p<=0.001 ** : up to p<=0.01

* : up to p<=0.05 + : up to p<=0.1

Item

X X


(SD) (SD) (sig.)

H1: Most physicians involve in elevating professional skills 4.20 (0.74) 3.81 (0.70) 0.004 (**)

H2: Individual department is systemized 3.96 (0.64) 3.72 (0.84) 0.080 (+)

H3: Physicians are empowered fully in clinical decisions 4.00 (0.80) 3.74 (0.77) 0.074 (+)

H4: Paramedics coordinate with physicians in testing 4.06 (0.69) 3.59 (0.89) 0.002 (**)

H5: Individual department encourage team work and discussions 4.20 (0.66) 3.64 (0.72) 0.000 (***)

H6: The head of hospital would communicate with physicians about medical quality 3.70 (0.86) 3.38 (0.88) 0.049 (*)

H7: Hospital encourage physicians to study and learn 3.89 (0.90) 3.62 (0.72) 0.069 (+)

H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients 3.78 (0.84) 3.48 (0.90) 0.064 (+)

H9: Hospital would organize medical seminars and conferences to improve medical quality 4.22 (0.63) 3.68 (0.75) 0.000 (***)

H10: Hospital evaluates patients’ satisfaction periodically 3.80 (0.86) 3.55 (0.83) 0.112

H11: Nurses coordinate with physicians in treating patients 4.09 (0.68) 3.89 (0.53) 0.082 (+)

H12: Hospital encourage physicians to involve in improving medical quality 3.80 (0.76) 3.45 (0.78) 0.017 (*)

H13: Physicians’ practice is respected and autonomous 3.80 (0.96) 3.40 (0.86) 0.019 (*)

H14: The head of hospital clearly understand the fundamental principles of medical quality 4.04 (0.70) 3.62 (0.79) 0.004 (**)

H15: Customers’ complaints are the beginning of improvement for medical quality 3.83 (0.82) 3.57 (0.86) 0.095 (+)

H16: Hospital would communicate with physicians about patients’ responses 3.70 (0.96) 3.52 (0.79) 0.264

H17: Department chair encourage an organizational culture with trust and commitment 3.93 (0.79) 3.62 (0.72) 0.028 (*)

H18: Administrative department do their best to support medical affairs 3.65 (0.87) 3.15 (1.02) 0.006 (**)

H19: Hospital would interfere with physicians’ decisions in medicinal prescription 2.85 (0.99) 3.27 (0.97) 0.021 (*)

H20: Use clinical path analysis and evidence based medicine to improve medical quality 4.02 (0.59) 3.80 (0.67) 0.063 (+)

H21: Department chair would communicate with physicians about medical quality 3.94 (0.76) 3.64 (0.80) 0.039 (*)

H22: The head of hospital would support the implementation of quality planning 3.85 (0.68) 3.58 (0.88) 0.072 (+)

H23: Individual department tries to build some clinical quality indicators 3.72 (0.84) 3.42 (0.88) 0.055 (+)

H24: Each department has the same target in elevating medical quality 3.39 (0.96) 3.20 (0.91) 0.284

*** : up to p<=0.001 ** : up to p<=0.01

* : up to p<=0.05 + : up to p<=0.1

Item

Table16. Comparison of physician and hospital TQM relationship between altruism and egoism physicians

X X


(SD) (SD) (sig.)

Q1: Observe the repeated patient’s recovering situations after surgery 4.31 (0.51) 4.05 (0.37) 0.002 (**)

Q2: Patients show their affirmative about treatment to physicians directly 4.11 (0.46) 3.77 (0.52) 0.000 (***)

Q3: Patients show their affirmative about treatment to hospital 3.85 (0.60) 3.63 (0.52) 0.036 (*)

Q4: Repeated visit rate of patients after surgery 4.33 (0.51) 4.00 (0.43) 0.000 (***)

Q5: Do best to prevent malpractice suits 4.16 (0.61) 3.83 (0.52) 0.001 (***)

Q6: Explain patient’s conditions to patient himself/ herself orally 4.26 (0.68) 3.97 (0.43) 0.008 (**)

Q7: Tell patients the truth about after-effects and syndromes 4.18 (0.68) 3.78 (0.72) 0.002 (**)

Q8: Illustrate the functions of medicine and instruct patients how to take medicines 3.92 (0.72) 3.57 (0.68) 0.007 (**)

Q9: Both oral and written form of communication to understand patients’ life quality after surgery 4.04 (0.61) 3.52 (0.71) 0.000 (***)

Q10: The accuracy of decisions about the requirements of tests 3.98 (0.53) 3.78 (0.48) 0.037 (*)

Q11: Self assessment about the surgery conditions and results 4.02 (0.46) 3.86 (0.39) 0.045 (*)

Q12: Discuss the factor incurring syndromes and the corresponding treatments 4.13 (0.55) 3.89 (0.40) 0.010 (**)

Q13: The degree of consistence between diagnosis and pathology 4.22 (0.50) 3.85 (0.40) 0.000 (***)


Item

Table17. Comparison of medical quality between altruism and egoism physicians

X X


(SD) (SD) (sig.)

Q14a: Participate clinical medical seminars 4.56 (1.11) 4.09 (1.28) 0.039 (*)

Q14b: Participate regular meeting within hospital 5.00 (1.10) 4.56 (1.14) 0.042 (*)

Q14c: Doing up-to-date literature review about professional clinics 4.65 (1.01) 4.49 (1.06) 0.417

Q14d: Publishing clinical research results in journals 3.15 (1.61) 2.68 (1.61) 0.114

Q14e: To learn by observation from other hospitals domestically and abroad 3.31 (1.65) 3.23 (1.67) 0.783

Table18. Comparison of professional advanced study between altruism and egoism physicians

Item

*** : up to p<=0.001 ** : up to p<=0.01

* : up to p<=0.05 + : up to p<=0.1

X X

Fshe1-Fshe5

Fsq141

altruistic

vs.egoism

Fsqe1,

Fsqe2

Linear Regression Analysis(stepwise) — One control variable: B70, years spending in senior attending

— VIF is 1.3 for 1 cv & 6 indep. vars.

— α=0.05

Results

Altruism: Adj-R2

Fsqe1 = 0.363 + 0.395*Fsq141 0.061

Fsqe2 = 0.357 + 0.422*Fshe1 + 0.378*Fshe3 + 0.327*Fshe5 0.257

Egoism : Fsqe1 = -0.185 + 0.323*Fsq141 0.116

Fsqe2 = -0.182 + 0.213*Fshe4 + 0.196*Fsq141 0.096

Results

Discussions & Conclusions

For both type doctors

— advanced study (Fsq141) help preventing malpractice (Fsqe1) For altruism doctors

— hospital encourage physicians’ promoting medical skill with customer in mind (Fshe1),

hospital actively communicating with physicians about medical quality (Fshe3),

full empowering physicians in clinical decisions (Fshe5),

help patients’ affirmation and treatment accuracy (Faqe2)

For egoism doctors

— advanced study (Fsq141) & teamwork to elevating medical

profession (Fshe4) help patients’ affirmation and treatment

accuracy (Fsqe2)

Building TQM relationship with physicians, hospitals can help in different ways.

— for egoism, emphasizing team working can promote patient’s affirmation and treatment accuracy.

— for altruism, emphasizing patient satisfaction, communicating about medical quality, fully empowering in clinical decisions can promote patients’ affirmation and treatment accuracy.

Physician’s advanced study(an indicator of physician’s profession ) help preventing mal-practice.

Confirm the interaction between personal value and organizational culture — Match of altruism doctors with TQM outperform in patient’s affirmation,

treatment accuracy and preventing mal-practices. Building physician-hospital TQM relationship helps all senior attending

doctors.

Discussions & Conclusions

physicians in tqm: a survey in taiwan fenghueih huarng department of business adm,southern taiwan...

Documents

physicians personal

physicians effort

tqm culture

clinical medical quality

tqm weiner

tqm zabada

altruism physician

egoism physician