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This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/15982688200700028. When citing the article, please cite: Noor Hazilah Abd Manaf, Phang Siew Nooi, (2007), “Patient Satisfaction as An Indicator of Service Quality In Malaysian Public Hospitals”, Asian Journal on Quality, Vol. 8 Iss: 3, pp. 113 - 122.

This study aims to investigate applications of Lean Six Sigma approaches and quality performance in Malaysian hospitals. It identifies five dimensions of Lean Six Sigma conformance (i.e. continuous quality improvement, Lean management initiatives, Six Sigma initiatives, patient safety and teamwork) and quality performance of the hospitals based on demographics such as gender, types of hospital and working experience.

This study distributed 1,007 self-administered survey questionnaires to hospital staff resulting in 438 useful responses with 43.5 per cent response rate. Research data were analysed based on reliability analysis, exploratory factor analysis (EFA), independent samples t-tests and one-way ANOVA using SPSS version 23.

Research findings indicate that there are significant differences between public and private hospital staff on Lean management initiatives, Six Sigma initiatives, patient safety and teamwork. Private hospital staff perceives Lean management initiatives, Six Sigma initiatives, patient safety and teamwork more favourably compared to public hospital staff. The present study findings also indicate that senior hospital staff (more than 10 years working experience) perceives patient safety and teamwork more favourably compared to other working experience groups.

The research focused solely on the Malaysian health sector, and thus, the results might not be applicable to other countries.

This research provides theoretical, methodological and practical contributions for the Lean Six Sigma approach and the research findings are expected to provide guidelines to enhance the level of quality performance in healthcare organisations in Malaysia as well as other countries.

This study aims to investigate applications of Six Sigma methodology in Malaysian private hospitals. It measures Six Sigma initiatives of the private hospitals based on demographics such as gender, position and working experience.

The present study measures Six Sigma initiatives of private hospitals and used stratified random sampling to collect data from eight selected hospitals in Peninsular Malaysia. The respondents of the study include doctors, nurses, pharmacists and medical laboratory technologists. In this study, 520 questionnaires were distributed to respondents who are working in Malaysian private hospitals. In total, 251 responses were received (48.27 per cent response rate). The descriptive analysis, independent samples t-test and one-way ANOVA were undertaken using SPSS version 23.

The findings of this study indicate that male respondents have better perception on four aspects of Six Sigma applications such as process improvement tools, process improvement methods, manage quality improvement activities and formal planning process compared to female respondents. The research findings also indicate that doctors have better perception regarding process improvement tools to measure quality improvement process, leadership to continuous improvement processes, training in process improvement tools for employees’ skill improvement compared to nurses, pharmacists, medical laboratory technologists.

The present research focussed solely on the Malaysian private hospitals, and thus the results might not be applicable to other countries. This study focussed on Six Sigma initiatives of private hospitals in Malaysia, while the future research may consider investigating the difference or conformance between private and public hospitals on Six Sigma initiatives and its relationship with quality performance. In addition, present study findings are expected to provide guidelines to enhance the applications of Six Sigma methodology in private hospitals in Malaysia as well as other countries.

This research provides theoretical and practical contributions for the Six Sigma initiatives in private hospitals. Most of the past studies of Six Sigma initiatives are centred on manufacturing sector, but few empirical studies have been conducted on the health-care organisation. Thus, findings of the present study on the health-care sector contribute to the on-going pursuit of knowledge in the area of Six Sigma by using the strength of related theories and parent disciplines.

This study aims to measure quality performance of the Malaysian hospitals based on eight items, namely, progress of quality management, medical service cost, reduce errors in medical services, patient waiting time, reduce waste in processes, patient complaint, employee job satisfaction and patient satisfaction. Mainly, it identifies difference or conformance between public and private hospitals on quality performance.

This study distributed 1,007 self-administered survey questionnaires to the hospital staff (i.e. doctors, nurses, pharmacists and medical laboratory technologists), resulting in 438 useful responses (43.5 per cent response rate). Research data were analysed based on descriptive analysis and independent samples’ t-tests using SPSS version 23.

The findings of this study indicate that there are significant differences between public and private hospital staff on progress of quality improvement process, patient satisfaction and cost of the medical services. Private hospital staff believed that their hospital’s quality management process and patient satisfaction has been improved over the past years compared to public hospital. However, private hospital staff does not perceive their medical service cost has been reduced over the past years compared to public hospital.

This research focused solely on quality performance of the Malaysian health sector and, thus, the results might not be applicable to other countries.

Present research findings provide guidelines for enhancing quality performance in Malaysian public and private healthcare sectors and other countries.

The purpose of this paper is to investigate the effects of Lean Six Sigma (LSS) and workforce management on the quality performance of Malaysian hospitals. This paper also investigates the direct and indirect relationships between top management commitment and quality performance of the healthcare organisations in Malaysia.

This study applied stratified random sampling to collect data from 15 different hospitals in Peninsular Malaysia. The self-administered survey questionnaires were distributed among 673 hospital staff (i.e. doctors, nurses, pharmacists, and medical laboratory technologists) to obtain 335 useful responses with a 49.47 per cent valid response rate. The research data were analysed based on confirmatory factor analysis and structural equation modelling by using AMOS version 23 software.

The research findings indicated that LSS and workforce management have a significant impact on quality performance of the Malaysian hospitals, whereas senior management commitment was found to have an insignificant relationship with quality performance. The research findings indicate that senior management commitment has no direct significant relationship with quality performance, but it has an indirect significant relationship with quality performance through the mediating effects of LSS and workforce management.

This research focussed solely on healthcare organisations in Malaysia and thus the results might not be applicable for other countries as well as other service organisations.

This research provides theoretical, methodological, and practical contributions for the LSS approach and the research findings are expected to provide guidelines to enhance the level of quality performance in healthcare organisations in Malaysia as well as other countries.

The purpose of this paper is to identify the dimensions of preparedness for hospital practice among newly graduated medical officers in Malaysian hospitals who are undergoing their housemanship training; and to compare the level of preparedness among the different curricula and predict the dimensions of preparedness for hospital practice.

A national study was carried out and data collection was by means of self-administered questionnaire. Data obtained (n=1,213) were subjected to exploratory factor analysis using Statistical Package for Social Sciences version 18 in extracting the dimensions of preparedness for hospital practice.

Nine dimensions of hospital practice were identified which were access to information and IT skills, interpersonal skills, basic skills, and continuing professional development, holistic skills, coping skills, ethic and legal skills, patient management skills, scientific knowledge, and clinical skills. Overall, the respondents felt their medical schools prepared them for hospital practice. The strongest predictor for preparedness for hospital practice is coping skills. Holistic skill and preparedness for hospital practice was found to be negatively associated. Those who graduated from twining programmes between Malaysian and overseas universities were found to be better prepared for hospital practice.

An understanding on preparedness for hospital practice among newly graduated medical officers is a step forward in assuring patient safety and quality of care.

Although of significant importance, however, a study of this nature is rarely researched and the first for Malaysian houseman.

This paper aims to address and identify the major stakeholders in the medical tourism industry, based on their participation in medical tourism activities and their support for medical tourism development.

This paper systematically reviews the content of medical tourism studies from literature to identify key stakeholders and address the roles they play in the medical tourism industry.

This study shows that the key stakeholders in the medical tourism industry are eight, namely, medical tourists, health-care providers, government agencies, facilitators, accreditation and credentialing bodies, health-care marketers, insurance providers and infrastructure and facilities. These stakeholders strongly influence medical tourists’ decision-making process in seeking medical treatment abroad. Besides, a successful medical tourism development depends greatly on the excellent partnership between all stakeholders.

This paper sheds light on the crucial role of these stakeholders that can be an important consideration in medical tourists’ decision-making process and industry growth. The study can facilitate policymakers in designing and developing policies to improve medical tourism practices.

This paper expands the knowledge about medical tourism literature by identifying and explaining the significant role of each stakeholder in the industry. The results of this paper are quite revealing to all practitioners in terms of the potential strategies and medical tourism growth. The study establishes a foundation for future medical tourism research in the rapidly growing industry.

本文旨在根据医疗旅游的参与及其对医疗旅游发展的支持, 来确定医疗旅游的主要利益相关者。

本文系统地回顾了文献中的医疗旅游研究内容, 以识别关键的利益相关者并探讨他们在医疗旅游行业中所扮演的角色。

这项研究表明, 医疗旅游的主要利益相关者有八个：医疗游客, 医疗保健提供者, 政府机构, 促进者, 资格认证机构, 医疗保健营销人员, 保险提供者以及基础设施。这些利益相关者强烈影响医疗旅游游客在国外寻求医疗服务的决策过程。此外, 医疗旅游业的成功发展很大程度上取决于所有利益相关者之间的良好伙伴关系。

本文阐明了这些利益相关者的关键作用, 这是医疗游客决策过程和行业增长的重要考虑因素。该研究可以帮助决策者设计和制定改善医疗旅游实践的政策。

本文通过确定和解释每个利益相关者在行业中的重要作用, 扩展了对医疗旅游文献的了解。本文的结果在潜在策略和医疗旅游的增长方面对所有从业者都颇具启发性。该研究为快速发展的医疗旅游行业的未来方向研究奠定了基础。

Este artículo, tiene como objetivo abordar e identificar, los principales actores en la industria del turismo médico, en función de su participación en actividades de turismo médico y su apoyo al desarrollo del turismo médico.

El trabajo revisa sistemáticamente, la literatura y el contenido de los estudios de turismo médico para identificar a las partes interesadas, elementos clave y abordar los roles que desempeñan en la industria del turismo médico.

Este estudio muestra que los actores clave en la industria del turismo médico son ocho: turistas médicos, proveedores de atención médica, agencias gubernamentales, facilitadores, organismos de acreditación y acreditación, comercializadores de atención médica, proveedores de seguros e infraestructura e instalaciones. Estos actores, influyen de forma notable, en el proceso de toma de decisiones de los turistas médicos, al buscar tratamiento en el extranjero. Además, un desarrollo exitoso del turismo médico depende en gran medida de una excelente asociación entre todas las partes interesadas.

Este documento arroja luz sobre el papel crucial de estos actores y puede ser una consideración importante en el proceso de toma de decisiones de los turistas médicos y el crecimiento de la industria. El estudio puede facilitar, en el diseño y desarrollo de políticas para mejorar las prácticas de turismo medico, a los responsables políticos.

Este documento amplía el conocimiento sobre la literatura de turismo medico, identificando y explicando el papel importante de cada actor en la industria. Los resultados de este documento son bastante reveladores para todos los profesionales, en términos de estrategias potenciales y crecimiento del turismo médico. El estudio establece una base para futuras investigaciones sobre turismo médico en la industria de rápido crecimiento.

The purpose of this paper is to investigate the influence of direct-to-physician promotion on physicians’ prescription behaviour. There were very few studies which have investigated to what extent the pharmaceutical promotion directed towards physicians influences physicians’ prescription behaviour in the Malaysian context.

A research framework has been developed based on the buyer behaviour stimulus-response model. A survey method has been used to collect data from 154 medical practitioners from private health-care facilities located at Klang valley in Malaysia. IBM SPSS and SmartPLS statistical programs have been used to analyse the data and validate the model.

This study found that personal selling is the most significant promotional tool for physicians’ prescription behaviour, whereas advertising is the least significant one. Sales promotion and public relations are the second and third most significant promotional tools. Direct marketing is found to be not significant.

This paper will help the pharmaceutical companies develop more effective plans to gain a competitive advantage for their business by having a guideline for pharmaceutical marketers as an input to the more efficient allocation of their promotional budgets.

This study has introduced a comprehensive understanding of all the factors in the pharmaceutical promotion that influence physicians’ prescription behaviour in Malaysia and how these factors are interrelated, influencing physicians’ prescribing medicines for patients.

The World Health Organization identified vaccine hesitancy as one of the ten threats to global health in 2019. The purpose of this paper is to evaluate the implications and factors affecting parental decision on childhood immunisation in Malaysia.

This paper reviews literature on vaccine hesitancy and evaluation of factors affecting parental decision on childhood immunisation in Malaysia.

Vaccine hesitancy is a growing public health concern in Malaysia with factors such as influence of Internet and social media, personal choice and individual right, conspiracy theory, religious reasons and alternative medicine as among the influencing dynamics. An urban, educated demography operating within a postmodern medical paradigm compounds the diminishing value of vaccines.

This paper provides a comprehensive examination of vaccine hesitancy in Malaysia. Critical appraisal on personal choice over societal responsibility within an Asian/Muslim collectivist society has not been discussed in previous studies. The acceptance of homeopathy as an Islamic medicine alternative is peculiar to multi-ethnic, multi-cultural Malaysia.

The Ministry of Health (MOH) is the major healthcare provider in Malaysia, although the service is also being complemented by the private sector which constitutes about 35% of overall healthcare services. Public hospitals in the country are organised into national level, state level and district level. The national level hospital is Hospital Kuala Lumpur, which serves as the National Referral Centre. It is the largest hospital in the country with 2500 beds, providing a comprehensive range of tertiary care services. The state level hospitals provide a comprehensive range of secondary care services and are located in the state capital of each of the thirteen federal states in the country. These are also large hospitals with bed capacity ranging from 800‐1200. The district level hospitals on the other hand, provide basic impatient care services. For those with resident specialist, some secondary level speciality services are also provided. District hospitals without specialities are generally smaller with beds ranging from 30 to 150, while those with specialists may have beds ranging from 200 to 500.