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
Medical
quality
•Physician’s professional
advanced study
Physician’s
personal value
Qualitative results
—interviewing 22 doctors(most lasting at least 2 hours)
•NHI reimbursement rules
•Hospital cost policy
•Hospital payment policy about physicians
Medical
Quality
•Patients’ attitude
•The prevention of mal-practice suits
•Physicians’ professional ability
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)
Literature Review
 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)
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
Table1. Types of physician's department
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
36
16.2
2
0.9
222
100
Others
Missing value
Total
Table2.Types of physician's rank
Rank
Full time senior attending physician
Numbers
Percentage(%)
123
55.4
Chief residence physician
23
10.4
Residence physician
66
29.7
Others
10
4.5
222
100.0
Total
Table3. # of years after graduation
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
12
5.4
222
100.0
Missing value
Total
Table4. # of years with the title of senior attending physicians
Years
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
2
1.6
123
100.0
Missing value
Total
Numbers
Table5. N=222(total samples)
Variables
# of items
Physician's personal value
21
0.7897
Hospital and physician TQM relationship
24
0.9357
Medical quality
13
0.8871
5
0.7690
Physician's professional study
Table6. N=123(senior attending physician samples)
Variables
# of items
Physician's personal value
21
0.7840
Hospital and physician TQM relationship
24
0.9307
Medical quality
13
0.8866
5
0.7611
Physician's professional study
Table7. Comparison of physician's personal value between senior attending and residence physicians
Item
Senior attending
X
(SD)
Residence
X
(SD)
C1: Good Interaction between physician and patient
C2: Physicians should be mainly responsible for medical quality
C3: Willing to assist new colleagues to adjust to the work environment
C4: Make constructive suggestions that can improve the medical quality of the company
C5: Treating more patients can elevate my performance
C6: Instead of make-up treatments, we should improve in advance
C7: To reduce the length of stay can reduce the waste of cost
C8: Taking care of patients at all costs is the calling of doctors
C9: Use position power to pursue selfish personal gain
C10: Willing to coordinate and communicate with colleagues
4.50 ( 0.63 )
3.36 ( 1.18 )
4.21 ( 0.56 )
3.60 ( 0.71 )
3.70 ( 0.96 )
4.59 ( 0.51 )
3.92 ( 0.86 )
3.73 ( 1.02 )
3.11 ( 1.04 )
4.25 ( 0.61 )
4.35 ( 0.66 )
2. 90 ( 1.15 )
4.23 ( 0.53 )
3.35 ( 0.77 )
3.14 ( 1.04 )
4.42 ( 0.59 )
3.93 ( 0.86 )
3.26 ( 1.09 )
3.45 ( 0.98 )
4.27 ( 0.57 )
C11: Being a good person comes before being a good doctor
C12: Taking protective diagnosis to avoid malpractice suit
C13: Tries hard to self-study to elevate the quality of work outputs
C14: Willing to cover work assignments for colleagues when needed
C15: Reinforce legal concepts to avoid malpractice suits
C16: Treating patients as family
C17: Open-minded for advice when treating a tough case
C18: Answer patients’ and their family’s questions in detail
C19: Reducing tests can reduce cost
C20: Complies with hospital rules even when nobody watches and no evidence can be traced
C21: Feel uncorrelated if others use illicit tactics to seek personal influence
4.21 ( 0.74 )
3.72 ( 0.85 )
4.14 ( 0.63 )
4.11 ( 0.46 )
4.26 ( 0.056 )
4.14 ( 0.57 )
4.32 ( 0.59 )
4.36 ( 0.55 )
4.21 ( 0.72 )
4.29 ( 0.52 )
2.40 ( 0.99 )
4.10 ( 0.90 )
3.88 ( 0.86 )
4.19 ( 0.71 )
3.98 ( 0.68 )
4.26 ( 0.55 )
3.78 ( 0.79 )
4.30 ( 0.58 )
4.17 ( 0.74 )
4.18 ( 0.63 )
4.13 ( 0.66 )
2.48 ( 0.87 )
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
p-value
(sig.)
0.085 （+）
0.004 （**）
0.689
0.014 （*）
0.000 (***)
0.026 (*)
0.914
0.001 (***)
0.014 (**)
0.868
0.310
0.186
0.622
0.119
0.974
0.000 (***)
0.780
0.033 (*)
0.747
0.044 (*)
0.496
Table8. Comparison of physician and hospital TQM relationship between senior attending and residence physicians
Item
Senior attending
X
H1: Most physicians involve in elevating professional skills
H2: Individual department is systemized
H3: Physicians are empowered fully in clinical decisions
H4: Paramedics coordinate with physicians in testing
H5: Individual department encourage team work and discussions
H6: The head of hospital would communicate with physicians about medical quality
H7: Hospital encourage physicians to study and learn
H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients
H9: Hospital would organize medical seminars and conferences to improve medical quality
H10: Hospital evaluates patients’ satisfaction periodically
H11: Nurses coordinate with physicians in treating patients
H12: Hospital encourage physicians to involve in improving medical quality
H13: Physicians’ practice is respected and autonomous
H14: The head of hospital clearly understand the fundamental principles of medical quality
H15: Customers’ complaints are the beginning of improvement for medical quality
H16: Hospital would communicate with physicians about patients’ responses
H17: Department chair encourage an organizational culture with trust and commitment
H18: Administrative department do their best to support medical affairs
H19: Hospital would interfere with physicians’ decisions in medicinal prescription
H20: Use clinical path analysis and evidence based medicine to improve medical quality
H21: Department chair would communicate with physicians about medical quality
H22: The head of hospital would support the implementation of quality planning
H23: Individual department tries to build some clinical quality indicators
H24: Each department has the same target in elevating medical quality
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
(SD)
3.99 ( 0.73 )
3.83 ( 0.75 )
3.82 ( 0.82 )
3.79 ( 0.84 )
3.89( 0.74 )
3.52 ( 0.88 )
3.75 ( 0.81 )
3.61 ( 0.87 )
3.92 ( 0.74 )
3.66 ( 0.84 )
3.98 ( 0.60 )
3.62 ( 0.77 )
3.55 ( 0.94 )
3.79 ( 0.78 )
3.68 ( 0.84 )
3.62 ( 0.87 )
3.75 ( 0.76 )
3.38 ( 0.97 )
2.94 ( 1.02 )
3.89 ( 0.64 )
3.76 ( 0.79 )
3.69 ( 0.80 )
3.53 ( 0.87 )
3.28 ( 0.93 )
Residence
X
(SD)
3.84 ( 0.81 )
3.73 ( 0.87 )
3.42 ( 0.96 )
3.76 ( 0.75 )
3.55 ( 0.97 )
3.05 ( 1.11 )
3.54 ( 1.04 )
3.32 ( 1.01 )
3.66 ( 0.86 )
3.42 ( 0.84 )
3.71 ( 0.87 )
3.46 ( 0.84 )
2.90 ( 1.03 )
3.15 ( 0.99 )
3.40 ( 0.92 )
3.32 ( 0.92 )
3.39 ( 1.06 )
3.08 ( 1.09 )
3.53 ( 0.99 )
3.89 ( 0.73 )
3.59 ( 0.93 )
3.31 ( 0.92 )
3.39 ( 0.87 )
3.12 ( 1.04 )
p-value
(sig.)
0.136
0.395
0.002
0.763
0.005
0.001
0.009
0.020
0.020
0.048
0.010
0.135
0.000
0.000
0.019
0.016
0.005
0.033
0.000
0.970
0.168
0.001
0.234
0.001
(**)
(**)
(***)
(**)
(**)
(**)
(*)
(**)
(***)
(***)
(*)
(*)
(**)
(*)
(***)
(***)
(***)
Table9. Comparison of medical quality between senior attending and residence physicians
Item
Q1: Observe the repeated patient’s recovering situations after surgery
Q2: Patients show their affirmative about treatment to physicians directly
Q3: Patients show their affirmative about treatment to hospital
Q4: Repeated visit rate of patients after surgery
Q5: Do best to prevent malpractice suits
Q6: Explain patient’s conditions to patient himself/ herself orally
Q7: Tell patients the truth about after-effects and syndromes
Q8: Illustrate the functions of medicine and instruct patients how to take medicines
Q9: Both oral and written form of communication to understand patients’ life quality after surgery
Q10: The accuracy of decisions about the requirements of tests
Q11: Self assessment about the surgery conditions and results
Q12: Discuss the factor incurring syndromes and the corresponding treatments
Q13: The degree of consistence between diagnosis and pathology
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
Senior attending
Residence
X (SD)
4.17 ( 0.46 )
3.93 ( 0.52 )
3.74 ( 0.56 )
4.14 ( 0.50 )
3.97 ( 0.59 )
4.10 ( 0.56 )
3.98 ( 0.72 )
3.75 ( 0.72 )
3.76 ( 0.71 )
3.87 ( 0.51 )
3.92 ( 0.44 )
4.00 ( 0.49 )
4.02 ( 0.49 )
X (SD)
3.93 ( 0.62 )
3.81 ( 0.57 )
3.69 ( 0.61 )
3.75 ( 0.70 )
3.83 ( 0.74 )
4.04 ( 0.59 )
4.05 ( 0.65 )
3.78 ( 0.77 )
3.80 ( 0.70 )
3.80 ( 0.61 )
3.72 ( 0.75 )
3.94 ( 0.61 )
3.96 ( 0.57 )
p-value
(sig.)
0.001 (***)
0.125
0.561
0.000 (***)
0.145
0.476
0.413
0.726
0.616
0.393
0.022 (*)
0.357
0.361
Table10. Comparison of professional advanced study between senior attending and residence physicians
Item
Q14a: Participate clinical medical seminars
Q14b: Participate regular meeting within hospital
Q14c: Doing up-to-date literature review about professional clinics
Q14d: Publishing clinical research results in journals
Q14e: To learn by observation from other hospitals domestically and abroad
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
Senior attending
X
(SD)
4.30 (1.21)
4.73 (1.14)
4.57 (1.03)
2.94 (1.61)
3.31 (1.64)
Residence
X
(SD)
3.87 (1.43)
4.71 (1.13)
3.94 (1.26)
2.46 (1.76)
1.97 (1.82)
p-value
(sig.)
0.015 (*)
0.888
0.000 (***)
0.043 (*)
0.000 (***)
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)
Table11. Factor analysis for physician's personal value
Item
(Fsce1) elevating physician’s own professional ability
Loading
C15: Reinforce legal concepts to avoid malpractice suits
C13: Tries hard to self-study to elevate the quality of work outputs
C14: Willing to cover work assignments for colleagues when needed
(Fsce2) emphasizing professional ethics
0.746
0.668
0.631
C16: Treating patients as family
C11: Being a good person comes before being a good doctor
C20: Complies with hospital rules even when nobody watches and no evidence can be traced
C18: Answer patients’ and their family’s questions in detail
C8: Taking care of patients at all costs is the calling of doctors
(Fsce3) emphasizing cooperation among colleagues to be responsible for medical quality
0.658
0.582
0.565
0.512
0.470
C2: Physicians should be mainly responsible for medical quality
C3: Willing to assist new colleagues to adjust to the work environment
C17: Open-minded for advice when treating a tough case
(Fsce4) emphasizing communication and coordination
0.769
0.628
0.572
C1: Good Interaction between physician and patient
C10: Willing to coordinate and communicate with colleagues
C6: Instead of make-up treatments, we should improve in advance
(Fsce5) emphasizing on understanding medical cost
0.800
0.718
0.482.
C7: To reduce the length of stay can reduce the waste of cost
C19: Reducing tests can reduce cost
(Fsce6) pursue individual benefit
0.737
0.719
C9: Use position power to pursue selfish personal gain
C5: Treating more patients can elevate my performance
C12: Taking protective diagnosis to avoid malpractice suit
(Fsce7) emphasizing public benefit
0.788
0.739
0.584
C21: Feel uncorrelated if others use illicit tactics to seek personal influence
C4: Make constructive suggestions that can improve the medical quality of the company
0.816
0.713
Extraction Method: Principal Component Analysis.
Rotation Method: Equamax with Kaiser Normalization.
Table12. Factor analysis for physician - hospital TQM relationship
Item
Loading
(Fshe1) hospitals encouraging physicians to promote their medical skill with customer orientation in mind
H7: Hospital encourage physicians to study and learn
H10: Hospital evaluates patients’ satisfaction periodically
H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients
H22: The head of hospital would support the implementation of quality planning
H6: The head of hospital would communicate with physicians about medical quality
H14: The head of hospital clearly understand the fundamental principles of medical quality
H12: Hospital encourage physicians to involve in improving medical quality
H16: Hospital would communicate with physicians about patients’ responses
(Fshe2) supporting from all other departments
0.807
0.721
0.701
0.685
0.679
0.576
0.556
0.439
H11: Nurses coordinate with physicians in treating patients
H15: Customers’ complaints are the beginning of improvement for medical quality
H4: Paramedics coordinate with physicians in testing
H9: Hospital would organize medical seminars and conferences to improve medical quality
H13: Physicians’ practice is respected and autonomous
(Fshe3) hospital actively communicating with physicians about medical quality
0.762
0.679
0.557
0.519
0.507
H21: Department chair would communicate with physicians about medical quality
H23: Individual department tries to build some clinical quality indicators
H24: Each department has the same target in elevating medical quality
H17: Department chair encourage an organizational culture with trust and commitment
H18: Administrative department do their best to support medical affairs
(Fshe4) using team work to elevate medical profession
0.828
0.735
0.688
0.558
0.459
H1: Most physicians involve in elevating professional skills
H2: Individual department is systemized
H5: Individual department encourage team work and discussions
(Fshe5) fully empowering physicians in clinical decisions
0.869
0.809
0.587
H19: Hospital would interfere with physicians’ decisions in medicinal prescription
H20: Use clinical path analysis and evidence based medicine to improve medical quality
H3: Physicians are empowered fully in clinical decisions
Extraction Method: Principal Component Analysis.
Rotation Method: Equamax with Kaiser Normalization.
0.743
0.599
0.508
Table13. Factor analysis for efforts in elevating medical quality
Item
Loading
(Fsqe1) prevention of malpractice
Q7 : Tell patients the truth about after-effects and syndromes
Q6: Explain patient’s conditions to patient himself/ herself orally
Q10: The accuracy of decisions about the requirements of tests
Q8: Illustrate the functions of medicine and instruct patients how to take medicines
Q12: Discuss the factor incurring syndromes and the corresponding treatments
Q5: Do best to prevent malpractice suits
Q9: Both oral and written form of communication to understand patients’ life quality after surgery
(Fsqe2) patient’s affirmation and treatment accuracy
0.803
0.746
0.665
0.645
0.614
0.597
0.596
Q13: The degree of consistence between diagnosis and pathology
Q4: Repeated visit rate of patients after surgery
Q3: Patients show their affirmative about treatment to hospital
Q2: Patients show their affirmative about treatment to physicians directly
Q1: Observe the repeated patient’s recovering situations after surgery
Q11: Self assessment about the surgery conditions and results
Extraction Method: Principal Component Analysis.
Rotation Method: Equamax with Kaiser Normalization.
0.727
0.725
0.684
0.644
0.617
0.423
Table14. Factor analysis for professional advanced study
Item
Fsq141
Q14c: Doing up-to-date literature review about professional clinics
Q14e: To learn by observation from other hospitals domestically and abroad
Q14d: Publishing clinical research results in journals
Q14a: Participate clinical medical seminars
Q14b: Participate regular meeting within hospital
Extraction Method: Principal Component Analysis.
Rotation Method: Equamax with Kaiser Normalization.
0.757
0.756
0.727
0.721
0.653
Results
 Cluster Analysis
— using factor scores of physician personal values
— two groups: altruism vs. egoism
Table15. Comparison of physician's personal value between altruism and egoism physicians
Item
Altruism
X
C1: Good Interaction between physician and patient
C2: Physicians should be mainly responsible for medical quality
C3: Willing to assist new colleagues to adjust to the work environment
C4: Make constructive suggestions that can improve the medical quality of the company
C5: Treating more patients can elevate my performance
C6: Instead of make-up treatments, we should improve in advance
C7: To reduce the length of stay can reduce the waste of cost
C8: Taking care of patients at all costs is the calling of doctors
C9: Use position power to pursue selfish personal gain
C10: Willing to coordinate and communicate with colleagues
C11: Being a good person comes before being a good doctor
C12: Taking protective diagnosis to avoid malpractice suit
C13: Tries hard to self-study to elevate the quality of work outputs
C14: Willing to cover work assignments for colleagues when needed
C15: Reinforce legal concepts to avoid malpractice suits
C16: Treating patients as family
C17: Open-minded for advice when treating a tough case
C18: Answer patients’ and their family’s questions in detail
C19: Reducing tests can reduce cost
C20: Complies with hospital rules even when nobody watches and no evidence can be traced
C21: Feel uncorrelated if others use illicit tactics to seek personal influence
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
(SD)
4.81 (0.39)
3.00 (1.23)
4.37 (0.56)
3.83 (0.69)
3.46 (1.14)
4.94 (0.23)
4.30 (0.71)
3.76 (1.10)
2.87 (1.13)
4.56 (0.50)
4.44 (0.77)
3.52 (1.00)
4.31 (0.54)
4.20 (0.49)
4.44 (0.50)
4.39 (0.49)
4.44 (0.63)
4.59 (0.53)
4.48 (0.63)
4.44 (0.60)
3.78 (0.98)
Egoism
X
(SD)
4.25 (0.69)
3.69 (1.01)
4.08 (0.54)
3.45 (0.66)
3.89 (0.75)
4.28 (0.48)
3.63 (0.84)
3.66 (0.97)
3.28 (0.94)
4.01 (0.59)
4.05 (0.67)
3.88 (0.70)
4.00 (0.66)
4.03 (0.43)
4.09 (0.55)
3.94 (0.56)
4.22 (0.54)
4.17 (0.48)
4.00 (0.70)
4.18 (0.42)
3.45 (1.00)
p-value
(sig.)
0.000 (***)
0.001 (***)
0.005 (**)
0.002 (**)
0.020 (*)
0.000 (***)
0.000 (***)
0.608
0.038 (*)
0.000 (***)
0.004 (**)
0.029 (*)
0.006 (**)
0.043 (*)
0.000 (***)
0.000 (***)
0.039 (*)
0.000 (***)
0.000 (***)
0.009 (**)
0.072 (+)
Table16. Comparison of physician and hospital TQM relationship between altruism and egoism physicians
Item
H1: Most physicians involve in elevating professional skills
H2: Individual department is systemized
H3: Physicians are empowered fully in clinical decisions
H4: Paramedics coordinate with physicians in testing
H5: Individual department encourage team work and discussions
H6: The head of hospital would communicate with physicians about medical quality
H7: Hospital encourage physicians to study and learn
H8: Hospital encourage physicians to adopt new method with scientific medical evidence to treat patients
H9: Hospital would organize medical seminars and conferences to improve medical quality
H10: Hospital evaluates patients’ satisfaction periodically
H11: Nurses coordinate with physicians in treating patients
H12: Hospital encourage physicians to involve in improving medical quality
H13: Physicians’ practice is respected and autonomous
H14: The head of hospital clearly understand the fundamental principles of medical quality
H15: Customers’ complaints are the beginning of improvement for medical quality
H16: Hospital would communicate with physicians about patients’ responses
H17: Department chair encourage an organizational culture with trust and commitment
H18: Administrative department do their best to support medical affairs
H19: Hospital would interfere with physicians’ decisions in medicinal prescription
H20: Use clinical path analysis and evidence based medicine to improve medical quality
H21: Department chair would communicate with physicians about medical quality
H22: The head of hospital would support the implementation of quality planning
H23: Individual department tries to build some clinical quality indicators
H24: Each department has the same target in elevating medical quality
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
Altruism
Egoism
X
X
(SD)
4.20 (0.74)
3.96 (0.64)
4.00 (0.80)
4.06 (0.69)
4.20 (0.66)
3.70 (0.86)
3.89 (0.90)
3.78 (0.84)
4.22 (0.63)
3.80 (0.86)
4.09 (0.68)
3.80 (0.76)
3.80 (0.96)
4.04 (0.70)
3.83 (0.82)
3.70 (0.96)
3.93 (0.79)
3.65 (0.87)
2.85 (0.99)
4.02 (0.59)
3.94 (0.76)
3.85 (0.68)
3.72 (0.84)
3.39 (0.96)
(SD)
3.81 (0.70)
3.72 (0.84)
3.74 (0.77)
3.59 (0.89)
3.64 (0.72)
3.38 (0.88)
3.62 (0.72)
3.48 (0.90)
3.68 (0.75)
3.55 (0.83)
3.89 (0.53)
3.45 (0.78)
3.40 (0.86)
3.62 (0.79)
3.57 (0.86)
3.52 (0.79)
3.62 (0.72)
3.15 (1.02)
3.27 (0.97)
3.80 (0.67)
3.64 (0.80)
3.58 (0.88)
3.42 (0.88)
3.20 (0.91)
p-value
(sig.)
0.004 (**)
0.080 (+)
0.074 (+)
0.002 (**)
0.000 (***)
0.049 (*)
0.069 (+)
0.064 (+)
0.000 (***)
0.112
0.082 (+)
0.017 (*)
0.019 (*)
0.004 (**)
0.095 (+)
0.264
0.028 (*)
0.006 (**)
0.021 (*)
0.063 (+)
0.039 (*)
0.072 (+)
0.055 (+)
0.284
Table17. Comparison of medical quality between altruism and egoism physicians
Item
Q1: Observe the repeated patient’s recovering situations after surgery
Q2: Patients show their affirmative about treatment to physicians directly
Q3: Patients show their affirmative about treatment to hospital
Q4: Repeated visit rate of patients after surgery
Q5: Do best to prevent malpractice suits
Q6: Explain patient’s conditions to patient himself/ herself orally
Q7: Tell patients the truth about after-effects and syndromes
Q8: Illustrate the functions of medicine and instruct patients how to take medicines
Q9: Both oral and written form of communication to understand patients’ life quality after surgery
Q10: The accuracy of decisions about the requirements of tests
Q11: Self assessment about the surgery conditions and results
Q12: Discuss the factor incurring syndromes and the corresponding treatments
Q13: The degree of consistence between diagnosis and pathology
*** : up to p<=0.001
* : up to p<=0.05
** : up to p<=0.01
+ : up to p<=0.1
Altruism
Egoism
X
X
(SD)
4.31 (0.51)
4.11 (0.46)
3.85 (0.60)
4.33 (0.51)
4.16 (0.61)
4.26 (0.68)
4.18 (0.68)
3.92 (0.72)
4.04 (0.61)
3.98 (0.53)
4.02 (0.46)
4.13 (0.55)
4.22 (0.50)
(SD)
4.05 (0.37)
3.77 (0.52)
3.63 (0.52)
4.00 (0.43)
3.83 (0.52)
3.97 (0.43)
3.78 (0.72)
3.57 (0.68)
3.52 (0.71)
3.78 (0.48)
3.86 (0.39)
3.89 (0.40)
3.85 (0.40)
p-value
(sig.)
0.002 (**)
0.000 (***)
0.036 (*)
0.000 (***)
0.001 (***)
0.008 (**)
0.002 (**)
0.007 (**)
0.000 (***)
0.037 (*)
0.045 (*)
0.010 (**)
0.000 (***)
Table18. Comparison of professional advanced study between altruism and egoism physicians
Item
Q14a: Participate clinical medical seminars
Q14b: Participate regular meeting within hospital
Q14c: Doing up-to-date literature review about professional clinics
Q14d: Publishing clinical research results in journals
Q14e: To learn by observation from other hospitals domestically and abroad
*** : up to p<=0.001
** : up to p<=0.01
* : up to p<=0.05
+ : up to p<=0.1
Altruism
X (SD)
Egoism
X (SD)
4.56 (1.11)
5.00 (1.10)
4.65 (1.01)
3.15 (1.61)
3.31 (1.65)
4.09 (1.28)
4.56 (1.14)
4.49 (1.06)
2.68 (1.61)
3.23 (1.67)
p-value
(sig.)
0.039 (*)
0.042 (*)
0.417
0.114
0.783
Results
 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
Fshe1-Fshe5
Fsqe1,
Fsq141
Fsqe2
altruistic
vs.egoism
Results
 Altruism:
Fsqe1 = 0.363 + 0.395*Fsq141
Fsqe2 = 0.357 + 0.422*Fshe1 + 0.378*Fshe3 + 0.327*Fshe5
Adj-R2
0.061
0.257
 Egoism :
Fsqe1 = -0.185 + 0.323*Fsq141
Fsqe2 = -0.182 + 0.213*Fshe4 + 0.196*Fsq141
0.116
0.096
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)
Discussions & Conclusions
 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.