城市社区居家养老服务质量研究
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摘要
所谓社区居家养老,是指老年人在家中居住,但由社区提供养老服务的一种社会化养老模式。社区居家养老服务,则是以家庭为核心,以社区为依托,以专业化服务机构为载体,通过上门、日托或邻里互助的服务形式,为居家老年人提供生活照料、康复护理、医疗保健等为主要内容的社会化服务。基于我国人口老龄化日益加剧这一新的重要国情,社区居家养老已经成为绝大多数老人选择的养老方式,由此带来对社区居家养老服务的需求日益增加,发展社区居家养老服务已经成为我国应对人口老龄化的一项迫在眉睫的任务。
作为一种社会性公共服务,社区居家养老服务具有公平性、福利性的普遍特征,又具有需求个性化、多样化和不确定性特点,其服务质量直接关系到老年人晚年生活质量和自身的健康。因此,服务质量管理是当前社区居家养老服务发展的关键。对社区居家养老服务质量的研究,有利于推动社区居家养老服务管理的科学化,进而促进社区居家养老服务质量的提高；有利于提高公共财政的投入效率、促进社会服务的公平、高效发展,对于保证和提高老年人的养老生活质量有着重要的现实意义。同时,构建社区居家养老服务质量的理论框架,运用PZB服务质量模型建立社区居家养老服务质量模型,将管理学的理论和研究方法运用到公共服务领域,是对公共管理理论的发展和研究方法的新拓展,具有较强的理论价值。需要指出的是,由于我国城乡社区居家养老服务发展存在着较大的差异,本文的研究对象是城市社区居家养老服务的质量,文中所提到的社区居家养老服务均是指城市社区居家养老服务。
首先,本文在社区居家养老服务质量理论阐释的基础上,构建了社区居家养老服务质量的理论模型。本文从社区居家养老服务发展的理论依据、社区居家养老服务的公共服务属性、公共服务质量评估理论,以及顾客感知服务质量理论四个层面构建了社区居家养老服务及其质量的理论框架；接着,本文分析了城市社区居家养老服务体系的构成,对社区居家养老服务质量的基本概念进行了界定,并进一步阐述了社区居家养老服务的服务产品一般特征：无形性、差异性、不可分离性和不可储存性,同时阐明了其独有特征：服务内容多样性、服务供给主体多元性、服务环境不确定性等；在此基础上,从社区居家养老服务的特点、属性出发,依据老年人养老的基本需求,将社区居家养老服务分为生活照料服务、医疗护理服务和精神慰藉服务等三个大类,进而将居家养老服务质量内容结构分解为助餐服务、助洁服务、助医服务和康乐服务四个核心部分。同时,将SERVQUAL(即SERVICE QUALITY的缩写,专指一种特定的服务质量评价方法)引入到社区居家养老服务的质量评价,并用“可感知性”评价维度修正了原来的“有形性”维度,从而形成了可靠性、保证性、响应性、可感知性和移情性5个基于SERVQUAL的社区居家养老服务质量维度,进而构建了社区居家养老服务质量的理论模型。
其次,本文以上海市为例,对城市社区居家养老服务质量模型进行了实证研究。依据SERVQUAL模型设计问卷和开发测评量表,通过对上海市享受社区居家养老服务老人的入户调查采集的样本数据,借助SPSS和结构方程专业统计软件,采用探索性因子分析、验证性因子分析等方法,对城市社区居家养老服务质量模型的进行了实证研究。研究结果表明,社区居家养老服务质量模型是一个包括助餐服务质量、助洁服务质量、助医服务质量以及康乐服务质量的二阶结构方程模型,进一步通过信度、效度分析以及拟合优度检验,发现社区居家养老服务质量模型具有较高的可靠性和稳定性。
再次,本文通过对社区居家养老服务质量实证研究结果的比较发现：不同类别的服务质量、不同维度的服务质量存在着明显的差异。服务类别方面：助洁、助餐、助医和康乐服务中,服务质量评价最高的是助洁服务,其次是助餐服务,助医服务质量明显低于前二者,而康乐服务质量与前三者尚有较大的差距；通过对服务质量不同维度的比较发现：可靠性、可感知性和响应性三个维度评价结果比较接近,总体评价比较高,而对服务质量的移情性评价则较低,服务质量最为欠缺的是保证性。在上述服务质量差异分析的基础上,进一步对服务质量的影响因素进行研究发现：影响社区居家养老服务质量的因素来自于服务供给方和服务接受方二个方面。来自服务供给方的影响因素有：社区居家养老服务体系的不完善,服务人员队伍不稳定且素质较低,这些因素影响了社区居家养老服务质量的提高。来自服务接受者老年人的影响因素有：老人的个体差异和老年人的生活状况。老年人的个体差异,如：年龄、性别、生活自理能力等会不同程度地影响到社区居家养老服务的质量；老年人的生活状况,如：居住安排、经济收入、接受政府补贴状况以及所在区域等差别,也会对社区居家养老服务质量产生影响。
最后,根据上述研究结果,本文提出了提高社区居家养老服务质量的政策建议：通过完善服务体系以提升社区居家养老服务整体质量；通过加强人力资源队伍建设以保证社区居家养老服务的专业性；通过提供个性化服务以增强社区居家养老服务的针对性；通过加大政府投入力度以提高社区居家养老服务的满意度。
Elderly home care indicates a pattern that senior citizens living in their homes meanwhile they are offered old-age support from the society. While elderly home care services in communities indicates a pattern in which a family is the nuclear, a community is the support and a professional organization is the service deliver.
Elderly home care in the community has become most Chinese older people's choice to live their late life in the background of fast population aging, which brings growing service demands and enables developing the service to be a pressing task in the process of tackling problems led by population aging. As a public service, elderly home care featured common characteristics like equality and welfare-related, as well as demands individuality, plurality and uncertainty. And its quality is directly related to the standard of older people's late life. Therefore, researching on the service quality of elderly home care in urban communities is beneficial to promote the scientificility of its management thus enhancing its quality and is beneficial to increase the efficiency of public inputs and facilitate social services to grow in an equal and efficient mode, as well as is of critical practical significance to secure and enhance older people's life standard. Meanwhile, it will make new explorations to public management theory and research methods and be of some theoretical values to construct a theoretical framework of quality assessment of elderly home care in community, establish a quality assessment model based on PZB (A·Parasuraman, Valarie A·Zeithaml&Leonard L·Berry) Model and apply theories and research methods of management science to public service studies.
This dissertation firstly defines the basic concept of service quality of elderly home care in community and analytically states that this service embodies the common characteristics of service products, namely intangibility, heterogeneity, inseparability and perishability as well as its own special characteristics such as various service items, plural service suppliers, uncertain service environments, etc. The dissertation starts from the analysis of characteristics and attributes of elderly home care in community and divides this service into three categories, namely life assistance service, medical care service and spiritual comfort in accordance with older people's basic needs. Furthermore, quality assessment of elderly home care is divided into four core components, namely meals assistance service, cleanliness assistance service, medical care assistance service and recreation and rehabilitation assistance service. In the meantime, SERVQUAL (Service Quality) method is introduced into the quality assessment of this service and the former dimension of tangibles is replaced by sensibility. After this adjustment, five assessment dimensions of elderly home care in community's quality are formed based on SERVQUAL, namely sensibility, reliability, assurance, responsiveness, and empathy. And a theoretical framework of quality assessment of elderly home care in community is established.
The questionnaire and assessment scales in this research are based on the theoretical framework. Through a door-to-door questionnaire survey with the samples in Shanghai and a constitutive equation of quality assessment of elderly home care in community established by SERVQUAL model, this research constructs an empirical model of quality assessment of elderly home care in urban community with statistics software SPSS and Structural Equation Modeling (SEM) and in the methods of principal component analysis of exploratory factor analysis, confirmatory factor analysis, multivariate analysis of variance and so on. SEM is applied to test the structure of the empirical research, and the quality of elderly home care in community is defined as the higher-order model of quality of meal assistance service, cleanliness assistance service, medical care assistance service and recreation and rehabilitation assistance service. Through constructing a measurement model to assess the quality of elderly home care in community from five dimensions, a conclusion can be drawn that the quality of this service has positive correlation with its sub-services, namely meal assistance, cleanliness assistance, medical care assistance and recreation and rehabilitation assistance. And it is found that the model has high reliability and stability after validity, reliability and goodness of fit test.
According to comparative research of the different services and different dimensions, we can find that phenomenal difference exists among the quality of four assistance services, i.e. cleanliness assistance service has the highest quality, meals assistance service has the second highest quality, and the quality of medical care assistance service is phenomenal lower than the first two while that of recreation and rehabilitation assistance service is phenomenal lower than other three. And through comparing different dimensions of measuring this service's quality, we can find that the results of assurance, sensibility and responsiveness are similar and high, while empathy is much lower and assurance is the lowest.
With the multivariate analysis of variance of elderly home care in community, it's found there are differences of service clients like age, gender and self-care ability will impose influences to the assessment results to various extents and older people's livelihood like living conditions, income, welfare benefits and residence locations will also influence their expectancy of the service, thus influencing their assessments of service quality.
The last part of the dissertation puts forward following suggestions of enhancing the service quality of elderly home care in community:enhancing the standard of the service through improving service system, providing personalized service to enhance the community home care services targeted, strengthening human resources to ensure the professional community home care services, and enlarging governmental inputs to increase service satisfaction;
作为一种社会性公共服务,社区居家养老服务具有公平性、福利性的普遍特征,又具有需求个性化、多样化和不确定性特点,其服务质量直接关系到老年人晚年生活质量和自身的健康。因此,服务质量管理是当前社区居家养老服务发展的关键。对社区居家养老服务质量的研究,有利于推动社区居家养老服务管理的科学化,进而促进社区居家养老服务质量的提高；有利于提高公共财政的投入效率、促进社会服务的公平、高效发展,对于保证和提高老年人的养老生活质量有着重要的现实意义。同时,构建社区居家养老服务质量的理论框架,运用PZB服务质量模型建立社区居家养老服务质量模型,将管理学的理论和研究方法运用到公共服务领域,是对公共管理理论的发展和研究方法的新拓展,具有较强的理论价值。需要指出的是,由于我国城乡社区居家养老服务发展存在着较大的差异,本文的研究对象是城市社区居家养老服务的质量,文中所提到的社区居家养老服务均是指城市社区居家养老服务。
首先,本文在社区居家养老服务质量理论阐释的基础上,构建了社区居家养老服务质量的理论模型。本文从社区居家养老服务发展的理论依据、社区居家养老服务的公共服务属性、公共服务质量评估理论,以及顾客感知服务质量理论四个层面构建了社区居家养老服务及其质量的理论框架；接着,本文分析了城市社区居家养老服务体系的构成,对社区居家养老服务质量的基本概念进行了界定,并进一步阐述了社区居家养老服务的服务产品一般特征：无形性、差异性、不可分离性和不可储存性,同时阐明了其独有特征：服务内容多样性、服务供给主体多元性、服务环境不确定性等；在此基础上,从社区居家养老服务的特点、属性出发,依据老年人养老的基本需求,将社区居家养老服务分为生活照料服务、医疗护理服务和精神慰藉服务等三个大类,进而将居家养老服务质量内容结构分解为助餐服务、助洁服务、助医服务和康乐服务四个核心部分。同时,将SERVQUAL(即SERVICE QUALITY的缩写,专指一种特定的服务质量评价方法)引入到社区居家养老服务的质量评价,并用“可感知性”评价维度修正了原来的“有形性”维度,从而形成了可靠性、保证性、响应性、可感知性和移情性5个基于SERVQUAL的社区居家养老服务质量维度,进而构建了社区居家养老服务质量的理论模型。
其次,本文以上海市为例,对城市社区居家养老服务质量模型进行了实证研究。依据SERVQUAL模型设计问卷和开发测评量表,通过对上海市享受社区居家养老服务老人的入户调查采集的样本数据,借助SPSS和结构方程专业统计软件,采用探索性因子分析、验证性因子分析等方法,对城市社区居家养老服务质量模型的进行了实证研究。研究结果表明,社区居家养老服务质量模型是一个包括助餐服务质量、助洁服务质量、助医服务质量以及康乐服务质量的二阶结构方程模型,进一步通过信度、效度分析以及拟合优度检验,发现社区居家养老服务质量模型具有较高的可靠性和稳定性。
再次,本文通过对社区居家养老服务质量实证研究结果的比较发现：不同类别的服务质量、不同维度的服务质量存在着明显的差异。服务类别方面：助洁、助餐、助医和康乐服务中,服务质量评价最高的是助洁服务,其次是助餐服务,助医服务质量明显低于前二者,而康乐服务质量与前三者尚有较大的差距；通过对服务质量不同维度的比较发现：可靠性、可感知性和响应性三个维度评价结果比较接近,总体评价比较高,而对服务质量的移情性评价则较低,服务质量最为欠缺的是保证性。在上述服务质量差异分析的基础上,进一步对服务质量的影响因素进行研究发现：影响社区居家养老服务质量的因素来自于服务供给方和服务接受方二个方面。来自服务供给方的影响因素有：社区居家养老服务体系的不完善,服务人员队伍不稳定且素质较低,这些因素影响了社区居家养老服务质量的提高。来自服务接受者老年人的影响因素有：老人的个体差异和老年人的生活状况。老年人的个体差异,如：年龄、性别、生活自理能力等会不同程度地影响到社区居家养老服务的质量；老年人的生活状况,如：居住安排、经济收入、接受政府补贴状况以及所在区域等差别,也会对社区居家养老服务质量产生影响。
最后,根据上述研究结果,本文提出了提高社区居家养老服务质量的政策建议：通过完善服务体系以提升社区居家养老服务整体质量；通过加强人力资源队伍建设以保证社区居家养老服务的专业性；通过提供个性化服务以增强社区居家养老服务的针对性；通过加大政府投入力度以提高社区居家养老服务的满意度。
Elderly home care indicates a pattern that senior citizens living in their homes meanwhile they are offered old-age support from the society. While elderly home care services in communities indicates a pattern in which a family is the nuclear, a community is the support and a professional organization is the service deliver.
Elderly home care in the community has become most Chinese older people's choice to live their late life in the background of fast population aging, which brings growing service demands and enables developing the service to be a pressing task in the process of tackling problems led by population aging. As a public service, elderly home care featured common characteristics like equality and welfare-related, as well as demands individuality, plurality and uncertainty. And its quality is directly related to the standard of older people's late life. Therefore, researching on the service quality of elderly home care in urban communities is beneficial to promote the scientificility of its management thus enhancing its quality and is beneficial to increase the efficiency of public inputs and facilitate social services to grow in an equal and efficient mode, as well as is of critical practical significance to secure and enhance older people's life standard. Meanwhile, it will make new explorations to public management theory and research methods and be of some theoretical values to construct a theoretical framework of quality assessment of elderly home care in community, establish a quality assessment model based on PZB (A·Parasuraman, Valarie A·Zeithaml&Leonard L·Berry) Model and apply theories and research methods of management science to public service studies.
This dissertation firstly defines the basic concept of service quality of elderly home care in community and analytically states that this service embodies the common characteristics of service products, namely intangibility, heterogeneity, inseparability and perishability as well as its own special characteristics such as various service items, plural service suppliers, uncertain service environments, etc. The dissertation starts from the analysis of characteristics and attributes of elderly home care in community and divides this service into three categories, namely life assistance service, medical care service and spiritual comfort in accordance with older people's basic needs. Furthermore, quality assessment of elderly home care is divided into four core components, namely meals assistance service, cleanliness assistance service, medical care assistance service and recreation and rehabilitation assistance service. In the meantime, SERVQUAL (Service Quality) method is introduced into the quality assessment of this service and the former dimension of tangibles is replaced by sensibility. After this adjustment, five assessment dimensions of elderly home care in community's quality are formed based on SERVQUAL, namely sensibility, reliability, assurance, responsiveness, and empathy. And a theoretical framework of quality assessment of elderly home care in community is established.
The questionnaire and assessment scales in this research are based on the theoretical framework. Through a door-to-door questionnaire survey with the samples in Shanghai and a constitutive equation of quality assessment of elderly home care in community established by SERVQUAL model, this research constructs an empirical model of quality assessment of elderly home care in urban community with statistics software SPSS and Structural Equation Modeling (SEM) and in the methods of principal component analysis of exploratory factor analysis, confirmatory factor analysis, multivariate analysis of variance and so on. SEM is applied to test the structure of the empirical research, and the quality of elderly home care in community is defined as the higher-order model of quality of meal assistance service, cleanliness assistance service, medical care assistance service and recreation and rehabilitation assistance service. Through constructing a measurement model to assess the quality of elderly home care in community from five dimensions, a conclusion can be drawn that the quality of this service has positive correlation with its sub-services, namely meal assistance, cleanliness assistance, medical care assistance and recreation and rehabilitation assistance. And it is found that the model has high reliability and stability after validity, reliability and goodness of fit test.
According to comparative research of the different services and different dimensions, we can find that phenomenal difference exists among the quality of four assistance services, i.e. cleanliness assistance service has the highest quality, meals assistance service has the second highest quality, and the quality of medical care assistance service is phenomenal lower than the first two while that of recreation and rehabilitation assistance service is phenomenal lower than other three. And through comparing different dimensions of measuring this service's quality, we can find that the results of assurance, sensibility and responsiveness are similar and high, while empathy is much lower and assurance is the lowest.
With the multivariate analysis of variance of elderly home care in community, it's found there are differences of service clients like age, gender and self-care ability will impose influences to the assessment results to various extents and older people's livelihood like living conditions, income, welfare benefits and residence locations will also influence their expectancy of the service, thus influencing their assessments of service quality.
The last part of the dissertation puts forward following suggestions of enhancing the service quality of elderly home care in community:enhancing the standard of the service through improving service system, providing personalized service to enhance the community home care services targeted, strengthening human resources to ensure the professional community home care services, and enlarging governmental inputs to increase service satisfaction;
引文
2 2009年上海市老年人口和老龄事业监测统计信息,上海市民政局网上公布,www.shmzj.gov.cn
8 上海市民政局关于鼓励社区设立老年人助餐服务点的通知.沪民福发[2008]12号
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