A Study of the Level of Satisfaction with the Quality of Educational Services among Students of Nursing-Midwifery in Islamic Azad University of Dezful Based on the Model of European Foundation of Quality Management

This study aimed to examine level of satisfaction with the quality of educational services among students of nursing-midwifery in Islamic Azad University of Dezful based on EFQM model. Statistical population of this survey consisted of all university students who had spent at least one semester in midwifery-nursing faculty of Islamic Azad university of Dezful. 270 students were selected through random sampling method. A questionnaire was developed by the researcher of current study based on customer-centered orientation of EFQM organizational excellence model. Data was analyzed through descriptive statistics and Chi-Square Test. The results showed that level of satisfaction at the educational services of nursing-midwifery and the affiliated hospitals was low (p = 0.99). Based on Freidman test, level of satisfaction at the accountability of staff was the most important factor, and it had the highest priority (mean rank 2/77). On the other hand, level of satisfaction at post-educational services was the least important, and it had the lowest priority (mean rank 2/30).


INTRODUCTION
One of the most important criteria in the quality of work and its continuous improvement is to attract customers and to keep them. Higher education is one of the most important organizations whose aim is to educate people and to develop human resources. Higher education is the foundation of progress and development in every country. A sustainable development in higher education system involves improvement in both qualitative and quantitative aspects of this system.
The model of European Foundation for Quality Management (EFQM) is a multidimensional model which is based on nine criteria. Five criteria (leadership, strategy, people,  (Faraji et al, 2010).
The cost of attracting a new customer is five to 10 times more than retaining current the customer. Today, organizations are able to properly explore their customers' expectations and take the necessary measures to address those expectations. Business excellence models are tools for improving quality (Biekzad et al, 2009). The aim of this study was to examine level of satisfaction at the quality of educational services among students of nursing-midwifery in Islamic Azad University of Dezful based on the model of European Foundation for Quality Management.

RESEARCH METHOD
This research is a descriptive-survey study which is based on the data collected by a questionnaire. The statistical population consisted of all students of nursing and midwifery (first and second semester of 1390-91). This group totally consisted of 898 students. Among these students, 548 people were studying midwifery and 350 people were studying nursing. Samples were selected through stratified random sampling method based on Morgan table, 270 students were selected for the study. 160 participants were midwifery students and 110 participants were nursing students.

INSTRUMENT (MATERIAL)
The questionnaire was made by the researcher of the study on the basis of criteria related to customer in the model of European Foundation for Quality Management.
This questionnaire was modified on the basis of some experts' views.

1. Validity
In order to determine the validity of the questionnaire, the supervisor and advisor of the research were consulted. A number of questions were modified or removed from the questionnaire. Finally, 20 questions were included in the questionnaire. SPSS software was used to analyze the data. For all hypotheses, level of significance was 0.05.

RESULTS
The descriptive results showed that midwifery students had the highest frequency (160 people or 59.3%) and nursing students had lowest frequency (110 people or 40.7%) in the sample.
The second-year students had the highest frequency (151 people or 55.9%) and the fourth-year students had the lowest frequency (29 people or 10.7%) in the sample of study.
Based on the frequency distribution and the percentage of general research question, the low-satisfaction at the performance of midwifery-nursing faculty had the highest frequency (149 people or 55.2%) and the high-satisfaction at the performance of midwifery-nursing faculty had the lowest frequency (5 people or 1.9%) ( Table 2 and Diagram 1). The mean and standard deviation of students' satisfaction scores were 2.89 and 0.84 respectively. The obtained mean is lower than the mean of Likert scale (the range was from 1 to 5; so, the mean of Likert scale was 3). It shows that students' satisfaction is low.

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Mean and standard deviation of students' satisfaction scores at quality of communication were 2.84 and 0.74 respectively. Also, Mean and standard deviation of students' satisfaction scores at follow-up educational services were 2.70 and 0.78 respectively. It shows a low level of satisfaction among students.
Mean and standard deviation of students' satisfaction scores at quality of educational services were 2.97 and 0.44 respectively. Mean and standard deviation of students' satisfaction scores at quality of staff accountability were 2.99 and 0.37 respectively. It shows a medium level of satisfaction among students.
Based on Freidman test, satisfaction at the quality of staff accountability had the highest priority (with a mean rank of 2/77) and the level of satisfaction at follow-up educational services had the lowest priority (with a mean rank of 2/30) among the factors related to students' satisfaction.

DISCUSSION AND CONCLUSION
The mean of students' satisfaction scores at the performance of midwifery-nursing faculty was 2.89 out of 5. It shows a low satisfaction. These results are not consistent with the results obtained from EFQM model for customers. Najmi (2010) says that the only way to satisfy customers is to focus on their demands and expectations.
The results of this study are consistent with the results obtained by Banidavoodi et al (2011). On the other hand, they are not consistent with the results of the study conducted by Aslani Katooli (2012). To explain these findings, we can say that the main reason of students' dissatisfaction is related to enablers' factors.

The quality of follow-up educational services
The mean score at the quality of follow-up educational services was 2.70. It shows a low level of satisfaction. The results related to this index are consistent with the results obtained by Ezadi et al (2009). On the other hand, these results are not consistent with the results of a study conducted by Akhshik and Farajpahlou (2009).

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In the following table, the weaknesses related to follow-up educational services and the suggested solutions have been presented. Table 4. The weaknesses related to follow-up educational services in the faculty and affiliated hospitals, and the suggested solutions have been presented.

Weaknesses Suggested solution
Dissatisfaction at non-accountability and nonresponsibility to address educational problems Holding workshops on the importance of having an effective relationship and to teach them how to offer services to customers (students) Dissatisfaction at the ways that educational services are offered Holding workshops on the importance of having an effective relationship and to teach them how to offer services to customers (students) Lack of a clearly-defined plan for the evaluation of activities Designing a proper plan for the evaluation of activities

Quality of educational services
The results related to this index are consistent with the results obtained by Aslani Katooli (2012) and Ezadi et al (2009). However, they are not consistent with the results of the study conducted by Faraji et al (2010).
Therefore, it can be said that students' satisfaction at the quality of library resources, practical trainings in hospitals, educational methods employed by the lecturers, and equipments and facilities in the faculty and hospitals is medium. It shows that nursingmidwifery faculty is improving its quality management. But, because the mean score of satisfaction is not high, more emphasis should be placed on the new theories of quality management. Also, authorities and educational planners should attempt to improve the performance of systems in these areas.

Accountability of staff
In this study, among the various indices, accountability of staff had the highest mean. These results are not consistent with the results of the study conducted by Kebriaie et al (2005) in which accountability of staff had the minimum mean score.
Therefore, it can be said that students have a medium level of satisfaction at the accountability of clinical trainers, the presence of faculty member in the department, and the ability of faculty to offer suitable services. This shows that faculty of nursing-midwifery is moving toward new theories of quality management. But, because the mean score of satisfaction is not high, more emphasis should be placed on the new theories of quality management. Also, authorities and educational planners should attempt to improve the performance of systems in these areas.