The Influence of Health Services Licenses to the Quality of Services at the Capital Investment and Integrated Services Office One Door of the City of Medan

The research objective was to analyze the effect of health service licensing policies on service quality at the Medan City Investment Service and One Stop Integrated Services. This research method is mixed methods, amounting to 27 people. The results of the research on the relationship of health service licensing policies with the satisfaction of the online licensing application for the SiCantik Cloud application, it is known that the licensing policy is good quality service with the relationship between physical evidence and satisfaction of the online licensing applicant for the SiCantik Cloud application, it is known that physical evidence of the applicant is satisfied, the relationship of reliability with the satisfaction of the online licensing applicant of the SiCantik application. Cloud, it is known the reliability of the applicant's clinical licensing officer, the relationship of responsiveness with the satisfaction of the online licensing applicant of the SiCantik Cloud application, it is known the responsiveness of the applicant's clinic licensing officer, the guarantee relationship with the satisfaction of the online licensing applicant for the SiCantik Cloud application, it is known that the clinical licensing guarantee of the applicant is satisfied, the relationship of empathy with the satisfaction of the licensing applicant online application SiCantik Cloud, it is known that the empathy of the applicant's clinical licensing officer is satisfied. Research suggestions are expected to the next researchers to prioritize research related to public services, especially health, because health services have a very important role in people's lives.


Introduction
Talking about public services, it cannot be separated from the bureaucracy because the government uses the bureaucracy to provide services to the community, but the fact is that since the bureaucratic reform agenda was rolled out, the community has not felt significant changes in public services. Public services by government officials today still have many weaknesses. so that it cannot meet the quality expected by the community.
Public service is an activity that must prioritize public interests, simplify public affairs, shorten service time and provide satisfaction to the public (Lipsky, 2010;Pollitt et al., 2016). The task of public service (public service) emphasizes prioritizing public interests, facilitating public affairs, shortening the process time for implementing public affairs, and providing satisfaction to the public (Thoha, 2003;Box, 2015).
The One Stop Integrated Services and Investment Agency or Medan City DPMPTSP is one of the organizations that provide public services in Medan City in the field of investment and onestop integrated services. In carrying out services, DPMPTSP is based on Medan Mayor Regulation Number 3 of 2017 concerning the Implementation of the Delegation of Part of the Mayor's Authority to the Medan City Investment and One Stop Integrated Services Service in Implementing Government Affairs and Medan Mayor Regulation Number 41 of 2018 concerning Delegation of Partial and Non-Licensing Authorities Licensing to the Head of the Medan City One Stop Investment and Integrated Service Service.
In order for the ideal health licensing service to be realized, there are several factors that support it, therefore, In public services there are several important supporting factors, including the awareness factor of officials and officers involved in public services, regulatory factors that form the basis of work (Julnes & Holzer, 2001;Christensen & Laegreid, 2005;Sullivan & Skelcher, 2017). Services, organizational factors which are tools and systems that enable the operation of service activity mechanisms, income factors that meet the minimum life needs, staff skill factors and facility factors in carrying out service tasks (Al Mamun & Hasan, 2017;Lee et al., 2006).
Based on the background description, the research problem is formulated as follows: There is an Effect of Health Service Licensing Policy on Service Quality in the Investment Service and One Stop Integrated Services in Medan City. The purpose of this study was to analyze the effect of health service licensing policies on service quality at the Medan City Investment Service and One Stop Integrated Services.

Methods
This type of research is mix methods by combining or combining quantitative research methods and qualitative research methods. The study population for quantitative data were all clinical permit applicants who had gone through the process and received clinical operational permits through online clinical licensing services using the sicantik cloud system from 01 June 2020 to 30 September 2020. Samples for the quantitative approach totaled 30.
The sampling technique for collecting quantitative data uses a saturated sampling method in which all applicants who have obtained permission will be given the opportunity to become respondents. While the sampling technique for qualitative data collection uses purposive sampling where the researcher has considered the selection of informants who have an important role.

Respondent Characteristics
The distribution of respondent characteristics based on the gender of the clinical licensing applicant, the results are shown in the following Based on the data in Table 4.1, based on the Gender of the Clinical Licensing Applicant, the percentage of the majority is female, as many as 15 people (55.56%). Furthermore, the description of the characteristics of respondents by gender can be seen in Figure 1 below:

Figure 1. Characteristics of respondents based on gender
The distribution of respondent characteristics based on the education of the clinical licensing applicant, the results are shown in the following Based on the data in Table 4.2, it is known that based on the Education of Clinical Licensing Applicants, the percentage of the most recent education of the Bachelor (S1) respondents was 15 people (55.56%). Furthermore, the description of the characteristics of the respondents based on the latest education can be seen in Figure 2 below:

Figure 2. Characteristics of respondents based on latest education
Distribution of respondent characteristics based on the type of facility and classification of clinical permit applicants, the results are shown in the following  Based on the data in Table 4.3, it is known that based on the type of facility and classification, the percentage of the types of facilities and the classification of the clinic, the majority of respondents, including the primary outpatient clinic category, were 22 people (81.48%). The description of respondent characteristics based on the type of facility and classification can be seen in Figure 3 below:

Figure 3. Characteristics of respondents by type of facility and classification
The distribution of respondent characteristics based on the type of clinical licensing applicant application, the results are shown in the following table: Based on the data in Table 4.4, it is known that based on the type of application, the percentage of the type of request that the majority of respondents is including the type of new application is 18 people (66.67%). The description of respondent characteristics based on the type of request can be seen in Figure 4 below: 82% 7% 11%   Based on the data in table 5, it is known that the relationship between the online licensing policy of the SiCantik Cloud application with the quality of online clinic licensing services, from 19 people (70.37%) of respondents, it is known that the licensing policy is good with quality services as many as 17 people (62.96%) and 2 unqualified ones. people (30.00%). Then the online licensing policy of the SiCantik application is not good with quality services as many as 7 people (25.93%) and the licensing policy is not good with not quality services as many as 1 person (3.70%).The relationship between the quality of the online licensing service for the SiCantik Cloud application with the satisfaction of the online clinic licensing applicant, in table 6 below: applicants, of 24 people (88.89%) of respondents, it is known that the online licensing service for the online SiCantik Cloud application is quality with 19 satisfied online licensing applicants (70,37 %) and those who are not satisfied are 5 people (18.52%). Then the online clinic licensing service of the SiCantik Cloud application is not of high quality with the online clinic licensing applicants are not satisfied, while 3 people who are not satisfied are (11.11%).

Type of Means and Classification
The relationship between the physical evidence of online licensing for the SiCantik Cloud application with the satisfaction of the online clinic licensing applicant, in table 7 below: Based on the data in table 7, it is known that the physical evidence of online licensing for the SiCantik Cloud application is related to the satisfaction of online clinic licensing applicants, from 17 people (62.96%) of respondents it is known that physical evidence is available for clinical licensing facilities with satisfied applicants as many as 14 people (51.85%) and those who dissatisfied as many as 3 people (11.11%). Then the physical evidence of SiCantik Cloud application online clinic licensing is not available with 5 people satisfied (18.52%) of the SiCantik Cloud application online licensing applicants (18.52%) while 5 people who are not satisfied The relationship between the reliability of the online licensing officer for the SiCantik Cloud application with the satisfaction of the online clinic licensing applicant, in table 8 below: Based on the data in table 7, it is known that the relationship between the reliability of online licensing officers for the SiCantik Cloud application with the satisfaction of online clinic licensing applicants, of 20 people (74.07%) of respondents, it is known that the reliability of online licensing officers for the SiCantik Cloud application online clinic with satisfied online licensing applicants is 17 people (62.96 %) and those who are not satisfied are 3 people (11.11%). Then the online clinic licensing officer for the SiCantik Cloud application was not reliable with 2 satisfied online licensing applicants (7.41%) and 5 people who were dissatisfied (18.52%).
The relationship between the responsiveness of the online licensing officer for the SiCantik Cloud application with the satisfaction of the online clinic licensing applicant, in table 8 below: Based on the data in table 4.17, it is known that the relationship between the responsiveness of the online clinic licensing officers for the SiCantik Cloud application with the satisfaction of the online licensing applicants, from 21 people (77.78%) of respondents, it is known that the responsiveness of the online clinic licensing officers for the SiCantik Cloud application with online licensing applicants is satisfied as many as 17 people (62.96%) ) and those who were not satisfied were 4 people (14.81%). Then the online clinic licensing officer for the SiCantik Cloud application was not responsive with 2 satisfied online licensing applicants (7.41%) and 4 people who were dissatisfied (14.81%).

Multivariate Analysis
The results of the multivariate logistic regression test on the selected candidate variables can be seen in the following table: .000 Variable (s) entered on step 1: Online Licensing Policy for the SiCantik Cloud application, physical evidence, reliability, responsiveness, assurance, empathy.
Based on the data in Table 4:22, it can be seen that the results of the logistic regression analysis of the SiCantik Cloud Application Online Licensing Policy variable with an OR (ExpB) value of 5.793, a B value of 1.757 and a Wald value of 1.235, meaning that the applicant for clinical operational licensing is by looking at the Online Licensing Policy of the SiCantik Cloud application. those who are fast, effective, efficient and transparent have a high chance of giving satisfaction of online licensing applicants of 5,793 times. The results of the logistic regression analysis of the variable online licensing policy, pvalue=0,015 (0,015 <α=0,05). The conclusion is that there is a relationship between the Online Licensing Policy of the SiCantik Cloud application with the satisfaction of online clinic licensing applicants at the Medan City Investment Service and One Stop Integrated Service, with a strong relationship category. physical evidence have a great opportunity to give satisfaction to online clinic licensing applicants of 2.147 times. The results of logistic regression analysis of physical evidence variables, pvalue = 0,019 (0,019 < α=0,05). The conclusion is that there is a relationship between physical evidence and satisfaction of online clinic licensing applicants at the Medan City Investment and One Stop Integrated Service, with a strong relationship category.
The reliability variable test results with an OR (ExpB) value of 2.309, a B value of 1.175 and a Wald of 0.692, meaning that the applicant for clinical operational licensing with employee reliability has a great opportunity to give satisfaction to the online clinic licensing applicant of 2.309 times. Reliability variable logistic regression analysis results, pvalue = 0,022 (0,022< α=0,05). The conclusion is that there is a relationship between reliability and satisfaction of online clinic licensing applicants at the Medan City Investment Service and One Stop Integrated Service with a strong relationship category.
The results of the responsiveness variable test with an OR (ExpB) value of 9.065, a B value of 2.262 and a Wald value of 3.125, meaning that applicants for clinical operational licensing with good employee responsiveness have a great chance of giving online licensing applicants' satisfaction of 9.065 times. The results of the logistic regression analysis for the variable family attitudes were obtained p-value = 0,012 (p-value < α 0,05), then the conclusion is that there is a relationship between responsiveness and satisfaction of online clinic licensing applicants at the Medan City Investment and One Stop Integrated Service with a strong relationship category.
The results of the Assurance variable test with an OR (ExpB) value of 7.313, a B value of 1.990 and a Wald value of 1.804, which means that the applicant for clinical operational licensing with a good guarantee has a great opportunity to give satisfaction to the online licensing applicant of 7,313 times. The results of the logistic regression analysis for the guarantee variable were obtained p-value=0,017 (0,017< α=0,05). The conclusion is that there is a relationship between the guarantee and the satisfaction of the online clinic licensing applicant at the Medan City Investment and One Stop Integrated Service with the category of a strong relationship.
The results of the test for the Empathy variable with an OR (ExpB) value of 1.340, a B value of 3.722 and a Wald value of 5.348 means that the applicant for clinical operational licensing with employee empathy has a great chance of giving online licensing applicants 1,340 times. The results of the logistic regression analysis for the Empathy variable were obtained p-value = 0,011 (0,011 < α=0,05). The conclusion is that there is a relationship between the empathy of health workers with the satisfaction of the online clinic licensing applicants at the Medan City Investment Service and One Stop Integrated Services.
Thus it can be concluded that the responsiveness factor is the factor that most influences the satisfaction of the online clinic licensing applicant at the Medan City Investment and One Stop Integrated Service Service is the responsiveness variable of the SiCantik Cloud online application officer with an OR (ExpB) value of 9.605, a B value of 2.262 and a value amounting to Wald 3,125. The results of the logistic regression analysis for the variable family attitudes were obtained p-value = 0,012 (p-value < α 0,05).

Qualitative Descriptive
Based on the results of interviews and observations by the author at the Medan City One Stop Investment Service, it can be seen that employees in carrying out their duties are in accordance with the SOP and service notices issued by the Acting Head of the Medan City DPMPTSP Service as evidenced by the attitude of officers who serve online licensing of SiCantik Cloud and Employees in the DPMPTSP Office as a whole show a polite, friendly, responsible and professional attitude in providing services to the community who take care of permits. It must be admitted that there are still employees and licensing officers online who are not thorough in carrying out their duties. This is supported by the results of a literature review of public complaints recapitulation, there are still employees who are not thorough in carrying out their duties as evidenced by the presence of applicants / communities complaining about the delay in completing permits his property, which turned out to be caused by the staff's lack of thoroughness in checking the completeness of the applicant's files.

Conclusion
There are still various obstacles found in the implementation of online licensing for the SiCantik Cloud application so that it has not been able to be implemented optimally, where there is clear evidence of service users choosing to apply for licenses on the spot rather than online because submitting licenses online is quite troublesome. This is because they have to upload the existing files, while the files for each permission field are quite a lot. Then the area has not yet been touched on the internet itself and also not all licensing users are aware of the existence of clear online licenses. Another obstacle is the completion of licensing that is not yet on time and there is a time delay. However, the time delay in completing permits is not entirely the fault of the UPT PTSP of the One Stop Investment Service, Medan City itself, sometimes also from the related Office of the permit. For this reason, cooperation from several parties is needed in improving the online licensing process at the Medan City DPMPTSP Service. The DPMPTSP Office, the Communication and Information Technology Office, and the community must work together in utilizing information technology as a whole so that the licensing process can run efficiently. In addition, the online licensing of the SiCantik Cloud application must be improved so that it can be used as a system that actually takes care of clinical licensing from input to input.