Analysis of the Effect of Health Service Quality on Patients in the Inpatient Room of Haji Hospital Medan

The hospital is one of the institutions engaged in health services. The main indicator of the standard of a health facility and is a measure of the quality of service, low customer satisfaction will have an impact on the number of visits that will affect the profitability of health facilities. This study aims to determine the effect of quality and the dominant variables that affect service on patient satisfaction at the Haji-Medan Hospital in 2020. The quantitative research was conducted through an analytical survey research approach with a cross sectional study approach. Testing through logistic regression on the independent variables, namely; Reliability, Responsiveness, Assurance, Empathy and Tangible from the respondents' questionnaire data as many as 80 samples. The results showed that service quality had a significant effect on patient satisfaction from four variables, namely; reliability p value 0.020 (p < 0.05), responsiveness p value 0.038 (p < 0.05), empathy p value 0.000 (p < 0.05), p value tangible 0.001 (p < 0.05). Assurance variable, the quality of health services has no effect on patient satisfaction with a p value of 0.332 (p> 0.05). The dominant variable affecting patient satisfaction is the empathy variable. It is recommended to improve services from the aspect of assurance in order to increase patient confidence in getting services so that patients can feel satisfied with the services provided.


Introduction
The hospital is one of the institutions engaged in the field of health services which with its development has undergone changes (Panter-Brick et al., 2014). At the beginning of its development, the hospital was an agency or institution that had a social function, but now with the existence of a private hospital, this will make the current hospital more referring to an industry that is engaged in health services by carrying out management based on management as described above. As well as business entities. Along with the development of the hospital, until now there is competition between fellow hospitals, both government-owned and private hospitals, all competing to attract consumers or patients so that prospective patients use the services provided by the hospital (Fitirani, 2014).
According to the Indonesian Ministry of Health (2010) the quality of health services includes performance that shows the level of perfection of health services, not only which can lead to satisfaction for patients in accordance with the satisfaction of the average population but also in accordance with the standards and professional code of ethics that have been set. The quality of health services will always involve two aspects, namely the first technical aspect of the health service provider itself and second, the humanitarian aspect that arises as a result of the relationship that occurs between the health service provider and the recipient of the health service (Padma ET AL., 2009).
The main indicator of the standard of a health facility and is a measure of the quality of service, low customer satisfaction will have an impact on the number of visits which will affect the profitability of the health facility, while employee attitudes towards customers will also have an impact on customer satisfaction where customer needs from time to time will increase. As well as the demand for the quality of services provided.
Factors of patient satisfaction with health services will affect the number of visits (Alhashem et al., 2011). If the quality of health services is not always maintained and improved, it is likely that the number of patients will shrink and if patients are not satisfied (eg waiting too long, the "provider" is not friendly, the skills are also lacking), will make the patient disappointed. Patient satisfaction factors can also create public perceptions of the hospital's image.

Methods
The type of research used is a type of analytical survey research (analytic research) with a cross sectional study approach, which is a research design where independent and dependent variables are measured and collected at the same time, with the aim of analyzing the effect of service quality on inpatient satisfaction at Haji Hospital. Medan Year 2020. The population is a large number of subjects who have certain characteristics (Sastroasmoro, 2010). The population in this study were patients who were treated in the inpatient room of the Medan Haji Hospital. The samples in this study were considered representative of the population and received 2x24 hour service and were determined using the Slovin formula as many as 80 respondents.

Respondent's Characteristics
The characteristics of the respondents studied included age, gender, occupation and education. Respondents as many as 80 people are inpatients at Haji Hospital Medan. The distribution of respondents based on their characteristics can be shown in the following table. Based on table 4.1, it is shown that the age distribution of respondents aged 50 years or above 50 years is 83.7% and under 50 years is 16.3%. The distribution is more over the age of 50 years which describes the respondents in the level of experience and maturity of the mindset. The psychologists at the Massachusetts Institute of Technology, United States, say that the age of 50-70 years of mastery of word cities is recorded as reaching maximum thinking ability.
Then female respondents are more dominant than male respondents who give the distribution of respondents that female characters are thought to be more thorough in everything they do (Hinduja & Patchin, 2008). From the results of data processing, it can be seen that the respondents were 50.5% female and 42.5% male.
The distribution of the level of work of the largest number of respondents is housewives, namely 40% which is suspected that the response is good, can be diligent and responsible. Furthermore, the distribution of education levels, of the respondents as many as 80, the most is high school education level as much as 45.0%.

Relationship of Reliability Aspects with Patient Satisfaction
The results in table 2 show that from 80 respondents, 26 respondents stated that they were satisfied, including 13 respondents (16.2%) who said they were satisfied with the good service, while 13 respondents (16.2%) said they were satisfied even though the service was not good from the reliability aspect. Source: Primary Data, 2020.
A total of 54 respondents said they were not satisfied, including 13 respondents (16.2%) said they were not satisfied even though the service was good and 41 respondents (51.2%) said they were not satisfied with the service that was not good from the aspect of reliability. The results of statistical tests with chi-square on the aspect of reliability obtained p = 0.02.

Aspects of Responsiveness with Satisfaction
The results in table 3 show that from 80 respondents, 26 respondents stated that they were satisfied, including 15 respondents (18.8%) who were satisfied with the service they were satisfied with, while 11 respondents (13.8%) said they were satisfied even though the service was not good in terms of responsiveness. Source: Primary Data, 2020.
A total of 54 respondents stated that they were not satisfied, including 18 respondents (22.5%) who said they were not satisfied even though the service was good and 36 respondents (45.0%) said they were not satisfied with the service that was not good in terms of responsiveness. The results of the statistical test with the square-test on the Responsiveness aspect obtained p = 0.034.

Aspects of Guarantee with Satisfaction
The results of the study in table 4. show that from 80 respondents, 26 respondents stated that they were satisfied including 16 respondents (20.0%) who were satisfied with the good service, while 10 respondents (12.5%) of respondents said they were satisfied even though the service was not good from the Empathy aspect. A total of 54 respondents stated that they were not satisfied, of which 27 respondents stated that they were not satisfied even though the service was good and 27 respondents (33.8%) stated that they were not satisfied with the service that was not good from the Empathy aspect. The results of the statistical test with the square-test on the aspect of empathy obtained p=0.233.

Aspects of Empathy with Satisfaction
A total of 54 respondents stated that they were not satisfied, of which 27 respondents stated that they were not satisfied. The results in table 5. show that from 80 respondents, 26 respondents stated that they were satisfied, of which 16 respondents (20.0%) stated that they were satisfied with the good service, while 10 respondents (12.5%) stated that satisfied even though the service is not good from the aspect of Guarantee or the service is good and 27 respondents (33.8%) stated that they were not satisfied with the service that was not good from the Empathy aspect. The results of the statistical test with the square-test on the aspect of empathy obtained p=0.233. A total of 54 respondents said they were not satisfied, including 11 respondents (13.8%) not satisfied even though the service was good and 43 respondents (53.8%) said they were not satisfied with the service that was not good from the aspect of guarantee. The results of the chisquare statistical test on the assurance aspect obtained p=0.00.

Aspects of Physical Evidence with Satisfaction
The results of the study in table 6. show that from 80 respondents, 26 respondents stated that they were satisfied including 16 respondents (20.0%) were satisfied with the good service, while 10 respondents (12.5%) said they were satisfied even though the service was not good from the aspect of physical evidence. A total of 54 respondents stated that they were not satisfied, where 12 respondents (15.0%) were not satisfied even though the service was good and 42 respondents (52.5%) were not satisfied with the poor service. The results of statistical tests with square-test on aspects of Physical Evidence obtained p = 0.001.  The results show the research variables that have been significant in the bivariate test and then continued with multivariate analysis using multiple linear regression tests. Then the results of the regression test showed that the empathy variable was more dominant with p value = 0.452.

Multivariate Analysis
The quality of service is increasing and competition in the service business in hospitals is increasingly complex (Ghodeswar & Vaidyanathan, 2008). The quality of hospital services offered is not as easy as efforts to improve product quality because of its unique characteristics (Rhodes et al., 2017). Patient satisfaction will be fulfilled if the process of delivering services from the medical team to patients is in accordance with what is perceived by the patient. One indicator to determine satisfaction is seen from the increasing number of patients who are satisfied with the service. Therefore, it is not surprising that customer satisfaction always gets special attention when formulating an activity strategy. To realize the level of satisfaction, especially the level of satisfaction of inpatients at Haji Medan Hospital, five variables are supported, namely; variables of Reliability, Responsiveness, Security Assurance, Empathy and Physical Evidence. Service through a smile, friendly, skilled and fast attitude in handling and decision-making processes in the preparation and determination of an activity. Satisfaction is not enough with the provision of physical facilities, but in an effort to provide satisfaction, especially in the process of interaction between officers and patients in health services. Interaction is a very deep thing that is felt when receiving services, especially when they really need help. This interaction process is influenced by the behavior of officers in carrying out services, namely hospitality, skills, responsiveness of attention, communication speed of service and others.
The reliability aspect relates to the ability of medical officers and employees to provide services accurately, reliably, optimally, on time and responsibly to provide patient satisfaction (Ericsson, 2004). Service accuracy by minimizing errors in service, timeliness of service, including waiting time, courtesy and friendliness when providing services, ease of getting services, such as the availability of human resources and supporting facilities (Lutur, 2020).

Conclusion
There is a significant effect of the quality of health services on patient satisfaction in terms of reliability, responsiveness, empathy, and physical evidence, while there is no significant effect on patient satisfaction in terms of assurance. The variable (aspect) that is more dominant in influencing patient satisfaction at the Medan Haji Hospital in 2020 is the Empathy aspect.