Effective Communication to Support Inpatient Service Innovation: Room Available Without Added Cost (KT3B) Program at Mardi Rahayu Hospital

Communication is needed in an organization to overcome various problems that exist. Problems that arise usually greatly affect the quality of service to the public. Improving service quality is not only the addition of service variables, but can be done through improvements to previously running services. Innovation in the health service industry is an obligation that is carried out. Efforts to improve access to health services for patients are a priority that is presented in services in all health facilities. Efforts to build Mardi Rahayu Hospital's effective communication strategy to support inpatient service innovation which is a priority inpatient program. This research uses descriptive qualitative methodology belonging to (Moleong, 2012) by trying to reveal what effective communication strategies are used in launching inpatient service innovations. Data collection was carried out by interviewing registration officers, and nurses who became the primary data of researchers, and also direct observation.


Introduction
The dynamics of health facility services are quite diverse, providing encouragement for health service providers to be adaptive in facing any changes (Elawati & Roekminiati, 2023) This is motivated by a policy/regulation or suggestions and criticisms from consumers.Realizing challenges in a fairly competitive competition with other health service providers is expected to create service products that have strong characteristics in the eyes of consumers.The superiority of health facilities is not only indicated by the presence of complete technology, the availability of adequate human resources, but also needs to be considered in providing service quality assurance.The aim of providing service quality assurance effectively and efficiently is able to produce quality products or services.it is expected to have a significant impact on customer satisfaction.Improving service quality is not only the addition of service variables, but can be done through improvements in services that have been running before (Elawati & Roekminiati, 2023).Service improvements are carried out with the hope of providing customer-oriented service convenience.The importance of understanding consumer needs, by making a service product that is made easily accepted by consumers, because it is considered right on target and in accordance with consumer desires.Various ways can be done to explore consumer needs, including listening to feedback submitted by consumers both directly and indirectly.Services that are innovative and in favor of consumer desires as service users will be more in demand by the community.
Innovation in the healthcare industry is an obligation that is carried out.Efforts to improve access to health services for patients are a priority that is presented in health facility services.Providing easy access to services is a manifestation of improving the quality of service both from the quality of service of officers, the availability of adequate public facilities, a good and smooth administrative process and the provision of other supporting facilities needed in running the wheels of service.The application of innovation which is part of the hospital's strategy to increase trust in service quality can have a positive impact on the realization of customer satisfaction.
As an effort to support the innovation program designed by hospital management, it can run well, not separated from communication.Building communication is an important element in a health service in implementing its role and function (Fanny et al., 2022).One of the basic skills that hospital employees must have is the ability to communicate effectively.Effective communication is believed to help the process of improving performance holistically.Having verbal skills such as giving good explanations, conveying messages that are easy to understand, understanding the flow of services well, having good non-verbal gesture, attitude, and facial expressions have an impact on consumer assessment of hospital services.The frontline officer (front liner) as an initial image-forming figure in service delivery greatly determines the psychological condition of the patient in its reception.When front-line officers cannot provide good service, are not communicative, are not informative, it certainly affects the image of hospital services.Good interaction and communication between hospital staff is necessary in shaping the quality and quality of service.
Mardi Rahayu Hospital is one of the type B private health facilities in the Kudus area that provides comprehensive individual health services including inpatient, outpatient, and emergency services (Permenkes no. 3 of 2020, concerning Hospital Classification and Licensing) (Kesuma et al., 2022).The implementation of all health services if it can run well and can find out the benefits that will be generated, it will lead to success.One of the breakthrough programs made from Mardi Rahayu Hospital is Room Available Without Added Cost (KT3B).This program was created in 2018 with the main objective of increasing the hospital's Bed Occupancy Rate (BOR).The commitment of the Room Available Without Additional Cost (KT3B) program in terms of providing temporary treatment rooms up to a maximum of Executive class for patients who require hospitalization in the Inpatient Installation and Intensive Care Installation.With private financing who do not get a treatment room according to the desired class or inpatients with third party guarantees who do not get a treatment room according to their treatment class rights at no additional cost and without limiting the length of treatment in temporary treatment rooms.
The establishment of the KT3B program is an innovation developed to increase the utility of inpatient rooms.The phenomenon that occurs where patients when going to do hospitalization have difficulty getting a hospitalization room according to their class rights.The difficulty in obtaining treatment class rights is due to the limited / full number of treatment classes.The impact of this problem is that it is difficult for officers to find referrals between health facilities so that patients queue long enough in the emergency room to get a treatment room.As a result of full treatment rooms, patients often have to be referred to other health facilities or patients choose to go to a higher treatment class than their treatment class rights.Patients who occupy the right class of care not according to their class rights or higher than their class rights create new problems.Problems arising from patients not occupying the treatment according to their class rights will incur additional costs.Although there are guarantors such as insurance that provide a maximum tolerance to increase the class of care for a maximum of 3 days, if up to 3 days the right class of care is not available, the patient will still be charged additional treatment costs.This issue will have an impact on patient dissatisfaction with hospital services.Looking at the Bed Occupancy Rate (BOR) data for inpatients as follows: ISSN 2721-0960 (Print), ISSN 2721-0847 (online)  Copyright © 2024  In providing services, it must be considered how service officers interact with customers and can usually be used to determine how good or bad the service is.Every service officer must have and master these communication skills.The provision of services by an organization (private, government, or company) to the public with or without charge to meet the needs, and or interests of the community is called public service.Principles of public service implementation, which are used among others: 1) Every action taken in the implementation of services has the possibility to be communicated; 2) Communication allows organizations to interact with their communities; and 3) Communication aims to influence, control, and encourage (positive) cooperation.Communication is concerned with giving meaning to every interaction that occurs so that people can understand each other.The purpose of this research is to find out how effective communication can help improve innovation services at Mardi Rahayu Hospital.Giving the public a good perception of the institution's program being implemented is the goal of this effective communication.

Effective Communication
Communication is an effective tool to influence human behavior.The role of health workers in placing communication as a top priority in carrying out services is a must.Effective communication techniques play an important role in providing influence / persuasive for patients to be able to understand the messages conveyed so that the desired goals are achieved.Illusion in a communication occurs due to several factors referred to as noise that makes the communication message cannot be understood properly.

Health Care Facilities
Health care facilities are services that are used to provide health services, whether promotive, preventive, curative or rehabilitative.The organizers of health services are carried out from the central government, as well as local governments.In an effort to create a comprehensive health degree in the community, it is necessary to provide health facilities.The availability of health care facilities that are adequate and affordable for the entire community at large so that improvement, maintenance, treatment of disease, and health recovery can be realized evenly.
Hospitals are organizations that provide health services organized by the government or private sector.Hospitals include outpatient, inpatient, and emergency services, as stipulated in Permenkes Number 3 of 2020 (Susanti & Widjaja, 2021).With facilities held in public services such as in the service sector, perception can affect communication, and communication can also affect perception.All the processes that a person does to understand information about his environment are called perceptions.Whether the communication process is good or bad depends on what each person involved thinks.Communication failure occurs when people in an organization do not understand information correctly.
According to Syakur et al. (2020), several important communication requirements are needed to create and maintain objective authority in the organization: the lines of communication must be known with certainty; each member of the organization must have a formal communication channel, which must be as direct and short as possible, formal communication lines must be used regularly, and communication management officers must have the ability.Every communication that is made must be legalized so as not to disrupt organizational processes.Communication according to organizational behavior, is a process that occurs between individuals that aims to change behavior.Behavior in an organization is very important for the communication process.Therefore, communication can also be defined as the dissemination of messages, information, or ideas from one or more individuals to another person or group of people using the same symbol.
Interpersonal communication also falls under the category of organizational communication.
The following traits affect the effectiveness of interpersonal communication: includes the same atmosphere and position between people who communicate (Ghorbanzadeh et al., 2015;Nurachman, 2022).
The post-positivistic model and descriptive qualitative approach were used in this research.The purpose of this research is to obtain an understanding and explanation of the phenomena experienced by the subject in terms of behavior, perception, motivation, action, and other factors (Schweiker et al., 2020).This study interviewed two main informants, namely patient administration nurses and patients at Mardi Rahayu Hospital.

Data Collection Technique
Literature study by collecting various references from books, articles, journals, decrees related to the research that will be conducted by researchers.Observation by making field observations of officer behavior, performance processes, and the impact of respondents on information submitted by hospital staff.Interviews were conducted by researchers to sources directly involved in research activities to obtain comprehensive information in supporting the research process.The process of processing and reviewing data from pre-existing documents to support research data.Documentation is a method used to conduct historical searches.

Data Analysis Techniques
Qualitative research, the data analysis stage is carried out after data collection for a certain period of time.The technical analysis used is an interactive model where according to Miles and Huberman (1992: 27), the stages of analysis include data reduction, data presentation, and conclusion drawing.

Results and Discussion
Mardi Rahayu Hospital has a Room Available Without Added Cost (KT3B) program.The form of communication used in organizing the program is a pattern of relationships between two or more people in the context of transmission and the way they receive messages or information in an appropriate way so that messages can be understood (Ullmann & Tomalin, 2020).
Communication patterns are very important in communication, so in order for the transmission and reception of messages to go smoothly, both parties must have a safe and comfortable environment.Communication can be done openly in this way.Based on the evaluation of the Room Available at No Extra Cost (KT3B) program, it can be seen in Table 2 as follows: The benefits obtained from the program are very helpful for patients because they do not need to be referred to other hospitals, do not need to wait long in the emergency room to get a room and the most important benefit is that patients do not need to "tombok" or add costs even though they are placed in a treatment class while above their treatment class rights.The implementation of the KT3B program has several criteria in its implementation, among others: (1) Patients with third-party guarantees from the beginning want a treatment room class above the treatment room class entitlement set by the guarantor; (2) Patients with private financing who have applied for a Room commitment available without additional costs during the treatment period want to move the treatment room to a higher class than the desired one; (3) Patients with third-party guarantees who have been committed to a Room Available Without Added Cost during the treatment period wish to move to a higher class than their treatment class entitlement; (4) A patient to whom a No Cost Available Room commitment has been applied refuses to be transferred to: (a) A treatment room in the class originally desired for patients with private pay or a treatment room in accordance with their treatment class entitlement for patients with third party guarantees, or; (b) A treatment room of a lower class than the treatment room temporarily occupied before the class than the treatment room temporarily occupied before the class of treatment room originally desired or the treatment class entitlement is available; (5) In conditions 2, 3, and 4, all health service costs are calculated according to the highest class desired by the patient from the beginning of treatment, including the cost of surgery and the patient will be charged according to the provisions of Mardi Rahayu Hospital.
The implementation stage of the KT3B program requires effective communication between the hospital environment, especially front liner officers, namely inpatient registration and also nurses in the inpatient room.Administratively, inpatient registration officers provide explanations to families of patients/patients where the right of the treatment class is full, so the KT3B facility is given.Verbal communication is conveyed to the patient's family / patient with straightforward, and clear with the following material: "If the room according to the class entitlement is full, the patient is temporarily placed up to the maximum Executive class or the class currently occupied by the patient at no additional cost, without limitation of days according to the KT3B program and is willing to be transferred to the room according to his class entitlement at any time.If during hospitalization, the patient wishes to upgrade to a permanent class, the KT3B program does not apply and all treatment costs are calculated according to the highest class from the first day of treatment, including the cost of surgery." After the patient's family/patient understands the message conveyed by the registration officer, then validation is carried out by signing the hospitalization and financing agreement form.The form is stamped by the registration officer as a marker for the nurse of the room that the patient will occupy while undergoing treatment.The stamp marker will be used by the nurse to provide information that the patient is temporarily placed and if the treatment class rights are available and the patient is still undergoing treatment, the nurse will communicate to the patient to prepare to move to the treatment room according to the treatment class rights.Not only that, nurses in carrying out patient transfers to other treatment rooms need to convey to other nurses so that the service transfer process can run well.

Position and Function of Communication
Effective communication can improve the quality of service and performance of hospital staff.Of course, for every work process, a standardized SOP is needed as a guideline, and a legal basis as a reference for carrying out task (Septyaningtyas & Taufeni Taufik, 2022) Simplifying the flow of communication is a way to reduce unnecessary ineffectiveness of the communication process so that errors can be avoided.Effective communication should be used as the culture of a health facility to foster a work environment that conveys information appropriately.Patients come to the hospital with various disease and psychological conditions, requiring a special approach to support recovery.The aim of implementing effective communication in health facilities is to create patient satisfaction, create loyal patients, form good relationships between hospitals, improve the hospital's image, and indirectly bring significant benefits to the profitability of health facilities.
, Journal La Sociale, Under the license CC BY-SA 4.0 ISSN 2721-0960 (Print), ISSN 2721-0847 (online) Copyright © 2024, Journal La Sociale, Under the license CC BY-SA 4.0 According to Hyland-Wood et al. (2021), there are five characteristics of good and effective communication: (1) Understanding: the communicator understands the content of the message conveyed to the audience correctly.(2) Pleasure: creating a good and familiar relationship with others.(3) Influencing attitudes: communicators can change communicants through the messages conveyed.(4) Establishing social relationships: can form and maintain good and satisfying interactions.(5) Action: communicants are willing to do according to the message delivered Effective communication can improve the performance of communication actors, and service quality.Talking about performance in public services is closely related to the way a person assesses their own work, which results in performance or achievement standards.Mitchel states in his book Human Resources and Work productivity (2001:51) that there are five ways to measure a person's performance: quality of work, timeliness, initiative, communication, and ability to communicate.
(1) Openness, which includes aspects of the desire to remain open when interacting with others and the desire to respond honestly to all stimuli.(2) Empathy, which is trying to feel the other person's feelings or feeling their feelings.(3) Support, sometimes needing to be verbalized, sometimes not.(4) Positivity includes positive attention to oneself, positive feelings are communicated, and effective communication cooperation to improve the quality of public services.(5) Equality ISSN 2721-0960 (Print), ISSN 2721-0847 (online) Copyright © 2024, Journal La Sociale, Under the license CC BY-SA 4.0

Table 1 .
Bed Occupancy Rate (BOR) Data of Inpatients of Mardi Rahayu HospitalBased on the data above, it shows that the BOR of inpatients in 2018 has decreased significantly compared to the previous 3 years.Seeing this, hospital management took steps to optimize inpatient services.This situation encourages the management of Mardi Rahayu Hospital to innovate inpatient services because inpatient care is one of the hospital's profit centers.Of course, this service can run well with the support of related units.As a health service provider, the commitment of the KT3B program is expected to benefit people who need health services, one of which provides administrative convenience.Optimal product utilization is a real measure of the success of a product.The existence of innovation is prioritized to be presented in public services in order to provide new breakthroughs to improve service quality.Utilization of the Room Available Without Added Cost (KT3B) program is a top priority of several services scheduled from Mardi Rahayu Hospital.Based on the description above, the researcher is interested in researching Effective Communication Supporting Inpatient Service Innovation: Room Available Without Added Cost (KT3B) Program at Mardi Rahayu Hospital.

Table 2 .
Utilization Data of the KT3B Program Mardi Rahayu Hospital From the data above, it can be concluded that the utilization of the KT3B program at Mardi Rahayu Hospital can run well, it can be seen that there was an increase from 2018 to 2019.In 2020 -2021 there was a decrease in the number of inpatient visits due to the Covid 19 Pandemic in Indonesia where the phenomenon occurred because many people were afraid to visit the hospital.Despite fluctuations in the number of utilizations of the KT3B program at Mardi Rahayu Hospital, the innovation is still being used by inpatients to date.
ISSN 2721-0960 (Print), ISSN 2721-0847 (online) Copyright © 2024, Journal La Sociale, Under the license CC BY-SA 4.0 if the officer can remember the name of some consumers, consumers will feel happy because they are noticed.This form of remembering names is a high appreciation given by officers to consumers; (6) Smile.Providing service with a smile gives the impression of joy, pleasure when carrying out tasks. the impact caused by serving with a smile forms a comfortable atmosphere when interacting with customers; (7) Empathy.The ability to understand what other people feel is an important role in building relationships between people.Trying to see from another point of view we can more objectively understand others; (8) Build a sense of enthusiasm.Enthusiasm in doing work gives us the understanding that we are eager to carry out the task.The form of enthusiastic attitude when dealing with others such as positioning the body when communicating facing each other, nodding the head as a sign of understanding other people's income, and so on; (9) Not easy to blame.The tendency of people does not like to be criticized, blamed, or given orders.Thus, when communicating with customers, you should be careful and good at choosing polite words.If we find fault with others, we can give a good warning so that it can be accepted and understood together.Creating a good relationship between one individual and another requires several aspects to be fulfilled.Interaction that occurs through several ways and other approaches can positively create a successful communication process.Successful communication is a top priority in the success of the Room Available at No Extra Cost (KT3B) program.Communication built by registration officers and nurses in providing education to patients who get KT3B facilities runs effectively.The running of the Room Available at No Extra Cost (KT3B) innovation program is due to the contribution of effective communication between hospital staff that is done well.Service effectiveness can be demonstrated through good information management so as to avoid misperceptions among communicants.Placing communication as part of the organization is an important step in making the work program a success.Understanding standards, rules, communication flows is the main step in carrying out communication that can be applied in the work environment.