895
Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 12 December 2023
ANALYSIS POLICIES AND NETWORK TO IMPROVE PATIEN
SATISFACTION AT THE PRIMARY CLINIC OF MEDAN HEALTH
POLYTECHNIC
Ida Nurhayati
1
, Ali Khatibi
2
1
Health Polytechnic Ministry of Health Medan, Indonesia
2
Management Science University Malaysia, Malaysia
Email: in260394@gmail.com
Abstract
Health Polytechnic of the Ministry of Health Medan is one of the Vocational Health
Education Institutions, which applies a larger proportion of practical curriculum than
theory. This policy due to the availability of required health workers following
optimization through the Medan Poltekkes director's policy of increasing the need
for appropriate medical personnel.The regulations decided by the director of Medan
Health Polytechnic as a policy include two things, namely by adding and
restructuring human resources such as recruiting general practitioners as the person
in charge of clinics, dentists, and other health workers such as nurses, midwives,
nutritionists, sanitation experts, pharmacy, medical laboratory personnel.
Networking is needed as process of building and managing productive relationships,
both personal and organizational to improve quality of services clinic. Another
opinion states that the networking is an information system consisting of humans,
data, software (software), hardware (hardware) and the network it self. Networking
is the art of communicating with each other, sharing ideas, information and resources
to achieve individual or group success. This type of research was experiment study,
pre and post test design, used primary data. Data were taken from the result
satisfaction indicators from the Service Quality Model namely the SERVQUAL
model from Hertanto (2017). The research was conducted for 1 year in 2017 at the
Health Polytechnic Clinic of the Ministry of Health Medan. The population in this
study were all customers about 500 population, inclusion criteria to be sample 20 –
50 years old about 133 population, and all of the sample have been taken about
41respondent. Analysis data by Wilcoxon test. The majority of patient satisfaction
levels related to clinical services are satisfied with the following types of satisfaction
criteria: tangible (63%), reability (66%), responsiveness (83%), assurance (68%),
emphaty (73%). Only a small proportion expressed dissatisfaction to the services
provided.
Keywords: Policies, Network, Improve Patien
896
INTRODUCTION
Health Polytechnic of the Ministry of Health Medan is one of the Vocational
Health Education Institutions, which applies a larger proportion of practical
curriculum than theory. The application of practice is carried out through
experimental learning to educational mediums that will help students to integrate
theory and practice (Lisko & O’dell, 2010)
In health education, experiential learning is one strategy that can be used to
help students integrate theory and practice
(
(Lisko & O’dell, 2010)
).
This strategy is
built on the understanding that clinical competence will gradually be achieved
through repeated experiences with various complex clinical cases. Critical thinking
skills and clinical reasoning are important structures needed to build students' clinical
competence. The results showed that, experiential learning can improve critical
thinking skills and clinical reasoning of students who face various cases with varying
characteristics so as to increase the desired competence
(
(Coker, 2010)
) (
(Fajrin et al.,
2016)
)
.
This is in line with previous research which states that laboratory and clinical
teaching is an attempt to explore ways in which students understand and use the
concepts that have been learned so that they can be applied in practice. In this
teaching, students must have clinical skills and prepare students to get training before
they practice in real conditions with real patients. Thus laboratory skills are one of
the learning strategies to achieve clinical skill competencies that must be mastered by
students
(
(Ali et al., 2011)
) (
(Akaike et al., 2012)
)
. Based on the previous description,
it is considered necessary to build a primary clinic at the Health Polytechnic of the
Ministry of Health Medan, it will be used as a vehicle for students practicing and also
provide health services for the surrounding community
(
(Peraturan Menteri
Kesehatan Republik Indonesia Nomor 35 Tahun 2019 Tentang Wahana Pendidikan
Bidang Kesehatan, 2014)
) (
(Situmorang, 2016)
) (
(Bailey et al., 2016)
)
.
Health services provided to them by primary clinic at the Health Polytechnic of
the Ministry of Health Medan, it have to pay attention to the quality and quantity of
services. Service quality is measured through patient satisfaction, while service
quantity is measured through clinical facilities and human resources at the clinic.
This requires related policy and networking to support activities in the clinic
(
(Bangun, 2012)
)
(
(Kemenkes RI, 2015)
) (
(Li et al., 2016)
) (
(Boulding et al., 1993)
)
.
Customer satisfaction is the level of a person's feelings after comparing the
performance he feel compared to expectations and can be formulated as a post-
purchase evaluation. If the perception of performance cannot meet expectations, it
will happen dissatisfaction. Services in the field of health is realized between patients
as customers and health facilities. Satisfaction is the suitability of consumer
assessment results on various aspects services that are felt and expected, so that
patient satisfaction can be an evaluation service providers regarding the quality of
their services
(
(PRATIWI, 2010)
)
(
(Lannes, 2015)
) (
(Khasanah & Pertiwi, 2010)
)
(
(Khabbah et al., 2017)
)
.
Furthermore, Networking is needed as process of building and managing
productive relationships, both personal and organizational to improve quality of
services clinic. Another opinion states that the networking is an information system
consisting of humans, data, software (software), hardware (hardware) and the
network it self (Damsar, 2009; Hu et al., 2016).
897
Networking is the art of communicating with each other, sharing ideas,
information and resources to achieve individual or group success. Relationships that
are beneficial and mutually beneficial. In other words, building a network must be
based on the principle of mutual benefit and two-way communication. Networking
is also a process of building communication or relationships, sharing ideas,
information and resources on the basis of mutual trust and mutual benefit between
partnering parties, which is outlined in the form of a memorandum of understanding
or memorandum of understanding (MoU) in order to achieve success. greater shared
interests in a particular line of business or a particular goal (Castells, Manuel &
Cardoso, 2005).
Several MoU are needed to improve clinical services, it aimed to provide
service satisfaction customers, they are CSR (Customer Social Responsibility), BPJS
(Badan Penyelenggara Jaminan Sosial/National Insurance Client) and Pharmacy. In
this case the Health Polytechnic of the Ministry of Health Medan has obtained the
MoU needed to improve clinical services. Likewise, public health centre as a
community health service is managed by the local government, have to join with
another sector such as BPJS. Public health center also need complete facilities and
infrastructure to provide primary services according to community will. However,
the level of satisfaction between the clinic Health Polytechnic of the Ministry of
Health Medan and public health center have a different because it depends on the
type of consumer, so that the assessment of patient satisfaction is too subjective (Fida
et al., 2020)
(
(Deharja et al., 2017)
(Sureshchandar et al., 2001).
Based on the description above, a study was conducted which aimed to find out
the level of patient satisfaction served at the clinic Health Polytechnic of the Ministry
of Health Medan, both of the places have been exposed to policy and networking.
RESEARCH METHODS
This type of research was experiment study, pre and post test design, used
primary data. Data were taken from the result satisfaction indicators from the Service
Quality Model namely the SERVQUAL model from Hertanto (2017). The research
was conducted for 1 year in 2017 at the Health Polytechnic Clinic of the Ministry of
Health Medan. The population in this study were all customers about 500
population, inclusion criteria to be sample 20 – 50 years old about 133 population,
and all of the sample have been taken about 41 respondent. Analysis data by
Wilcoxon test. This research was carried out after obtaining a research ethics
feasibility letter from the Ethics Committee of the Polytechnic Health of Health
Ministry Medan. This research was also carried out after obtaining approval from
respondents as evidenced by affixing the respondent's signature to the research
approval sheet
(
(R. F. M. Kalijogo, 2019)
) (
(Bungin, 2007)
)
.
RESULTS AND DISCUSSION
The following is an overview of the assessment of the quality of services
provided by clinic Medan Health Polytechnic officers obtained based on an
assessment by patients who have visited Clinic of Medan Health Polytechnic as
below.
898
Figure 1. Customer Satisfaction with Services at the Clinic of Medan Health
Polytechnic 2017
Based on Figure 1, it can be seen that the majority of patient satisfaction levels
related to clinical services are satisfied with the following types of satisfaction criteria:
tangible (63%), reability (66%), responsiveness (83%), assurance (68%), emphaty
(73%). Only a small proportion expressed dissatisfaction to the services provided.
Increasing of patient satisfaction at the clinic Medan Health Polytechnic significantly
after optimization is carried out by providing policy and networking as table below
discribed analysis Multivariate Analysis of Variance (LSD test) before and after
optimization.
Table 1. Multivariate Analysis of Variance (LSD test) before and after
optimization
No
Description
Independent Variabel
Dependent Variabel
p Value
1
Before Optimization
Human Resource
Type of Service
1,000
Visitor
1,000
Income
1,000
Patients satisfaction
1,000
Facilities
Type of Service
1,000
Visitor
1,000
Income
1,000
Patients satisfaction
1,000
2
After Optimization
Human Resource
Type of Service
0,000
Visitor
0,102
Income
0,041
Patients satisfaction
0,000
Facilities
Type of Service
0,000
Visitor
0,102
Income
0,041
Patients satisfaction
0,000
Patient satisfaction in Clinic of Medan Health Polytechnic s services is most
were very satisfied with the service of the Clinic of Medan Health Polytechnic. A
complete implementation of service quality concepts would assist the effectivenness
of patient’s satisfaction in public healthcare institution. Research has proven that
there is a relationship between customer satisfaction and service quality (Ampah &
899
Ali, 2019; Sureshchandar et al., 2001). According to service quality implies
management paradigm the deals with service management in the area of marketing
which emphasises the important of customer interaction with service provider in
giving service and creating value for money (Ampah & Ali, 2019; Gummesson,
1994). Previous research stated that the correlation results depicted a significant
relationship between the three variables: service quality, customer satisfaction, and
customer loyalty. Similarly, regression results demonstrated that empathy and
responsiveness dimensions have a significant positive impact on customer
satisfaction. It is, therefore, recommended that banks should focus more on empathy
and responsiveness considering the significant relationship of these two variables on
customer satisfaction, in line in this study (Fida et al., 2020).
Based on figure 1. above, it is known that all study participants usually reported
being satisfied with the clinical services provided by Medan Health Polytechnic. Five
service characteristics make up the level of satisfaction: tangible, reliability,
responsiveness, assurance, and empathy. On a tangible level, 63% of visitors said
they were satisfied with the Medan Health Polytechnic Clinic's services. This could
be due to the clinic's proximity to the main road, the cleanliness and comfort of the
waiting room, the adequacy of seats in the waiting room to avoid long lines, and the
clinic's relatively new facilities and infrastructure. This is consistent with previous
research conducted at the Semaja Samarinda Health Center, which revealed that the
value of respondents' satisfaction with the comfort of the waiting room and the
cleanliness of the waiting room is 77% and 80%, respectively. The comfort and
cleanliness of the waiting room are important dimensions of respondent satisfaction
because a comfortable and clean waiting room environment can aid the patient's
healing process (Khabbah et al., 2017). As a result, adequate facilities and facilities
are a tangible dimension that influences patient satisfaction.
The quality of health services is determined by the reliability dimension.
Quality health services will be largely determined by the health care profession in this
case. Sixty-six percent of visitors were satisfied with the reliability dimension. This is
due to the availability of required health workers following optimization through the
Medan Poltekkes director's policy of increasing the need for appropriate medical
personnel.The regulations decided by the director of Medan Health Polytechnic as
a policy include two things, namely by adding and restructuring human resources
such as recruiting general practitioners as the person in charge of clinics, dentists, and
other health workers such as nurses, midwives, nutritionists, sanitation experts,
pharmacy, medical laboratory personnel. The personnel used for the restructurisation
do not recruit from outside the institution, but using human resources from within
the institution namely lecturers. The recruitment also facilitates the issuance of
practice license for medical personnel and paramedics who works at the clinic.
Other regulations also regulate the standard operating procedure (SOP) for
services in the primary clinic of Medan Health Polytechnic which one visitors are
served with ease of administrative procedures, speed, and accuracy of services
provided so the service is faster than before (Prayitno & Suharmiati, 2018). The clinic
was still classified as a Medical Center in its early days, with only one type of service
and one officer. Starting in 2016, there has been a gradual addition of competent
officers according to their fields, supported by adequate facilities and infrastructure,
after optimizing through policies and building an extensive network. This is what
makes satisfied consumer satisfaction levels possible.
900
As many as 83% of customers stated that they were satisfied with the
responsiveness of officers in providing health services at the Medan Health
Polytechnic Clinic properly and quickly. Responsiveness can be seen from the
openness or willingness of officers to receive and respond to complaints from
patients/patient families, the availability of officers according to patient needs to
provide services and the ability of officers to communicate to inform the things that
customers need
(
(Prayitno & Suharmiati, 2018)
)
.
At the Clinic of Medan Health Polytechnic, 68% of customers said they were
satisfied with the service guarantee. The therapeutic communication provided by
officers to patients demonstrates the dimension of health service guarantee. Officers
providing information about service procedures, actions taken, maintaining patient
confidentiality, and responding to patient/patient family problems related to
prescribed drugs precisely and quickly are examples of therapeutic communication.
Therapeutic communication performed by front-line health workers a the clinic of
Medan Health Polytechnic can reassure patients and build customer trust.
As many as 73% of customers expressed satisfaction with the officers'
empathy in providing health services at the clinic of Medan Health Polytechnic.
Officers' empathy in serving customers is demonstrated by their friendliness and
willingness to listen to patients without regard to the patient's social status
(
(Prayitno
& Suharmiati, 2018)
)
. Furthermore, the care of health workers in serving patients can
be seen in good communication with patients or with the patient's family so that
patients feel at ease and confident that they will receive quality care.
The level of visitor satisfaction in the 5 dimensions of health services at the
clinic of Medan Health Polytechnic can actually be further improved through
periodic officer competency training. This policy program can be regulated by the
existence of regulations and policies from the Director of Medan Health Polytechnic.
If this can be done on an ongoing basis, the clinic of Medan Health Polytechnic which
is a primary clinic (FKTP) can provide the primary services needed by academics in
the Medan Health Polytechnic Environment and the surrounding community on a
wider scope. This policy is also one that supports health transformation on the first
pillar. The role of the clinic Medan Health Polytechnic in the first pillar of health
transformation is that apart from providing health education to the community, it
also plays a role in increasing the capacity and capability of primary services through
policies and building networking for the development of Medan Health Polytechnic
clinics.
The results of this study are in line with previous research on the effect of
Service Quality on Consumer Satisfaction at St. Hospital. Elisabeth Semarang stated
that about 71.6% of consumers are satisfied with health services described through
these 5 dimensions, while the remaining 28.4% is influenced by other variables
outside of the observed variables (Khasanah, Imroatul & Pertiwi, 2010). In today's
very tight competition, the key to gaining a competitive advantage is the provision of
high quality services which will result in customer satisfaction or customer
satisfaction. Optimizing the improvement and development of Clinics as a medium
for education carried out by improving infrastructure, infrastructure, health
personnel, types and numbers of health services can improve service quality. High
customer satisfaction is expected to create high loyalty from consumers, so that it will
attract repeat patient visits and become one of the sources in increasing income from
the clinic of Medan Health Polytechnic as public service agency.
901
Previous research stated that the correlation results depicted a significant
relationship between the three variables: service quality, customer satisfaction, and
customer loyalty. Similarly, regression results demonstrated that empathy and
responsiveness dimensions have a significant positive impact on customer
satisfaction. It is, therefore, recommended that banks should focus more on empathy
and responsiveness considering the significant relationship of these two variables on
customer satisfaction (Fida et al., 2020). Based on research, findings indicated that
while all three dimensions are somewhat influential on patient satisfaction, in public
hospitals tangibles dimension seems to exert no significant influence on satisfaction.
Findings are important both for public and private hospital managers and for policy
makers (Yesilada, Figen & Direktör, 2010). Majority of the respondents expressed
their discontentment over the responsiveness of the service providers when compared
to tangibility and reliability quality variables. There is no relationship between the
quality variable tangibility and overall satisfaction. Related to the overall satisfaction,
42 percent of respondents have neutral perspective indicated that they are either
satisfied or dissatisfied as against the 43.3 percent of dissatisfied customers (Potluri
& Angiating, 2018).
Previous studies indicated that service quality has a significantly positive
impact on loyalty. When products or services exceed the expectations of customers,
their repurchase intention will increase (Boulding et al., 1993)
(Cronin et al., 2000).
The excellent service quality contributes to customer retention and loyalty (Potluri,
Rajasekhara Mouly & Zeleke, 2009). In the health care context, (Boshoff & Gray,
2004)
)
verified a positive relationship between service quality and loyalty as measured
by buying intentions. Hence, service quality perceived by a patient will affect patient
loyalty (Wu, 2011) Data was collected from public healthcare delivery respondents
in health administration in Ghana. There are 252 respondents from public healthcare
institutions (healthcare administrators, medical doctors, nursing officers, and
patients). Results showed that 55% healthcare participants stated service quality
adoption in public healthcare institutions to be medium, followed by 45% of
respondents to be high. The study concluded that marketing mix adoption among
public healthcare institutions in Ghana is medium. Also, there is a fairly good
relationship between patients (customers) satisfaction, and service quality and hence
effective adoption of service quality leads to customer satisfaction (Ampah & Ali,
2019).
Interventions to improve performance of existing staff and service quality have
the potential to improve patient care in underserved settings. But in order to
implement interventions effectively, policy makers need to understand and address
the contextual factors which can contribute to differences in local effect. Researchers
therefore must recognise the importance of reporting how context may modify effect
size
(
(Blacklock et al., 2016)
)
. Previous study about final number of respondents was
864 including 161 from county hospitals, 190 from rural community health centers
(CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from
urban CHCs. Type of health care facilities was significantly associated with total
PCAT score and domain scores. CHC was associated with higher total PCAT score
and scores for first contact-access, ongoing care, comprehensiveness-services
available, and community orientation than secondary and/or tertiary hospitals, after
controlling for patients' demographic and health characteristics. Higher PCAT score
was associated with greater satisfaction with primary care received. CHC patients
902
were more likely to report satisfactory experiences compared to patients from
secondary and tertiary facilities (Hu et al., 2016). Patient satisfaction with outpatient
and inpatient care was significantly associated with type of healthcare delivery setting
in Jilin, China. Seeking outpatient care from community health centers (CHCs) was
significantly associated with a higher ratio of patient satisfaction. Patients of county
and tertiary hospitals complained about long-waiting times, bad attitudes of health
workers, high expense of treatment, and their overall satisfaction towards outpatient
care was lower. In the terms of inpatient care, patients were more satisfied with
treatment expense in CHCs compared with county hospitals (Li et al., 2016).
Consumer satisfaction is a person's feeling of pleasure or disappointment that
comes from the comparison between his impression of the performance or results of
a product with his expectations. The level of patient satisfaction indicates the level of
success of a health service in improving the quality of its services. Measuring the level
of patient satisfaction can be done using various measurement methods. From several
existing methods, various studies show that the Service Quality (Servqual)
instrument is valid for various service contexts through measuring the five service
dimensions (Tangible, reliability, responsiveness, assurance, and empathy) in
determining the level of customer satisfaction. Physical evidence (tangibles) in the
form of appearance and ability of clinical physical facilities and infrastructure and
the condition of the surrounding environment provided by service providers which
include physical facilities (buildings), technology (equipment and equipment used),
appearance of employees and means of communication. Reliability is the clinic's
ability to provide services as promised accurately and reliably. This must be in
accordance with consumer expectations such as timely performance, error-free
service, sympathetic and reliable attitude. Responsiveness is a willingness to help and
provide fast and appropriate service to consumers by delivering clear information.
Assurance is the knowledge, courtesy and ability of clinical officers to foster
consumer confidence in the clinic (F. M. Kalijogo, 2019). Managing relationship
with costumers (patients) is becoming more important in the new paradigm. The
paper discusses Costomer Relationship Management (CRM) in healthcare and
proposes a social CRM or CRM 2.0 model to to take adventage of the multi-way
relationships created by web 2.0 and its widespread use in improving costomer
services for mutual benefits between providers and their costumers (Almunawar &
Anshari, 2012).
Measurement of patient satisfaction level related to market planning primary
Clinic of Medan Health Polytechnic as a vehicle practice learning for student its
surrounding. Medan Health Polytechnic has 20 study programs for health workers
in North Sumatera. If the level of patient satisfaction can be maintained and
improved, the primary Clinic of Medan Health Polytechnic can be used as own a
vehicle for student practice learning, because it is one of the indicators of clinical
quality, so it becomes one of the requirements as a vehicle for student practic (Estri
& Fajarini, 2017; Kencana, 2017; PERMENKES RI Nomor 30, 2022).
Director of Medan Health Polytechnic by making cooperation with BPJS,
partnerships with banks and independent practice doctors as well as pharmacists and
independent practice midwives. The cooperation built improves health facilities and
services, such as ambulance assistance, patient beds, waiting chairs, medical
equipment and others. Increasing cooperation networks to improve facilities and
903
infrastructure, this is part of the indicator for patient satisfaction assessment
(Soumokil et al., 2021).
CONCLUSION
About consumer satisfaction in health services at the Medan Health
Polytechnic Clinic after intervention that the majority of patient satisfaction levels
related to clinical services are satisfied and only a small proportion expressed
dissatisfaction to the services provided.
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Copyright holders:
Ida Nurhayati, Ali Khatibi (2023)
First publication right:
AJHS - Asian Journal of Healthy and Science
This article is licensed under a Creative Commons Attribution-ShareAlike 4.0
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