The Influence of Leadership Style and Work Culture on the Work Productivity of Nurses at Mitra Medika Tanjung Mulia Medan General Hospital

ABSTRACT

Every job requires human resources to improve the quality of work, one of the efforts to produce good quality work is to increase work productivity.The importance of productivity for nurses is an evaluation material to make continuous improvements to all components of the hospital, improving the quality of work by the hospital which plays an important role is the approach by leaders and a positive culture in the workplace.The purpose of this study is to determine the effect of leadership style and work culture to produktivity of nurses.This type of research is analytic survey with cross sectional approach.The study population was all nurses at Mitra Medika Tanjung Mulia Hospital Medan as many as 145 people with 106 samples taken by simple random sampling technique.Analyzed using univariate, bivariate analysis using chi-square test with 95% confidence level, using multivariate logistic regression.The results showed that most of the leadership style less, namely 39 respondents (36.8%), work culture enough that 35 respondents (33.0%), labor productivity sufficiently at 42 respondents (39.6%).The results of the analysis of the influence of leadership style statistikmenunjukkan (p = 0.000), and the work culture p = 0.017) on the productivity of nurses in hospital Mitra Medika Tanjung Mulia Medan in 2016.It is recommended to the hospital for further enhancing cooperation and better relations between the leaders with nurse in order to improve the productivity of nurses better.Keywords: Leadership Style, Culture Work and labor productivity ABSTRAK Setiap pekerjaan menuntut sumber daya manusia untuk meningkatkan kualitas kerjanya, salah satu usaha untuk mengasilkan kualitas kerja yang baik adalah meningkatkan produktivitas kerja.Pentingnya produktivitas bagi perawat adalah bahan evaluasi untuk melakukan perbaikan secara terus menerus bagi seluruh komponen rumah sakit, peningkatan mutu hasil kerja oleh rumah sakit yang didalamnya berperan penting adalah cara pemdekatan oleh pimpinan dan budaya positif ditempat kerja.Tujuan 466 penelitian ini yaitu untuk mengetahui pengaruh gaya kepemimpinan dan budaya kerja terhadap produktivita kerja perawat.Jenis penelitian ini adalah survey analitik dengan pendekatan cross sectional.Populasi penelitian adalah seluruh perawat di RSU Mitra Medika Tanjung Mulia Medan sebanyak 145 orang dengan sampel 106 yang diambil dengan teknik simple random sampling.Analisis data menggunakan analisis univariat, bivariat menggunakan uji chi-square dengan tingkat kepercayaan 95%, multivariat dengan menggunakan uji regresi logistik.Hasil penelitian menunjukkan sebagian besar gaya kepemimpinan kurang, yaitu 39 responden (36,8%), budaya kerja cukup yaitu 35 responden (33,0%), produktivitas kerja cukup yaitu 42 responden (39,6%).Hasil analisis statistic menunjukkan ada pengaruh gaya kepemimpinan (p = 0,000), dan budaya kerja p = 0,017) terhadap produktivitas kerja perawat di Disarankan kepada rumah sakit untuk lebih meningkatkan kerja sama dan hubungan yang lebih baik antar pemimpin dengan perawat guna meningkatkan produktivitas kerja perawat yang lebih baik.Kata Kunci: Gaya Kepemimpinan, Budaya Kerja dan Produktivitas kerja

INTRODUCTION
Nursing services are the main key in hospital services.In terms of quantity, nurses are the largest number of personnel and are beside patients for 24 hours.According to Marquis and Huston in 2010, the management of nursing services requires a proper management system to direct all existing nursing resources to be able to produce excellent and quality nursing services.(1) The quality of health services by many health institutions can be seen from the achievement or absence of patient satisfaction.The definition of health service quality refers to the ability of hospitals to provide services in accordance with health professional standards and the results can be received by patients with satisfaction.The quality of health services is greatly influenced by the performance of nurses in providing nursing care to patients.In an effort to maintain the quality of health services in hospitals, it will not be separated from the role of the nursing profession.Based on evaluation and quality control standards, nursing services will ensure the existence of high-quality nursing care, by continuously involving themselves in every quality control program held at the hospital.(2) Law of the Republic of Indonesia No.38 of 2014 concerning nursing, a nurse is someone who has graduated from higher education in nursing, both at home and abroad which is recognized by the government in accordance with the provisions of laws and regulations.(3) Nursing according to the National Nursing workshop is a form of professional nursing service that is an integral part of health services based on nursing science in the form of comprehensive bio-psycho-sociospiritual services, addressed to individuals, families and communities both sick and healthy covering the entire process of human life.
Nurse performance is a form of professional service that is an integral part of health care.In the nursing care system, performance can be interpreted through the compliance of professional nurses in carrying out nursing care according to standards.Where performance contains two important components, namely, competence means the individual or organization has the ability to identify the level of performance, and second, productivity i.e. the competence mentioned  467 above can be translated into appropriate actions or activities to achieve performance results (outcome).( 4) According to Siagian in 2013, in the current era of globalization, the tight competition for human resources, especially nurses, is felt by hospitals.Every job requires human resources to improve the quality of work, which human resources are not able to compete will be left out by themselves.One of the efforts to produce good quality work is to increase work productivity.The importance of productivity for nurses is an evaluation material to make continuous improvements for all components of the hospital, improving the quality of work by the hospital.From the impact of hospitals that have low productivity will result in a decrease in the number of customers due to the low quality of service produced so that customers will move to other organizations that have high work productivity and the creation of quality service quality.(5) According to Robbins (2003) leadership is the ability to influence a group towards achieving goals, in essence leadership is an effort to achieve goals through people ( 6).Mulyati's (2006) research on the implementation of nursing care documentation at RSUD DR.Muwardi Surakarta obtained incomplete documentation results, this was due to lack of motivation and supervision from the leadership (7).The results of the study are in accordance with the results of Rossyana Fatimah &Ida Wahyuni's (2016) research that respondents who rated good leadership will have high job satisfaction, explained that there is a significant influence of leadership on job satisfaction (8).Research Finarti et al (2017) states that there is a significant relationship between leadership style and nurse performance (9).
Mitra Medika Tanjung Mulia Hospital is one of the private hospitals for inpatients and receives various types of health insurance both from the government (Jamkesmas, Jamkesda, Medan Sehat, Jampersal ASKES), PT and other companies that collaborate with the hospital.
Based on an initial survey conducted by researchers in June at Mitra Medika Tanjung Mulia Hospital Medan, it is known that 10 out of 15 nurses whose productivity still needs to be improved, this can be seen from the high absenteeism rate, communication errors, relationships between superiors are less harmonious and lack of appreciation from superiors so that this will have an impact and affect the productivity of nurses' work.Based on the background above, researchers are interested in conducting a study entitled "The Influence of Leadership Style and Work Culture on Nurse Work Productivity at Mitra Medika Tanjung Mulia Hospital Medan in 2021.

RESEARCH METHODE
This research design uses a type of analytical survey research with a cross sectional approach, namely research that tries to explore how and why the phenomenon occurs.Then analyze the dynamics of correlation between phenomena, both between risk factors and effect factors.(10) This research was conducted at Mitra Medika Hospital Tanjung Mulia Medan.That is because based on the initial survey I conducted that there are still problems in the productivity of nurses' work in providing nursing care to patients at the hospital.The population in this study was all nurses working at Mitra Medika Tanjung Mulia Hospital as many as 145 people, the population in the study was large, namely as many as 145 nurses, so the researcher took a sample of part of the population, namely 106 nurses as respondents.Sampling is done using simple random sampling techniques.Data analysis techniques using logistic regression tests.In Table 2, it is known that the distribution of gender education of respondents is mostly 89 people (84%) and the rest are men as many as 17 people (16%).Based on this formula, it can be seen that the regression coefficient of leadership style (2,260) is greater than work culture (1,077).iniindicating that the leadership style variable most dominantly affects the work productivity of respondents at Mitra Medika Tanjung Mulia Hospital Medan The results showed that there was an influence of leadership style on the work productivity of respondents at Mitra Medika Tanjung Mulia Hospital Indonesian Workers Medan (p = 0.000<0.05).The better the leadership style applied, the more optimal the respondent's work productivity.In accordance with Dewi Sartika Nasution's research entitled "The Influence of Leadership and Organizational Culture on Employee Performance at the Huragi Health Center, Huta Raja Tinggi District, Padang Lawas Regency", that the presence or influence of leadership and organizational culture greatly affects employee performance.(11) One factor that is very supportive and decisive in the success of efforts to increase nurse work productivity is the full support of all managers (leaders) both top-level, middle-level, and lowerlevel managers.To increase the work productivity of nurses, leaders who are responsible for efforts to increase productivity and always hold monitoring and follow-up such as awards for nurses in their inpatient rooms who have work programs above standard so that nurses are given a stimulus to work better.(12) According to the researcher's assumption that there is an influence of leadership style on respondents' work productivity due to the head of nursing applying democratic leadership while working.The Head of Nursing strives to maintain a working relationship with respondents well, provide direction and guidance and provide motivation without having to do direct supervision so that respondents can actualize themselves providing nursing care to improve their competence so that the nursing process runs well and in accordance with hospital expectations.The results of this study build on previous research conducted by Parashakti (2016) which states that organizational culture influences one's personal formation and supports the growth of creativity so as to foster one's innovative behavior.According to Prayudhayanti (2014), organizational culture is very important for every organization to foster innovative work behavior in the context of achieving organizational performance.

RESULT AND ANALYSIS
According to the researcher's assumption that there is an influence of work culture on respondents' work productivity due to the work culture adopted by respondents in nursing care related to hospital culture as stated in the hospital's mission that respondents must implement a culture of communication, information and education and involve patients and families in services and develop a comprehensive culture of teamwork.If a work culture is applied that contains the values of the hospital's organizational culture, the stronger the respondent's work culture will be.A strong work culture will result in high respondents' work productivity, while a weak work culture will create low work productivity.

Table 1
Frequency Distribution of Respondents Based on Age at Mitra Medika Hospital Tanjung Mulia MedanNo.In Table1, it is known that the age distribution of respondents mostly aged 31-40 years as many as 47 people (44.3%) and fewer respondents over 50 years old as many as 8 people (7.5%).Table 2 Frequency Distribution of Respondents by Gender at Mitra Medika Hospital Tanjung Mulia Medan No.

Table 3
In Table6, it is known that the distribution of respondents' productivity in nursing care is mostly categorized as good as 64 people (60.4%) and a small part is categorized as less as many as 42 people (39.6%).In Table7above, it can be explained that of the 67 respondents (63.2%) stated that the leadership style of the head of nursing is good, most of them have good work productivity as many as 53 people (50%) and the rest work productivity is less than 14 people (13.2%).Of the 39 people (36.8%) stated that leadership style was categorized as lacking, most had less work productivity as many as 28 people (26.4%) and the rest of the work productivity was less than 11 people (10.4%).

Table 8 The
Relationship between Work Culture and Work Productivity of Respondents at Mitra Medika Hospital Tanjung Mulia MedanIn Table8above, it can be explained that of the 71 respondents (67%) stated that work culture is categorized as good, most have good work productivity as many as 49 people (46.2%) and the rest work productivity is less as many as 22 people (20.8%).Of the 35 people (33%) stated that the work culture was categorized as lacking, most had less work productivity as many as 20 people (18.9%) and the rest good work productivity as many as 15 people (14.2%).The results of the chi square statistical test at a confidence level of 0.05 obtained a p value = 0.017<0.05,meaningthatthere is a significant relationship between work culture and respondents' work productivity at Mitra Medika Tanjung Mulia Hospital.Table10The Influence of Leadership Style and Work Culture on Respondents' Work Productivity at Mitra Medika Hospital Tanjung Mulia Medan In Table10of the results of multivariate analysis, it is known that the variables of leadership style and work culture affect respondents' work productivity with significance values of 0.000 and 0.029.The results of the logistic regression test obtained a leadership style variable with an Exp (B) value of 9.585 means that respondents stated that a good leadership style has a chance of work productivity of 9.585 better than a less leadership style.The work culture variable with a value of Exp (B) = 2.937 means that respondents working with a good work culture have a chance of work productivity of 2.937 better than a work culture that is less.The Influence of Leadership Style on Nurse Work ProductivityThe results of the model show that the variables of leadership style and work culture have a significant effect on work productivity with an Overall Percentage value obtained of 76.4%, which means that the variables of leadership style and work culture are able to explain their influence on respondents' work productivity by 76.4%,While the remaining 100%-76.4%, which is 23.6%, is influenced by other factors.
(13)Influence of Work Culture on Nurses' Work Productivity The results showed that there was an influence of work culture on the work productivity of respondents at RSU Mitra Medika Tanjung Mulia Pekerja Indonesia Medan (p = 0.017<0.05).The more respondents who accept the values of work culture in hospitals, the stronger the work culture that occurs.A strong work culture will result in high respondents' work productivity, while a weak work culture will create low work productivity.In accordance with Lusiari Pandia's research entitled "The Influence of Organizational Culture on the Performance of Employees of the Hamparan Perak Inpatient Health Center, Hamparan Perak District, Deli Serdang Regency in 2014" that the influence of organizational culture with the categories of management support, direction and communication patterns affects employee performance.(13)