Internal and External Factors that Affect Employee Motivation at Materna Medan Hospital

Employees are the main capital in a company or organization including hospitals. Good health services are produced by hospital employees who have great motivation in working. Motivation is influenced by basic human needs including physiological needs, a sense of belonging, a sense of security, self-actualization, and appreciation. This study aims to determine and assess external and internal factors that affect employee motivation at Materna Hospital Medan. This research is quantitative research with a cross-sectional approach. The population of all employees working at Materna Hospital Medan amounted to 137 people and all of them were sampled. Data collection techniques through questionnaire dissemination, documentation, and literature study. The analysis method uses univariate, multivariate, and bivariate analysis using multiple linear regression equations. Research findings show that internal factors in the form of recognition affect employee motivation at Materna Medan Hospital while internal factors in the form of responsibility and work itself do not influence. External factors in the form of compensation, supervisors, and relationships with colleagues affect the motivation of employees at Materna Medan Hospital while external factors in the form of working conditions do not influence. Internal and external factors that predominantly influence motivation are internal factors in the form of recognition. It is recommended to hospital management/leaders give statements of recognition to employees according to their performance, and compensate accordingly and supervisors should understand the nature and characteristics of employees who are subordinates to be able to provide appropriate motivation.


INTRODUCTION
The hospital is one of the health service facilities that are still consistent in providing health services to the community both individually and in groups.Hospital health services can be said to be effective if the services provided are in line with the principles of good clinical management through an integrated and comprehensive system that can be considered through various existing service indicators.A very important indicator of hospital services is the service provided by employees or health workers who work at the hospital.
Employees are the principal capital in an organization.Employees have an important role in determining the success of an organization because the main function of employees is to implement, design, manage, and evaluate the activities carried out.Good health services are produced by hospital employees who have great motivation at work.Motivation is a crucial thing in a job because with motivation in each employee, employees will be enthusiastic and work hard in achieving great work productivity.
Motivation is a psychological process that describes the interaction between perceptions, needs, attitudes, and decisions that take place within an individual.Motivation is influenced by basic human needs including security, physiological needs, belonging, selfactualization, and reward.Research by (Suratri et al., 2020a) found that workers in the health sector who have easy access to hospitals have a higher proportion of large motivations than those who have difficult access.The type of hospital, access to hospitals, and hospital accreditation have a relationship with the work motivation of health workers in hospitals.
One of the private hospitals in Medan City is Materna Hospital located on Jl.Teuku Umar No. 11, Petisah Tengah, Medan with class C type.The provision of health services at this hospital is supported by 137 employees.Based on a preliminary survey on employee motivation through interviews, the results of interviews with 10 employees provided information that providing services to patients made them sometimes experience fatigue at work so work motivation decreased.Based on this, motivation is needed for employees, both motivation from within themselves such as passion and enthusiasm for work, and from outside themselves such as the atmosphere of the environment and working relationships with fellow health workers.Another factor that employees complain about is that the provision of rewards from the hospital is still lacking, which has an impact on the lack of motivation to work employees.
In interviews with the head of the room or section, it appears that there is still a problem of employees who have not worked optimally according to the SOP and this indicates that employee motivation is still not high, so researchers are interested in researching "Internal and External Factors that Affect Employee Work Motivation at Materna Hospital Medan."

METHODS
This study is a quantitative research using descriptive analysis with a cross-sectional design.This research was conducted at Materna Hospital Medan.This study was conducted from February 2022 to May 2023.The population in this study is all employees working at Materna Hospital Medan amounting to 137 people.The sample in this study is all populations (total sampling), which is 137 employees.Data collection is carried out based on the type of research data, namely primary data and secondary data through questionnaire methods and literature studies.The data analysis to be carried out is univariate, bivariate, multivariate analysis.Bivariate data analysis is intended to analyze the relationship between independent variables and dependent variables using chi-square statistical testing with a p<0.05 value expressed as significant.Multivariate analysis in this study was used in reviewing the effect Vol 5 between independent variables on dependent variables.The statistical test used is multiple linear regression.

RESULTS
The frequency distribution of the characteristics of employees at the Materna Hospital, Medan City can be seen in Table 1 below  Based on the table 1, the results of the study show that the age of the employees in the Materna Hospital, Medan City majority aged 25 -45 years was 86 people (62,8%).As many as 113 respondents are the majority were female (82,5%).Furthermore, employees with last education majority Diploma (D3) were 107 respondents (78,1%).
The characteristics of respondents based on work space, the majority served in the inpatient room of 65 people (47.4%),The characteristics of respondents according to the length of service, the majority for 1-5 years amounted to 55 people (40.1.0%),The characteristics of Vol 5 respondents based on employee status, the majority for permanent amounted to 100 people (73%).

Hospital
Internal Factors: Recognition Based on Table 2, from the results of respondents' answers regarding internal factors in the form of recognition, it can be seen that the category is medium 75 respondents (54.7%).
From the results of respondents' answers regarding internal factors in the form of responsibility, it can be seen that the category is medium 83 respondents (60,6%).From the results of respondents' answers regarding internal factors in the form of work, it can be seen that the category is medium 67 respondents (48,9%).From the results of respondents' answers regarding external factors in the form of work, it can be seen that the category is medium 78 respondents (56,9%).From the results of respondents' answers regarding external factors in the form of work, it can be seen that the category is medium 71 respondents (51,8%).From the results of respondents' answers regarding internal factors in the form of work, it can be seen that the category is medium 66 respondents (48,2%).From the results of respondents' answers regarding external factors in the form of work, it can be seen that the category is medium 66 respondents (48,2%).From the results of respondents' answers regarding external factors in the form of work, it can be seen that the category is medium 56 respondents (40,9%).
Vol 5 Bivariate Analysis The results of the multiple linear regression test showed that the recognition variable had an opportunity value (p) = 0.067 < 0.05, meaning that there was no recognition effect on employee motivation at Materna Medan Hospital.Based on the results of the multiple linear regression test, the responsibility variable has an opportunity value (p) = 0.007 > 0.05, meaning that there is an influence of responsibility on the work motivation of workers at Materna Medan Hospital.According to the results of the multiple linear regression test, the job variable itself is p = 0.056 > 0.05, meaning that there is no effect of the work on employee motivation at Materna Hospital Medan.According to the results of the multiple linear regression test, the compensation variable has a value of p = 0.060 < 0.05, meaning that there is no effect of compensation on employee motivation at Materna Hospital Medan.According to the results of multiple linear regression testing, the variable working conditions that are opportunity value (p) = 0.001 > 0.05 means that there is an influence of working conditions on the work motivation of workers at Materna Medan Hospital.Based on the results of multiple linear regression testing, the working condition variable value p = 0.275< 0.05 means that there is no supervisory influence on employee motivation at Materna Medan Hospital.According to the results of multiple linear regression testing, the working condition variable which is p = 0.000 Vol 5 < 0.05 means that there is an influence of relationships with colleagues on employee motivation at Materna Medan Hospital.

DISCUSSION
The measurement of employee motivation at Materna Medan Hospital in this study was based on internal factors (recognition, responsibility and the work itself) and external factors (compensation, working conditions, supervisors and relationships with colleagues).The results of the bivariate analysis of the seven variables had a relationship with the work motivation of employees at Materna Hospital Medan and the seven variables were included in the multivariate analysis (p < 0.25).
The results of the study based on internal recognition factors stated that the majority recognition was categorized as medium (57.4%).The results of the multiple linear regression test showed that the recognition variable had an opportunity value (p) = 0.007 < 0.05, meaning that there was an effect of recognition on employee motivation at Materna Medan Hospital.
In other words, the better the recognition felt by employees, the more work motivation increases.The results of this study are relevant to some previous studies including (Cambu et al., 2019) which found that there was a significant influence on the perception of recognition with nurses' work motivation at the Inpatient Installation of GMIM Pancaran Kasih Hospital Manado.
The results showed that employees on duty at Materna Medan Hospital stated that the majority of responsibilities were categorized as medium (60.6%).Based on the results of the multiple linear regression test, the responsibility variable has an opportunity value (p) = 0.056 > 0.05, meaning there is no influence of responsibility on the work motivation of workers at Materna Medan Hospital.The results of this study are relevant to some previous studies including Maulida (2021) research which found that there was no significant influence Responsibility is not significant influence and positive for Productivity Employee CV.Rahayu Sentosa.Based on the researcher's assumption that the results of the study show no influence of responsibility on motivation because basically employees already know that employees have responsibilities that must be carried out in order to get the expected compensation as employees.Responsibility is the basis for employees to be present at work and fulfill what they have recognized as their responsibilities, so that with the responsibility itself, employees are automatically motivated to carry out all their duties.In the results of the study, it was also found that there were respondents with good responsibility but less work motivation, this according to the researchers' assumptions was caused by other factors that affect the work Vol 5 motivation of an employee, such as compensation, so that even though the employee has high responsibility, when the compensation given is less, work motivation also decreases.
The results showed that employees on duty at Materna Medan Hospital stated that the majority of work factors themselves were categorized as medium (48.9%).According to the results of the multiple linear regression test, the job variable itself is p = 0.060 > 0.05, meaning that there is no effect of the work on employee motivation at Materna Hospital Medan.It can be said that the better the work itself, not necessarily the work motivation increases.The results of this research are in accordance with several previous studies, including Cambu (2019) research which found that there was no significant influence in the perception of the work with the motivation of nurses at the Inpatient Installation of GMIM Pancaran Kasih Hospital Manado.
The results showed that employees on duty at Materna Medan Hospital stated that the majority of compensation factors were categorized as medium (56.9%).According to the results of the multiple linear regression test, the compensation variable has a value of p = 0.001 < 0.05, meaning that there is an effect of compensation on employee motivation at Materna Hospital Medan.The results of this research are in accordance with several previous studies Sultan (2021) with the findings there is a direct effect of compensation on motivation.
The results studies from Sembiring & Prasetio (2018), Armantari et. al (2021), Jaya et., al (2020), Mubaroq & Zulkarnaen (2017) found that there is an effect of compensation on work motivation.Compensation has a large level of influence, this means that the better compensation provided by the company, so that the work motivation aimed at by employees will be better.
The results showed that employees on duty at Materna Medan Hospital stated that the majority of working conditions were categorized as moderate (51.8%).According to the results of multiple linear regression testing, the variable working conditions that are opportunity value (p) = 0.275 > 0.05 means that there is no effect of working conditions on the work motivation of workers at Materna Hospital Medan.The findings of this research are in accordance with some previous studies, including Cambu (2019) research which found that there was no significant influence in the perception of the state of the work environment with the motivation of nurses at the Inpatient Installation of GMIM Pancaran Kasih Hospital Manado.However, the results of this study are not in accordance with the research Arjun (2022) with the finding that one of the variables related to work motivation is working conditions.
The results showed that employees on duty at Materna Medan Hospital stated that the

Table 3 . The relationship of Internal and external factors with work motivation
Thus, it means that there is a relationship between compensation and employee motivation at Materna Medan Hospital.Test results with Chi Square on the relationship of working