Analysis of Factors Affecting Inpatient Satisfaction at Vina Estetika General Hospital

Measurement of health service user satisfaction is one indicator to determine the quality of health services. The purpose of the study was to analyze the factors that influence the satisfaction of inpatients at the Vina Estetica General Hospital. The research design was a cross-sectional study, the sample was patients who were treated at the Vina Aesthetic Hospital Medan. The research variables were measured using a questionnaire prepared by the researcher and tested for validity and reliability. Analysis of multiple logistic regression test data. The results of the multiple linear regression equation research show that from these five independent variables, there is only one variable that has a positive effect on the dependent variable or patient satisfaction, namely the Physical Evidence variable (Tangibles) with a value of 0.165. Meanwhile, the other four independent variables have a negative effect on the patient satisfaction variable. The regression coefficient for each variable is -0.145 for the Empathy variable, -0.129 for the Reliability variable, then -0.028 for the Responsiveness variable. , and -0.266 for the assurance variable,


Introduction
Satisfaction is a function of perceptions or impressions of performance and expectations, if performance is below expectations then the patient will be dissatisfied, if performance meets expectations then the customer will be satisfied and if performance exceeds expectations then the patient will be very satisfied or happy (Bustoami, 2017). Standards for patient satisfaction in health services are set nationally by the Ministry of Health. According to the Regulation of the Ministry of Health of the Republic of Indonesia of 2008 concerning Minimum Service Standards for patient satisfaction, namely >90% (Ministry of Health, 2008). If a health service is found with a patient satisfaction level below 90%, it is considered that the health service provided does not meet the minimum standards or is not of good quality. While some research results show data on the level of patient satisfaction in Indonesia, the patient satisfaction rate only reaches 42.8% (Cahyadi, 2017).
The poor management given by hospitals to patients has long been recognized as causing many losses for both the hospital and the patient. Surveys prove that not every consumer who is disappointed with the company's services is happy to submit a complaint. The findings obtained by TARP (Technical Assistance Research Program) in Washington, D.C. discovered the fact that 96% of dissatisfied consumers secretly switched to competitors' services. That means, the silence of the patient is a bad signal for the hospital (Kurniadi, 2013).
Patient satisfaction with health services is satisfaction with the quality of service provided by health workers to patients while being treated in health facilities. The services and care provided to clients are a form of professional service that aims to assist clients in recovering and improving their abilities through comprehensive and continuous fulfillment of client needs until clients are able to carry out their routine activities without assistance (Indrawijaya, 2017).
Measurement of user satisfaction of health services is one indicator to determine the quality of health services. Customer satisfaction and dissatisfaction with the product provided will affect behavior patterns such as interest in repurchasing the product. To find out the quality of service that is felt by consumers in real terms, there are indicators that measure customer satisfaction which lie in the five dimensions of service quality. The five dimensions are: physical evidence (tangibles), direct evidence which includes physical facilities, equipment and materials used by the hospital and the appearance of existing employees. Reliability, related to the hospital's ability to provide prompt and accurate services from the first time without making any mistakes and satisfactorily; responsiveness, in relation to the willingness and ability of employees to help patients and respond responsively to their requests, as well as inform services in a timely manner; assurance (assurance), which includes knowledge, skills, courtesy, being able to foster the patient's trust; Empathy means ease in carrying out good communication relationships, personal attention in understanding the needs of patients as customers and acting in the interests of patients (Listiono, 2010) Society's demands on the quality of service are getting higher, so the services provided by hospitals must be truly quality and satisfying. Patient satisfaction depends on the quality of service. Based on an initial survey of patient satisfaction at the Vina Estetica General Hospital for 10 patients, it was found that 3 patients (30%) said they were satisfied with inpatient services, while the remaining 7 patients said they were dissatisfied with services in the inpatient room because the patient received less attention. and nurses are less friendly in providing services. Based on the background above, the authors are interested in conducting research on the analysis of factors that influence patient satisfaction at Vina Estetica General Hospital.

Methods
The type of research used in this research is quantitative research. The design used in this study is an analytical survey with a cross-sectional study design (Notoatmodjo, 2010) (Notoatmodjo, 2016). The population in this study were all inpatients from January to February 2022 with a total of 125 inpatients. The sample is determined based on the following criteria: The inclusion criteria to be examined are as follows: 1) Willing to be a respondent. 2) Inpatients who have been treated for >2 days receive treatment. Patients with compliments level of consciousness (full awareness). The sample size is 56 people. The analysis used multiple linear regression.

Results
The distribution of respondent characteristics based on age and education at Vina Estetica Medan General Hospital in 2022 can be seen in the Based on Table 1 above, it is known that out of 56 respondents, 20 (35.7%) were aged 41-50 years, while other respondents aged 15-20 were 10 (17.9%), aged 21 -30 years as many as 17 (30.4%), aged 31-40 years as many as 9 (16%). Of the 56 respondents, it was found that 29 (51.8%) respondents had high school education, 5 (8.9%) had elementary school, 15 (26.8%) junior high school, and 56 (26.8%) respondents had 7 (12.5%) have a bachelor's level of education. 05. This shows that the Empathy dimension has no effect on patient satisfaction (Y). 3. After testing the p-value, the significance value of the Reliability dimension on patient satisfaction (Y) is 0.540 > 0.05. This shows that the Reliability dimension has no effect on patient satisfaction (Y). 4. After testing the p-value, the significance value of the Responsiveness dimension to patient satisfaction (Y) is 0.876 > 0.05. This shows that the Reliability dimension has no effect on patient satisfaction (Y). 5. After testing the p-value, the significance value of the Assurance dimension on patient satisfaction (Y) is 0.181 > 0.05. This shows that the Assurance dimension has no effect on patient satisfaction (Y).

Discussion
This is in line with research conducted by Dewi, (2014). Quality has a close relationship with customer satisfaction. Service quality provides an impetus to customers to establish strong relationships with the company. In such a long-term bond, it allows the company to understand carefully the customer's expectations as well as their needs. Thus the company can increase customer satisfaction where the company maximizes a pleasant customer experience and minimizes or eliminates an unpleasant customer experience. In turn, customer (consumer) satisfaction can create loyalty or loyalty with customer satisfaction (Dewi, 2014) The beauty, comfort, cleanliness and tidiness of the inpatient room and patient care room are one of the components in standard precautions, absolutely necessary to support the patient's healing process during the period of care and treatment. It is very important as a nurse to make the patient care room as comfortable as possible by regulating the room temperature, maintaining adequate ventilation, avoiding unpleasant odors and maintaining cleanliness and keeping the room/room neat and orderly so that the patient will feel more comfortable in treatment.
Tangible variable (physical evidence) is the appearance of physical facilities, tools and personnel.
Physical appearance includes cleanliness, lighting, atmosphere and appearance of health workers. In general, someone will see a potential for the hospital with clean, tidy and orderly conditions, people will expect that the hospital will carry out its functions properly. The relationship between physical evidence and patient satisfaction is that physical evidence has a positive and significant effect on patient satisfaction. The better the customer's perception of physical evidence, the higher will be patient satisfaction, and if the patient's assessment of physical evidence is poor, then patient satisfaction will be lower.
Good service can create patient loyalty, service here can be in the form of effective communication, namely one's ability to convey messages, analyze, and respond quickly to existing situations. Good service is something that can be heard or understood properly by the recipient of the message. Things that are highly valued in providing responsive services, mean the response or alertness of health workers in helping patients and providing fast services and which includes the alertness of health workers in serving patients, the speed of health workers in handling transactions and understanding what is conveyed by patients.
The empathy dimension is a dimension related to the special concern and attention of staff to each service user, understanding their needs and making it easy to be contacted at any time if service users want to get help by giving genuine attention to patients who are individual or private. Trying to understand the patient's wishes. This is in line with research according to research conducted by Irmawati, S in 2017 concerning the Quality of Health Services at the Sangurara Health Center, Tatanga District, Palu City, showing that empathy, in the context of health services at the Sangurara Health Center, Tatanga District, is related to the treatment or personal attention given by health officials at the Sangurara Health Center in Tatanga District to the people served, so as to create a harmonious atmosphere and mutual understanding between those who serve and those who are served. The empathy dimension can be seen from the friendliness of employees in the process of health services and the ease of being contacted by the public in providing health services (Irmawati, 2017).
Reliability is the ability of health workers to provide health services in a timely and accurate manner according to what is offered. To improve reliability in the field of health services, top management builds a quality culture, namely a corporate culture of no mistakes that is applied from top management to staff. This kind of work culture is implemented by forming a cohesive work group and receiving continuous training according to developments in medical technology and patient expectations.
The reliability of the services provided must be in accordance with what was promised accurately and reliably. Performance must be in accordance with patient expectations which means timeliness, equal service, for all customers without errors, sympathetic attitude, and with high accuracy. According to Tjiptono, reliability is the ability of a hospital to provide the promised service promptly, accurately and satisfactorily. This means that in the inpatient room of RSU Vina Estetica Medan, they provide their services right from the first time (right the first time). In addition, it also means that in the inpatient room of RSU Vina Estetica Medan, the person concerned fulfills his promise, for example delivering his services according to the agreed schedule.
Good service can create patient loyalty, service here can be in the form of effective communication, namely one's ability to convey messages, analyze, and respond quickly to existing situations. Good service is something that can be heard or understood properly by the recipient of the message. Things that are highly valued in providing responsive services, mean the response or alertness of health workers in helping patients and providing fast services and which includes the alertness of health workers in serving patients, the speed of health workers in handling transactions and understanding what is conveyed by patients.
In line with research conducted by Yustisia, B in 2017 concerning Quality of Health Center Services with Elderly Patient Satisfaction (Study at the Jombang Mojowanro Health Center), it shows that the results of bivariate analysis with the Mann Whitney test obtained a p value of responsiveness of 0.000 <0.05. The conclusion of this study is that there is a relationship between responsiveness and satisfaction of elderly patients (Yustisia, 2017).
The responsiveness dimension is the ability of health workers to help customers and their readiness to serve according to procedures and be able to meet customer expectations. Health services that are responsive to the needs of its customers are mostly determined by the attitude of the front-line staff. They are in direct contact with service users and their families, either faceto-face, non-verbal communication, in person or by telephone.
Responsiveness (responsiveness) is the willingness of health workers to help when patients need clear information, resolve patient complaints quickly, the ability of officers to provide services to consumers quickly in service. Responsiveness and sensitivity to patient needs will improve the quality of health services. The effect of perceived responsiveness on patient satisfaction is the result of stimulus and the patient's five senses from the service received will be perceived so that later they will be able to assess the quality of service, if what they expect is in accordance with the reality they get, then it will be able to provide satisfaction to patients with regard to patient satisfaction. the response of health workers, and vice versa if what they expect does not match reality then the patient is dissatisfied.
The assurance dimension is a dimension related to knowledge, courtesy, and the nature of officers who can be trusted by customers. Fulfillment of these service criteria will result in service users feeling free from risk. Based on research, this dimension includes friendliness, competence, credibility, and security factors. In this case, health workers, both doctors and nurses, are always encouraged to use evidence-based medicine in providing services. This precise and accurate information and treatment must be conveyed to the patient, even better if it is available in print media and can be given to the patient to help make decisions is interpersonal communication with the starting point of giving mutual understanding between patients and nurses. The nurse uses her interpersonal communication (interpersonal communication) to develop a relationship with the client that will result in an understanding of the client as a whole human being. This kind of relationship is therapeutic which will promote a conducive psychological climate and facilitate the change and development of the patient. Nurse performance has an influence on patient satisfaction (Dewi, 2021).
In line with research conducted by Sari (2022) concerning the Relationship between Socioeconomic Factors and Satisfaction of Pregnant Women on the Quality of Antenatal Care Services at Puskesmas, the results show that there is a relationship between ANC user satisfaction and education (p = 0.003), income (p = 0.001), tangible (p = <0.001, assurance (p = <0.001), responsiveness (p = <0.001) and no relationship between ANC user satisfaction with reliability (p = 0.479) and empathy (p = 0.227). The study concluded that there is a relationship between satisfaction with education, income, tangible, assurance, and responsiveness There is no relationship between satisfaction with reliability and empathy (Sari, 2022) Service quality arises because patient expectations are fulfilled (Harahap, 2022), (Tamara, 2021).
Based on the researcher's assumptions that patient satisfaction in the assurance variable includes knowledge of health workers, skills and abilities of health workers in providing services to consumers, maintaining patient confidentiality, so as to foster a sense of security in customers so as to instill customer trust in the Hospital. For this reason, this needs to be improved because guarantees are very important in helping the patient's recovery process accurately and reliably so that they can provide quality and satisfying services.

Conclusion
There is a Tangible effect on inpatient satisfaction at Vina Estetica General Hospital Medan, physical evidence (tangibles) such as completeness of facilities gives a sense of satisfaction to respondents and fosters confidence that service is quality. There is no effect of Empathy on inpatient satisfaction at RSU Vina Estetica Medan. There is no effect of reliability on inpatient satisfaction at RSU Vina Estetica Medan. There is no effect of Responsiveness on inpatient satisfaction at RSU Vina Estetica Medan. There is no effect of Assurance on patient satisfaction at RSU Vina Estetica Medan. For Officers in the Inpatient Room of RSU Vina Estetica Medan So that the results of this study can be used as input material to be able to provide even better service quality.