Abstract

The development of private hospitals is competing to improve the quality of its services in order to increase the number of patient visits to hospitals. RSIA Pucuk Permata Hati is no exception, as a private hospital that has only been around for 2 years and is required to work extra to improve patient visits. One of them is to improve the quality of service and increase the value of the Hospital so as to create patient satisfaction and loyalty as the ultimate goal. The population in this study were 100 inpatients at RSIA Pucuk Permata Hati and using convenience sampling techniques. The data analysis technique used is path analysis (path analysis) which previously tested the instrument (validity and reliability), classic assumption test (normality, multicollinearity and outliers). The results of the data analysis showed that the quality of service had a positive and significant effect on the satisfaction at RSIA Pucuk Permata Hati Permata Hati. Values ​​have a positive and significant influence on patient satisfaction. Service quality has a positive but not significant effect on loyalty. Value has a positive and significant effect on loyalty. Consumer power (patients) has a positive and significant effect on loyalty.

How to Cite
Permana, A. W., Suardika, N., Sujana, W., & Yuesti, A. (2019). Analysis of Service Quality and Value Effect on Patient Satisfaction and Its Effect on Loyalty of Hospital Patients in Hospital and Children of Pucuk Permata Hati. International Journal of Contemporary Research and Review, 10(02), 21255-21266. https://doi.org/10.15520/ijcrr.v10i02.653
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Introduction:

Increasingly tight competition and increasingly selective and knowledgeable patients require that private hospitals in Bali compete to provide the best service to patients by offering various advantages. As one of the RSIA Pucuk Permata Hati health care providers which is a new private hospital is required to always improve the quality of its services. To be able to improve the quality of service, it must first be known whether the services provided to patients have been in accordance with the expectations of patients or not. This is important as a reference in improving service so that it can provide optimal satisfaction, so RSIA Pucuk Permata Hati is

required to always maintain patient trust and satisfaction by improving the quality of services so that patient satisfaction increases. RSIA Pucuk Permata Hati needs to carefully determine the patient's needs, as an effort to meet expectations and improve patient satisfaction for the services provided.

Hospital is one of the agencies that plays a role in administering health services to the community, required to improve the quality of performance in providing services to the community. Services provided are able to meet the needs of the wishes and expectations of the community and be able to provide satisfaction. Patient satisfaction can be an assessment of service elements that still need improvement and become a driver for each service unit to improve service quality ( Ratminanto et al., 2010 ).

The creation of quality services will certainly create satisfaction with service users. Own service quality must begin with customer needs and end at the customer's perception or judgment. This means that good quality is not seen from the perception of the service provider, but based on customer perceptions. Customer perception of service quality is a comprehensive assessment of the superiority of a product or service. The quality of service itself is formed by a comparison between ideal and perceptions of the quality dimension performance. The quality of the service itself is solely determined by the customer so that customer satisfaction can be achieved by providing good quality.

According to Tjiptono ( 2008 ), service quality is defined as how far the difference between reality and the expectations of customers for the service they receive. Service quality as a measure of how well the level of service provided is able to be in accordance with customer expectations, based on the definition above, it can be concluded that there are factors that influence service quality, namely expected services and perceived services. The results of research on service quality affect loyalty performed by Hidayat ( 2016 ), entitled the influence of service quality, perceptions of costs and images on user satisfaction and loyalty (Study in the outpatient installation of RSUD Dr. Saiful Anwar Malang). Conclude that service quality has a significant positive effect on patient loyalty.

Customer value according to Kotler and Keller ( 2013 ), is a combination of quality, service, price of a product offer. The value of the customer is the difference between the amount of value for the customer and the amount of cost from the customer. The amount of value for the customer itself is a group of benefits expected from customers of certain goods or services. The results of the research conducted by Kusniati ( 2016 ), entitled The influence of service quality and customer value on interest in repeat visits through patient satisfaction at general poly at RSISA Semarang, concluded that customer value had a significant positive effect on patient loyalty.

Customer satisfaction according to Kotler and Keller ( 2013 ), is the level of one's feelings after comparing performance or the results he feels compared to his expectations. So the level of satisfaction is a function of the difference between perceived performance and expectations.

Satisfaction reflects a person's judgment about product performance in relation to expectations. If the performance does not meet expectations, the patient is not satisfied and disappointed or vice versa if it meets expectations, the customer will be happy and satisfied. The results of the research conducted by Hidajahningtyas ( 2013 ), entitled The Effect of Image, Service Quality and Satisfaction on Patient Loyalty in the Regional Hospital executive polyclinic, Dr. Soebandi, Kabupaten Jember, concluded that satisfaction had a significant positive effect on patient loyalty.

Based on research conducted by As'ad ( 2013 ); Monica ( 2016 ); Wungow ( 2013 ); Mahmudi ( 2016 ); Adarajad ( 2016 ); Fajar and Hasibun ( 2016 ), service quality as an independent variable and customer loyalty as the dependent variable. Conclude that service quality has a significant effect on customer loyalty. This significant value indicates that the better quality of services provided makes patients loyal to the Hospital.

Based on research conducted by As'ad ( 2013 ); Wungow; Adarajad ( 2016 ); Kusniati ( 2016 ), about customer value variables as independent and loyalty variables as the dependent variable, concludes that customer value has an effect on loyalty through satisfaction variables. The higher the value given by the customer will increase the loyalty of the customer.

Based on research conducted by Wungow ( 2013 ; Hidayahningtyas ( 2013 ); Rif'adarajad ( 2016 ); Fajar and Hasibun ( 2016 ), about satisfaction variables as independent variables and loyalty as the dependent variable. Conclude that satisfaction variables significantly influence customer loyalty. If the customer is satisfied with the product or service he bought, the customer will buy the product or service repeatedly, so that it can lead to loyalty to the customer.

According to the results of research conducted by Kusniati ( 2016 ); Afriliawan ( 2013 ), about value variables as independent variables and satisfaction as the dependent variable. Conclude that the value variable has a significantly positive effect on patient satisfaction.

According to research conducted by Utami et al., ( 2018 ); Kusniati ( 2016 ), concluded that there was a significant positive relationship between service quality and customer satisfaction. The better the quality of services provided, the patient satisfaction will also increase.

This research is a development of research conducted by Hidayahningtyas ( 2013 ), which examines image variables, service quality and satisfaction with patient loyalty. The next study was carried out by Kusniati ( 2016 ), who examined the variable quality of service and customer value towards interest in repeat visits through patient satisfaction.

The difference between this research and the previous research was on the research subjects and the variables taken from the two studies, namely the quality of service and the value of patient satisfaction and its effect on the loyalty of hospitalized patients at the RSIA Pucuk Permata Hati. In this study, we will examine the overall effect of customer quality and value on patient satisfaction so as to ensure the loyalty of hospitalized patients at RSIA Pucuk Permata Hati.

Research Methods:

Loyalty:

Tjiptono ( 2008 ) defines customer loyalty as a repurchase can be the result of market dominance by companies that succeed in making their products the only alternative available. Consequently, customers do not have the opportunity to choose. In addition, repurchases can also be the result of continuous promotional efforts in order to lure and persuade customers to buy back the same brand. If there is no market dominance and intensive promotion efforts, customers who are loyal to certain products tend to be tied to the product and will buy the same product again even though there are many other alternatives available. In principle, the concept of customer loyalty applies to products, services, organizations (shops, suppliers, services, sports clubs), product categories (for example cigarettes), and activities (eg swimming and playing soccer). Broadly speaking, the literature on customer loyalty is dominated by two main streams: stochastic flow (behavioral) and deterministic flow (attitude). In other words, brand loyalty can be viewed from what brand consumers buy and how consumers feel or attitude towards a particular brand. In the latest development, there is also an integrative flow that attempts to link attitude and behavioral perspectives, Tjiptono ( 2008 ).

According to Kotler and Keller ( 2013 ), loyalty comes from fulfilling consumer expectations or expectations, while expectations themselves come from previous purchasing experiences by consumers, opinions from friends and relatives, promises or information from marketers or competitors. There are reasons to develop long-term relationships with consumers. Here are the things that cause customer loyalty:

Creating superior products, services and experiences for the target market

Organize and access data base information about needs, previews, and relationships, frequency of purchases and satisfaction of individual customers.

Make it easier for customers to reach the right company cellphone and express customer needs, perceptions and complaints.

According to Kotler and Keller ( 2013 ) loyalty is the commitment of customers to stay in depth for returning customers or to re-purchase selected products / services consistently in the future, even though the influence of the situation and marketing efforts has the potential to cause switching customer behavior.

Griffin ( 2007 ) in Fajar and Hasibun said that loyal consumers are people who carry out activities to buy goods or services that meet the following criteria:

Repeat regularly

Buy other products offered by the same manufacturer

Recommend these products or services to others

Requires a long time and several stages to have loyal customers. Loyal customers need different emphasis at each stage, because in the faithful stages have different emphases. By fulfilling the stages and needs of the customer, the company will have a fairly large opportunity to make prospective buyers loyal.

From some of the definitions above, it can be concluded that customer loyalty because of the existence of good service will make customers feel comfortable and valued so that they make repeated purchases not only once but can stay or become regular customers both products or services.

Service quality:

Service quality according to Kotler and Keller ( 2013 ), is the totality of features and characteristics of products or services that depend on their ability to satisfy these expressed or implied needs is clearly a customer-centered definition. Companies that satisfy their needs all the time are called quality companies.

According to Tjiptono ( 2008 ), service quality is the expected level of excellence and its control over the level of excellence to meet customer desires. Based on the definition above, it can be concluded that there are main factors that influence service quality, namely expected services and perceived services. If the services perceived can be in accordance with the services expected, then the quality of these services will be perceived as good or positive. Parasuraman and Tjiptono ( 2008 ) suggest that there are five dimensions of service quality as follows:

Reliability (reliability), namely the ability to provide services immediately and satisfactorily and in accordance with what has been promised.

Responsiveness, namely the ability to help customers and availability to serve customers well.

Assurance, which includes knowledge, politeness and trustworthiness of staff, free from danger, risk or doubt.

Empathy, namely caring for giving individual attention to customers, understanding customer needs and ease of contact.

Tangibles (direct evidence), which includes physical facilities, equipment, employees, and means of communication.

All these indicators can be used as parameters to determine the extent to which RSIA Pucuk Permata Hati provides quality services and the extent to which they affect loyalty.

Customer Value:

Value is the central concept of its role in marketing. We can see marketing as an activity of identifying, creating, communicating, conveying customer value according to Kotler and Keller ( 2013 ). Value reflects a number of tangible benefits and costs that are perceived by the customer to be a combination of quality, service and price. Bidding will be successful if it provides value and satisfaction to the target buyer. Based on the perception of the offer that provides the greatest value.

Customer-perceived value is the difference between prospective customer evaluations of all benefits and all certain bid costs and other alternatives considered. Total customer value (tcv-total customer value) is a monetary value that is thought of as a set of economic, functional, and psychological benefits that customers expect from a particular market offer. Total customer cost is a set of costs that must be incurred by the customer to evaluate, obtain, use, and dispose of certain market offers, including monetary, time, energy, and psychological costs. The value that the customer thinks is based on the difference between what the customer gets and what he gives for various possible choices. Customers get benefits by issuing certain costs to get products or services from a company. Whereas marketers can increase the value of customer bids by combining increasing functional or emotional benefits and or overseeing one or more different types of costs. According to Tjiptono ( 2008 ), the dimension of value consists of 4, namely:

Emotional value, a utility that comes from feelings or affective / positive emotions arising from consuming products.

Social value, a utility obtained from the ability of products to improve the self-concept of social consumers.

Quality / performance value, utility obtained from the product due to short-term and long-term cost reduction.

Price / value of money, utility obtained from the perception of the expected performance of the product or service.

From several concepts and definitions of customer value above, it can be concluded that customer value is a comparison between the benefits felt by the customer and what they sacrifice to get or consume a product or service.

Customer Satisfaction ( Patients ):

Customer satisfaction (patient) is the level of one's feelings after comparing performance or the results he feels compared to his expectations. So the level of satisfaction is a function of the difference between perceived performance and expectations. Satisfaction reflects one's judgment about product performance in relation to expectations if the performance does not meet expectations, the customer is dissatisfied and disappointed if the customer exceeds feeling happy according to Kotler and Keller ( 2013 )

Customer satisfaction has become a central concept in marketing theory and practice, and is one of the essential goals for business activities. Customer satisfaction contributes to a number of crucial aspects, such as the creation of customer loyalty, increased corporate reputation, reduced price elasticity, reduced future transaction costs, and increased efficiency and productivity of employees Tjiptono ( 2008 ).

According to Lupiyoadi ( 2009 ) there are five main factors that need to be considered in relation to customer satisfaction, namely:

Product quality. Customers will be satisfied if the results of their evaluation show that the products they use are of high quality.

Service quality. Customers will feel satisfied when they get good service or in accordance with expectations.

Emotional. Customers will feel proud and have confidence that other people will be amazed if someone uses a branded product and tends to have higher satisfaction. Satisfaction obtained is not because of the quality of the product but the social value that makes customers satisfied with certain brands.

Price. Products that have the same quality but set prices relatively cheaply will give higher value to their customers.

Cost. Customers who do not need to incur additional costs or do not need to waste time getting a product or service tend to be satisfied with the product or service.

According to Pohan ( 2007 ), aspects that affect patient / customer satisfaction from various research studies with successive results as follows:

  1. Healing1. Healing

  2. Availability of Hospital medicines2. Availability of Hospital medicines

  3. Personal privacy or privacy while in care3. Personal privacy or privacy while in care

  4. Hospital Hygiene4. Hospital Hygiene

Get comprehensive information, get information about the name of the disease, how to treat it at home, and information about the danger signs to immediately bring it back to treatment.

From the definition above are the factors that cause customers to feel satisfied, whether they are satisfied with the products or services issued by the company that causes these customers to be loyal.

Framework:

According to Uma Sekaran in Sugiyono ( 2014 ), a conceptual frame of mind about how theory relates to various factors that have been identified as important problems. A good mindset will explain theoretically the links between the variables to be studied. So theoretically it is necessary to explain the relationship between the independent variable (independent) and the dependent variable (dependent).

a. The relationship between service quality and patient loyalty

According to Tjiptono ( 2008 ), service quality is the expected level of excellence and its control over the level of excellence to meet customer desires. Service quality is defined as how far the difference between the reality and the expectations of customers for the services they receive. Quality of service as a measure of how well the level of service provided is able to meet customer expectations. Based on research conducted by As'ad ( 2013 ); Monica ( 2016 ); Wungow ( 2013 ); Mahmudi ( 2016 ); Adarajad ( 2016 ); Fajar and Hasibun ( 2016 ), service quality as an independent variable and customer loyalty as the dependent variable. Conclude that service quality has a significant effect on customer loyalty. This significant value indicates that the better quality of services provided makes patients loyal to the Hospital.

b. The relationship between customer value and patient loyalty

Customer value is the customer's perception of the balance between the benefits received and the sacrifices given to obtain these benefits Buttle ( 2007 ). Based on research conducted by As'ad ( 2013 ); Wungow; Adarajad ( 2016 ); Kusniati ( 2016 ), about customer value variables as independent and loyalty variables as the dependent variable, concludes that customer value has an effect on loyalty through satisfaction variables. The higher the value given by the customer will increase the loyalty of the customer.

The relationship between satisfaction and patient loyalty

According to Kotler ( 2013 ) customer satisfaction is the level of one's feelings after comparing performance or the results he feels compared to his expectations. So the level of satisfaction is a function of the difference between perceived performance and expectations. Satisfaction reflects a person's judgment about product performance in relation to expectations. If the performance does not meet expectations, the customer is dissatisfied and disappointed if the customer exceeds that feeling happy. Based on research conducted by Wungow ( 2013 ; Hidayahningtyas ( 2013 ); Rif'adarajad ( 2016 ); Fajar and Hasibun ( 2016 ), about satisfaction variables as independent variables and loyalty as the dependent variable. Conclude that satisfaction variables significantly influence customer loyalty. If the customer is satisfied with the product or service he bought, the customer will buy the product or service repeatedly, so that it can lead to loyalty to the customer..

The relationship between customer value and patient satisfaction

The value received by the patient can direct the feeling of overall satisfaction. Presentation of superior values ​​for patients is a real prerequisite for customer satisfaction. Patients form expectations of the value of a service performance and act based on the amount of benefits received with limited price, time, effort and psychological costs. The higher the perceived value of the patient, the higher patient satisfaction Kotler ( 2013 ). According to the results of research conducted by Kusniati ( 2016 ); Afriliawan ( 2013 ), about value variables as independent variables and satisfaction as the dependent variable. Conclude that the value variable has a significantly positive effect on patient satisfaction.

The relationship between service quality and patient satisfaction

Service quality is very closely related to patient satisfaction. The level of service quality provided by service providers will greatly determine patient satisfaction. Quality will be a support in the formation of patient satisfaction because if the service quality is felt by patients more than expected, it will create and maintain patient satisfaction. According to research conducted by Utami et al ( 2018 ); Kusniati ( 2016 ), concluded that there was a significant positive relationship between service quality and customer satisfaction. The better the quality of services provided, the patient satisfaction will also increase.

Figure 1 Conceptual Framework

This research is an explanatory study with a cross sectional time approach to quantitative analysis methods. The study was conducted by distributing questionnaires to respondents. Population is a set of units that are usually in the form of people, objects, transactions or events where we are interested in learning (Kuncoro, 2001: 22). In this study the intended population were all hospitalized patients at RSIA Pucuk Permata Hati. The sample is a subset (subset) of the population unit. Consumers who were sampled were patients who came for treatment at the RSIA Pucuk Permata Hati. The number of samples is based on Roscoe's opinion as quoted by Sekaran ( 2008 ) that the sample size is greater than 30 and less than 500 has been sufficient to be used in all studies. So the sample used in this study is 100 respondents. To facilitate this sampling, the convenience sampling method is used, which is to take individuals or members of the population that are easily found. Indeed, in non random samples, accuracy to reflect the population is less accurate. But that's what can be done, because the population is not homogeneous and difficult to identify. This method is also called accidental sampling or incidental sampling. So that research on the quality of service to patient satisfaction moderated by value variables can be done with a survey of each patient found in the RSIA Pucuk Permata Hati.

Path analysis is used to find an explanation of the patterns of relationships between variables studied based on theoretical considerations and empirical studies that have been done before, then displayed in the form of a picture (path diagram) as a tool to help conceptualize the problem of complex hangings. According to Sarwono ( 2007 ), path analysis is a method used to see the direct and indirect effects of variables that are hypothesized as causes for variables that are applied as a result. Variables in path analysis are exogenous variables as causes and endogenous variables as result variables

Research Results and Discussion:

Research result:

Hypothesis testing is done based on the path coefficients with the condition that the probability (p) value is below 0.05 (p <0.05) shown in the regression weight results presented in the following table 1.

Figure 2 Table 1 Recapitulation of Regression Weight

Based on the test results presented in Table 1 above, it shows that the four paths analyzed show a significant causal relationship. This can be seen from the magnitude of the path coefficient ( Estimate and Standardized Estimate ) with the value of the critical ratio (CR) greater than 2.0 or the level of significance of the hypothesis test which is smaller than 5%. Whereas there is one path showing a non-significant causal relationship. This can be seen from the magnitude of the path coefficient ( Estimate and Standardized Estimate ) with the value of the critical ratio (CR) that is smaller than 2.0 or the level of significance of the hypothesis test that is greater than 5%. To make it easier to determine the amount of direct, indirect and total effects of the relationship between variables, it is necessary to do decomposition as presented in Table 2 below.

Figure 3 Table 2 Standardized

According to the explanation in Table 2 above, the results of hypothesis testing can be submitted as follows:

Service quality (X1) has a positive and significant effect on consumer satisfaction (Y1) which is shown in the path coefficient (standardized regression weight) a positive value of 0.677 with significance (p) = 0,000 (p <0.05). These results indicate that service quality is getting better able to increase customer satisfaction. Thus, hypothesis 1 (H1) fails to be rejected.

Customer value (X2) has a positive and significant influence on consumer satisfaction (Y1) which is shown in the path coefficient (standardized regression weight) of a positive value of 0.281 with significance (p) = 0,000 (p <0.05). These results indicate that the better customer value can increase customer satisfaction itself. Therefore, hypothesis 2 (H2) can be accepted.

Service quality (X1) has a positive but not significant effect on patient loyalty (Y2) shown in the path coefficient (standardized regression weight) of a positive value of 0.077 with significance (p) = 0.401 (p> 0.05). These results indicate that the better service quality can increase patient loyalty but not significant. Therefore, hypothesis 3 (H3) is acceptable.

Customer value (X2) has a positive and significant effect on patient loyalty (Y2) which is shown in the path coefficient (standardized regression weight) of positive value of 0.187 with significance (p) = 0.012 (p <0.05). These results indicate that the higher customer value can increase patient loyalty. Therefore, hypothesis 4 (H4) is acceptable.

Consumer satisfaction (Y1) has a positive and significant effect on loyalty (Y2) which is shown in the standardized regression weight positive value of 0.710 with significance (p) = 0.000 (p <0.05). These results indicate that the more satisfied the patient is, the higher the patient's loyalty. Thus, hypothesis 5 (H5) can be proven.

Other information that can be conveyed from the results of the path analysis presented in Table 2 above, service quality (X1) turns out to have a positive indirect effect on loyalty (Y2) with a positive path coefficient of 0.480. Customer value (X2) has a positive indirect effect on loyalty with a positive path coefficient of 0.199.

Figure 1 Figure shows the progress of the system

Discussion:

The results of the analysis presented in the above presentation will be discussed in accordance with the formulation of the problems raised in this study.

Effect of Service Quality on Patient Satisfaction:

The results of hypothesis testing indicate that service quality has a positive and significant effect on customer satisfaction. These results mean that the better the quality of service provided to patients, the better the patient’s satisfaction during hospitalization. In addition, the results of this study provide clues that the quality of services provided at RSIA Pucuk Permata Hati facilities has been well implemented. With the quality of good service, patients are satisfied with the services provided. The findings generated in this study are consistent with the results of previous studies, such as: Kusniati ( 2016 ); Monica ( 2016 ) and Utami et al ( 2018 ); who have found that service quality can improve patient satisfaction. Based on the explanation above, it can be emphasized that good service quality has an important role in increasing customer satisfaction in this case is the patient. This is because good service quality in accordance with the four indicators, namely tangible, empathy, reliability, responsiveness and assurance can lead to a sense of comfort to the patient so that the patient will feel satisfied.

Influence of Customer Values ​​on Patient Satisfaction:

The results of hypothesis testing indicate that customer value has a positive and significant effect on customer satisfaction. These results mean that the higher the value given by the customer (patient) to the Hospital, it will automatically be able to increase patient satisfaction itself. The findings of this study also illustrate that the customer value of RSIA Pucuk Permata Hati is high. Patients feel comfortable with the services, places and facilities provided during treatment at the RSIA inpatient unit. Permata Hati. This finding is consistent with Kusniati ( 2016 ) and As’ad ( 2013 ) who find that customer value has a positive and significant effect on customer satisfaction. As’ad ( 2013 ) found that prices have a positive and significant effect on customer satisfaction. Based on the explanation above, it can be confirmed that good customer value will automatically be able to increase customer satisfaction itself, in this case RSIA inpatients, Permata Hati.

Effect of Service Quality on Patient Loyalty:

The results of hypothesis testing indicate that service quality has a positive but not significant effect on patient loyalty. These findings indicate that the better the quality of services provided, the patient loyalty will also increase but not significantly. This finding is not in accordance with the results of Hidayahningtyas ( 2013 ), Hasibuan ( 2016 ), Wungow ( 2013 ), Mahmudi ( 2016 ), Adarajad ( 2016 ), and Monica ( 2016 ) who found that service quality has a significant positive effect on loyalty. This is not in accordance with this study, which is that service quality has a positive but not significant effect on loyalty. Based on the explanation above, it can be stated that service quality can affect loyalty but is not significant. The better the quality of services provided, the higher patient loyalty to RSIA Pucuk Permata Hati.

Effect of Value on Patient Loyalty:

The results of hypothesis testing indicate that the value has a positive and significant effect on customer satisfaction. These results give the meaning that the better the value of the customer, the better the patient’s loyalty to the Hospital. In addition, the results of this study explain that the customer value of the RSIA Pucuk Permata Hati is good. With this high value, it can also cause high loyalty to the RSIA Pucuk Permata Hati. The findings generated in this study are consistent with the results of previous studies, such as: Wungow ( 2013 ) and Adarajad ( 2016 ) who have found that customer value has a significant positive effect on loyalty. Based on the explanation above, it can be affirmed that good customer value has an important role in increasing patient loyalty to the Hospital. The better the patient’s assessment of the RSIA Pucuk Permata Hati, the more loyal the patient will be.

Effect of Patient Satisfaction on Patient Loyalty:

The results of hypothesis testing indicate that patient satisfaction has a positive and significant effect on patient loyalty. These results mean that the more patients are satisfied with the service provided during treatment, the more loyal the patient will be to RSIA Pucuk Permata Hati. In addition, this study also showed that most patients were satisfied while being treated at the RSIA Pucuk Permata Hati inpatient unit. The findings generated in this study are consistent with the results of previous studies, such as: Hidayahningtyas ( 2013 ), Hasibuan ( 2016 ); Wungow ( 2013 ), Adarajad ( 2016 ), and Utami et al ( 2018 ); who have found that customer satisfaction has a positive and significant effect on loyalty.

Based on the explanation above, it can be emphasized that patient satisfaction has an important role in increasing patient loyalty itself. The higher the feeling of satisfaction felt by patients eating the patient will be more loyal to the Hospital.

Conclusion:

Based on the results of the analysis and discussion of the results of the study, in this study it can be concluded that:

Service quality has a positive and significant effect on the satisfaction of hospitalized patients at RSIA Pucuk Permata Hati. The better the quality of service, the patient satisfaction will increase.

Values ​​have a positive and significant effect on the satisfaction of hospitalized patients at RSIA Pucuk Permata Hati. The higher the customer value ( Patient ), the patient satisfaction will increase.

Quality of service has a positive but not significant effect on patient loyalty. Improving the quality of service does not necessarily affect patient loyalty to RSIA Pucuk Permata Hati.

Values ​​have a positive and significant effect on the loyalty of hospitalized patients at RSIA. Pucuk Permata Hati. The higher the value of the customer (patient) eating patient loyalty will increase.

Patient satisfaction has a positive and significant effect on the loyalty of hospitalized patients at RSIA Pucuk Permata Hati. The higher patient satisfaction, the patient’s loyalty will increase.

Suggestion:

In a study that examined the relationship of 4 (four) variables, namely service quality, value, patient satisfaction and patient loyalty, there were several suggestions that the researcher wanted to convey, namely:

  1. For RSIA Pucuk Permata Hati1) For RSIA Pucuk Permata Hati

  2. For Further Researchers2) For Further Researchers

Quality of service to be maintained because it is good but in the information giving section is still the lowest. So it needs to be improved in the provision of information and more responsive in serving patients.

The value (patient) is good but at the cost section the lowest result is obtained. So it needs to be evaluated regarding the medical costs at RSIA Pucuk Permata Hati.

Patient satisfaction gets a good value and needs to be maintained. The patient is satisfied with the services provided by RSIA Pucuk Permata Hati. But the research found the lowest value on satisfaction with information and costs. So it is necessary to evaluate how to deliver information to patients and evaluate the cost of hospitalization.

Patient loyalty to RSIA Pucuk Permata Hati is good. However, loyalty was obtained whether the patient was not interested in going to another hospital for the lowest, which meant that the patient was still interested in going to another hospital. So that it should be noted that the development of the Hospital is to be more complete so that all the patient's needs are available under one roof at RSIA Pucuk Permata Hati.

It is hoped that in the future this research can be used as one of the references for the research then by using different independent variables that influence patient satisfaction and loyalty.

Research results can be used for the development of Marketing Management sciences especially for service quality, customer value, patient satisfaction and loyalty

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