The Influence of Doctor Service and Facilities on Healthcare Service Quality

The Influence of Doctor Service and Facilities on Healthcare Service Quality

Anne Suria Marliane^1*, Muhardi², Albert Hendarta³

^1,2,3Faculty of Economic and Business, Universitas Islam Bandung, Indonesia

DOI: https://dx.doi.org/10.47772/IJRISS.2023.70856

Received: 18 July 2023; Accepted: 31 July 2023; Published: 24 August 2023

ABSTRACT

To support the basic human rights provision, The Indonesian government issued several policies. One of these policies is the Health Insurance program issuance in 2014. With the issuance of the program, doctors and healthcare facilities must follow certain procedures, while also providing enhanced services to optimize healthcare service quality. This research is a quantitative study using descriptive and inferential statistics, conducted on 94 people as the sample in this research. Based on the results of this research, it was revealed that doctor service and healthcare facilities simultaneously affect service quality insignificant ways. Based on a further detailed test, both doctor service and healthcare facilities are also proven to partially provide a significant effect on the quality of service. Based on these results, it can be concluded that by improving the quality of doctor services and healthcare facilities, service quality in healthcare facilities will improve significantly and will lead to optimized patient satisfaction.

Keywords: Doctor service, healthcare facilities, service quality

INTRODUCTION

Based on the Government Regulation of the Republic of Indonesia Number 47 of 2016 on general provisions health service facilities function as providers of health services in the form of promotive, preventive, curative and rehabilitative. As fulfilment of basic rights related to access to quality, safe and affordable health services [1], [2], the Indonesian government issued national health insurance known as Jaminan Kesehatan Nasional (JKN) in January 2014. With the implementation of the program, there has been a significant increase in patient visitation to first-class healthcare services and hospitals. However, the quality aspect is yet to reach an optimum level. A number of researchers developed healthcare quality concepts which include clinical service, administration process, safety, trust, and accessibility [3]–[6]. Satisfaction resulted from the conformity of expectation and reality of service experienced by patients [7]–[10]. Based on the satisfaction concept, most healthcare facilities are developed based on patient’s needs and expectations.

According to Zeithaml [11], there are five dimensions that can explain customer perception of service quality; reliability, responsiveness, assurance, empathy, and tangibility. Reliability relates to the ability of service provision with accuracy and trustfulness. Responsiveness relates to the agility of service provision towards customers. The dimension is influenced by technological factors that are highly related to speed and response. Assurance is a dimension that is related to the ability to instils trust and faith in the customers’ minds, based on the capability to perform courtesy and service-related skills. Empathy reflects sincerity and a personal approach, in order to create added value by providing additional services unexpected by the service provider. Meanwhile tangibility, is mostly related to the physical availability of certain service providers in the forms of buildings, transportation, facilities, and other types of physical appearance shown by service the provider.

Service quality is vital because it has a direct impact on organizational image [12]. Service quality will shape an organization’s competitive advantage by strengthening customers’ relatedness and positive valuations. It is one of many fundamental bases that would drive regular customer into a repeat customer [13]. Excellent service would also enhance customer willingness to recommend and advertise their positive experiences to certain groups of people, and increase organizational profitability [14].

Indonesian Government Regulation 47/2016 explains that clinics have to consider a number of aspects in providing healthcare service namely geographical condition and accessibility, utility, operational hours, and personnel availability (doctors, dentists, specialists, nurses, supporting agents, etc.). Indonesia is a massive and densely populated country. That is why, the geographical placement of a clinic is highly important to ensure optimum accessibility. To facilitate this requirement, the Indonesian Ministry of Health issued a decree; Decree 9/2014 regarding clinics to ensure strategic placement and facilitate private healthcare units to grow and compete in the healthcare service provision industry. The decree also regulates the minimum types of services that should be provided in a single clinic, along with its specifications and conditions of clinic establishment. For example, the compliance with the level of population in a designated area.

Asri Husada II Primary Clinic in Bandung is a private healthcare facility located in Bandung City. Based on the clinic’s medical record, the number of patients visiting this clinic is currently at a decent level. On average, Asri Husada II Primary Clinic receives 1,713 patients with various health problems. The number reflects a high level of trust that indicates a decent level of satisfaction and impression related to healthcare service quality. Based on Google review and surveys, the customers and patients who visit the clinic is also quite satisfied with the service provided, especially the ones related to doctors, dentists, pharmacists, and administration officers. The clinic also provides extra services for patients such as National Healthcare Insurance availability, online registration, gifts (keychain, mug, stickers), home visitation for certain health cases, and partnership with a number of companies in the form of discounts.

Doctors become one of the most important components in determining patient satisfaction. Several studies have been conducted to determine the effect of doctors on patient satisfaction. Among them a study conducted by Al Omari [15], revealed that doctors’ services are represented by their ability and willingness to provide detailed information about patients’ illness, medication, and courtesy. Besides that, Kurniawan [16] discovered that there are a number of indicators which influence patients’ satisfaction namely doctor time punctuation, doctors’ communication skill, courtesy, and choice of words will shape patients’ satisfaction level. Besides doctors and other personnel, physical availability such as cleanliness, comfortable waiting room, sophisticated machinery, and modern medication methods also influence patients’ satisfaction levels[17].

Based on the presented research background, the objective of this study is to understand the influence of doctor service and facilities provided by healthcare units on the quality of healthcare service.

RESEARCH METHOD

This research is a quantitative research that utilizes descriptive and inferential statistics. The research focuses on the influence of doctor services and facilities on service quality by collecting data, describing data and testing hypotheses. The population in this study was based on an average of 1,713 clinic patient visits in one month. The sample used in this study was 94 people. The types of data in this study are primary and secondary data. Primary data is data obtained from the first source, such as the results of interviews or the results of filling out questionnaires from respondents, while secondary data is obtained from scientific articles empirically and data provided from institutions related to this research. To obtain primary and secondary data, a questionnaire was used as a data collection instrument. The analytical method used in this study is to use multiple linear regression analysis. The data that has been analyzed is then presented in a descriptive and verifiable form so that it is expected to produce a good level of understanding of the research results.

RESULTS

Based on the analysis on the responses provided by 94 people as respondents in this research, it was revealed that the general characteristic of the respondent are 17 to 27 years old (33.0%), most of them are graduated from high school (44.7%), and currently working as private company employees (40.4%). These characteristics can be summarized into a general categorization that represents the respondents. The categorization of the respondents are people with adequate ability to evaluate, educated, and familiar with organizational structure and how it works to ensure optimum satisfaction. To provide detailed illustration of the respondent, the characteristics are shown in Table 1.

Table 1. Characteristics of Respondents

The results of the study revealed that the services of Asri Husada II Primary Clinic doctors in Bandung were in the good category. As evidenced by the minimum total score of the doctor’s service variable is 1.598 and the maximum is 7.990 while the total score of the research/actual results is 6.343, so it can be said that the respondent’s assessment of the doctor’s service at the Pratama Asri Husada II Primary Clinic in Bandung is in the good category. This shows that the doctor’s services have provided satisfaction for the patients served, but the satisfaction felt by the patient cannot be said to be optimum. The highest score is produced from questionnaire statement that the doctor always greets, so that it is indicated that the friendliness of the doctor towards the patient has a high influence on the doctor’s services which will further improve the quality of service. Then in carrying out the examination the doctor acts quickly has the second highest value, patients who have diseases that tend to require quick action state that quick action taken by doctors is able to improve the quality of service, but in fact long actions or interactions between doctors and patients are preferred by patients because the action can be said to be careful so as to minimize the error of the action given.

Health facility measurement was calculated by five dimensions, namely safety and security, health equipment, management of hazardous materials and waste, emergency and fire management, and utilities systems which are further divided into several statement items. The results of the study describes that Asri Husada II Primary Clinic facilities are in the good category. This is evidenced by the minimum total score of the health facility variable of 2.350 and a maximum of 11.750 while the total score of the research/actual results is 9.120, so it can be said that the respondents’ assessment of the Asri Husada II Primary Clinic health facility in Bandung is in the good category. The statement with the highest score is produced at adequate lighting system for the room or building. The patient witnessed that the lighting of the room and building is a very important health facility because of non-stopping activities or traffic in the health sector. Then the facilities that are said to be important are the presence of air conditioning in the room or building, the availability of tissues and hand towels, clean medical equipment, and the availability of sanitizers and public sinks.

Service quality variables are divided into five dimensions, namely: tangibles, reliability, responsiveness, assurance, and empathy which are further divided into several statements. The results of the study revealed that the quality of service at the Asri Husada II Primary Clinic in Bandung was in the good category. This is evidenced by the minimum total score of the service quality variable of 3.008 and a maximum of 15.040 while the total score of the research/actual results is 11.981, so it can be said that the respondents’ assessment of the service quality of the Asri Husada II Primary Clinic in Bandung is in the good category. Officers at the clinic provide clear information related to the diagnosis given which is the statement with the highest valuation results. It means that the officers have the ability to explain the disease experienced by patients. Another statement that has the highest score is produced in assurance category where officers are consistently take action in accordance with applicable procedures, officers quickly provide treatment for patient complaints, officers take action very quickly and precisely, and officers are always friendly in serving patients who ask questions.

Test results for the doctor’s service obtained a significance value of 0.000<0.05 and a t_count value of 4.574 > t_table 1.661. Based on the test criteria, the doctor’s service partially has a positive and significant effect on service quality. The research results are in line with the research by Debby [21] which mentioned that services that match or exceed customer expectations will give every employee inner satisfaction, and research by Novitasari which mentioned that [22], employees who are satisfied with their work results tend to always provide the best service quality.

The test results for the health facility, obtained a significance value of 0.000 <0.05 and a t_count value of 5.741 > t_table 1.661. Based on the test criteria, service quality has a partially positive and significant effect on service quality. The research results are in line with the research of Syafitri [23] who say that adequate health facilities are able to increase patient satisfaction because of the proper quality of service. Health facility management has the goal of ensuring the functioning, comfort, sense of security, patient and staff safety and how efficient the facility is in a place that provides health services for patients, visitors and the health service facility.

Handling of waste management for hazardous and toxic materials at Asri Husada II Primary Clinic has been going well and in accordance with the Regulation of the Minister of Environment and Forestry of the Republic of Indonesia, by placing toxic and hazardous materials on a marked and separated room so that it can protect the people around it.

The results of the F test show the value of 0.05 or 5%, and significance value of 0.000 < alpha = 0.05. Based on the result, it can be concluded that doctor’s service and facilities have a simultaneously significant effect on service quality. The result is in accordance with a number of researches which states that the patient’s experience of the services provided by health facilities has a strong impact on user satisfaction. High quality service significantly strengthens satisfaction[24]–[27].Based on the analysis, a study on factors that influence service quality, especially doctor service and facilities are important to determine the ability of certain healthcare facility to optimize satisfaction level, in order to enhance competitive advantage.

DISCUSSION

According to Schneider [18], basically the intermediate goal of a business is to create satisfied customers. The creation of customer satisfaction can provide several benefits, including the influence between the company and the customer to be harmonious, providing a good basis for repurchasing. Related to service industry there are certain unique characteristics that separate them from other industry. Service industry is measured by its intangibility, inseparability, variability, perishability and lack of ownership. The findings of this research revealed that Asri Husada II Primary Clinic in Bandung already decently performed the service quality measurement indicators.

Intangibility is a characteristic that relates to visibility and physical presence. In the service industry, uncertainty is relatively high because customer can only evaluate product quality after they buy or access it. As a consequence, customer decision making is more influenced by the credibility of information sourced from trusted personnel that advertise positive or negative messages related to the service providers. The patients of Asri Husada II Primary Clinic in Bandungare proven to be highly motivated to advertise the service provided by the clinic. This motivation reflects the quality and satisfaction level of the patients achieved by Asri Husada II Primary Clinic in Bandung. Besides that, customers often look for physical clues (tangible clues) such as the shape or appearance of service facilities and service provider staff and the prices set, ability to achieve optimum satisfaction level, and loyalties. The presence of Asri Husada II Primary Clinic in Bandung is greatly felt by the surrounding communities. The clinic has physically represented itself as a decent healthcare provider for the community.

Inseparability related to the purchase of services. Services are generally sold first and then produced and consumed at the same time and place. The medical examination is one example. Doctors cannot produce their services without the presence of patients. The patient concerned is actually involved in the production process by answering the doctor’s questions and explaining the symptoms he is feeling. This interaction is an important factor that determines customer satisfaction with the service. The general and medical staff of Asri Husada II Primary Clinic in Bandung are able to provide good quality which reflected by the willingness of patients to revisit the clinic to access various healthcare services.

Variability is the nature of services because non-standardized output means that there are many variations in form, quality and type depending on who, when and where the service is produced. This happens because services involve the human element in the process of production and consumption. According to Tjiptono[19], there are 3 (three) factors that cause variability in service quality: (1) customer cooperation or participation during service delivery, (2) employee morale/motivation in serving customers and ( 3) company workload. All of these things have an impact on service provider companies that find it difficult to deliver consistent standardized service standards all the time. These factors have also become parts of Asri Husada II Primary Clinic in Bandung daily routines. The medical staff are participative, motivated, and well-understand their workloads and scopes.

Perishability means that the service industry product cannot be stored. Unlike goods that can be bought and stored and used at any time, services must be shared between the customer and the service provider at a set time. The agreement between the doctor and the patient is one example, if the customer wants to consult with the doctor and has a set time, then if the patient does not attend or cancels, of course, he must reschedule. Another example is when a patient access therapy center, the product, in form of physical therapy, can only be felt when the session is in order. The effect of the session will be experienced after, and in a certain period of time, it might improve or weaken the patient’s ability to mobile. Lack of ownership is a fundamental difference between services and goods. In purchasing goods, customers have full rights over the use and benefits of the products they buy. Can be consumed, stored or resold. Services cannot be owned by customers. The experience of Asri Husada II Primary Clinic in Bandung patients is shown by the comments and their word-of-mouths. As witnessed by the patients through research instruments, it was discovered that these patients are generally satisfied with the medical services provided by Asri Husada II Primary Clinic in Bandung. They are willing to tell their relatives about the quality, advertise it for free to people the know, and revisit the clinic as primary healthcare provider.

Customer satisfaction is very dynamic in nature and tends to be influenced by the factors it experiences in the process of using the service. There are 3 (three) stages in the consumer decision process to use services, namely pre-purchase, consumption and post-purchase evaluation [20]. The pre-purchase stage includes all customer activities that occur before the purchase transaction and service usage occurs. At this stage there are three processes, namely identification of needs, search for information and evaluation of alternatives. The consumption stage is the stage of the customer’s decision process to buy and use a product or service. The post-purchase evaluation stage is the stage of the customer’s decision-making process whether he has made the right decision. There are 2 (two) defined customer behaviors, namely high-involvement service customers and low-involvement service customers. Highly involved services are services that are psychologically important to customers because they involve social needs and have a high-risk perception such as wedding planner services, higher education services and doctor services.

The research revealed that with the performance of doctors, also decent and complete facilities providedin Asri Husada II Primary Clinic in Bandung, the service quality have improved significantly. The quality can be reflected by the level of satisfaction achieved by the clinic. The patients are motivated to advertise the clinic to their relatives and friends, and also choose the clinic as their primary healthcare facility option to access different health-related services.

CONCLUSION

Based on the questionnaire analysis, the research revealed that Asri Husada II Primary Clinic in Bandungdoctor services, facilities, and service quality are in decent category. The categorization is concluded based on the valuation results by the patients in the utilized Likert scale which further analyzed with frequency distribution calculation. Besides that, based on the regression analysis, we also discovered that doctor service and facilities are significantly influence service quality. Based on that, to maintain the level of satisfaction and quality, Asri Husada II Primary Clinic should conduct regular satisfaction survey both to patients and healthcare personnel, to measure and improve their quality of services. In increasing the capacity of facilities and infrastructure related to health facilities, a survey is also needed which is carried out periodically, as a basis for repairs, improvement of service facilities, and needs according to the expectations of patients and service users.

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