Relationship of Reliability, Responsiveness, and Nurse Empathy to

Inpatient Satisfaction

Riaty Simbolon, Ermi Girsang and Ali Napiah Nasution

Faculty of Medichine, Universitas Prima Indonesia, Indonesia

Keywords: Patient Satisfaction, Reliability, Responsiveness, Empathy.

Abstract: Surveysof patient satisfaction about unprofessional nurses providing in services still often sound unfriendly

and inattentive to their patients. Nurses in quantity are the most workers in the hospital, amounting to 60.55%

and providing 24-hour services directly related to patients. The purpose of this study was to analyze the

relationship of reliability, responsiveness, and empathy towards inpatient satisfaction. This research was an

analytic study with cross sectional approach, with a population of 865 people and a sample of 190 repondents.

The tools used in this research were instruments (questionnaires) that have been tested for validity and

reliability. Furthermore, data were processed using univariate analysis, bivariate with chi-square test, and

multivariate with multiple logistic regression at a 95% confidence level ( = 0.05). The results showed that

the variables of reliability, responsiveness, and empathy were significantly associated with inpatient

satisfaction, p <0.05. The most significant variable related to inpatient satisfaction was empathy with Exp (B)

/ OR = 8,132 meaning that patients who stated that nurses empathized had a chance of being satisfied 8.1

times higher than patients who stated nurses lack empathy.

1 INTRODUCTION

The Ministry of Health has issued regulations that

determine patient satisfaction standards in health

services that are set nationally. Based on the

Regulation of the Ministry of Health of the Republic

of Indonesia in 2016 concerning minimum service

standards for patient satisfaction that is above 95%

(Ministry of Health Republic of Indonesia, 2016).

Health services with a level of patient satisfaction

<95% are considered not to meet minimum standards

or are not satisfactory.

Patient satisfaction surveys about officers who

are not professional in providing health services are

still oftenly heard (complains officers which are not

friendly and lack attention to their patients) (Isnindar,

Saputra, & Robiyanto, 2018).

The quality of nursing care services provided to

inpatients can be assessed based on the service quality

theory developed by Parasuraman, Zeithaml, and

Berry which consists of dimensions of physical

evidence (tangibles), reliability (reliability),

responsiveness (responsiveness), assurance

(assurance), and empathy (empathy) (Tjiptono and

Chandra, 2015). In their study the quality of service

studied is related to reliability, responsiveness, and

empathy.

According to Griffith (2017), in order to increase

loyalty can be done by adding value to what is

offered.Adding value can be done in ways such as

increasing the speed and responsiveness of service.

(Yu and Kirk 2009) Empathy is considered essential

to the provision of quality care. Research by Simbala

et al. (2013) shows a probability value of (p = 0.001

<0.05) which means there is a significant relationship

between nurse empathy services and patient

satisfaction.

Research Purwanti, Prastiwi, & Rosdiana (2017)

found that good service provided by nurses from

empathy factors almost all patients felt nurses lack

understanding of patient problems such as giving

personal attention to asking complaints experienced

by patients. “Being empathic has a significant place

in nursing within the therapeutic relationship. The

studies reviewed demonstrated that it is possible to

increase nurse’s empathic ability from a range of

clinical specialties and at both undergraduate and

postgraduate levels.”

(Brunero and Coates 2010).

Al-Damen's research results (2017) in Jordan

show that there is an impact of perceived health

service quality on overall patient satisfaction.

Simbolon, R., Girsang, E. and Nasution, A.

Relationship of Reliability, Responsiveness, and Nurse Empathy to Inpatient Satisfaction.

DOI: 10.5220/0010286700510057

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 51-57

ISBN: 978-989-758-500-5

Reliability has the most influence, followed by

empathy and assurance. Ozlii and Uzun, (2015) found

that there were differences in patient satisfaction in

various hospitals in Turkey related to the educational

background, profession, hospital where the patient

lived and previous hospital experience. Shan et al.

(2016) found a lack of trust as a source of patient

dissatisfaction in Heilongjiang, China. Devi and

Muthuswamy (2016) who examined in India, found

that physical evidence, reliability and responsiveness

were the three most important dimensions in

increasing patient satisfaction. Cunico, et al, (2012).

Empathy is the quality responsible for creating a

caring environment. Several nursing theorists have

identified empathy as a crucial component of caring.

Yousapronpaiboon and Johnson (2013), who

examined in Thai private hospitals, found that

assurance is the most dominant dimension, followed

by empathy, responsiveness, tangibles and reliability

in influencing patient satisfaction. The service quality

dimensions Empathy of nursing staff and Assurance

impact positively on both Loyalty and Cumulative

satisfaction (Gray and Boshoff, 2004.)

Furthermore, research (Essiam, 2013) examining

in state university hospitals in Ghana obtained results

that patient satisfaction is best explained by

responsive variables, followed by variables of

empathy, assurance, physical evidence, and

reliability.

Dissatisfaction felt by patients related to nurse

services which sometimes comes a long time when

called, nurses often play mobile phones, nurses are

less friendly, nurses less explain about the treatment

of illness in patients. This indicates that the

performance of some nurses is still not satisfying the

patient and family. One of the most important factors

for patient survival is to keep using hospital services

or encourage others to come to the same hospital

depending on the level of patient satisfaction in

getting services from the performance of nurses,

especially patients and families get services in the

inpatient room.

Based on the description above, the researcher is

interested in taking the title “Relationship Of

Reliability, Responsiveness, And Nurse Empathy To

Inpatient Satisfaction”

It is increasingly important that nursing care be

associated with measurable patient outcomes. A

correlational study examined relationships between

nurse‐expressed empathy and two patient outcomes:

patient perceived empathy and patient distress.

(Olson, 1995).

2 METHOD

This research was conducted at Stella Maris Hospital

in Medan in November 2019. The study population

was all inpatients with an average of 865 people per

month, and samples were obtained as many as 190

people. The research sampling technique was

accidental sampling. Characteristics of the majority

of respondents aged <39 years (50.5%), aged> 39

years (49.5%), all women (100.0%), educated

diploma (48.9%), minority educated high school

people (21, 1%). The majority of respondents were

private employees (40.0%), a minority worked as

housewives (8.4%). Based on the length of stay, the

majority had been treated for 2 days (45.3%), the

minority had been treated for 4 days (25.8%). Data

was collected by distributing questionnaires to

inpatients who will go home as in Figure1.

Univariate data analysis, bivariate using chi-

square test, and multivariate using multiple logistic

regression tests with a confidence level of 95%. The

research instrument was a questionnaire that had been

tested for validity and reliability with a sample of 20

people at Sarah's Hospital. The result was that all

instruments are valid (> 0,361) and reliable (> 0,600)

as shown in Table 1.

Univariate data analysis, bivariate using chi-

square test, and multivariate using multiple logistic

regression tests with a confidence level of 95% were

applied. Multiple logistic regression is a multiple

regression model if the dependent variable is

dichotomous data. Dichotomy means in the form of

categories with a total of 2 categories. The scheme of

entire reseach proses is decribed n Figure 1.

Table 1: Validity and reliability test results.

No Variables r-count r-table

Cronbach

Alpha

1 Reliability 1-10 0.436 0.361 0.733

Responsiveness 1-

0.465 0.361 0.725

3 Empathy 1-10 0.505 0.361 0.739

Patient

Satisfaction 1-10

0.532 0.361 0.745

Based on figure 1, the research process begins

with a sample application for approval to each

respondent through filling out the consent form. After

getting approval, the respondents filled out a research

questionnaire where the questionnaire had been tested

for its validity and reliability at Sarah's hospital to 20

respondentsThe questionnaire consists of

independent variables (reliability, responsiveness,

empathy) and dependent variables (Inpatient

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Satisfication).The study population was 865 people

located at Stella Maris Hospital. The sample is part of

the population and with the Lameshow formula, a

sample of 190 people is obtained. This research is an

analytical study with a cross sectional approach. The

data analysis methods used were univariate, bivariate

(Chi Square), and multivariate (Multiple Logistic

Regression). The result of multivariate analysis with

multiple logistic regression test shows that 3

variables, namely reliability, responsiveness and

empathy are all related to patient satisfaction, where

empathy is the variable that has the greatest

relationship with inpatient satisfaction.

Informed of Consent

Questionnaire

Validity and

Reliability Test

Location: Sarah Hospital

Samples: 20 Respondents

Independent

variables : reliability ,

responsiveness ,

empathy

Dependent variable:

Inpatients

Satisfaction

Population: 865

people

Samples: 190

Research Type: Analytic

study

Design: Cross sectional

Location: Inpatient at

Stella Maris Hospital

DataAnalysis :Univariate,

Bivariate(ChiSquare),

Multivariate(MultipleLogistics

Regression)

Multivariateresults :reliability,

responsiveness,empathyand

inpatientsatisfaction

Figure 1: The Scheme of the Research Process.

3 RESULT AND DISCUSSIONS

Figure 2. Data of recorded quessionare data from 190

respondents.

Figure 2 was the measured data of each variable

from the quessionare instrument. In the Figure 2. X

and Y axis areindicates the number of scores

respondents, respectively. Independent and

dependent variables data distribution shows that the

mean value of reliability was 22, Responsiveness was

23, empathy was 24, and patient satisfaction was 30.

All the results of the questionnaire were ploted

according to the variable namely: reliability,

Responsiveness, empathy, and satisfication with each

of 10 questions (the option in the quessionare were

Yes (score 3), Sometimes (score 2), and No (score

1)). The lowest score was 10, the highest score was

30. Good if score 21 - 30 (category 1) and Less if

score 10-20 (category 0). As for Patient Satisfaction

variable with 10 questions with answer choices Very

Satisfied (score 4), Satisfied (score 3), dissatisfied

(score 2), Very Dissatisfied (score 1), the lowest score

was 10 and the highest score was 40, so it says

Satisfied: if the results are 26-40 (category 1), Less

Satisfied 10 - 25 (category 0).

Found some differences in the results of the

respondents' scores for each variable, among others:

Reliability variable, the lowest score is 12. This result

was because during the treatment period respondents

did not get nurses who were always responsive when

need in help, did not pay attention to cleanliness of

the body and the area of the inpatient ward, less do

infusion control and sometimes do not routinely

check health conditions, likewise drug administration

is not timely while the highest score was 30 where

respondents get reliable nurse services which were

always responsive to all tested variables.

Responsibility variable found the lowest score

was 15, this is likely due to nurses never discussing

about health conditions, illness or continued care at

home, not checking health conditions, not providing

moral support, sometimes even nurses want to show

cooperation and want to help if needed. While the

highest score was 30, where nurses are quick to

respond to the complaints and the needs of

respondents. The Empathy variable found to be the

lowest score was 13, this is due to the nurses not

showing a sense of empathy towards the respondent,

only inviting communication about conditions but not

explaining their rights and obligations as well as

regulatory rules and not even asking for approval of

every action to be performed, explaining the

procedure difficult to understand, answering

questions that do not match the answers, even do not

treat with friendly and polite so that patients feel

uncomfortable. While the highest score was 30 where

a nurse has carried out her services with empathy

through good communication, explaining in language

Relationship of Reliability, Responsiveness, and Nurse Empathy to Inpatient Satisfaction

that was easy to understand both about the rules,

rights and obligations, all actions are asked for

approval, full of courtesy and courtesy, each

communicates a feeling of security and

comfortable.In the variable patient satisfaction found

the lowest score was 22, this is still found in

hospitalization, especially nursing services that are

not reliable, unresponsive and not empathetic in

carrying out their daily work, while the high score

was 40 where a nurse in his service has includes

nurses who are reliable, responsive and empathetic so

that respondents feel comfortable and safe.

Based on the univariate analysis, the results

showed that the majority of respondents grade the

reliability, responsiveness, and empathy with good

were ranged between 72.1% -76.3%, while those that

stated were not good between 23.7% -27.9%. For the

satisfaction variable, 74.7% of satisfied inpatients and

25.3% less satisfied, as shown in

Table 2: Variable Frequency Distribution (n = 190).

Variables

Quantity

Reliability:

Good

Not Good

145

76,3

23,7

Responsiveness:

Good

Not Good

144

75,8

24,2

Empathy:

Good

Not Good

137

72,1

27,9

Satisfications

Satisfied

ot Satisfie

142

74,7

25,3

Furthermore, based on the results of the bivariate

analysis, all independent variables were significantly

related to inpatient satisfaction, namely reliability (p

= 0.021), responsiveness (p = 0.016), and empathy (p

= 0.001). The complete Chi-Square statistical test

results can be seen in Table 3.

Table 3: Relationship of Each Independent and Dependent

Variables.

Variables

Patient Satisfaction

Qty

value

Satisfied

Not

Satisfie

n % n % N %

Reliability:

Good

ot Goo

124

85,5

40,0

14,5

60,0

145

100

0,021

Responsiveness:

Good

ot Goo

124

86,1

39,1

13,9

60,9

144

100

0,016

empathy:

Good

ot Goo

121

88,3

39,6

11,7

60,4

137

100

0,001

The results of multivariate analysis with multiple

logistic regression tests showed that about 3 variables

as model candidates, all were related to inpatient

satisfaction which area reliability, responsiveness,

and empathy as in Table 4 (B is beta value, sig.

(significant), Exp (B) was exponential beta is read as

an OR (Odds ratio) value, and 95% CI for exp (B) was

a 95% confidence level for exponential beta values

for the upper and lower limits).

The variable that has the greatest relationship with

patient satisfaction for inpatients was the empathy

variable which has a value of Exp (B) / OR = 8.132

by mean that patients who have empathy were good

nurses, have the opportunity to feel satisfied by 8.1

times higher than patients who expressed empathy

nurses were not good.

The variable responsiveness (responsiveness)

which has a value of exp (B) / OR = 7.483 means that

patients with good nurse responsiveness have a 7.8

times higher chance of being satisfied than patients

who think that nurses' responsiveness is not good.

The variable reliability (reliability) which has a

value of Exp (B) / OR = 4.973 means that patients

who say the reliability of nurses are good, have a

chance to feel satisfied by 4.9 times higher than

patients who say that their reliability is not good.

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Table 4: Results of Multiple Logistic Regression Tests.

Variable B Sig. Exp(B)

95%CI for

Exp(B)

Reliability

Responsiveness

Empathy

Constants

1,604

2,060

2,096

-2,696

0,001

0,000

4,973

7,843

8,132

1,987-12,447

3,126-19,679

3,328-19,868

3.1 Reliability

The results showed that there was a relationship with

reliability on inpatient satisfaction. Patients who

stated good nurse reliability, had a 4.9 times higher

chance of being satisfied compared to patients who

expressed poor nurse reliability.

This study is in line with the results of research

conducted by Simbala, Rattu, & Sondakh (2013)

showing the probability value (p = 0.002 <0.05)

indicates that there is a significant relationship

between the service of nurses' responsiveness and

patient satisfaction. The results of research conducted

by Mubin & Jalal (2017), found that the assessment

of the quality of nursing services: high reliability

category is 45 respondents (45%), moderate category

is 52 respondents (52%), and low category is 3

respondents (3%). The quality of nursing services on

the reliability dimension is significantly related to

inpatient satisfaction. From those results of the

regression analysis can be concluded that the

reliability variable has a positive and significant

relationship to patient satisfaction.

In hospital services, nurses are very much in the

spotlight, because it is closely related to patient and

family satisfaction. Even the presence and touch of

nurse services have the largest proportion of services

in hospitals, so without ignoring the services of other

officers, the nurse service with its reliability in

providing nursing care is certainly a service that

should get more attention for management at the

hospital. Reliability That is the ability to provide the

promised service immediately, accurately and

satisfactorily, honestly, safely, on time, availability.

According to the researchers' assumptions, the

results of this study prove that nurse reliability is

related to inpatient satisfaction. This shows that if

nurses demonstrate reliability in providing nursing

care to patients, the satisfaction felt by inpatients also

increases. According to the researchers' assumptions,

the reliability of nurses perceived by inpatients while

being treated is that nurses are always responsive

when asked by patients for help, keep the room clean

and quiet, pay attention to cleanliness and maintain

the peace of the room, the bed linen is replaced

immediately if it looks dirty or wet, conducts an

examination of conditions patients from morning to

night even though carried out alternately by nurses,

routinely control the infusion that is placed on the

patient, do physical examinations especially vital

signs in accordance with the specified time.

Patients also stated that nurses' reliability was still

not good because nurses paid less attention to the

patient's body hygiene during treatment. Usually the

patient's family wipes the patient's body because the

patient is not allowed to take a shower. Others that

patients felt less well were the nurse also does not

help the patient on taking the medication but assisted

by the family. Nurses got medical checks in late, since

the nurses work baed on the shifts and also the nurses'

behavior varies from one to another, especially in

providing services to inpatients.

3.2 Responsiveness

Based on the study results indicate that there was a

relationship between responsiveness to the inpatient

satisfaction. Patients who stated that nurses

'responsiveness were good, had a 7.8 percent higher

chance of being satisfied than stated not good. The

responsiveness variable is associated with inpatient

satisfaction. Demands for services that address

various complaints from the forms of service

provided become a positive assessment of the

responsiveness of the providers and receiver of the

services. The party providing the service should find

that the person being served lacks understanding of

the various procedures or mechanism requirements, it

is necessary to provide a clear and wise

understanding,also provide various alternative

facilities to follow the correct service conditions.

Therefore, the impression of the customers or

responds to the customer desires of being served.

Responsiveness is the desire of an employees to

help consumers and provide services that are

responsive to the needs of a consumers, quickly pay

attention and address the needs.According to the used

assumptions, the results of this study indicate that

nurses' responsiveness in providing nursing care was

related to inpatient satisfaction. Also, the more

responsive of the nurses to the inpatientscomplaints

and needs, the more satisfied the inpatients feel.

Inpatient satisfaction with nurses' responsiveness

because nurses immediately come when called (less

than 5 minutes), nurses help eat/drink patients if

unable to do it themselves, nurses provide moral

support (enthusiasm) for healing inpatients, discuss

patient problems with the family in performing

Relationship of Reliability, Responsiveness, and Nurse Empathy to Inpatient Satisfaction

nursing actions, the nurse also explained about further

care at home. Those makes the patient feel satisfied

and feel comfortable during treatment.

The study also found that some patients felt that

nurses' responsiveness was still lacking, such as the

nurse does not immediately check the patient's

condition after treatments. Patients expect that

after a treatment from a nurse or a doctor, the

patient wish the nurse to always check the patient's

condition but there are some patients who do not

get such attention. There are also patients who say

that nurses do not provide moral support /

enthusiasm for patient recovery. This causes the

patient to feel less satisfied with the nurse's

responsiveness service.

3.3 Emphaty

It was found that the empathy variable has a

relationship with inpatient satisfaction. Patients who

expressed good nurse empathy were more likely to be

satisfied by 8.1 times higher than patients who stated

nurse empathy was not good. Empathy or concern

includes ease in making good communication

relationships and understanding consumer needs that

are manifested in attention to each consumer, serving

friendly and attractive, understanding consumer

aspirations, communicating well and correctly and

behaving sympathetically.

It has been proven that empathy is related to the

satisfaction felt by inpatients. According to the

Assumption, nurses' empathy is obtained by showing

concern and sympathy for what the patient feels,

communicating about the patient's condition,

explaining hospital regulations, and taking care of

nursing in a friendly and polite manner. Empathy is

the variable most related to inpatient satisfaction.

This means that empathy has a positive and

significant relationship to patient satisfaction. The

better the patient's perception of nurse empathy, the

patient satisfaction will be higher, and if the patient's

evaluation of nurse empathy is not good, the patient

satisfaction will be lower.

The things that make some patients feel that the

empathy of nurses less than good was some patients

assume that nurses do not provide satisfactory

answers to the questions asked. Also the nurses did

not provide opportunities for patients to express the

patientsfeelings or complaints. In addition, some

patients feel that nurses were not easily contacted if

needed.

4 CONCLUSIONS

From the results of a study of a number of

respondents, it was found that patients who felt less

satisfied were 25.3%, while those who were satisfied

were 74.7%. Patients' good perceptions about

reliability, responsiveness and empathy ranged from

72.1% -76.3%, while unfavorable between 23.7% -

27.9%. The reliability, responsiveness, and empathy

of nurses are related to inpatient satisfaction. The

most dominant variable related to inpatient

satisfaction is empathy. Patients who state that nurses

empathize have a chance of being satisfied 8.1 times

higher than patients who lack empathy.

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Relationship of Reliability, Responsiveness, and Nurse Empathy to Inpatient Satisfaction