Quality of Service and Customer Value against the Image
of the Hospital
Sugianto, *Ermi Girsang, Sri Lestari R. Nasution, Chrismis Novalinda Ginting
Faculty of Medical, Universitas Prima Indonesia
Keywords: Service Quality, Customer Value, Hospital Image
Abstract: The image of the hospital is very dependent on the patient's perception of the quality of service and will be a
differentiator between hospitals. Hospitals with a positive image attached to it in the eyes of patients, relatively
have products that are more acceptable to patients. On the other hand, a positive image can also affect
employees' feelings to be more motivated to improve their performance, be more productive, and serve
customers with excellent service. This study aims to analyze the effect of service quality and customer value
on hospital brand image. The design of this study used a cross sectional method that is research that
emphasizes the measurement time or observation of independent and dependent variable data only one time
at a time, with a sample of 82 people. Method of collecting data in this study through primary and secondary
data with questionnaires and interviews. The data analysis in this study is chi square analysis followed by
logistic regression analysis. The results showed the quality of service and the average customer value was
good. In the multivariate analysis, the simultaneous influence between service quality and customer value is
75.4% on the hospital brand image. These results indicate that the hospital's brand image is very dependent
on the quality of service and customer value, for it is expected that the hospital continues to improve the
quality of service.
1 INTRODUCTION
The image of the hospital is very dependent on the
patient's perception of the quality of services
provided. The image is a differentiator between one
hospital and another hospital. In understanding and
managing the relationship between the image of the
hospital and the intention of inpatients, it is necessary
to remember the experience of inpatients will be more
attached to the patient's perception of the hospital.
Hospitals with a positive image attached to it in the
eyes of patients, relatively have products that are
more acceptable to patients. On the other hand, a
positive image can also affect employee feelings.
Where employees will feel proud when working in a
company that has a good name. Thus, employees are
increasingly motivated to improve their performance,
be more productive, and try to serve customers with
excellent service.
In an effort to produce a positive image on an
ongoing basis, hospital orientation needs to lead to
patients who are basically buyers of services. One key
is trying to meet the health needs of patients so that
patients feel satisfied and happy with the experience
of being treated at the hospital. Satisfaction is an
assessment or form of patient perception that states
that a service has provided a level of enjoyment in
accordance with expectations even more than
expected. The level of enjoyment that is intended is a
match between perceived service quality from
experience using services and what is expected
(Sutojo, 2004).
Patient satisfaction is determined by the patient's
perception of the performance of the product or
service in meeting patient expectations. Customers
are satisfied when expectations are met or will be very
satisfied if expectations of customers are exceeded.
Basically all management efforts are directed at
achieving customer satisfaction. Whatever
management does is of no use if customer satisfaction
is not achieved. So the function is an impression of
performance and expectations, if the performance and
service exceeds expectations, the patient will feel
satisfied, but conversely if the performance and
service are below expectations, the patient will not be
satisfied (Tjiptono, 2016). Patient satisfaction is the
basis for determining whether or not the image of a
hospital. If the patient feels satisfied with the
58
Sugianto, ., Girsang, E., R. Nasution, S. and Ginting, C.
Quality of Service and Customer Value against the Image of the Hospital.
DOI: 10.5220/0010287200580065
In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 58-65
ISBN: 978-989-758-500-5
Copyright
c
2021 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
performance of hospital services, a patient
satisfaction will be formed. Satisfaction of patients
will encourage patients to come back for treatment or
interest in the hospital. Conversely, patients who are
dissatisfied will leave and won't even recommend it
to others. Because the patient is basically just
someone who receives the results of the performance
and service of an organization or agency, then only
they can know, feel and determine.
The concept of quality is basically relative, that is,
it depends on the perspective used to determine the
characteristics and specifications. Basically there are
three quality orientations that should be consistent
with each other, namely, consumer perceptions,
products / services, and processes. Quality of service
is much more difficult to define when compared to
quality of goods. If quality and quality control
measures have long been developed and applied for
tangible goods, services for various efforts are being
developed to formulate such measures (Herlambang,
2016; Turnip et al, 2020; Wijaya et al, 2019).
Similarly, the value of customers, all consumers
will perceive value with themselves and their
families, the perceived value of these consumers will
be an experience in their lives. The measurement of
customer value in increasing the proportion of
product value will affect subsequent consumer
purchasing decisions. Customers will make decisions
based on perceived benefits and the price to be paid
to enjoy these benefits. The final result to be received
is a positive image which will certainly benefit the
hospital (Kotler, 2009).
One of the most considered the first predictor and
determinant of service quality is reliability. Patients
view reliability as a combination of doing the right
thing and the availability of all information regarding
treatment, and some criteria and offers based on these
determinants including appointment and availability
of information. It is believed that by paying attention
to the principle of reliability in providing services in
the hospital, it has the potential to help reduce defects
in the process of care or care, improve consistency
with which appropriate care is given, and improve
patient outcomes such as satisfaction and positive
words from the patient's mouth (Akdere) , 2018).
As with reliability, assurance in the hospital
industry also refers to the knowledge and courtesy of
medical professionals in hospitals and supporting
employees. Assurance in medical services is
described as the ability of the hospital to convey
confidence in the minds of patients. In hospital
medical care settings, guarantees are reflected by
diagnostic competence, skills for interpreting
laboratory reports, providing appropriate
explanations for questions. Trained doctors and
nurses as well as other support staff must play an
important role in providing support to patients'
feelings of security and security (Mohsen, 2017).
Physical evidence also plays an important role in
the brand image of the hospital. The quality of
hospital physical evidence can include the appearance
of physical facilities and the comfort offered to
customers by the layout of physical facilities. Some
literature shows that the physical appearance of the
hospital is important for customers. It also shows that
customers (patients) appreciate the comfort offered
during treatment, especially in physical aspects such
as hospital building arrangements and their facilities
(Kalutharawithana, 2017).
The initial survey findings at the hospitals that
were studied related to service quality, showed that
some patients rated the quality of services at the
hospital to be quite good. However, there are some
patients who disagree because they are not satisfied
with some of the performance of some services, such
as nursing services which are considered not
responsive to complaints from patients. From the
background explanation, it can be seen that there has
been no research linking the quality of service and
customer value to the image of the hospital, so the
authors assess the need for deeper studies regarding
"Service Quality and Customer Value Against the
Image of the Hospital".
2 METHOD
The design of this study uses a cross sectional method
that is research that emphasizes the measurement time
or observation of independent and dependent variable
data only one time at a time. The study was conducted
at Dr. R.M. Djoelham City of Binjai which starts from
July-September 2019. The population in this study
were general patients undergoing hospitalization.
Based on medical records, the number of inpatients in
the hospital was 567. Samples were taken using an
accidental sampling technique of 82 people, with
selected sample criteria must be inpatients
undergoing treatment for at least 3 days as evidenced
by the patient's medical record. In addition, patients
must be able to communicate well (can read and
write), be willing to be respondents.
Primary data were obtained directly through
interviews with respondents who were undergoing
hospitalization. In this study primary data include the
characteristics of respondents, independent variables
of service quality (reliability, responsiveness,
empathy, physical evidence and guarantees),
Quality of Service and Customer Value against the Image of the Hospital
59
customer value (quality, price, reputation and
emotional factors) as well as and the dependent
variable of the hospital's image. Interviews were
conducted based on a questionnaire that had
previously been tested for validity and reliability.
Where, for the 5 service quality variables, the number
of questions for each variable is 5 items so the total
questions are 25 items. In the 4 customer value
variables, the number of questions for each variable
is 3 items so that the total number of questions is 12
items.
Next, the hospital image variable is measured by
10 question items. Measurement results of the
questionnaire using the Guttman scale. The scale
developed by Louis Guttman with a choice of positive
or yes answers was given a score of 1, while for
negative answers or not given a score of 0. Then the
total score is converted into a percentage, then it can
be described for the answer yes score 1 = 1 x 100% =
100%, while the answers are not given a score of 0 =
0 x 0% = 0%. To anticipate the measurement results
that are not absolute 100% or 0%, the researchers
used a range of percentage scales. The percentage
range in this study is <70% which is interpreted not
well and> 70% is interpreted well (Sugiyono, 2014).
The results of the questionnaire were then
analyzed using the chi-square test to see the
relationship between the independent variables and
the dependent variable. Followed by a logistic
regression test to see the effect of the entire
independent variable on the dependent. The research
procedure can be seen in Figure 1.
Figure 1. Research procedure
3 RESULT
3.1 Validity and Reliability Analysis
Before conducting a statistical analysis, testing the
validity and reliability of the research instruments is
first performed. This test is useful to find out if there
are questions or questions on the questionnaire that
must be removed or replaced because they are
considered irrelevant. Validity test is done by using
the Pearson correlation method (Pearson Correlation)
where a question item can be said to be valid if the
product moment correlation coefficient value is
greater than the r table. In this study with a sample of
82 people, the value of n is 80 (82-2) and by using
alpha of 5%, the r value of the table is 0.1966. From
the test results obtained by the entire question item is
valid.
Next, reliability measurements are divided into
repeat shots and one shot, in this study the method
used is one shot where the measurement is only once
and then the results are compared with other values.
In this one shot method a variable can be said to be
reliable if the acquisition value of Cronbach's
Alphabet is greater than 0.600. The test results show
that the Cronbach's Alphabet value of the variables of
reliability, responsiveness, assurance, empathy,
physical evidence, quality, price, reputation, and
emotional factors are greater than 0.6, which means
that each variable is already reliable.
3.2 Univariate Analysis
After the research instrument has been declared valid
and reliable, the analysis can be continued. Univariate
analysis basically aims to describe each of the
variables including the characteristics of the
respondent, the independent variable (free) and the
dependent variable (bound) using the frequency
distribution table. Frequency distribution of
respondent characteristics based on demographic data
which includes gender, age, education, occupation
and income. Based on the characteristics of the
respondents it can be seen that of the 82 respondents
observed, the majority of respondents were female,
namely as many as 43 people (52.4%), aged> 30 years
as many as 69 people (84.1%), educated high school
/ high school / equivalent as much 32 people (39.0),
other types of work as many as 24 people (29.3%),
with income> Rp. 3,000,000 as many as 69 people
(84.1%). Next, the univariate results of the service
quality, service value and hospital image variables
show, of the 82 respondents studied were dominated
by the same total percentage of answers for each
Preparation Phase
Research Design:
Cross Sectional Analysis
Population and Sample:
567 and 82 Res
p
ondents
Research Sites:
RSUD dr. Djoelham Binjai
Proposal Preparation:
Implementation Phase
Taking Primary Data
Input and Coding
Data Analysis:
Chi Square & Logistic
Regression
Validity and Reliability
Independent Variable:
Reliability, Responsiveness,
Assurance, Empathy,
Tangibles, Quality, Price,
Reputation and Emotional
Factors
Dependent Variable:
Hospital Image
Analysis Results
Conclusions and Recommendations
HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical
60
question. The results of this questionnaire can be
summarized through the line graphs in Figure 2 and
Figure 3.
Figure 2. Graph of the results of measurement of service
quality questionnaire and the image of the hospital
Figure 3. Graph of the results of the questionnaire
measurement of customer value and the image of the
hospital
3.3 Bivariate Analysis (Chi Square
Analysis)
The next step was bivariate analysis using the Chi
Square test at the significance level (α) = 0.05. The
purpose of this analysis is to see whether there is a
relationship between the independent variables
(service quality which includes: reliability,
responsiveness, assurance, empathy, physical,
evidence and customer value which includes: quality,
price, reputation, and emotional factors) with the
dependent variable (image hospital). Based on the
cross tabulation, it was found that on the reliability
quality, of the 82 respondents observed, there were 66
people who rated reliability well with 51 people
(77.3%) of whom rated the image of the hospital
good, while 15 people (22.7%) the rest rated the
image of the hospital is not good. Next, there were 16
people who rated reliability as not good with 15
people (93.8%) of whom rated the hospital's image
not good, while 1 person (6.2%) the rest rated the
hospital's image as good. In the quality of
responsiveness, there were 43 people who rated the
responsiveness as good with 31 people (72.1%) of
whom rated the image of the hospital as good, while
12 people (27.9%) the rest rated the image of the
hospital as not good. Next, there were 39 people who
rated poor responsiveness with 21 people (53.8%) of
whom rated the hospital's image good, while the
remaining 18 people (46.2%) rated the hospital's
image not good.
In the quality of guarantee there are 51 people
who rate good guarantees with 41 people (80.4%) of
whom assess the image of a good hospital, while 10
people (19.6%) the rest rate the image of the hospital
is not good. Next, there were 31 people who rated
collateral as not good with 20 people (64.5%) of
whom rated the hospital's image as not good, while
the remaining 11 people (35.5%) rated the hospital's
image as good. In the quality of empathy, there were
53 people who rated empathy well with 35 people
(66.0%) of whom rated the hospital's image good,
while 18 people (34.0%) the rest rated the hospital's
image not good. Next, there were 29 people who rated
empathy as not good with 12 people (41.4%) of
whom rated the image of the hospital as not good,
while 17 people (58.6%) rated the image of the
hospital as good. In the quality of fiisk evidence, there
were 64 people who rated good physical evidence
with 51 people (79.7%) of whom rated the image of
the hospital as good, while 18 people (20.3%) the rest
rated the image of the hospital as not good. Next,
there were 18 people who rated the physical evidence
as not good with 17 people (94.4%) of whom rated
the hospital's image not good, while 1 person (5.6%)
the rest rated the hospital's image good.
Next, on the quality score, of the 82 respondents
observed, there were 54 people who rated good
quality with 49 people (90.7%) of whom rated the
image of the hospital good, while 5 people (9.3%) the
rest rated the image of the hospital not well. Next,
there were 28 people who rated the quality as not
good with 25 people (89.3%) of whom rated the
hospital's image as not good, while 3 people (10.72%)
the rest rated the hospital's image as good. A total of
61 people rated the price of a good price with 42
people (68.9%) of whom rated the hospital's image as
well, while the remaining 19 people (31.1%) rated the
hospital's image not good. Furthermore, there were 21
people who rated the price was not good with 11
people (52.4%) of whom rated the image of the
hospital as not good, while the remaining 10 people
(47.6%) rated the image of the hospital as good. As
many as 64 people rated good reputation with 51
people (79.7%) of whom rated the hospital's image as
good, while the remaining 13 people (20.3%) rated
the hospital's image not good. Furthermore, there
were 18 people who rated bad reputation with 17
people (94.4%) of whom rated the hospital's image
Quality of Service and Customer Value against the Image of the Hospital
61
not good, while 1 person (5.6%) the rest rated the
hospital's image good.
And finally, as many as 69 people rated good
emotional factors with 46 people (66.7%) of whom
rated the image of the hospital as good, while 23
people (33.3%) the rest rated the image of the hospital
as not good. Next, there were 13 people who rated
emotional factors as not good with 7 people (53.8%)
of whom rated the hospital's image as not good, while
the remaining 6 people (46.2%) rated the hospital's
image as good. (see Table 1).
Table 1. Chi Square results
Variables
Hospital Image
p-
value
Good Not good
n % n %
Reliability
Good
51 77,3 15 22,7
0,001
Not good
1 6,2 15 93,8
Responsiveness
Good
31 72,1 12 27,9
0,160
Not good
21 53,8 18 46,2
Assurance
Good
35 66,0 18 34,0
0,011
Not good
17 58,6 12 41,4
Emphaty
Good
21 51,2 20 48,8
0,175
Not good
5 26,3 14 73,7
Tangibles
Good
51 79,7 13 20,3
0,001
Not good
1 5,6 17 94,4
Quality
Good
49 90,7 5 9,3
0,075
Not good
3 10,7 25 89,3
Price
Good
42 68,9 19 31,1
0,041
Not good
10 47,6 11 52,4
Reputation
Good
51 79,7 13 20,3
0,156
Not good
1 5,6 17 94,4
Emotional
Factors
Good
46 66,7 23 33,3
0,131
Not good
6 46,2 7 53,8
In the results of the analysis with chi square is
known only the quality factors of reliability,
collateral, physical evidence, and the price value
which has a value of p <α, it can be concluded that
there is a significant relationship between the
variables of reliability, guarantee, physical evidence,
and price with the image of the hospital .While on the
quality of responsiveness, empathy, quality,
reputation, and emotional factors have a value of p>
α, it can be concluded that there is no significant
relationship between responsiveness, empathy,
quality, reputation, and emotional factors with the
image of the hospital.
3.4 Multivariate Analysis (Logistic
Regression Analysis)
Table 2. Final Results of Logistic Regression Analysis
Variables B S.E Wald Df
p
value
OR
Reliabillit
y
0,645 0,091 4,590 1 0,001 5,203
Assurance 0,339 0,086 6,591 1 0,003 3,652
Tan
g
ibles 0,185 0,199 3,400 1 0,001 4,103
Price 0,142 0,071 2,921 1 0,011 4,201
4 DISCUSSION
4.1 Influence of Reliability Quality on
Hospital's Positive Image
In general, a positive image of a hospital is strongly
influenced by the level of patient satisfaction with the
services provided. This satisfaction can arise if
patients get the good results they want. The thing that
most contributes to the full satisfaction of patients is
the reliability of those who provide services, in this
case doctors, nurses, midwives, and other health
workers. It is known in the hospitals studied, the level
of reliability of medical personnel in handling
patients is considered good. The quality of service
from doctors is considered to most influence the
positive image of the hospital, it is seen as many as
86.6% of patients agree that the doctor in charge of
the hospital has the ability and knowledge in
determining the diagnosis of the disease quite well, so
as to be able to answer every patient's questions good
and convincing. In providing services, doctors can
explain the actions that will be done well. Doctors
always show a friendly attitude towards their patients
so that patients feel it is not awkward to interact with
their doctors. Besides doctors, the quality of nurses is
also considered quite good, as many as 75% of
patients agree that nurses work deftly. The nurse
always informs the patient and the patient's family
about plans for medical action to be taken and
routinely reminds patients to take medicine. The same
thing can also be seen from the patient's nursing care
record which is filled out completely. However, some
patients still complain about the performance of
HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical
62
nurses who are less fast, such as when the schedule
for fluid replacement in hospitalized patients is
slightly delayed. Therefore, it is necessary to have a
routine evaluation of the performance of hospital staff
so that patients feel satisfied and impressed, and
create a positive image in the hospital. The same
results were found by Tan (2019), Almomani (2019)
& Wu (2018) that reliability has the potential to make
changes in the level of patient satisfaction in public
hospitals and have an impact on the image of the
hospital.
4.2 Influence of Quality Assurance
Against Hospital's Positive Image
After reliability, quality assurance is also considered
to significantly influence the positive image of the
hospital. Evidenced by the results of logistic
regression analysis that obtained a p value of 0.001 (p
<0.05) with an OR of 5.2, which means that the
positive image of the hospital will increase by 5 times
higher if the hospital can provide a good guarantee of
service which are given. Researchers found overall
hospitals can provide a good guarantee for the
services provided. The idea is illustrated from the
results of the questionnaire that as many as 84% of
patients agree that medical personnel, especially
doctors treat patients well and convincingly so that
patients feel safe while undergoing treatment. The
same thing was obtained at the interview session with
several patients. It is known that doctors always
involve patients when providing services, which
before giving special actions to patients, the doctor
always communicates first with the patient and the
patient's family. In addition, doctors and nurses
sometimes provide moral support and provide
feelings of calm to patients or families of patients who
are panicking about their health conditions. Things
like this are considered by patients to be more value
for the services provided by the hospital, so that
patients always return to the hospital if they need
treatment or medication. This result is supported by
the findings of Oktarina (2016), Ekayanti (2013) that
guarantee perceptions affect patient satisfaction
4.3 Influence of Quality of Physical
Evidence on Hospital's Positive
Image
The next dimension of service quality that also affects
the positive image of the hospital is physical evidence
or the physical appearance of the hospital. The
physical appearance of a hospital is a tangible form
that can be directly seen by patients. Some important
components relating to physical evidence of a
hospital include, hospital facilities, hospital medical
equipment and the appearance of employees and
health workers when on duty at the hospital. In the
hospitals studied, the majority of patients rated the
hospital building as beautiful and neat. The patient
care room looks clean and comfortable because it is
equipped with adequate facilities. Food services are
also presented with good quality, some patients
revealed that the food provided was quite tasty and
varied so that the patient felt happy.
4.4 Influence of Price Value on Positive
Image of Hospitals
The last factor that contributes to the hospital's image
is the customer's value as seen from the suitability of
the price offered. The findings of researchers related
to the price of services provided to patients, that the
price of services is considered to be in accordance
with the services provided. Some patients even
consider the price offered at the hospital to be more
acceptable compared to other hospitals. In the
interview session, several patients who often went to
the hospital also revealed that even though the price
of the service would increase, it would not affect the
patient to return to using the hospital's services. From
the observations of researchers, it is known that many
patients are loyal to the hospital, it is not uncommon
for patients to recommend the hospital to their
relatives and coworkers when they need care services.
This result is supported by previous research by
Nurlia (2012) & Santoso (2016) showing that the
price variable has a significant relationship with the
decision of hospitalized patients to choose health
services.
4 CONCLUSION
This research found that the quality of reliability,
guarantee, price and physical evidence are the factors
that most influence the image of the hospital.Some
conclusions that can be generated from this research
are:
a. It is known in the hospitals studied, the level of
reliability of medical personnel in handling
patients is considered good. The quality of
service from doctors is considered to most
influence the positive image of the hospital. It
is predicted from the odds ratio value of the
logistic regression test results that the hospital's
image will increase 5.3 times higher if the
quality of reliability is increasingly improved.
Quality of Service and Customer Value against the Image of the Hospital
63
b. Researchers found overall hospitals can
provide a good guarantee for the services
provided. The idea is illustrated from the
results of the questionnaire that as many as
84% of patients agree that medical personnel,
especially doctors treat patients well and
convincingly so that patients feel safe while
undergoing treatment. It is predicted from the
odds ratio value of the logistic regression test
results that the hospital's image will increase
3.6 times higher if the quality of guarantees is
increasingly improved.
c. In the hospitals studied, the majority of patients
rated the hospital building as beautiful and
neat. It is predicted from the odds ratio value of
the logistic regression test results that the
hospital's image will increase 4.1 times higher
if the quality of physical evidence is improved.
d. The findings of researchers related to the price
of services provided to patients, that the price
of services is considered to be in accordance
with the services provided. It is predicted from
the odds ratio value of the logistic regression
test results that the hospital's image will
increase 4.2 times higher if the price value is
further adjusted.
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