Identification of Parental Satisfaction Parameters to Re-utilize

Outpatient Services

Happyria Tarigan, Ermi Girsang*, Sri Lestari R. Nasution

Faculty of Medichine, Universitas Prima Indonesia, Indonesia

Keywords: Parental Satisfaction, Desire to Return, Outpatient.

Abstract: Based on a survey results on satisfaction in Indonesian private hospitals, it was found that outpatient

dissatisfaction was 60.7%, while in government hospitals it was higher at 74.96%. Hospital minimum service

standards state patient satisfaction must reach 90%. One of the dissatisfaction effects is a decrease in loyalty

or a desire to use the service again. The purpose of this study is to identify the relationship between parental

satisfaction and the desire to re-use outpatient services. A cross sectional study using a population of 5,879

respondents with a sample of 100 respondents were used. Data were analyzed by univariate, bivariate through

chi-square test, and multivariate through multiple logistic regression at a 95% confidence level ( = 0.05).

The results of the study showed that the variables that led to the desire to re-use outpatient services were S (p

= 0.016), service procedures (p = 0.003), and environment (p = 0.0026) while the unrelated variable was

comfort (p = 0.468), and service results (p = 0.411). The variable with the biggest effect was the service

procedure variable with the value Exp (B) / OR = 7.959. This value shows the opportunity to re-use outpatient

services by 7.9 times higher.

1 INTRODUCTION

The more established hospitals, the tighter the

competition in serving and attracting the interests of

customers (Susilowati, 2017). Service quality, patient

satisfaction and loyalty data can be used in quality

management, thereby enabling service managers to

monitor and maintain service quality. Service

providers can better understand how various

dimensions and item affects averall service quality

and to desing service delivery progress efficiently. By

identifying servive quality strengths and weaknesess,

providers can allocate resources to service and

ultimately enhance their service quality. Hospitals are

required to provide quality services in accordance

with established standards and can reach all levels of

society (Kartajaya, 2016). Satisfied or not of the

provided services directly by the hospital can be seen

and felt by the community as users of health services

(Sari, 2015). Satisfaction felt by patients and families

is a measure of the level of quality of health services.

Based on the results of a satisfaction survey in

Indonesia, in private hospitals, outpatient

dissatisfaction was 60.7%, while in government

hospitals 74.96% was higher. Hospital Minimum

Service Standards state patient satisfaction must

reach 90% (Wijono, 2015). If a company or health

service organization such as a hospital is able to

create customer satisfaction, customer loyalty will be

created (Tjiptono and Chandra, 2015). Loyalty will

provide great benefits for the company, being the key

to success in the short and long term (Hasan, 2016).

The quality of health services felt by patients is

predicted to increase patient satisfaction. Good

Service quality will affect patients satisfaction as a

hospital costumer. The more quality the service

provided by the hospital, the more patients will feel

satisfaction with the services provided to patients will

be more loyal patients to the hospital (Priyono et

all,.2020) . Costumer satisfaction and significant

positive effect on costumer loyalty Balikpapan

Pertamina Hospital. These results suggest that

perceived costumer satisfaction by Pertamina

Hospital Balikpapan able to increase costumer loyalty

(Wulur, Lenny Meltha, et al., 2020). Service quality

and perceived value become measurement methods to

predict customer satisfaction. (Rusmana, Research on

the relationship of satisfaction with patient loyalty has

been conducted by several researchers (Fitri, Adelina,

et al., 2016, Fatima, Taqdess, Et.all, (2017). Loyal

patients will re-use the same health services when

needed again. In addition, loyal patients will invite

Tarigan, H., Girsang, E. and R. Nasution, S.

Identiﬁcation of Parental Satisfaction Parameters to Re-utilize Outpatient Services.

DOI: 10.5220/0010296002290235

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 229-235

ISBN: 978-989-758-500-5

229

others to use the same health services (Sari, 2015).

Having loyal patients increases the selling power of

health care institutions (Supriyanto and Ernawaty,

2014). There is a relationship between service quality

and loyalty (Jayadipraja, Erika SekarNingrum, 2016,

Kim et al., 2017). Other studies have found results

that satisfaction with six dimensions of service

quality: service costs, hospital environment, services

provided, access to doctors and health care

institutions, provision of information, and hospital

environment have been identified as the factors that

most influence loyalty (Rostami et al. ., 2019).

Hasan's research, 2018 was conducted to analyze

patient loyalty from the perspective of service quality,

hospital image, patient value and satisfaction, analyze

patient loyalty and develop a model of increasing

patient loyalty based on hospital service quality.

Bahari, Chabib, et all. found that the marketing mix

strategy consist of product, price, distribution,

promotion, human resources, physical evidence, and

processes simultaneously had a positive and

simultaneous influence in determining patient

loyalty. Suasna, I Gede, et al., 2017 examined that

excellent service and customer relationship

management can lead to satisfaction and trust of

patients to come back. Service quality is positively

and directly linked to costumer satisfaction and

costume loyalty. The outcome suggest that

maintaining high quality of services in the hospitals

can significantly increase the perception of values

among the costumers, it can also be helpful in raising

the goodwill of the costumers in the form of loyalty

and can provide high level of satisfaction. (Dubey,

Pushkar, 2019; Turnip et al, 2020; Wijaya et al,

2019).

From the results of previous studies no one has

examined the satisfaction of parents using parameter

identification. For this reason, this paper will discuss

in more depth aboutthe influence and the most

dominant factors towards parental satisfaction with

the desire to re-use outpatient services.

2 METHOD

A cross sectional study was conducted at Stella Maris

Hospital, Medan in November 2019. The selected

population was all parents who brought their children

to visit with an average monthly visit of 5,879 people,

and the sample was obtained by 100 respondents with

accidental sampling. Sampling was done by taking 3-

4 samples per day for 1 month. Data recording was

carried out with a questionnaire instrument that had

been tested for validity and reliability (sample of 20

respondents at Sarah Hospital). The results of all

instrument granules were declared valid and reable.

The used test was to determine the correlation

between the question grain and the total score of the

variable.

The used questionnaire consisted of 5 variables

(i.e., comfort, service officers, service procedures,

service results and the environment), which each

consist of 10 questions with 4 choices of answer

categories (1 = very dissatisfied, 2 = dissatisfied, 3 =

satisfied and 4 = very satisfied) for each question.

Data was collected by distributing questionnaires to

parents who took their children to the hospital during

an outpatient visit.

Tabel 1: Validity and reliability test results

No Variables r-

count

r-table Cronbach’

s Alpha

1 comfort 1-10 0,437 0,361 0,732

2 Officer

services 1-10

0,501 0,361 0,790

3 Services

procedure 1-

0,438 0,361 0,770

4 ResultsServic

es 1-10

0,506 0,361 0,803

5 Environment

1-10

0.605 0,361 0,877

The validity test was carried out at Sarah Hospital

with 20 samples. After the validity test valid, the

research begins. This study is an analytic study with

a cross-sectional design by accidental sampling.

Population is 5879 and 100 samples were taken. The

research was carried out in the Outpatient Department

of Stella Maris Woman and Children Hospital

(Figure.1)

Univariate and bivariate data analysis using chi-

square test, and multivariate using multiple logistic

regression tests with a confidence level of 95% ( =

0.05) were chosen. Multiple logistic regressionwas a

multiple regression model in case the dependent

variable is dichotomous data (categorical form with a

total of 3 categories). The chosen variables as

independent variables were comfort, service officers,

service procedures, service results, and the

environment, and as the dependent variable was the

desire to re-use outpatient services.

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

230

Figure1. The Scheme of the research process

3 RESULT AND DISCUSSIONS

From the questionnaire completed by the respondent,

the characteristics of the respondent were obtained as

follows: the majority were aged > 27 years (53.0%),

aged <37 years (47.0%). Productive age has greater

demands and expectations. For gender, Female 75,

male 25, Male has greater expectations and demands

and tends to be dissatisfied. Education :

Undergraduate 52 , Diploma 25, high school, Patients

with low education more satisfied than patients with

higher education . Occupation: Private employee 35,

government officials 8, others 35, Someone who

works more demanding and criticizing service .

House wife 27. Respondents who have 3 children as

many as 49 have 2 children as many as 34, have 1

child as many as 17 people. Patients who have more

children have more experience that can make them

calmer. Based on immunization visits obtained as

many as 40, consultation and 60. The results showed

that the majority of respondents said they were

satisfied with the indicators of comfort, service

officers, service procedures, environmental service

results ranged from 73% -80%, while those who were

dissatisfied between 20% -27% . The variable of

desire to re-use outpatient services was about 75%

loyal and 25% non-loyal. The desire to re-use

outpatient services has a value of Exp (B) / OR =

5,080 meaning that parents are satisfied with hospital

services, the opportunity to re-use outpatient services

was 5 times higher than that of unsatisfied parents.

The service procedure has an Exp value (B) / OR =

7.959 meaning that parents were satisfied with

Hospital service procedures, the chance to re-use

outpatient services is 7.9 times higher than that of

dissatisfied parents. The environment has a value of

Exp (B) / OR = 4.459 meaning parents are satisfied

with the hospital environment, the opportunity to re-

use outpatient services was 4.4 times higher than

parents who were less satisfied with the hospital

environment

Figure 2: Measured data of each variable from the

quessionare

In Figure 2, we can see the total score obtained for

each variable in the questionnaire with 100 samples.

The dark blue is the total score for patient comfort.

The purple is the total score for service results. The

red is the total score for officer services, the light blue

is the total score for the environment and the green is

for service procedures.

Based on univariate analysis, it was found that the

majority of respondents said they were satisfied with

the indicators of comfort, who were satisfied about

79.0%, a small portion felt less satisfied about 21.0%.

Hospital staff services were 76.0% satisfied and

24.0% less satisfied, 80.0% satisfied service

procedures and the rest less satisfied, 73.0% satisfied

service results, 75.0% satisfied environment. Overall,

Informed Consent

Quessionaire

Validity and Reability test

If valid and Reliable

Dependent Variable: Desire

to Reuse Outpatient Service

Result and Discussion

Data Analysis:

Univariate, Bivariate (Chi Square),

Multivariate (Multiple Logistic Regression)

Data Collection

Location: Outpatient

Depertement Stella Maris

Women and Children Hospital

Independent Variables:

comport, Officer service,

Service procedure, Results

Service, Environment

Location: Sarah

Hospital Sample : 20

samples

Type of research:

Analytic Study

Design: Cross

sectional sampling

Technique: Accidental

sampling

Population : 5.879

Peoples

Sample : 100 Peoples

Continue The

Research

Identiﬁcation of Parental Satisfaction Parameters to Re-utilize Outpatient Services

231

the uivariate value for each variable is given in Table

Table 2: Variable Frequency Distribution (n = 100)

Variables

Quantity

n %

Comfort:

Less satisfied

satisfied

21,0

79,0

Officer services

Less satisfied

satisfied

24,0

76,0

Services procedure:

Less satisfied

satisfied

20,0

80,0

Services Result:

Less satisfied

satisfied

27,0

73,0

Environment:

Less satisfied

Satisfied

25,0

75,0

Desire to Reuse Outpatient

Services:

No Loyalty

Loyal

25,0

75,0

The results of bivariate analysis obtained all

independent variables significantly related to the

desire of patients to re-use outpatient services namely

comfort (p = 0.038), S (p = 0.014), service procedures

(p = 0,000), service results (p = 0.032), and

environment (p = 0.024). The complete Chi-Square

statistical test results can be seen in Table 3.

The results of multivariate analysis with multiple

logistic regression tests showed that of the 5 variables

as model candidates, 3 variables were found that

relate to the desire to re-use outpatient services,

namely service personnel, service procedures, and the

environment as shown in Table 4 (B is beta value, sig.

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

OR (Odds ratio) value, and 95% CI for exp (B) is a

95% confidence level for beta exponential values for

upper and lower limits).

Table 3: Relationship of Each Independent and Dependent

Variable

Variables

Desire to Reuse Outpatient

Services

value

No Loyalty Loyal

n % n % N %

Comforts:

Less

Satisfied

66,7

13,9

33,3

86,1

100,0

0,038

Officer services

Less

Satisfied

66,7

11,8

33,3

88,2

100,0

0,014

Services

procedure:

Less

Satisfied

75,0

12,5

25,0

87,5

100,0

100,0 0,000

Services results:

Less

Satisfied

59,3

12,3

40,7

87,7

100,0

0,032

Environment:

Less

Satisfied

64,0

12,0

36,0

88,0

100,0

0,024

The most influential variable in this study was the

service procedure variable which has a value of Exp

(B) / OR = 7.959 meaning that parents who are

satisfied with hospital service procedures have the

opportunity to re-use outpatient services by 7.9 times

higher than parents who less satisfied with hospital

service procedures.

Table 4: Results multiple logistic regression test

Variables B Sig.

Exp(B)

/ OR

95%CI for

)

Officer services

Services procedure

Environtment

Constant

1,625

2,074

1,495

-2,460

0,016

0,003

0,026

0,014

5,080

7,959

4,459

1,355-19,049

2,005-31,595

1,201-16,559

3.1 Officer Services

Based on the results of the study showed that there

was a relationship between service officers and the

desire to re-use outpatient services. Parents who were

satisfied with S hospitals, have the opportunity to re-

use outpatient services by 5 times higher than parents

who are less satisfied with hospital staff services, with

an OR value = 5,080.

The relationship between service officers was

related to the ease and speed of service with the reuse

of services by outpatients. Re-use of outpatient

services was basically caused by the patient getting

ease of service, the speed of service starting from the

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

232

procedure for receiving patients, the speed of

examination, treatment until the time of discharge

from health workers. Satisfied patients will make a

repeat visit. The results in this study also showed that

the higher satisfaction felt by patients was related to

the reliability of health workers, the higher the level

of patient loyalty.

It is assumed that the child's parent's satisfaction

with the services of the officers was related to the

desire to re-use outpatient services. This was

supported by the studies mentioned above that

satisfaction with the service of the staff impacts on

the reuse of the services provided or the patient shows

loyalty to the health facility where he has been

treated.

The relationship between health services and

patient loyalty can be seen from health workers who

are skilled and agile in examining patients. Health

workers are also timely and patient in serving

patients, so that these patients are satisfied with the

service they receive and want to go back again for

treatment. Service officers, especially doctors who

show friendliness, always ask complaints felt by

children, doctors provide opportunities for parents to

ask about illnesses, doctors understand how to treat

children during the examination, health workers

(doctors and nurses) provide services quickly or not

wordy and conscientious. This satisfies the parents of

the child and if the child is sick the mother does not

hesitate to bring her child back for treatment to get

maximum service by the health workers.

Parents who feel unsatisfied with regard to their

comfort say that the location of poly children was

difficult to find. It was usually happaned to a first time

patient arrives so that it still has not adapted to the

location of an existing of child poly. In addition, some

parents feel uncomfortable in the administration of

child care administration. It was because parents

usually have to queue or wait for payments that make

parents and children feel uncomfortable.

3.2 Service Procedure

From the results of testing the variable service

procedure, it was found that there was a relationship

between the service procedure and the desire to re-use

outpatient services. Parents who were satisfied with

hospital service procedures have the opportunity to

re-use outpatient services at 7.9 times higher than

those who were less satisfied. Service procedure was

the biggest variable related to the desire of patients to

re-use outpatient services.

The relationship of patient satisfaction about

service procedures with service reuse can be seen

from the answers of the respondents who mostly

started from the officers providing fast services, the

outpatient service process from the administrative

counter to the polyclinic was easy to follow,

registration was open on time, patient calls were

based on the order number and polyclinic service

schedule was in accordance with the schedule posted.

From some respondents who were dissatisfied, it was

found that they tended to be satisfied with the service

procedures. From these results it can be concluded

that overall service procedures were sufficient to

satisfy the patient. It was because the service

procedures were not complicated when the

registration was not too long and easy. Service

procedures related to the service system and also

service standards. In this service procedure includes

patient registration at the counter and registration of

patients as well as information and service

instructions at the health center. Based on the

usedassumptions, the results of this study prove that

parental satisfaction with service procedures

influences the desire to re-use outpatient services

while 20% of respondents feel less satisfied. The

things that make the child's parents feel satisfied

because the service procedures at the Children's Poly

are done quickly and are not complicated, timely,

there was a readiness of health workers both doctors

and nurses in providing services to children.

The role of doctors and nurses must be able to

calm children who are usually afraid of doctors when

they will be examined or injected. The thing that was

felt unsatisfactory was that doctors and nurses lacked

explanations about things that had to be done when

the child was treated at home. Doctors and nurses

sometimes give advice on care at home but are less

detailed so parents feel less satisfied. Some parents

feel that the examinations carried out by doctors and

nurses are less thorough. It was because some parents

expect more examinations, especially if their children

were eager to quicklyrecover, but they assume that

the inspection services performed were not in line

with expectations.

3.3 Environment

The results showed that environmental variables

have a relationship with the desire to re-use

outpatient services. Parents who are satisfied with

the hospital environment, have the opportunity to

re-use outpatient services by 4.4 times higher than

those who are less satisfied.

Direct evidence / appearance of the physical

environment has a relationship to patient loyalty.

Some things that support direct evidence of good

Identiﬁcation of Parental Satisfaction Parameters to Re-utilize Outpatient Services

233

service are the comfort of the overall care building

which is supported by adequate infrastructure and

in accordance with patient needs. Respondents'

dissatisfaction with the direct evidence / physical

appearance of the service felt by patients usually

occurs because of discomfort from the hospital

environment. It has been proven that the

availability of facilities and a comfortable physical

environment is one of the factors that can

encourage and motivate the community to utilize

health services or treatment efforts. However, if a

health service is not complete with facilities, the

environment is not comfortable then the

community will choose another more complete

hospital, (p = 0.001). Respondents who are

interested in reusing outpatient services are very

closely related to the comfort of the environment,

the completeness of the facilities provided, and are

supported by equipment that is functioning well

and officers maintain the cleanliness / sterilization

of the equipment used.

Users of health services through health facilities

and quality services, not only concerning the recovery

from physical illness but also concerning satisfaction

with the attitudes, knowledge and skills of the officers

in providing services and the availability of adequate

facilities and infrastructure. Hospital environment

also means the comfort of the environment associated

with the completeness of equipment that can increase

the desire of patients to return for treatment. In terms

of comfort is very influential on direct evidence

because when a patient feel comfortable with the

facility then they will return and will convey to family

or relatives.

Based on the results of this study indicate that the

majority of parents of children (75%) studied

expressed satisfaction with the environment and there

were still 25% of parents of children who feel less

satisfied with the environment. For respondents who

said they were satisfied because of the cool and

comfortable environment, a children's playground

was provided, the room was neat and clean, the

examination room was comfortable and facilitated

with wall decoration that made the child feel

comfortable and not afraid.

Parents who feel unsatisfied were caused by the

condition of their children who cannot take advantage

of existing facilities at the hospital, due to the

condition of the sick child despite being provided

with a playground. There were also those who were

caused by the fact that their children were still afraid

of the doctors or nurses who were considered as other

people that will hurt them. The role of the doctor in

making a child comfortable is very important during

the examination process. The doctor must make the

child feel at home in his own home and not be afraid

of the actions the doctor will take. In general, parents

who were satisfied with the environment tend to reuse

if their children got sick.

4 CONCLUSIONS

The findings in this study were parents feel less

satisfied with the comfort of the hospital by 21%,

service officers by 24%, service procedures by 20%,

service results by 27%, environment by25%. About

25% of parents were not loyal or will not return to use

hospital services. The results of multivariate analysis

showed that the desire of parents to re-use outpatient

services when their children got sick was related to

Service Officers, service procedures, and the

environment. While the variable comfort and service

results were not related. The most dominant variable

related in this study was the service procedure which

has a value of Exp (B) / OR = 7.959 by mean that

parents who were satisfied with hospital service

procedures, have the opportunity to re-use outpatient

services by 7.9 times higher than parents who lack

satisfied with hospital service procedures. So it can be

concluded in this discussion the indication of parental

satisfaction parameters towards the desire to re-use

outpatient services is the highest is the service

procedure where parents will return to take advantage

of outpatient care when the procedures performed at

the hospital meet or even more than the expectations

of patients and family. Although feeling dissatisfied

with other services, but feeling satisfied with the

service procedures, overall it is sufficient to satisfy

the patient and make the patient reuse outpatient

services.

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