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

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

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

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

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

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

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

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

value

Reliabillit

0,645 0,091 4,590 1 0,001 5,203

Assurance 0,339 0,086 6,591 1 0,003 3,652

Tan

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

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

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.

REFERENCES

Akdere, M. Examining patient perceptions of service

quality in Turkish hospitals:The SERVPERF model,

total quality management & business excellence.

DOI:10.1 080/14783363. 2018.142750, 2018.

Almomani, R.Z.Q.A., 2019. Patients’ satisfaction of health

service quality in public hospitals: A PubHosQual

analysis *, doi: 10.5267/ j.msl. 2019.12.038

Management Science Letters 10 (2020) 1803–1812.

University Sultan Zainal Abidin Kuala Nerus,

Terengganu, Malaysia.

Asnawi, A.A. 2019. The influence of hospital image and

service quality on patients’ satisfaction and loyalty.

Management Science Letters 9 (2019) 911–920.

Universiti Sultan Zainal Abidin Kuala Nerus,

Terengganu, Malaysia.

Cho, S . 2019. The Impact of Corporate Image, Service

Quality, Trust, and Perceived Value on Chinese

Customer Satisfaction and Loyalty: Medical Services in

Thailand. Human Behavior, Development and Society

Journal ISSN 2651 -1762, Vol 20 No 3 ,September

2019. Panyapiwat Institute of Management, Thailand.

Dubey, P. 2019. Effect of Service Quality on Perceived

Value, Satistaction and Loyality of Customers: A Study

on Selected Hospitals of Chhattisgarh. Internationla

Journal of Computer Sciences and Engineering Vol 7,

Specila Issue, Feb 2019. University Chhattisgarh,

Bilaspur, India.

Ekayanti, E.F, Pasinringi, S.A, dan Kapalawi, I. 2013.

Pengaruh Persepsi Pasien Tentang Kualitas Pelayanan

Rawat Inap Terhadap Image di Rumah Sakit

Universitas Hasanuddin. Fakultas kesehatan

masyarakat, UNHAS. Makassar.

Herlambang, S. 2016. Manajemen Pelayanan Kesehatan

Rumah Sakit. Gosyen Publishing. Yogyakarta.

Kalutharawithana, K., & Jayawardena, N. The Impact of

Service Quality towards Customer satisfaction in

Private sector Hospitals- A Case Study on the ABC

Private Hospital in Sri Lanka. International Journal of

Scientific & Engineering Research, 8(12), 375-384,

2017.

Kotler, Philip dan Gary Armstrong. 2010. Principles Of

Marketing, 14th Edition, PrenticeHall Pearson, USA;

Kotler Philip, Kevin Lane Keller. 2009. Manajemen

Pemasaran. Jakarta: Penerbit Prenhallindo; 2009.

Lovelock, H Cristopher and Wright K Lauren. 2012.

Manajemen Pemasaran Jasa. Alih Bahasa Agus

Widyantoro. PT. Indeks.

Lubis. 2011. Analisis Pengaruh Kualitas Pelayanan

Terhadap Citra Merek Pada Poliklinik RS.Haji Medan.

Marzaweny, Dishka 2012. Analisis Kepuasan Pasien

sebagai Mediasi Pengaruh Kualitas Pelayanan

Kesehatan terhadap Citra Rumah Sakit Umum Daerah

(RSUD) Arifin Achmad Pekanbaru. Jurnal Aplikasi

Manajemen. September 2012. Vol 10 No 3; hal 566-

573.

Mohsen, M. Hospital Services Quality from Patient’s

Viewpoint in Iran: A Systematic Review and Meta-

Analysis. Evidence Based Health Policy. Management

and Economics. 1(4), 261-9, 2017.

Nurlia, C., A. Hamzah dan Indar. 2012. Hubungan Bauran

Pemasaran dengan Keputusan Pasien Rawat Inap

memilih Layanan Kesehatan di Rumah Sakit Islam

Faisal Makassar Tahun 2011. Jurnal AKK. Vol. 1, No.

1:15-21.

Oktarina, D. 2016. Kualitas layanan, dan citra merek, serta

pengaruhnya terhadap kepuasan mahasiswa. Tesis.

Universitas muhammadyah metro. Bandar lampung.

Santoso. 2016. Pengaruh kualitas pelayanan terhadap

Brand image pada Rumah Sakit Umum Daerah

Wonosari Kabupaten Gunung Kidul

Tan. C 2019. Measuring the Influence of Service Quality on

Patient Satisfaction in Malaysia. Quality Management

Journal, Volume 26, 2019-issue 3.

Tjiptono F. 2016. Service Quality and Satisfaction, Andi

Offset,Yogyakarta.

Turnip, A., Andrian, Turnip, M., Dharma, A., Paninsari, D.,

Nababan, T., Ginting, C.N., 2020. An application of

modified filter algorithm fetal electrocardiogram

signals with various subjects, International Journal of

Artificial Intelligence, vol. 18, no., 2020.

Sutojo, S. 2004. Membangun Citra Perusahaan, Jakarta:

Damar Mulia Pustaka. 2004.

Sharon, Lyrissa Gisela. Analisis Pengaruh Kualitas

Layanan, Fasilitas, Citra Rumah Sakit, Kepuasan

Pasien Dalam Rangka Meningkatkan Loyalitas Pasien.

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

Skripsi. Fakultas Ekonomi dan Bisnis. Universitas

Diponegoro Semarang; 2017.

Wijaya, C., Andrian, M., Harahap, M., Turnip, A., 2019.

Abnormalities State Detection from P-Wave, QRS

Complex, and T-Wave in Noisy ECG, Journal of

Physics: Conference Series, Volume 1230, (2019)

012015. doi:10.1088/1742-6596/1230/1/012015.

Wu, C.C 2018. The impact of hospital brand image on

service quality, patient satisfaction and loyalty.

DOI:10.5897 /AJBM10.1347.

Quality of Service and Customer Value against the Image of the Hospital