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Analysis Quality of Services on and Satisfaction Loyalty Patients Sumberglagah Hospital Mojokerto

Hospitals were health facilities that provide individual health services including promotive, preventive, curative and rehabilitative services. Hospital services provided in the form of quality will be able to satisfy patients. Patients satisfied with the services provided can also create patient loyalty. This study aims to determine the effect of service quality on satisfaction and loyalty of patients at Sumber Glagah General Hospital Mojokerto. Research design used in this study a correlation analytic with a cross sectional approach. The population study were all in patients at Sumber Glagah General Hospital Mojokerto in August 2018 as many as 315 patients. The sampling technique used simple random sampling with a sample size of 100 patients. The independent variable was service quality and the dependent variable is satisfaction and loyalty. The instrument used a questionnaire that is tested for its validity and reliability. Data analysis used linear regression with a significance level of 0.05. The results showed that respondents stated that the services of the Sumberglagah General Hospital were of high quality at 56%. Respondents who stated that they were very satisfied were 94%. Respondents who stated were very loyal at 93%. The results of the linear regression test showed that p = 0.025 (α = 0.05) that H0 is rejected means that there is an influence between the quality of service of Sumberglagah Hospital in Mojokerto and patient satisfaction. The results of the linear regression test showed that p = 0.015 means that there is an influence between the quality of services of Sumberglagah Hospital in Mojokerto on patient loyalty. The quality of health services felt by patients is predicted to increase patient satisfaction. Good service quality will affect patient satisfaction as a hospital customer. The more quality the services provided by the hospital, the more patients will feel satisfaction with the services provided. The better quality of hospital services provided to patients will be more loyal patients to the hospital.


INTRODUCTION
Hospitals are health facilities that provide individual health services including promotive, preventive, curative and rehabilitative services that provide inpatient, outpatient, and emergency services (Permenkes RI, 2008). Hospital services are provided in the form of quality that can satisfy patients (Asmuji, 2012). The patient is satisfied if the quality of hospital services is above his perception. This link between service quality and satisfaction can be proven by the results of a study by Suryanti et al. (2014) in patients at the Muhammadiyah Banyuwangi Hospital. Patients who are satisfied with the services provided can also create patient loyalty. The better the patient's assessment, the better the quality of hospital nursing services. Loyalty according to Tjiptono (2010) is a customer commitment based on a very positive attitude and reflected in consistent repurchases. Having loyal patients is certainly a sign of satisfaction from patients as hospital customers. Parasuraman et al. (2008) define service quality as a universal decision (global judgment), or attitude that is related to customer satisfaction. Satisfaction obtained depends on the situation when the service interaction occurs. And satisfaction is also a very subjective and abstract nature. Each patient can feel it depends on their background and can have different levels of satisfaction for one type of service that is the same (Alena Meygi, 2013). Customer satisfaction is the main key that makes organizations able to compete and can maintain the survival of the organization in the long run (Goetsch and Davis, 2017).The dimensions or aspects of nurse quality are based on the standard of nursing care services, Siyoto, S., Peristiowati, Y. (2017). While patient satisfaction is the fulfillment of patient expectations for nursing services obtained during hospital care known as serqual, including variables of tangibility, reliability, responsiveness, assurance, empathy (Lupiyor, 2011). The loyalty is the return of patients to the same hospital.
According to Zeithaml (2015), there are ten dimensions of service quality which include reliability, responsiveness, competence, access, courtesy, communication, credibility, security, knowing the customer and tangibles. The quality of health services is to refer to the level of perfection of health services. On the one hand it can lead to satisfaction with patients, while on the other hand the procedure must be in accordance with the established professional standard code of ethics (Azwar, 2008).
Sumber Glagah General Hospital is one of the many hospitals in Mojokerto district that provide health services for the community. Sumberglagah General Hospital is a government hospital under the direct control of the East Java provincial government. A preliminary study on September 20, 2018 through interviews with 12 inpatient patients at Sumber Glagah General Hospital Mojokerto found that 9 people were satisfied with the actions given by nurses, 1 patient stated dissatisfaction because only blood pressure checks were performed, body temperature checks without other actions and 2 patients felt that their condition was neglected by nurses. Patients who expressed satisfaction as many as 8 people are old patients, while 1 person is a patient is a new patient. While those who stated that they were not satisfied were 2 new patients and 1 old patient. The results of the preliminary study showed that there was still patient dissatisfaction with the services provided by the hospital, which affected loyalty.
This study aims to determine the effect of service quality on satisfaction and loyalty of patients at Sumber Glagah General Hospital Mojokerto. This study will identify the quality of health services in the Sumber Glagah General Hospital Mojokerto, identify patient satisfaction, identify patient loyalty, analyze the influence of nurse service quality on patient satisfaction and analyze the effect of nurse service quality on patient loyalty.

METHODS
The research design used in this study is a correlation analytic design with a cross sectional approach. The population in this study were all inpatients at Sumberglagah General Hospital Mojokerto in 315 as many as 315 patients. Data retrieval was carried out at October until November 2018. The sampling technique used simple random sampling with a sample size of 100 patients. The independent variable is service quality and the dependent variable is satisfaction and loyalty. Quality validity test r = 0.600; satisfaction r = 0.652 and loyalty r = 0.671. Quality reliability test α = 0.916; satisfaction α = 0.942 and loyalty α = 0.683. Data analysis using linear regression with a significance level of 0.05. The study was conducted after passing the ethical test by an assessment team from Institut Ilmu Kesehatan STRADA Indonesia. Based on the table 1 above it is known that from the total of 100 respondents aged 35-49 years that is as many as 50 respondents (50%), female sex that is as much as 60 respondents (60%), high school education 50 respondents (50%), lenght of stay ≥3 days 70 respondent (70%) and work as enterpreneur 65 respondents (65%).

DISCUSSION
Base on table 2 shows the results of the linear regression test show p = 0.025. If p ≤ α (α = 0.05) means that there is an influence between the quality of service at Sumberglagah General Hospital Mojokerto to patient satisfaction. The test results of the determination coefficient are 0.040, meaning that 4.0% level of satisfaction is influenced by other variables. Patients who assess quality hospital services will feel very satisfied with the hospital that is equal to 50 respondents (50%). This link between service quality and satisfaction can be proven by the results of a study by Suryanti et al. (2014) in patients at the Muhammadiyah Banyuwangi Hospital. Service quality variables proved to have a significant and positive effect on customer satisfaction. The results of this study in accordance with the research conducted by Rao (2008) state that high service quality correlates with high customer satisfaction. According to Kotler (2008), that the quality of services / services is the form and total characteristics of a product of goods and services that show its ability to satisfy or meet the needs of patients. Patient satisfaction serves as a medium between service quality and behavioral intention (Lupiyoadi, 2011). The quality of health services is not only related to how the services of medical personnel provide services to patients but also how patients feel comfortable with the conditions and situations that the hospital creates. Satisfaction is a function of perception or impression of performance and expectations of hospital services (Aryani, Rosinta, 2010). Hospital performance that exceeds patient expectations, they will feel satisfied and happy. Every health service facility and social service has a view that might add or reduce patient satisfaction and work performance (Nuralim, 2015).Customers who are satisfied with goods and services, will provide an assessment of health facility services as quality service providers. The quality of health services felt by patients is predicted to increase patient satisfaction. Good service quality will affect the satisfaction of patients as consumers or hospital customers. The more quality the services provided by the hospital, the more patients will feel satisfaction with the services provided.
Base on table 4 the results of the linear regression test show p = 0.015. If p ≤ α (α = 0.05) means that there is an influence between the quality of service at Sumberglagah Hospital in Mojokerto on patient loyalty. The test results of the determination coefficient are 0.050, meaning that 5.0% of the loyalty level is influenced by other variables. Patients who assess quality hospital services will feel very loyal to the hospital that is equal to 49 respondents (49%). Customer satisfaction variables proved to have a significant and positive effect on customer loyalty. The results of this study are in the opinion of Nuryanti (2013) which shows that customer satisfaction affects buyer behavior in which satisfied customers tend to be loyal. Consumer satisfaction will have a positive impact on the hospital. If consumers are satisfied with hospital services, will create an assessment that the hospital has been able to provide maximum service to the community (Muninjaya, 2013). This means that the higher the satisfaction felt by patients, the higher the loyalty of hospital patients. Customer satisfaction is a feeling of pleasure or disappointment someone who comes from a comparison between his impression of the performance or results of a product and expectations (Griffith, D.D. dan Stephen W. Brown, 2017). Consumers who are satisfied will tend to make a repeat purchase of a product, in terms of banking means to make transactions in the same place and share their experiences with others. So from that satisfied customers will tend to be loyal, so that in order to be able to build customer loyalty, one way is to give satisfaction (Mills, 2010). The higher the level of customer satisfaction, the loyalty level will increase. Patients who have assumed that patients have been fulfilled for their basic needs both in the quality of services, products and costs that must be incurred in care or treatment at the hospital, patient loyalty will be stronger, so patients will be more confident in the quality of this hospital services recommend to others to use the service (Heryanti, 2008). The creation of patient satisfaction can provide benefits, including the relationship between the company and the patient to be harmonious, providing a good basis for the use of services again and the creation of patient loyalty, and forming something mouth-tomouth recommendations that benefit the hospital (Hurriyati, 2015). Quality hospital services will affect customer loyalty. The better quality of hospital services provided to patients will be more loyal patients to the hospital Setyawan Saryono (2010). Satisfaction is a function of perception or impression of performance and expectations of hospital services. Hospital performance that exceeds patient expectations, they will feel satisfied and happy. Customers who are satisfied with goods and services are likely to repurchase from the providers of goods and services. Patients who reuse health services are called loyal patients. Having loyal patients is the ultimate goal of the hospital. Patient loyalty is formed through several stages, starting from looking for patients as potential potential customers to the formation of customer advocates that will bring benefits to the hospital and ensure the hospital's survival into the future.

CONCLUSION
The quality of service in the Sumberglagah General Hospital in Mojokerto according to patients mostly states that quality is as much as 56%. Patient satisfaction with services according to patients mostly stated that they were very satisfied, amounting to as much as 94%. Most patient loyalty is very loyal, which is equal to 93%. The service quality of Sumberglagah Hospital in Mojokerto affects patient satisfaction. Good service quality will increase patient satisfaction as a customer or hospital customer. Service quality has an effect on patient loyalty. Quality hospital services will create a harmonious relationship between the hospital and the patient so that they will return to the use of services and recommend colleagues or family to come to the hospital. Hospitals in order to always maintain the quality of hospital services and further improve services through the accuracy of response times and the dissemination of services to the community. And the next researcher can research other factors that influence patient satisfaction and loyalty so that it can be a hospital recommendation to always improve based on the evidence base.