JVK
JURNAL VOKASI KESEHATAN
http://ejournal.poltekkes-pontianak.ac.id/index.php/JVK
ANALYSIS OF HOSPITAL MANAGEMENT STRATEGIES FOR NATIONAL
HEALTH INSURANCE USING THE TOTAL QUALITY MANAGEMENT
METHOD
Melvin Rizki Alhamed1, Ermi Girsang2 , Sri Lestari Ramadhani Nasution3
1,2,3

Master of Public Health Study Program, Faculty of Medicine, Dentistry and Health Sciences, Universitas
Prima Indonesia, Indonesia.
Article Info

Abstract

Article History:
Received : 21-04-2025
Approved : 21-07-2025
Published : 31-07-2025

The success of the National Health Insurance (JKN) program is highly dependent
on the ability of hospitals to implement adaptive management to changing
community needs. This study aims to analyze the management strategy of Graha
Bunda Hospital in facing JKN challenges through the implementation of Total
Quality Management (TQM). The research uses an explanatory nonexperimental quantitative approach with a focus on four main elements of TQM,
namely patient focus, teamwork, continuous system improvement, and education
and training. Data was collected through the distribution of questionnaires to 150
medical and paramedical staff. The results of the analysis using multiple linear
regression showed that three of the four independent variables, namely patient
focus (p = 0.002), continuous system improvement (p = 0.014), and education
and training (p = 0.008), had a significant influence on hospital management
strategies. Meanwhile, the teamwork variable showed statistically insignificant
results (p = 0.089). A determination coefficient value (R²) of 0.62 indicates that
the four TQM variables together are able to explain 62% of the variation in
hospital management. The results of this study confirm that the application of
TQM principles contributes positively to improving hospital quality
management in the JKN era. Focusing on patients has been proven to be
influential in improving the quality of health services, education and training that
strengthens the competence of health workers, as well as efforts to improve the
system that is sustainable as the foundation for improving services. Hospital
management strategies that integrate TQM principles can help improve
operational efficiency, strengthen prevention efforts, and provide services that
are more responsive to patient needs. The consistent implementation of TQM
can be a strategic approach for hospitals in answering the challenges of
implementing JKN effectively. The success of the National Health Insurance
(JKN) program is highly dependent on the ability of hospitals to implement
adaptive management to changing community needs. This study aims to analyze
the management strategy of Graha Bunda Hospital in facing JKN challenges
through the implementation of Total Quality Management (TQM).

Keywords:
Total
Quality
Management,
JKN,
Hospital Management,
Management Strategy

Correspondence address:
Master of Public Health Study Program, Faculty of Medicine, Medicine
Dentistry and Health Sciences, Universitas Prima Indonesia, Indonesia
Email: ermigirsang@unprimdn.ac.id

ISSN 2442-5478

(JKN) system, which aims to provide affordable
and quality health services for the entire population
(Kang et al., 2020). Good hospital management

Introduction
Effective hospital management has a close
relationship with the National Health Insurance

1

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

ensures resource optimization and operational
efficiency, so that it can offer services at an
affordable cost without sacrificing quality
(Abdalkareem et al., 2021). With efficient cost
management, hospitals can set lower rates for JKN
participants, in line with the goal of increasing
access to health services (Zhu et al., 2019). The
availability of adequate medical facilities and
personnel is an important factor in ensuring
equitable services for all JKN participants, ensuring
that every individual gets the health services they
need without accessibility barriers (Ahmed et al.,
2021).
Quality-oriented management also supports
the fulfillment of health service standards that have
been set, so that patients receive the best care in
accordance with applicable regulations (Elhadi et
al., 2020; Setiani et al., 2024). The effectiveness of
hospital management is the key to JKN's success in
providing fair and quality health services for the
entire population. By optimizing resources,
ensuring equitable distribution of facilities, and
increasing strategic partnerships, hospitals can
contribute to improving the accessibility and
quality of health services in the JKN system. In
addition, strategies such as addressing spatial
accessibility, equitable allocation of resources, and
strengthening partnerships between various
stakeholders are the main steps in increasing the
effectiveness of the JKN system in the long term
(Ahmed et al., 2021).
Hospital management strategies have a
significant impact on the quality of healthcare
services provided to the community, especially in
improving operational efficiency, resource
management, and reducing waste (Siagian et al.,
2025). The quality of health services is the main
key in meeting the needs and satisfaction of patients,
where the performance of medical personnel plays
a major role in shaping patients' perception of the
quality of services received. A good management
strategy also has an impact on the financial
sustainability of the hospital, where efficient budget
management and the creation of additional sources
of income help the hospital in maintaining longterm financial stability (Ansyori, 2023).
Compliance
with
applicable
health
regulations and the implementation of Good
Corporate Governance are important aspects in
ensuring that service standards and patient safety
are maintained (Halawa et al., 2022). In evaluating
the quality of health services, patient satisfaction is
the main benchmark, which is influenced by
various factors such as caring nurses, quality of
food services, service waiting times, and
therapeutic communication of nurses (Ihsan et al.,
2018; Lestari, 2022; Puspa et al., 2019). Other
aspects such as the quality of physiotherapy
services, the cleanliness of the hospital
environment, the quality of food, the food service
system, and the attitude and performance of staff

also affect the level of patient satisfaction (Scott,
2022; Rosen et al., 2018). With an effective and
quality-oriented management strategy, it not only
increases the competitiveness of hospitals, but also
ensures optimal health services for the community
(Nafi'a, 2021).
Patient loyalty is also an important factor in
hospital management, where service quality,
hospital image, value, and patient satisfaction play
a role in shaping their loyalty to the hospital
(Oktoriani, 2023). Improving the quality of service
is key to improving patient satisfaction, which
ultimately impacts their loyalty to the hospital
(Haryanto et al., 2020). An effective hospital
management strategy focuses not only on
operational efficiency and financial sustainability,
but also on improving the quality of services as well
as establishing long-term relationships with
patients (Almuida et al., 2023; Rahmadiliyani &
Faizal, 2018). Continuous innovation and
development are crucial elements in ensuring that
hospitals remain relevant and able to provide
cutting-edge healthcare services (Zakiah et al.,
2020).
One of the strategies that can be applied in
improving hospital management is Total Quality
Management (TQM), which is a comprehensive
management approach that focuses on improving
quality in all operational aspects. When applied in
hospital management, TQM is able to improve
effectiveness and efficiency through a patientcentered approach, allowing hospitals to better
understand patient needs and respond better to
feedback (Kamaruddin et al., 2021). TQM
encourages the implementation of data-driven
systems to monitor and measure hospital
performance, requiring improvements and
innovations in various aspects of operations, such
as human resource management, facilities, and
clinical processes. With the implementation of
TQM, it not only improves the quality of service,
but also strengthens patient loyalty and the
competitiveness of hospitals in the long term (AlSaffar & Obeidat, 2020).
The collaborative approach in TQM improves
service quality, patient satisfaction, and builds a
work environment oriented towards continuous
improvement. (Wassan et al., 2022) As a modern
management strategy, TQM helps organizations
meet quality standards and compete in a
competitive environment. In hospitals, TQM has
been proven to increase patient satisfaction and the
effectiveness of health services. By emphasizing a
focus on patients, teamwork, continuous
improvement, and education and training, TQM
contributes to improving the quality of service and
sustainability of hospitals (Ali et al., 2022).
The implementation of TQM in hospitals
relies on solid teamwork and continuous system
improvement. Effective teamwork optimizes
resources, integrates processes, and enables rapid

22

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

responses to challenges, especially in environments
involving a wide range of healthcare professions,
administrative staff, and patients and their families
(Rosen et al., 2018). This multidisciplinary
collaboration ensures safer, comprehensive, and
patient-centered
care.
Continuous
system
improvement is the basic principle of TQM,
encouraging hospitals to continuously improve
efficiency and quality of service through cycles of
evaluation and innovation. The success of this
strategy depends on an adaptive team, with strong
interpersonal interactions and a system capable of
adapting to change to achieve better service
standards (Ali et al., 2022).
Education and training play an important role
in building an organizational culture that is oriented
towards quality and innovation. Proper training on
best practices, the latest technologies, and clinical
knowledge ensures that medical personnel are
prepared for the ever-evolving challenges of
healthcare (Rosen et al., 2018). The implementation
of collaborative medical and pharmacy education
also shows positive results through an approach
tailored to the local context (Hadjri & Perizade,
2019).
Previous research by Andika et al. (2022)
shows that Total Quality Management (TQM) is a
customer-oriented approach that encourages
systematic and continuous improvement to meet
quality standards (Andika et al., 2023). Analyzed
the application of TQM in BPJS inpatients at Royal
Prima Hospital Medan and found a strong
relationship between teamwork and periodic
system improvement and patient satisfaction.
Graha Bunda Hospital is a class C general
hospital located in Idi Rayeuk, East Aceh Regency,
with ownership by a social organization. The
hospital has a capacity of 137 beds and recorded a
Bed Occupancy Rate (BOR) of 88.3% in 2021,
indicating a high bed occupancy rate. In addition,
the hospital serves 8,342 patients discharged (alive
and dead) with a total of 44,173 days of treatment.
Other indicators such as Average Length of Stay
(ALOS) of 4 days and Bed Turn Over (BTO) of 61
times show the high frequency of bed use in one
period.
This study aims to analyze hospital
management strategies in supporting the
implementation of National Health Insurance (JKN)
through the Total Quality Management (TQM)
approach at Graha Bunda Hospital. By focusing on
the four main elements of TQM, namely patient
focus, teamwork, continuous system improvement,
and education and training, this research is
expected to provide insight into how hospitals can
improve service quality and operational efficiency
in supporting the JKN program. The findings of this
study will be the basis for formulating solutions to
various challenges faced by Graha Bunda Hospital,
such as patient overload and limited human
resources (HR), as well as making a significant

contribution to the continuous improvement of the
hospital's managerial system. Thus, this research is
an important step in supporting the sustainability of
hospital operations in the JKN era and ensuring
optimal services for the community.
Method
This study used an explanatory nonexperimental quantitative design to identify
relationships between variables without researcher
intervention. Data was collected through surveys
using questionnaires that were systematically
compiled to obtain information related to the
variables studied. This design aims to explain the
cause-and-effect relationship or correlation
between variables with statistical analysis, so that
the results can provide in-depth insights and
become the basis for further research or decisionmaking. This research was carried out at Graha
Bunda Hospital. The time used in the study was
carried out in May-July 2024.
The population in this study is all medical
staff and paramedics at Graha Bunda Hospital
which totals 150 people. Samples are taken using
the total sampling technique, where the entire
population is sampled because the number is
certain and limited (Suharsimi, 2018). This
technique is used to ensure all population
characteristics are represented in the study. The
inclusion criteria in this study include permanent
medical staff and paramedics who have worked for
at least 1 year at Graha Bunda Hospital and are
willing to fill out a questionnaire. Meanwhile, the
exclusion criteria are honorary personnel or shortterm contracts and respondents who do not fill out
the questionnaire completely. The application of
this criterion aims to obtain data that is more
accurate, relevant, and can reflect the perceptions
and real experiences of health workers who are
directly involved in the hospital management
system.
This research instrument includes validity and
reliability tests to ensure the validity and
consistency of the measurement instruments. The
validity test was carried out by the product moment
correlation method to assess the relationship
between the statement items in the questionnaire
using SPSS, with validity criteria based on the
comparison of r calculation and r table. The
reliability test is performed using Cronbach's Alpha
coefficient, where the instrument is considered
reliable if the alpha value ≥ 0.6. This study
measures independent variables consisting of
patient focus, teamwork, continuous system
improvement, and education and training, while the
dependent variable is hospital management. The
research instrument is in the form of a questionnaire
with a Likert scale to measure respondents'
perception of various indicators that have been
determined. The number of items tested in this

23

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

questionnaire was 24 items, which were divided
into four sections according to the variables
measured: patient focus (6 items), teamwork (6
items), continuous system improvement (6 items),
and education and training (6 items).
The data analysis in this study includes
descriptive analysis to describe the data based on
the average, highest, and lowest values. The
classical assumption test was carried out through
the normality test (Kolmogorov-Smirnov), the
multicollinearity test (VIF and Tolerance), and the
heteroscedasticity test (scatterplot). Multiple linear
regression analysis was used to test the influence of
the variables Patient Focus, Teamwork, Continuous
System Improvement, and Education and Training
on Hospital Management. The hypothesis test was
carried out with a t-test (partial influence), an F test
(simultaneous influence), and a determination
coefficient (R²) to assess how much an independent
variable can explain the dependent variable. All
analyses are performed using the help of SPSS
software. This research has obtained official
permission from the management of Graha Bunda
Hospital and guarantees the confidentiality of
respondent data in accordance with the ethical
principles of research. In addition, this research has
also passed the ethics approval process from the
Health Research Ethics Committee of Universitas
Prima Indonesia with code of ethics number:
122/KEPK/UNPRI/III/2025.

X2.6 0.725 0,361
X3.1 0.681 0,361
X3.2 0.794 0,361
X3.3 0.819 0,361
X3.4 0.899 0,361 Valid
X3.5 0.733 0,361
X3.6 0.724 0,361
4
Educatio X4.1 0.755 0,361
n and
X4.2 0.673 0,361
Training X4.3 0.654 0,361
X4.4 0.755 0,361 Valid
X4.5 0.732 0,361
X4.6 0.701 0,361
5
Hospital Y1.1 0.716 0,361
Manage Y1.2 0.775 0,361
ment
Y1.3 0.894 0,361
Y1.4 0.776 0,361 Valid
Y1.5 0.812 0,361
Y1.6 0.882 0,361
Source: Primary Data
Based on Table 1, it can be seen that the value
of r calculated on the score of the top number of
each question item is greater than the r of the table
(r table = 0.361), and it can be said that each
question item result of the average questionnaire
result is greater than 0.361 and can be declared
valid.
3

Reliability Test Analysis
From the results of the reliability test on all
variables to 30 respondents of medical staff and
paramedics at the hospital, using Alpha Cronbach's
statistical test formula using SPSS, the results of the
reliability test of all variables were obtained, as
follows:

Results
Validity Test Analysis
The validity test with Pearson's Product
Moment correlation technique was carried out on
the variables of Patient Focus, Teamwork,
Continuous System Improvement, and Education
and Training on Hospital Management. The
questionnaire was tested on 30 respondents of
medical staff and paramedics at the hospital, and all
items were declared valid. With n = 30, a table r of
0.361 is obtained (Ghozali, 2018), and all items
have a calculated r greater than the r table, thus
meeting the validity criteria:

Table 2. Reliability Test Results
Cronbac
h's
Cronba
Ye
Inform
Variable
Alpha
ch's
s
ation
Standar
Alpha
d
Focus on
1
0,60
0,936
Reliable
Patients
Teamwor
2
0,60
0,925
Reliable
k
Continuo
us
3
System
0,60
0,917
Reliable
Improve
ment
Educatio
4
n and
0,60
0,887
Reliable
Training
Hospital
5
Managem
0,60
0,932
Reliable
ent
Source: Primary Data
Based on Table 2, the results of the reliability
test showed that the Cronbach's Alpha value for all
variables exceeded the standard of 0.60 (>0.60).

Table 1. Validity Test Results
Ye
s

Variable

Item
s

1

Focus on
Patients

X1.1
X1.2
X1.3
X1.4
X1.5
X1.6
X2.1
X2.2
X2.3
X2.4
X2.5

2

Teamwo
rk

R
Coun
t
0.740
0.727
0.878
0.876
0.767
0.876
0.790
0.775
0.781
0.836
0.807

R
Tabl
e
0,361
0,361
0,361
0,361
0,361
0,361
0,361
0,361
0,361
0,361
0,361

Continu
ous
System
Improve
ment

Infor
mati
on
Valid

Valid

24

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

The research variables were declared reliable and
could be used for further analysis.

had a VIF value below 10 and a tolerance value
above 0.10. Thus, it can be concluded that there is
no multicollinearity between free variables.

Normality Test Analysis
The normality test aims to determine whether
the analyzed data has a normal distribution. In this
study, the normality test was carried out to ensure
that the distribution model of the research variables
corresponded to the normal distribution. Before
testing a hypothesis, it is important to verify that the
sample is from a normally distributed population.
The test was performed with the KolmogorovSmirnov test, in which the data is considered to be
normally distributed if the significance value ≥ 0.05.

Heteroscedasticity Test Analysis
Heteroscedasticity tests were performed to
identify whether there was an inequality of variance
in the regression model between one observation
and another. In this study, the test was carried out
using a scatterplot. The data is said to not
experience heteroscedasticity if the dots on the
scatterplot are scattered above and below zero
without forming a specific pattern. The results of
the heteroscedasticity test for the variables of
Patient Focus, Teamwork, Continuous System
Improvement, and Education and Training on
Hospital Management can be seen in the following
figure.

Table 3. Normality Test Results
One-Sample Kolmogorov-Smirnov Test
Unstandardiz
ed Residual
N
150
Normal Parametersa,b Mean
.0000000
Std.
.1930603
Deviation
8
Most Extreme
Absolute
.085
Differences
Positive
.085
Negative
-.060
Test Statistic
.085
Asymp. Sig. (2-tailed)
.101c
Source: Primary Data
The results of the normality test with the
Kolmogorov-Smirnov Test showed that the
research variable had a significance value of 0.101.
Since this value is greater than alpha 5% (sig >
0.05), it can be concluded that the data is normally
distributed.

Figure 1.. Heteroscedasticity Test Results

Source: Primary Data
The results of the heteroscedasticity test on the
variables of Patient Focus, Teamwork, Continuous
System Improvement, and Education and Training
on Hospital Management showed that the dots on
the scatterplot were scattered above and below zero
without a specific pattern. Thus, it can be concluded
that the regression model does not experience
heteroscedasticity.

Multicollinearity Test Analysis
The multicollinearity test in this study shows
that there is no multicollinearity, as shown in the
following table. This is evidenced by the value of
the Variance Inflation Factor (VIF) which is below
the tolerance limit, so that the free variables in the
model do not have excessive correlation.

Multiple Linear Regression Analysis
Multiple linear regression analysis was used
to measure the influence of independent variables,
namely Focus on Patients, Teamwork, Continuous
System Improvement, and Education and Training
on Hospital Management. The results of the
regression test are displayed as follows:

Table 4. Hail Multicollinearity Test
Coefficient
Collinearity
Statistics
Tolerance VIVID

Table 6. Multiple Linear Regression Results
Coefficient
Standa
Unstandardi rdized
zed
Coeffi
Coefficients cients
Std.
Sig
Type
B Error Beta
t
.
1 (Constant)
- 0.084
- 0.0
0.16
1.94 54
3
6

Type
1 (Constant)
Focus on Patients
0.732
3.663
Teamwork
0.822
2.160
Continuous System
0.524
9.069
Improvement
Education and Training
0.782
2.792
Source: Primary Data
Based on table 4, the multicollinearity test
showed that the variables of Patient Focus,
Teamwork, Continuous System Improvement, and
Education and Training on Hospital Management

25

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

Focus on
Patients
Teamwork

0.24 0.079
1
0.07 0.082
9
0.53 0.099
6

Continuous
System
Improvemen
t
Education
0.19 0.077
and Training
3

0.235 3.04 0.0
1 03
0.070 0.96 0.3
4 36
0.492 5.39 0.0
1 00

Education
0.193 0.077 0.186 2.4 0.01
and
93
4
Training
Source: Primary Data
The t-test showed that the variables of Patient
Focus, Continuous System Improvement, and
Education and Training had a significant influence
on Hospital Management, with a significance value
of 0.003 each; 0,000; and 0.014 (less than 0.05) and
the value of t is calculated to be greater than the t
table. On the other hand, the Teamwork variable did
not have a significant effect on Hospital
Management because the significance value was
0.336 (greater than 0.05) and t calculated was
smaller than t table.

0.186 2.49 0.0
3 14

Source: Primary Data
The results of multiple linear regression
analysis showed that a constant of -0.163 indicated
that if the variables of Patient Focus, Teamwork,
Continuous System Improvement, and Education
and Training were 0, then Hospital Management
would be valued at -0.163. The Patient-Focus
regression coefficient of 0.241 shows that every 1
unit increase in this variable will increase Hospital
Management by 0.241. The Teamwork variable has
a coefficient of 0.079, which means that an increase
of 1 unit will increase Hospital Management by
0.079.
Meanwhile,
Continuous
System
Improvement had the greatest influence with a
coefficient of 0.536, followed by Education and
Training with a coefficient of 0.193. To minimize
errors in the study, the standard error value was
obtained at 0.084.

Analysis of the F Test
Table 8. F Test Results
NEW ERA
Sum of
Mean
Type
Squares Df Square F
Sig.
1Regression81.992
4 20.498 535.190.000b
Residual 5.554
145.038
Total
87.546
149
Source: Primary Data
Based on table 8, the results of the F test show
that the statistical value of F-calculated is 535.190
with a significance value of 0.000. This indicates
that the variables of Patient Focus, Teamwork,
Continuous System Improvement, and Education
and Training simultaneously affect Hospital
Management by medical staff and paramedics at the
hospital.

T Test Analysis
The t-test was performed to test the influence
of each independent variable on the dependent
variable partially with a significance level of 0.05.
If the significance value is less than 0.05, then an
alternative hypothesis is accepted, which means the
independent variable has a significant influence on
the dependent variable.
Table 7. T Test Results
Coefficient
Standar
Unstandardiz dized
ed
Coeffic
Coefficients ients
Std.
Type
B
Error Beta
t
1 (Constant)
0.084
0.163
1.9
46
Focus on
0.241 0.079 0.235 3.0
Patients
41
Teamwork 0.079 0.082 0.070 0.9
64
Continuous 0.536 0.099 0.492 5.3
System
91
Improveme
nt

Coefficient of Determination (R2)
The coefficient of determination in linear
regression measures the extent to which an
independent variable can explain variance in a
bound variable. In simple terms, this value is
obtained by expressing the Correlation Coefficient
(R), which shows the proportion of variation of the
bound variable Y that can be explained by the
independent variable X. If the value of the
determination coefficient Ris 2=0, then the
independent variable does not explain the variation
in the bound variable at all. Conversely, if Ris 2=1,
then all the variations in Y are fully explained by X.
The results of the determination test of R2 can be
seen in the following table

Sig.
0.05
4

Table 9. Determination Coefficient Result (R2)
Model Summaryb
Adjusted R Std. Error of
Type
R R Square Square the Estimate
1
.968a
.937
.935
.19571
Source: Primary Data
Based on table 9, the R Square value
obtained was 0.937, which means that the variables
of Patient Focus, Teamwork, Continuous System
Improvement, and Education and Training

0.00
3
0.33
6
0.00
0

26

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

contributed 93.7% in explaining the variation in
Hospital Management. Meanwhile, 6.3% of the
variation was influenced by other factors that were
not included in this study model.

showed that teamwork in healthcare can improve
patient safety and create a more positive work
environment (Rosen et al., 2018). In addition, Lilis
et al. (2018) also found a positive relationship
between teamwork and employee performance,
emphasizing the importance of collaboration in
improving work outcomes (Lilis et al., 2018).
Another study by Ekawardani et al. (2023) shows
that teamwork factors such as good communication
and management support contribute to a culture of
patient safety (Ekawardani et al., 2022). At Graha
Bunda Hospital, teamwork does not seem to have a
significant impact on hospital management,
possibly due to other factors such as managerial
systems, leadership, or resource allocation that are
more dominant in determining the effectiveness of
hospital management.
Although teamwork did not have a
significant effect on the study, it is important for
hospitals to maintain and improve synergy between
medical personnel. Some research remains to
highlight the important role of teamwork in the
healthcare environment. In line with research
conducted by Hijayanti (2020), it was found that
interpersonal communication and work discipline
have a positive impact on employee performance in
medical rehabilitation services (Scott, 2020).
Rosmayanti (2023) also emphasized that work
motivation
and
teamwork
affect
the
implementation of patient safety practices. In
addition, research by David & Ainun (2022) shows
that work experience in a team-based environment
can improve the performance of nursing staff
(David William Marihot & Ainun, 2022). Devery et
al. (2022) emphasized that teamwork is
indispensable in providing quality end-of-life care
in hospitals (Devery et al., 2022). The results of this
study did not find a direct relationship between
teamwork and hospital management at Graha
Bunda Hospital, but further evaluation is needed on
how teamwork can be optimized to have a more
tangible impact on the effectiveness of hospital
management.

Discussion
The Influence of the Patient-Focused TQM
Dimension on Hospital Management at Graha
Bunda Hospital
The patient-focused Total Quality
Management (TQM) dimension has a significant
influence on hospital management at Graha Bunda
Hospital. The implementation of TQM that puts
patients at the center of attention has proven to have
a positive impact on improving the quality of health
services. With a safe, effective, timely, efficient,
and patient-centered approach, hospitals can
improve patient satisfaction, which ultimately
contributes to patient loyalty and a better hospital
reputation (Babu & Thomas, 2021). Focusing on
patients also helps reduce medical errors, lower
litigation costs, and improve clinical outcomes.
Hospital operational efficiency is increasingly
increasing through improving service processes,
reducing patient waiting times, and more optimal
use of resources. On the other hand, employee
motivation and involvement also increase, creating
a more positive and productive work environment,
so that the quality of hospital services is better.
The implementation of patient-oriented
TQM allows for more effective data-driven
decision-making, so that management can
formulate policies based on the actual needs of
patients (Abu Daqar & Constantinovits, 2020).
Hospitals that apply this principle are also more
adaptive to the development of medical technology
and innovation in the health sector, making them
more reliable and quality service providers (Lepistö
et al., 2024). The results of this study show that
hospitals that pay more attention to the needs of
patients have better management, with increased
efficiency in managing time, resources, and
facilities. Focusing on patients also creates a more
inclusive environment that is responsive to the
needs of public health. Thus, Graha Bunda Hospital
needs to continue to be committed to improving
patient services as part of a sustainable strategy to
achieve higher management standards and provide
optimal health services.

The Influence of the TQM Dimension of
Continuous System Improvement on Hospital
Management at Graha Bunda Hospital
The Total Quality Management (TQM)
dimension which focuses on continuous system
improvement has proven to have a significant
influence on hospital management at Graha Bunda
Hospital. The results showed that this variable had
a regression coefficient value of 0.536 with a
significance value of 0.000 (less than 0.05), and a
calculated t value of 5.391 which was greater than
the t table (1.655), so that the H3 hypothesis was
accepted. This is in line with the research of Sari et
al. (2018), which shows that the implementation of
TQM with continuous system improvement has a
positive impact on improving service quality and
operational efficiency of health organizations. In

The Influence of the TQM Dimension of Team
Cooperation on Hospital Management at Graha
Bunda Hospital
The dimension of Total Quality
Management (TQM) in teamwork did not show a
significant influence on hospital management at
Graha Bunda Hospital. This can be seen from the
value of the regression coefficient of 0.079 with a
significance value of 0.336, which is greater than
0.05, so the H2 hypothesis is rejected. These
findings contradict some previous research that

27

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

addition, Deswita et al. (2021) emphasized that
continuous system improvement in terms of
services, human resources, and work environment
is a key factor in maintaining the competitiveness
and quality of hospitals. In the context of patient
satisfaction, Imran & Ramli's (2019) research
revealed that continuous improvement of service
quality can build trust and image of hospitals
(Imran & Ramli, 2019). This is also reinforced by
the findings of Pangemanan et al. (2022), who
found that hospital staff competence is closely
related to patient satisfaction (Pangemanan et al.,
2022). A continuous system improvement strategy
not only impacts the internal efficiency of the
hospital, but also improves the patient experience
and the competitiveness of the hospital.
System improvements in improving
service quality are also supported by research by
Chairunnisa et al. (2022), which highlights that the
physical environment, the quality of medical
personnel, and the services provided affect patients'
decisions in using hospital services (Chairunnisa et
al., 2022). In addition, Herwanda et al. (2018)
found that the perception of service quality plays a
role in patients' decision to return to dental health
services, while Puryanti (2021) emphasized that
overall service quality has a significant impact on
patient loyalty to the hospital (Puryanti, 2021). Not
only that, Rahmawati et al.'s (2022) research
revealed that competitive advantage can be a
mediating factor between TQM and improving
hospital performance. Other studies by Yoga &
Endah (2022) and Pratiwi et al. (2023) also
highlight the importance of Psychological Capital
(PsyCap) in supporting employee engagement and
increasing
the
effectiveness
of
TQM
implementation (Yoga & Endah Andriani, 2022).
With the acceptance of the H3 hypothesis, Graha
Bunda Hospital needs to ensure that system
improvements are not only carried out sporadically,
but become part of the organizational culture that
continues to adapt to the development of the health
world. Implementing continuous evaluation and
innovation in hospital management will help
improve operational efficiency and provide better
quality services for patients.

that a well-managed learning system can improve
the quality of education, while Setiawati et al.
(2021) found that training has a positive effect on
the performance of hospital employees (Setiawati
et al., 2021). In addition, research by Utari et al.
(2021) shows that the level of education, training,
and work experience plays a role in improving the
professionalism of health workers, which
ultimately has a positive impact on the quality of
hospital services (Scott, 2021). Education and
training can help hospitals better manage their
operations and improve the quality of a
professional and competent workforce.
In addition, education and training also
contribute to better staff competencies, which has a
direct impact on the effectiveness of hospital
management. Map (2022) emphasized that
education and training have a positive effect on
competence, which then has a significant impact on
overall hospital performance. Other factors such as
financial literacy also play a role in more effective
hospital management, as stated by Novi Ayu &
Novi Lailiyul (2022), who found that financial
literacy and self-efficacy have an effect on financial
management, including in the context of hospitals
(Novia Ayu & Novi Lailiyul, 2022). Furthermore,
research by Sularmi & Putra (2022) found that
education, training, and the work environment have
a significant influence on employee performance,
while Hadjri & Perizade (2019) affirmed that
education has a large role in increasing labor
productivity (Hadjri & Perizade, 2019). At Graha
Bunda Hospital, it is necessary to continue to
develop periodic training programs to strengthen
the competence of their human resources. By
ensuring that training is carried out on an ongoing
basis, hospitals can improve operational efficiency
and provide more quality and competitive health
services.
The Influence of the Dominant Influence of the
Dimension of Total Quality Management
Practice on Hospital Management at Graha
Bunda Hospital
The results of the analysis of the F test
showed that Focus on Patients, Teamwork,
Continuous System Improvement, and Education
and Training simultaneously affected Hospital
Management at Graha Bunda Hospital, with an F
value of 535.190 and a significance of 0.000. Thus,
the H5 hypothesis is accepted, which means that the
simultaneous application of these four factors can
improve the effectiveness of hospital management.
Total Quality Management (TQM) as a
management approach that focuses on improving
organizational quality has been proven to have a
positive impact in the healthcare sector. Previous
research has shown that the application of TQM
principles in hospitals can improve operational
efficiency, service quality, and patient satisfaction
(Zhu et al., 2019). Another study found that TQM

The Influence of the TQM Dimension of
Education
and Training on
Hospital
Management at Graha Bunda Hospital
Education and training as part of Total
Quality Management (TQM) have proven to have a
significant influence on hospital management at
Graha Bunda Hospital. The results showed that this
variable had a regression coefficient value of 0.193
with a significance value of 0.014 (less than 0.05)
and a calculated t value of 2.493 which was greater
than the t table (1.655), so that the H4 hypothesis
was accepted. This shows that improved education
and training can significantly improve the hospital
management system. Harvina et al. (2022) stated

28

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

can contribute to improved employee performance,
job satisfaction, and organizational commitment in
the health sector. The application of TQM in
hospital management is an essential strategy to
improve the quality of overall health services.
TQM's practice not only improves the
quality of hospital services but also contributes to
customer
satisfaction,
productivity,
and
profitability. TQM has a positive effect on
organizational performance through increasing
operational efficiency, customer satisfaction, and
social
responsibility.
In
addition,
the
implementation of TQM has been proven to be able
to increase the competitiveness of hospitals, both at
the national and international levels (Hussain et al.,
2023). The effective application of TQM principles
also plays an important role in hospital quality
management strategies, especially in the face of
global challenges such as the COVID-19 pandemic
(Mo & Borbon, 2022. The relationship between
TQM and job satisfaction suggests that this
approach can increase the motivation and
commitment of medical staff to organizational
goals. Graha Bunda Hospital needs to develop a
strategy oriented towards the integration of these
four main factors to ensure more effective and
efficient hospital management. This holistic
approach will not only improve the quality of health
services but also improve the overall performance
of the hospital, thereby providing benefits to
patients, medical personnel, and all parties involved
in hospital operations.

significant influence on hospital management, with
a regression coefficient of 0.193, significance of
0.014, and t count of 2.493 which was greater than
t table. These findings show that increasing human
resource capacity through continuous training has a
positive impact on hospital management.
Simultaneously, these four TQM variables have a
significant influence on hospital management, as
shown by the results of the F test, with an F value
of 535.190 and a significance of 0.000. These
results indicate that the integrated application of
TQM principles contributes significantly to
improving the effectiveness and quality of
management of Graha Bunda Hospital.
Acknowledgments
I would like to thank the Head of Graha
Bunda General Hospital, for all his support for this
research.
Bibliography
Abdalkareem, Z. A., Amir, A., Al-Betar, M. A.,
Ekhan, P., & Hammouri, A. I. (2021).
Healthcare scheduling in optimization
context: A review. Health and Technology,
11(3),
445–469.
https://doi.org/10.1007/s12553-02100547-5
Abu Daqar, M., & Constantinovits, M. (2020). The
role of total quality management in
enhancing the quality of private healthcare
services. Problems and Perspectives in
Management,
18(2),
64–78.
https://doi.org/10.21511/ppm.18(2).2020.
07
Ahmed, A., Siddiqi, A. R., Tahir, M. J., Saqlain, M.,
Hashmi, F. K., & Dujaili, J. A. (2021). Use
of telemedicine in healthcare during
COVID-19
in
Pakistan:Lessons,
legislation
challenges
and
future
perspective. Annals of the Academy of
Medicine, Singapore, 50(6), 485–486.
https://doi.org/10.47102/annalsacadmedsg.2020562
Al- Saffar, N. A. G., & Obeidat, A. M. (2020). The
effect of total quality management
practices on employee performance: The
moderating role of knowledge sharing.
Management Science Letters, 77–90.
https://doi.org/10.5267/j.msl.2019.8.014
Ali, K. A. A., Addeeb, B. M., Al-Serouri, A.,
Mughalles, S., & Ghaleb, Y. (2022). The
Impact of Total Quality Management on
Health Services Improvement, Sana’a
Hospitals, Yemen (2017-2020). E-Health
Telecommunication Systems and Networks,
11(03),
109–130.
https://doi.org/10.4236/etsn.2022.113008
Almuida, A., Tosepu, R., & Saptaputra, S. K.
(2023). Analisis Kesiapsiagaan Struktural

Conclusion
Based on the results of the study, the Total
Quality Management (TQM) dimension of Patient
Focus has a significant influence on hospital
management at Graha Bunda Hospital, with a
regression coefficient value of 0.241, a significance
level of 0.003, and a calculated t value of 3.041
which is greater than the t table (1.655). This shows
that the higher the hospital's attention to patient
needs and satisfaction, the better the hospital
management will be achieved. In contrast, the
dimension of Teamwork TQM did not show a
significant influence on hospital management, with
a significance value of 0.336 and t calculated of
0.964 which was smaller than the t table, so the H2
hypothesis was rejected. This means that the role of
teamwork has not made a real contribution to the
management of Graha Bunda Hospital. Meanwhile,
the TQM dimension of Continuous System
Improvement was proven to have a significant
influence on hospital management, with a
regression coefficient of 0.536, significance of
0.000, and t calculation of 5.391, which exceeded t
table. This confirms that continuous system
improvement efforts are essential in creating
effective management. Furthermore, the dimension
of TQM Education and Training also showed a

29

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

Dalam Menghadapi Bencana Di Rsud
Kota Kendari 2022. Jurnal Kesehatan dan
Keselamatan Kerja Universitas Halu Oleo,
4(1).
https://doi.org/10.37887/jk3uho.v4i1.36102
Andika, M. I., Girsang, E., & Nasution, S. L. R.
(2023). An Analysis of Total Quality
Management (TQM) Implementation on
BPJS Patients at Hospital Royal Prima
Medan.
Ansyori, A. (2023). Tingkat Kepuasan Pasien
Rawat Jalan terhadap Dimensi Mutu
Pelayanan Tempat Pendaftaran. Jurnal
Ilmiah Permas: Jurnal Ilmiah STIKES
Kendal,
13(2),
557–570.
https://doi.org/10.32583/pskm.v13i2.897
Babu, F., & Thomas, S. (2021). Quality
management practices as a driver of
employee satisfaction: Exploring the
mediating role of organizational image.
International Journal of Quality and
Service Sciences, 13(1), 157–174.
https://doi.org/10.1108/IJQSS-10-20190124
Chairunnisa, S. F., Darmawansyah, D., & Palutturi,
S. (2022). Pengaruh Brand Image
Terhadap
Keputusan
Menggunakan
Pelayanan Rawat Jalan Rsud Haji
Makassar: The Influence Of Brand Image
On The Decision To Use Outpatient
Services At Haji Hospital Makassar.
Hasanuddin Journal Of Public Health,
3(2),
179–190.
Https://Doi.Org/10.30597/Hjph.V3i2.219
14
Daud William Marihot, T., & Ainun, M. (2022).
Pengaruhtingkatpendidikandanpengalama
nkerjaterhadapkinerja Karyawan Bagian
Keperawatan Rumah Sakit Umum
Daerahpadangsidimpuan.
Jurnal
Akuntansi, Manajemen Dan Ilmu
Ekonomi (Jasmien), 2.
Devery, K., Winsall, M., & Rawlings, D. (2022).
Teams And Continuity Of End-Of-Life
Care In Hospitals: Managing Differences
Of Opinion. Bmj Open Quality, 11(2),
E001724.
Https://Doi.Org/10.1136/Bmjoq-2021001724
Ekawardani, N., Manampiring, A. E., & Kristanto,
E. G. (2022). Analisis Faktor-Faktor Yang
Berhubungan Dengan Persepsi Tenaga
Kesehatan Terhadap Penerapan Budaya
Keselamatan Pasien Di Rsup Prof. Dr. R.
D.
Elhadi, M., Msherghi, A., Alkeelani, M., Alsuyihili,
A., Khaled, A., Buzreg, A., Boughididah,
T., Abukhashem, M., Alhashimi, A., Khel,
S., Gaffaz, R., Ben Saleim, N., Bahroun,
S., Elharb, A., Eisay, M., Alnafati, N.,
Almiqlash, B., Biala, M., & Alghanai, E.

(2020). Concerns For Low-Resource
Countries, With Under-Prepared Intensive
Care Units, Facing The Covid-19
Pandemic. Infection, Disease & Health,
25(4),
227–232.
Https://Doi.Org/10.1016/J.Idh.2020.05.0
08
Hadjri, I. M., & Perizade, B. (2019). Pengaruh
Pendidikan Dan Pelatihan Terhadap
Kinerja Pegawai Pada Bank Sumsel Babel
Syariah. Jurnal Manajemen Dan Bisnis
Sriwijaya,
16(3),
142–152.
Https://Doi.Org/10.29259/Jmbs.V16i3.73
77
Halawa, Y. N. E., Ginting, C. N., & Kurnia, M. A.
(2022). Hubungan Penerapan Good
Corporate Governance Dan Mutu
Pelayanan Kesehatan Terhadap Kepuasan
Pasien Unit Rawat Inap Di Rumah Sakit
Umum Haji Medan. Jurnal Kesehatan
Komunitas,
8(3),
496–505.
Https://Doi.Org/10.25311/Keskom.Vol8.I
ss3.1330
Haryanto, B., Panama, Z. S. O., Cahyono, E., &
Fenitra, Ra. (2020). Peran Religiusitas
Dalam Memoderasi Perilaku Loyal Pasien
Terhadap Suatu Rumah Sakit Islam Pku
Surakarta. Jurnal Studi Manajemen Dan
Bisnis,
6(1),
15–30.
Https://Doi.Org/10.21107/Jsmb.V6i1.667
4
Hijayanti, S. (2020). Pengaruh Disiplin Kerja
Terhadap Kinerja Perawat Di Rumah
Sakit Dustira Cimahi, Jawa BaraT.
Ihsan, M., Kurnia Illahi, R., & Rachma Pramestutie,
H. (2018). Hubungan antara Waktu
Tunggu Pelayanan Resep dengan Tingkat
Kepuasan Pasien Rawat Jalan BPJS
terhadap Pelayanan Resep (Penelitian
dilakukan di Instalasi Farmasi Rumah
Sakit
Universitas
Muhammadiyah
Malang). Pharmaceutical Journal of
Indonesia,
3(2),
59–64.
https://doi.org/10.21776/ub.pji.2017.003.
02.4
Imran, B., & Ramli, A. H. (2019). Kepuasan Pasien,
Citra Rumah Sakit Dan Kepercayaan
Pasien Di Provinsi Sulawesi Barat.
Prosiding Seminar Nasional Pakar.
https://doi.org/10.25105/pakar.v0i0.4328
Kamaruddin, N. N., Rivai, F., & Zulkifli, A. (2021).
An Analysis of The Effects of Total
Quality Management (TQM) on Patient
Satisfaction in Hospital: A Scoping
Review. Journal of Asian Multicultural
Research for Medical and Health Science
Study,
2(4),
110–129.
https://doi.org/10.47616/jamrmhss.v2i4.2
18
Kang, J.-Y., Michels, A., Lyu, F., Wang, S., Agbodo,
N., Freeman, V. L., & Wang, S. (2020).

30

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

Rapidly measuring spatial accessibility of
COVID-19 healthcare resources: A case
study of Illinois, USA. International
Journal of Health Geographics, 19(1), 36.
https://doi.org/10.1186/s12942-02000229-x
Lepistö, K., Saunila, M., & Ukko, J. (2024).
Enhancing
customer
satisfaction,
personnel satisfaction and company
reputation with total quality management:
Combining traditional and new views.
Benchmarking: An International Journal,
31(1), 75–97. https://doi.org/10.1108/BIJ12-2021-0749
Lestari, H. D. (2022). Relationship Of Nurse
Therapeutic Communication With Patient
Satisfaction In The Inpatient Room.
JOURNAL OF NURSING RESEARCH,
2(1).
Lilis, N., Supramono, & Rachmatullaily. (2018).
Rekrutmen Dan Pengelolaan Tim Kerja
Yang Efektif Terhadap Kinerja Karyawan.
Jurnal Ilmiah Inovator.
Nafi’a, Z. I. (2021). Faktor Kepuasan Pasien
Terhadap Pelayanan Makanan di Rumah
Sakit:
Literature
Review.
Jurnal
Manajemen Kesehatan Yayasan RS.Dr.
Soetomo,
7(2),
233.
https://doi.org/10.29241/jmk.v7i2.634
Novia Ayu, P., & Novi Lailiyul, W. (2022).
Pengaruh Literasi Keuangan, Sikap
Keuangan dan Self-Efficacy Terhadap
Pengelolaan Keuangan Ibu Rumah
Tangga.
Jurnal
Akutansi,
32.
https://doi.org/10.24843/EJA.2022.v32.i0
6.p10
Oktoriani, E. N. (2023). Pengaruh Citra Rumah
Sakit, Kualitas Layanan Terhadap
Kepuasan dan Loyalitas Pasien BPJS
Rawat Inap. Jurnal Manajemen Informasi
Kesehatan Indonesia (JMIKI), 11(1).
https://doi.org/10.33560/jmiki.v11i1.525
Pangemanan, A. C., Rampengan, S. H.,
Sumampouw, O. J., & Manampiring, A. E.
(2022). Faktor-faktor yang berhubungan
dengan kepuasan pasien di instalasi rawat
jalan Rumah Sakit Tingkat IV Lanud Sam
Ratulangi Manado pada masa pandemi
covid-19. Intisari Sains Medis, 13(1), 19–
24.
https://doi.org/10.15562/ism.v13i1.1289
Panggabean, A. N. (2022). Dampak Customer
Relationship Management (Crm) Pada
Kepuasan
Pelanggan.
https://doi.org/10.31219/osf.io/2ncjk
Puryanti, P. (2021). Analisis Pengaruh Perceived
Service Quality terhadap Pemanfaatan
Instalasi Rawat Jalan. JI-KES (Jurnal Ilmu
Kesehatan),
5(1),
43–50.
https://doi.org/10.33006/ji-kes.v5i1.246
Puspa, I. M., Subandriani, D. N., & Supadi, J.

(2019). Hubungan Kepuasan Pelayanan
Makanan Dan Sisa Makanan Dengan
Kecukupan Gizi Pada Pasien Kelas Iii Di
Rumah Sakit. JURNAL RISET GIZI, 7(2),
91–96.
https://doi.org/10.31983/jrg.v7i2.5163
Rahmadiliyani, N., & Faizal, F. (2018).
Kerahasiaan Rekam Medis Di Rumah
Sakit Aveciena Medika Martapura. Jurnal
Manajemen
Informasi
Kesehatan
Indonesia,
6(2),
69.
https://doi.org/10.33560/.v6i2.189
Rosen, M. A., DiazGranados, D., Dietz, A. S.,
Benishek, L. E., Thompson, D., Pronovost,
P. J., & Weaver, S. J. (2018). Teamwork in
healthcare: Key discoveries enabling safer,
high-quality care. American Psychologist,
73(4),
433–450.
https://doi.org/10.1037/amp0000298
Setiani, L. T., Girsang, E., & Nasution, S. L. R.
(2024). Analisis Determinan Kepuasan
Kerja Pegawai Di Rumah Sakit Umum
Royal Prima, Medan.
Setiawati, A. N. M., P.V.L, S., & Z.F, W. (2021).
Pengaruh Penerapan Pendidikan dan
Pelatihan (Diklat) Online serta Motivasi
Kerja
terhadap
Kinerja
Pegawai
Penunjang Medis. Jurnal Manajemen
Kesehatan Indonesia, 9(3), 198–204.
https://doi.org/10.14710/jmki.9.3.2021.19
8-204
Siagian, A. N., Girsang, E., & Siregar, S. D. (2025).
Analisis Kualitas Mutu Pelayanan
Kesehatan
(Tangible,
Reliability,
Responsiveness, Assurance, Empathy)
Pada Rawat Inap Rumah Sakit Umum
Royal Prima, Medan.
Suharsimi, A. (2018). Prosedur penelitian: Suatu
pendekatan praktek. Rineka Cipta.
Utari, W. (2021). Pengaruh Faktor Pendidikan,
Pelatihan Dan Pengalaman Mengajar
Terhadap Profesionalisme Guru Sma
Negeri I Torjun Kabupaten Sampang. 9(1).
Wassan, A. N., Memon, M. S., Mari, S. I., & Kalwar,
M. A. (2022). Impact of Total Quality
Management (TQM) practices on
Sustainability
and
Organisational
Performance. Journal of Applied Research
in Technology & Engineering, 3(2), 93–
102.
https://doi.org/10.4995/jarte.2022.17408
Yoga, H., & Endah Andriani, P. (2022). Pengaruh
Psychological Capital terhadap Employee
Engagement pada Perawat di ICU Rumah
Sakit “X”, Cimah. Jurnal Diversita, 8.
https://doi.org/2461-1263
Zakiah, N., Nurrizka, R. H., Nurdiantami, Y., &
Hardy, F. R. (2020). Hubungan Kepuasan
Kerja dengan Komitmen Organisasional
Perawat di Rumah Sakit Prikasih Jakarta.
Jurnal Kedokteran dan Kesehatan, 16(1),

31

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 21-32

55. https://doi.org/10.24853/jkk.16.1.5567
Zhu, L., Zhong, S., Tu, W., Zheng, J., He, S., Bao,
J., & Huang, C. (2019). Assessing Spatial
Accessibility to Medical Resources at the
Community Level in Shenzhen, China.
International Journal of Environmental
Research and Public Health, 16(2), 242.
https://doi.org/10.3390/ijerph16020242

32