Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction: A Case Study at Sayang Regional General Hospital.
Cianjur Regency Neneng Efa Fatimah1* .
Azhar Affandi1 .
Horas Djulius1 Universitas Pasundan.
Bandung.
Indonesia Article History Submitted: 28-08-2025 Revised: 29-11-2025 Accepted: 18-12-2025 org/10.
58545/jkki.
Copyright .
2025 Neneng Efa Fatimah This is an open-access article under the CC-BY-SA License.
Abstract Background: Strengthening work culture grounded in service quality is critical for improving patient satisfaction, particularly in public healthcare settings.
However, gaps persist in its consistent implementation among health workers and administrative staff.
Objective: This study aimed to formulate a strategy for reinforcing a service qualityAebased work culture to enhance patient satisfaction at Sayang Hospital.
Cianjur Regency.
Methods: A qualitative case study was conducted using a descriptive-analytical approach.
Data were collected through in-depth interviews, participatory observation, and documentation, with source triangulation applied for validation.
Informants included hospital management, medical personnel .
octors and nurse.
, administrative staff, and patients.
Data analysis followed the Miles and Huberman interactive model comprising data reduction, data display, and conclusion drawing.
Results: The service qualityAe based work culture at Sayang Hospital remains partial and inconsistently practiced.
Patient satisfaction was rated as moderate, with recurring complaints concerning communication, service speed, and staff empathy.
Key barriers included a weak quality-oriented performance evaluation system, insufficient training on service excellence, and limited transformational leadership among managers.
Conclusion: To strengthen work culture, the study proposes an integrated strategy comprising continuous values-based training and coaching, embedding service quality indicators into performance management, and implementing a balanced reward-and-sanction system to promote patient-centered professionalism.
Keywords: Management strategy.
Service quality.
Work culture Correspondence Neneng Efa Fatimah.
Program Doktor.
Ilmu Hukum.
Universitas Pasundan.
Bandung.
Jl.
Sumatera No.
Sumur Bandung.
Kota Bandung.
Jawa Barat 40117.
Indonesia Email: neneng.
efafatimah@mail.
How to cite:
Fatimah.
Affandi.
, & Djulius.
Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction: A Case Study at Sayang Regional General Hospital.
Cianjur Regency.
Jurnal Kesehatan Komunitas Indonesia, 5.
, 359-372.
https://doi.
org/10.
58545/jkki.
BACKGROUND
Hospitals serve as critical pillars of functioning as centers for education, the public health system, delivering research, and health innovation.
Their primary mission is to restore, maintain, and Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 the adoption of the SOMEAH values contributing to national productivity and (Smile.
Optimist.
Respect.
Educational, quality of life.
However, achieving this Mainstay, mission requires more than adequate institutional commitment to delivering infrastructure, which demands a strong, high-quality service.
However, preliminary service-oriented work culture that aligns observations suggest these values have not been fully internalized across staff levels.
Humanis.
remaining sporadic rather than systemic.
National data from BAPPENAS This gap between policy and practice .
reveal persistent gaps in health service readiness: only 88.
4% of hospitals in patient satisfaction.
Indonesia are accredited, and merely 38% Patient meet the plenary standards set by the recognized as a key indicator of healthcare Hospital Accreditation Commission quality (Otani et al.
, 2.
, hinges not only (KARS).
This interpersonal communication, responsive- standards, often rooted in organizational ness, empathy, and the comfort of the factors, particularly work culture.
Work When work culture is weak or culture, defined as the shared values, fragmented, it often manifests in long beliefs, norms, and practices that shape waiting times, poor coordination, and behavior within an organization, plays a unempathetic staff behavior, precisely the pivotal role in driving service excellence complaints frequently reported by patients (Jacobs et al.
, 2021.
Halawa et al.
, 2.
at Sayang Hospital.
context of public hospitals.
Leadership further mediates this encompasses both formal policies and informal habits, such as daily interactions, teamwork, and a commitment to patient- responsible for creating, managing, and, centered care (Sudrajat, 2020.
Karunia et , 2.
organizational culture.
Transformational At Sayang Regional General Hospital Hattangadi .
in Cianjur Regency, a Class B public institutional values can foster engagement, teaching hospital and a key referral center, accountability, and a shared service ethos Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 (Ari Ruliati et al.
, 2023.
Kosnan, 2.
enables researchers to gain a holistic and Conversely, inconsistent leadership or lack in-depth phenomenon of work culture based on service quality from the perspective of Given the pressures of Universal Sayang Health Coverage (UHC), rising public Hospital.
Through a qualitative approach, expectations, and regulatory demands the data collected will explore the .
Law No.
25/2009 on Public Services and Ministry of Health Regulation No.
dynamics that occur in the implementation 4/2.
, hospitals like Sayang must move of work culture and its impact on patient beyond the symbolic adoption of values toward the systemic integration of service quality into their daily work culture.
This study, therefore, seeks to analyze the current state of work culture, identify barriers to its strengthening, and formulate excellence, ultimately enhancing patient
METHODS
Research approaches, methods, and steps are employed to gather relevant data in addressing research questions.
This study aims to analyze and formulate a strategy to enhance the work culture based on service quality, thereby increasing patient satisfaction at Sayang Hospital.
Cianjur Regency.
To achieve this goal, a qualitative approach was chosen as the basis for the research.
This approach This study employs a qualitative approach, aiming to gain an in-depth strengthening work culture based on service quality in increasing patient satisfaction at Sayang Hospital.
Cianjur Regency.
The qualitative approach enables a more comprehensive examination of social, cultural, and work-related behavior phenomena related to the quality of health The research design is designed to capture empirical reality in depth through interviews, observations, and document The selection of Sayang Hospital.
Cianjur Regency, as the location is based on the relevance and importance of the institution as the primary referral health service facility in Cianjur Regency, which presents both challenges and opportunities for strengthening a work culture centered on service quality.
The subject of the study Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 encompasses various parties with a direct out by creating a flow that begins with an or indirect connection to the work culture exploratory and descriptive approach to and health services at Sayang Hospital, describe objective conditions, explore including healthcare workers, hospital information, and identify patterns and management, and patients as service Using approach allows researchers to obtain in- various perspectives to obtain a complete depth and contextual data related to work and comprehensive picture.
The classic single-case study approach is employed performance, and patient satisfaction level when the research focuses on a single with the following steps: .
Creating a specific object that possesses unique or research background, designing research representative characteristics.
In this case, methods, and determining the theoretical Sayang Hospital was chosen as the sole basis that can support the research.
In this case analyzed because it has a distinctive study, the researcher also reviewed and implementation of a strategy to strengthen conducted documentation studies from a quality-based work culture and can serve scientific journals from previous research as a model for other institutions.
to serve as a reference.
Determine the This This unit of analysis in this study using the approach with an exploratory descriptive single case study.
Selecting sources that The approach entails detailed match the research criteria is a crucial next research planning, as well as meticulous It involves selecting groups or detailing, involving all parties in a series of individuals that match the research essential steps to achieve significant objectives, so that the results obtained are research outcomes.
The first step is to more relevant and representative of the explore in depth the phenomenon that desired population.
Proper timing is also occurs in the field related to management an important aspect.
Setting a research and services at Sayang Hospital.
Cianjur schedule helps organize the data collection.
Regency, analysis, and other stages to avoid strengthening a work culture based on unwanted delays.
The crucial method in research is interviews.
Through interviews, satisfaction at Sayang Hospital.
Cianjur researchers can collect in-depth qualitative Regency.
Furthermore.
Planning is carried data from respondents.
This provides Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 valuable insights and allows researchers to strategy of strengthening service quality- get direct views from the source.
The based work culture and its impact on next step is the stage of reporting the patient satisfaction.
This approach enables results of the research that was discussed in detail.
The data was analyzed and implementation of strategies, obstacles interpreted to identify key findings.
The discussion of these results is critical in linking the findings to the theory.
quality of services at Sayang Hospital.
In the study entitled "Strategies for Strengthening Service Cianjur Regency.
Quality-Based Work Culture in an Effort to Increase RESULTS Patient Satisfaction at Sayang Health .
Profile of Sayang Cianjur Hospital Hospital.
Cianjur Regency," the unit of Sayang Cianjur Regional Hospital is analysis is a crucial element in determining a government-owned Class B teaching the study's focus and the research's hospital with comprehensive facilities.
Unit analysis refers to the including 467 inpatient beds, various primary unit of information that is studied to understand the phenomenon being department, intensive care, and medical support services.
It also has a staff of 1,449 By using unit analysis at the individual, group, non-medical It has been fully accredited by KARS (Hospital Accreditation Commissio.
Table 1.
Patient Satisfaction Interview Results Waiting Time Satisfaction Rate Low Officer Behaviour Medium-Low Facilities & Cleanliness Cross-Unit Coordination Information & Education Keep Service Aspect Low Low Main Complaints Patient Recommendations Outpatient >60 minutesEmergency room 5-8 hoursConvoluted administration Not in accordance with SOMEAH's values- Lack of empathy- Lack of communication Smelly toilet- Limited waiting seat- Full room Patients feel tossed Information is unclear Flow is not integrated No explanation- Lack of program Improved queue system, better Socialization of SOMEAH values, strict supervision Facility improvements, additional facilities Regular coordination forums, integrated information systems Patient education, more open Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 .
Key Findings Based on Research Propositions Proposition 2: Patient Satisfaction Has Not Reached the Target 1: Quality-Based Work Patients and their families expressed Culture Has Not Been Implemented dissatisfaction with several aspects: Long Optimally waiting time .
mergency room, outpatient.
Proposition The values of SOMEAH (Smile.
Weak Optimist.
Respect.
Educational.
Mainstay, between units.
Officers' behavior was not Humanis.
are still sporadic and have not in accordance with the SOMEAH values .
ack Implementation relies more on individual communicatio.
Lack of physical and initiatives, rather than structured systems.
hygiene facilities.
Lack of support, and Some patients did not recommend Sayang Hospital to others.
Proposition 3: Factors Inhibiting the Implementation of Work Culture Table 3.
Inhibiting Factors by Category Category TBSP Inhibiting Factors Work fatigue- IndisciplineInappropriate competence Impact Inconsistent service, slow System Poor coordination- Unclear rewards- Unintegrated Limited facilitiesUncomfortable environmentOutdated medical devices Lack of exemplarInconsistent evaluationUnfocused planning UHC pressure- Regulations are not detailed- Public expectations are high Work culture is not formed, quality indicators are not achieved Low patient satisfaction, down work efficiency Means Leadership Milieu Human Resources:
Work culture is not followed, change is not Workload increase, service is not optimal Indiscipline.
Recommendations Training, placement according to competencies, addition of human resources System improvements, periodic Repair of facilities, addition of medical equipment Leadership commitment, structured evaluation Socialization, collaboration of local governments Leadership: Suboptimal leadership model, fatigue, misplacement of competencies.
Systems:
Inconsistent Unpreparedness for the Universal Health SOPs.
Coverage (UHC) program.
Facilities: Limited facilities Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction External:
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
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php/jkki eISSN 2503-2801, pISSN 2985-3435 Proposition Strategies Better cross-unit coordination.
Strengthening Work Culture Several Improved facilities and infrastructure.
irectors Strengthening .
Quality Indicator Monitoring Results .
resources through continuous training and Of the 13 national quality indicators, integrity pacts.
Exemplary leadership in Sayang Hospital's average achievement is 22%, which is below the standard Some indicators that have not Monitoring been achieved:
SOMEAH
evaluation based on behavioral indicators.
Table 4.
Quality Indicators and Achievements of Sayang Hospital in 2024 No.
Quality Indicators Hand Hygiene Compliance Use of Personal Protective Equipment Patient Identification Emergency Cesarean Surgery Response Time (<30 minute.
Outpatient Wait Time (<60 minute.
Elective Operation Delay (<1 hou.
Compliance with Doctor's Visit Time Laboratory Critical Results Reporting (<30 Use of the National Formulary Clinical Pathway Compliance Prevention of Patient Fall Risk Speed of Complaint Response Patient Satisfaction AVERAGE These are some key areas of focus, .
47%), outpatient waiting time (>60 Standard Achievements 77,47% 99,34% Information Not reached Not reached Almost Not reached <5% 65,55% 1,75% 97,34% Not reached Reached Reached Reached 76,61% 80,50% 90,35% 64,66% 99,99% 85,74% 60,22% Reached Not reached Reached Reached Reached Below Standard .
Analysis with the Servqual Theory and Regulation Approach Job Demands-Resources minute.
, emergency cesarean surgery This theory supports the finding that response time, and clinical pathway aspects of responsiveness and empathy patient dissatisfaction.
The implementation of work culture has not met the requirements of Law No.
25/2009
Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 concerning Public Services and Permenkes .
Human (HR): fatigue, lack of training No.
4/2019 concerning Hospital Service .
Method (Syste.
: poor coordination.
Standards.
unclear reward .
Materials (Facilitie.
: limited facilities .
Fishbone Diagram: The Root of the .
Management:
Work Culture Problem The Fishbone diagram identifies 5 .
Environment: external pressure such as UHC categories of root problems:
Table 2.
Strategies To Strengthen Quality-Based Work Culture Categories Strategy Strengthening Systems & Methods Facilities & Infrastructure Leadership External Environment Activity Details Person in Charge Timeline - Continuous training - Integrity pact - Refreshment of SOMEAH values - Improvement of SOPs - Clear reward & punishment system - Integrated monitoring - Addition of facilities - Improvement of the physical environment - Optimization of the registration system - Leadership example - Periodic evaluation - Regular coordination forum - Socialization of UHC programs - Collaboration with local governments - External evaluation Board of Directors.
HR Section Short & Long Term Quality Committee.
All Units Short-term General & IT Section Medium Term Board of Directors.
Deputy Director Sustainable Management.
Public Relations Long-term
The implementation of a work
culture based on service quality at Sayang
DISCUSSION
This Cianjur Hospital has not been optimal.
The disjunction between formal commitments value of SOMEAH has not yet become a to service excellence, as embodied in the collective habit, and patient satisfaction SOMEAH remains low due to weak support systems, enactment in daily operations at Sayang Regional General Hospital.
The findings facilities, and ineffective leadership.
align with ScheinAos .
model of systematic and sustainable strategy is necessary to establish a work culture that distinguishes between espoused values is truly vibrant and has a positive impact on .
hat leaders sa.
and basic underlying service quality.
hat is truly practice.
While hospital leadership has articulated a Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 vision of humanistic, responsive care through SOMEAH, this vision has not penetrated the cultural AusubsoilAy of the interpretation, a phenomenon Schein warns undermines cultural coherence.
Consequently.
KPI.
behaviors remain fragmented, reactive, and inconsistent across units.
Proposition 2: Patient Satisfaction as a Mirror of Cultural Health Despite internal reports indicating Proposition 1: The Gap Between Policy 74% of patient satisfaction is likely and Practice in Work Culture The sporadic implementation of derived from standardized surveys prone to SOMEAH reflects a common challenge in public sector reforms: symbolic adoption interviews revealed deep dissatisfaction without systemic integration.
Similar patterns have been observed in hospitals across low- and middle-income countries discrepancy aligns with global evidence (LMIC.
, where cultural transformation is that administrative metrics often obscure often reduced to posters, training modules, experiential realities (Otani et al.
, 2025.
Atira, 2.
Patients did not merely seek structural support (Braithwaite et al.
, 2018.
clinical accuracy.
they sought dignity.
Gilson et al.
, 2.
In Sayang Hospital, the recognition, and predictability dimensions absence of behavior-based performance AuempathyAy and AuresponsivenessAy constructs SERVQUAL This modelAos (Parasuraman et al.
, 1.
SOMEAH from becoming a lived reality.
Notably, complaints about being This corroborates findings by Islamy & Autossed between unitsAy and receiving Auno Sulima .
in Baubau.
Indonesia, where explanationAy signal a failure in relational service values remained superficial due to coordination, a known predictor of patient weak accountability mechanisms.
safety and satisfaction in integrated care Critically, the disconnect between leadershipAos .
iewing systems (Gittell, 2.
In the context of IndonesiaAos rapidly expanding Universal SOMEAH as part of quality managemen.
Health and frontline staffAos understanding .
ho coordination gaps threaten not only Coverage (UHC), see it as Aunon-technicalAy and secondary to Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 satisfaction but also system efficiency and Proposition 4: Toward a Systemic Strategy for Cultural Transformation The proposed strategies, integrated Proposition 3: Multilevel Barriers to Cultural Change leadership exemplarity, and cross-unit The identified inhibiting factors, behavior-based forums are not novel in isolation, but their such as human, systemic, infrastructural, leadership, and environmental, map onto Cultural change in complex organizations the Job DemandsAeResources (JD-R) model requires parallel interventions at multiple (Bakker & Demerouti, 2.
High job levels (Braithwaite, 2.
: Micro level:
UHC-driven patient loads.
Embedding SOMEAH into daily rituals understaffin.
are not offset by adequate .
, pre-shift huddles, patient handover.
, training, clear SOPs.
Meso level: Linking values to HR processes supportive leadershi.
, leading to fatigue, .
ecruitment, appraisal, promotio.
Macro level: Aligning hospital strategy classic signs of burnout that erode service with national standards .
Permenkes No.
4/2.
and UHC accountability Moreover, transformational leadership is particularly The recommendation to issue a As Hattangadi .
and DirectorAos Decree integrating SOMEAH Ari Ruliati et al.
emphasize, into quality indicators is a crucial first step healthcare leaders do not merely manage.
toward formalizing cultural expectations.
they ritualize, embody, and reinforce However, culture through daily actions.
When psychological ownership, all staff must co- managers fail to model SOMEAH, e.
, by create, not just comply.
Participatory action research or quality improvement complaints, or tolerating indiscipline, they collaboratives could foster this ownership implicitly signal that values are optional.
(Berwick, 2.
This Auleadership hypocrisyAy is more Theoretical and Practical Implications damaging than the absence of values altogether (Edmondson, 2.
Theoretically, this study extends the theory to public hospitals in LMICs
UHC
Strengthening Service QualityAeBased Work Culture to Improve Patient Satisfaction Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 demonstrates that accreditation alone is behavior of officers.
The support system is insufficient without cultural anchoring.
weak, with indicators that there is no Practically, it offers a context- behavior-based monitoring, rewards & sensitive roadmap for hospitals seeking to move from compliance-driven to values- leadership role models are not optimal.
driven service delivery.
The integration of Overall.
Sayang Regional Hospital in cultural indicators .
, empathy, respec.
Cianjur has not succeeded in establishing a into performance dashboards alongside clinical metrics could bridge the policyAe high-quality practice gap.
Future research should test the AUTHOR CONTRIBUTIONS impact of such integrated strategies Neneng Efa Fatimah: Conceptuali- through quasi-experimental designs and zation.
Data curation.
Formal analysis, explore the role of middle managers as Writing-original draft.
Writing-review & cultural Autranslators,Ay a group often editing.
Supervision.
Manuscript revision.
overlooked in top-down reforms.
Azhar Affandi: Conceptualization.
Data curation.
Formal analysis.
Writing-review & editing.
Supervision.
Horas Djulius:
CONCLUSION
Based implementation of a quality-based work Conceptualization.
Data curation.
Formal analysis.
Manuscript revision.
culture at Sayang Regional Hospital.
Cianjur Regency, has not been optimal.
The ACKNOWLEDGMENT formally ingrained values of SOMEAH The authors would like to express (Smile.
Optimism.
Respect.
Education, their sincere gratitude to Sayang Regional Reliability.
Humanis.
have not yet General Hospital.
Cianjur Regency, for become collective habits and remain their invaluable support and facilitation sporadic, depending on the initiative of during the conduct of this research.
Special each individual.
This work culture has not thanks are also extended to the Doctoral Program in Law.
Universitas Pasundan, for organization, which has only become a its academic guidance and institutional This is indicated by the gap between values and practices, so that the service tagline is not aligned with the CONFLICT OF INTEREST Fatimah et al.
Jurnal Kesehatan Komunitas Indonesia (JKKI) Volume 5 Issue 3.
December 2025, pp 359-372 https://ebsina.
id/journals/index.
php/jkki eISSN 2503-2801, pISSN 2985-3435 The authors declare that there are no conflicts of interest in this research.
Eka Juhana Ningsih.
Analisis Kewenangan Reformasi Birokrasi Terhadap DATA AVAILABILITY STATEMENT Kinerja Pemerintah Provinsi Kepulauan Riau Di Rumah The data are available from the Sakit Umum Daerah Raja Ahmad corresponding author upon reasonable Tabib.
In Jurnal Hukum Respublica (Vol.
Issue 1, pp.
1Ae.
Fachri.
Pelayanan dan Daya
REFERENCES