International Journal of Health and Pharmaceutical The Influence of E-WOM and Digital Marketing PatientAo Re-Visits at The Internal Medicine Polyclinic Sebening Kasih Hospital Nadhila Nur Amalina1*.
Enrico Adhitya Rinaldi2.
Nurminingsih3
1, 3
MasterAos Program in Hospital Administration.
Universitas Respati Indonesia.
Indonesia University of Muhammadiyah.
Prof.
DR.
HAMKA Faculty of Medicine.
Indonesia * Corresponding Author:
Email: nadhilaamalina97@gmail.
Abstract The research problem arose from indications that some nurses experience difficulties in optimally performing their nursing duties, which can impact the quality of patient care.
Unequal distribution of professional competence, low motivation due to a lack of recognition and career development, and a high workload due to an imbalance in the nurse-to-patient ratio are suspected to be the main causes of this decline in performance.
The purpose of this study was to analyze the influence of professional competence, work motivation, and workload on nurse performance in the inpatient ward of Sebening Kasih Hospital.
Pati Central Java Indonesia.
This study, a descriptive quantitative study, recruited 42 respondents: nurses working in the in the internal medicine polyclinic of Sebening Kasih Hospital.
Pati, who had worked in the inpatient ward for at least six months, were permanent nurses or active contract nurses, and were willing to The data collected consisted of primary data collected using a questionnaire.
The results concluded that professional competence and work motivation had a positive and significant effect on nurse performance in the inpatient ward of Sebening Kasih Hospital.
Pati.
Central Java Indonesia Workload negatively affected nurse performance.
The higher the workload, the lower their performance.
Keywords: Digital marketing.
electronic word of mouth.
outpatient patients and revisit intention.
INTRODUCTION
Patient satisfaction is a key indicator in assessing the quality of a hospital's services.
Outpatients, as the largest user group, are often the primary measure of overall satisfaction.
They interact directly with many service lines, from registration and examinations to the pharmacy.
If the service they receive is fast, friendly, and accurate, a positive perception of the hospital will develop.
This satisfaction extends not only to the treatment outcome but also to the overall experience during their visit.
Hospitals that focus on patient satisfaction tend to be more trusted by the public.
With satisfactory service, patients will feel valued and This can reduce complaints, increase loyalty, and improve the institution's reputation.
Therefore, maintaining outpatient satisfaction should be a core strategy in healthcare management.
Loyal outpatients become repeat users and recommend the hospital to others.
Satisfaction creates an emotional bond between the patient and the healthcare institution.
when patients are satisfied, they are more likely to return to a hospital in the future.
This is crucial in the context of increasingly fierce competition between hospitals.
Furthermore, outpatient loyalty helps maintain a stable daily number of visits.
Hospitals that maintain continuity of visits will find it easier to plan operations and finances.
Satisfaction also drives increased revenue through follow-up visits or the use of additional services.
With increased trust, patients will also be more open to following medical advice.
Therefore, hospitals need to invest in improving service quality to maintain patient trust and loyalty.
Advances in digital technology have made it easy for patients to share their experiences at hospitals.
Through social media, online review platforms, or healthcare apps, their stories and impressions can spread widely within minutes.
Although shared privately, these responses often serve as valuable insights for others seeking the right healthcare service.
Patients' voices are no longer limited to their immediate surroundings but can reach a broader and more diverse community.
This opens new opportunities for hospitals to better listen to and respond to community expectations.
Sincere feedback reflects the quality of service and provides an opportunity for continuous improvement.
Technology also serves as a bridge that connects https://ijhp.
International Journal of Health and Pharmaceutical patient expectations with the hospital's commitment to providing the best possible service.
In this climate, every patient experience is significant and can have a significant impact.
Therefore, supporting the delivery of positive experiences is a strategic step for hospitals in this digital era.
When satisfied patients share their positive experiences online, it can inspire confidence in other potential patients.
A single positive review can build a trusting perception, especially if it's presented honestly and in detail.
Even undecided potential patients can feel more confident choosing a hospital with a high number of positive reviews.
On the other hand, less positive feedback can also have its own impact, making it crucial for hospitals to respond openly and with solutions.
Thoughtful interactions with patients in the digital space demonstrate a commitment to continuously improving service.
In this context, the patient's voice becomes an asset that can strengthen the hospital's reputation and image.
Technology makes every experience more easily documented and accessible, making patient impressions a key determinant in decision-making.
Therefore, hospitals need to be proactive in fostering warm and professional communication across various digital channels.
This effort will strengthen loyalty and open up opportunities for new patients through the organic spread of positive influence.
Furthermore, the presence of technology not only broadens the patient's voice but also increases the transparency of healthcare services.
When hospitals actively respond to feedback and continuously innovate, this builds a healthy relationship between patients and providers.
The trust that grows from this openness is crucial for creating repeat visits.
Patients return not only for medical reasons, but also because they feel valued and heard.
In an era where reputations are built through digital reviews, attention to satisfaction and communication is increasingly vital.
By fostering positive interactions, hospitals can create a responsive and inclusive service ecosystem.
Technology is no longer just a tool, but a space that strengthens human connections in healthcare.
The internet, and word of mouth can now spread much faster and more widely than ever before.
Patient experiences, both positive and suggestions for improvement, can be shared through social media, online reviews, or digital health communities.
This information is easily accessible to other potential patients seeking the best healthcare services.
In many cases, satisfied patient testimonials can serve as powerful references and build trust in a hospital.
Therefore, good service experiences have strategic value because they spread organically in the digital space.
The internet makes patient voices an influential source of information, without the need for large-scale campaigns.
When one patient shares an efficient, friendly, and professional outpatient experience, that story can encourage others to try the same service.
The more positive information circulates, the greater the public's interest in visiting.
The power of word of mouth, amplified by digital technology, can increase interest.
A decline in patient return visits to a hospital can lead to serious problems, both operationally and in terms of the institution's image.
The decline in patient numbers directly impacts hospital revenue, particularly outpatient services, which typically provide the primary source of daily income.
If this situation persists, hospitals may struggle to cover operational costs, including medical staff salaries, facility maintenance, and medication procurement.
A decline in visits can be an indicator of patient dissatisfaction with the service provided, whether due to a lack of comfort, ineffective communication, or long wait times.
These risks damage the hospital's reputation in the eyes of the public, especially if the negative experience spreads through social media or online reviews.
This problem also occurs in the Internal Medicine Clinic at Sebening Kasih General Hospital.
Sebening Kasih General Hospital is a private general hospital in Pakis Village.
Tayu District.
Pati Regency.
Central Java.
It began operating on March 14, 2011, and officially received Type D hospital status on December 12, 2015, under the management of PT.
Sebening Kasih Sehat Abadi.
Sebening Kasih General Hospital is a general hospital committed to providing professional, affordable, and patient-oriented healthcare services.
Equipped with reliable medical personnel, modern facilities, and a comfortable atmosphere.
Sebening Kasih General Hospital serves as a trusted partner in maintaining and restoring public As a continuously developing healthcare institution, this hospital prioritizes quality service, patient safety, and a humanistic approach in every aspect of its services.
One of the flagship units at Sebening Kasih General Hospital is the Internal Medicine Clinic, which serves as a center for handling various medical complaints related to the internal organ system.
https://ijhp.
International Journal of Health and Pharmaceutical The Internal Medicine Clinic at Sebening Kasih Hospital is a medical service unit that handles various complaints and diseases related to the internal organ system, such as digestive tract disorders, respiratory disorders, kidney disorders, liver disorders, metabolic disorders, and chronic diseases such as diabetes mellitus and hypertension.
This service focuses on adult patients, both in the form of routine outpatient care and as a follow-up to referral services.
Based on the graph of the number of outpatient visits at Sebening Kasih Hospital, a significant decline is seen in 2025, especially for BPJS and general patients.
The number of BPJS patients, which initially reached a peak of 80,861 in 2024, dropped drastically to 38,654 A similar trend also occurred for general patients, which decreased from 19,581 to only 10,968.
This condition indicates a problem in maintaining patient interest in returning for treatment, especially in the Internal Medicine Clinic, which is the main service for adult patients with chronic diseases and disorders of the internal organ system.
Some possible contributing factors include dissatisfaction with service, long wait times, ineffective communication, and limited facilities that fail to respond quickly.
If this continues, public trust in hospital services could decline, prompting them to switch to other healthcare facilities.
This decline in visitation also has a direct impact on the operational stability and quality of services at the Internal Medicine Clinic.
Fewer visits can reduce doctors' opportunities for routine monitoring of chronic patients, ultimately worsening their health conditions.
Furthermore, the reduced workload can impact medical staff motivation and hinder the continuity of quality services.
From a managerial perspective, declining visitation translates into reduced revenue, which can impact facility financing, technology, and human resource development.
Therefore, it is crucial for hospitals to conduct indepth evaluations, including patient satisfaction surveys, improved digital communication, and strengthening patient-centred services.
Patient retention strategies and digital promotion of superior services are key steps to regaining demand for the Internal Medicine Clinic and enabling it to provide sustainable, high-quality This trend indicates a decline in return visits among general patients, particularly in the Internal Medicine Clinic, which is one of the primary services for adult patients.
This decline could signal the need for evaluation and improvement in service quality, comfort, and patient satisfaction.
The purpose of this study was to analyse the influence of electronic word of mouth and digital marketing on return visits among general patients at the Internal Medicine Clinic at Sebening Kasih General Hospital.
II.
METHODS
This research is a quantitative associative research which is a data analysis method used to determine the relationship or connection between two or more variables, the data of which is measured quantitatively .
In associative research, researchers not only describe phenomena but also attempt to test the existence or absence of relationships and measure the degree or direction of these relationships, for example, positive, negative, or no relationship at all.
This research design is quantitative descriptive with a survey method, which aims to describe and analyze the influence of electronic word of mouth .
-WOM) and digital marketing on patient revisit intentions at the hospital.
This design was chosen because it is able to explain the relationship between variables objectively and measurably based on numerical data collected from respondents through a questionnaire instrument.
This study focuses on the influence of electronic word of mouth and digital marketing on the return visit interest of general outpatients at the internal medicine polyclinic at Sebening Kasih Hospital.
The population in this study were all general outpatients of the internal medicine polyclinic of Sebening Kasih Hospital who were the object of research in the past year, namely 10,968 patients.
This population was chosen because they have direct experience in using hospital services and the potential to respond to electronic word of mouth and digital marketing delivered by the The sample of this study was 100 respondents who were patients who had received outpatient treatment at least once at the internal medicine polyclinic of Sebening Kasih Hospital in the past 12 months, patients who had read reviews or received digital information .
-WOM/digital marketin.
about the internal medicine polyclinic of Sebening Kasih Hospital through online media were at least 17 years old and were able to fill out the questionnaire independently and were willing to be respondents and provide data through https://ijhp.
International Journal of Health and Pharmaceutical the questionnaire.
This research was conducted in August 2025.
The location of this research was at Sebening Kasih General Hospital, located at Jl.
Raya Pati - Tayu No.
99A KM.
Kebun Dan Tambak Area.
Pakis.
Tayu District.
Pati Regency.
Central Java 59155.
The data collection technique in this research was carried out by distributing questionnaires.
This research used quantitative analysis.
Quantitative data analysis is the process of processing and interpreting numerical data obtained from research instruments .
questionnaires or survey.
to test hypotheses or answer research questions objectively and measurably.
Multiple linear regression analysis is used to determine the simultaneous influence of more than one independent variable on a dependent variable.
In this study, it was used to measure the influence of electronic word of mouth (X.
and digital marketing (X.
on patient return visit interest (Y).
RESULT AND DISCUSSION
The regression equation formed is Y = 4.
225X1 0.
401X2, which states that the baseline value of patient return visit interest .
153 when both independent variables are zero.
The larger beta coefficient in Digital Marketing .
compared to Electronic Word of Mouth .
indicates that Digital Marketing has a more dominant contribution to increasing patient return visit interest.
In addition, the Tolerance value of 0.
349 and VIF 2.
869 for both variables indicate the absence of multicollinearity problems, so the influence of each variable can be interpreted independently.
The strategy to increase patient return visit interest can be more focused on strengthening Digital Marketing efforts while maximizing the positive influence of Electronic Word of Mouth.
The regression equation formed is Y = 4.
225X1 0.
401X2,
which states that the baseline value of patient return visit interest .
153 when both independent variables are zero.
The higher beta coefficient for Digital Marketing .
compared to Electronic Word of Mouth .
indicates that Digital Marketing has a more dominant contribution to increasing patient return visit interest.
In addition, the Tolerance value of 0.
349 and VIF 2.
869 for both variables indicate the absence of multicollinearity problems, so the influence of each variable can be interpreted independently.
Thus, strategies to increase patient return visit interest can be more focused on strengthening Digital Marketing efforts while maximizing the positive influence of Electronic Word of Mouth.
Hypothesis It is suspected that electronic word of mouth has an influence on the return visit interest of general outpatients at the internal medicine polyclinic at Sebening Kasih Hospital.
It is suspected that digital marketing has an influence on the interest of general outpatients in revisiting internal medicine polyclinics at Sebening Kasih Hospital.
Coefficient 2,409 Sig Conclusion Hypothesis 1 is accepted 3,329 Hypothesis 2 is accepted Fig 1.
t-Test Results Source: Processed Primary Data .
The t-test results indicate that both independent variables have a significant individual effect on Patient Revisit Intention.
For Hypothesis 1, namely the effect of Electronic Word of Mouth on patient revisit intention, the t-value obtained is 2.
409 with a significance of 0.
018 (<0.
The resulting equation is:
Y = 4.
225X1 0.
This indicates that Electronic Word of Mouth has a positive and significant effect on patient intention to return to the internal medicine polyclinic services of Sebening Kasih Hospital.
In other words, the better the reviews or information patients obtain from other patients online, the higher their tendency to Therefore.
Hypothesis 1 is accepted.
The regression test data shows that the contribution of E-WOM to patient revisit intention is significant although smaller than Digital Marketing.
This indicates that although patients utilize online reviews, they also need additional information through the hospital's digital platform to ensure their decisions.
However.
E-WOM remains an important factor because it provides psychological influence in the form of confidence and validation of patient decisions.
From the hospital management perspective, monitoring online reviews and ensuring positive and responsive review content is an important strategy to support patient loyalty.
Patients who read positive reviews tend to rate their previous experiences https://ijhp.
International Journal of Health and Pharmaceutical as consistent with their expectations, thus encouraging them to return.
Thus, e-WOM serves as an effective patient decision-maker.
Overall, the influence of e-WOM on patients' intention to revisit at Sebening Kasih General Hospital can be seen from a combination of statistical test results, respondent profiles, and patient digital behaviour.
A high mean e-WOM indicator indicates that patients actively seek information through online reviews before deciding to visit.
Patient demographic profiles support this tendency, as patients aged over 35 and with secondary education tend to be cautious and heed the recommendations of others.
A significant ttest result confirms that e-WOM contributes positively to intention to revisit, although not as significantly as digital marketing.
Therefore, hospitals need to strategically manage online reviews as part of efforts to increase patient loyalty.
This strategy can include patient testimonials, service reviews, and responsive interactions that encourage patients to feel confident and return to Sebening Kasih General Hospital.
Hypothesis 2, namely the influence of Digital Marketing on patient revisit intention, the t-value obtained was 329 with a significance of 0.
001 (<0.
This value indicates that Digital Marketing has a positive and significant effect on patient revisit intention.
This means that the more effective the digital marketing strategy implemented by Sebening Kasih Hospital, such as providing doctor schedule information, service promotions, and interactions through digital media, the more likely patients are to continue using the hospital's services.
Based on these results.
Hypothesis 2 is accepted, confirming that digital marketing is a key factor in driving patient loyalty.
The results of the regression test show that the contribution of Digital Marketing to patient revisit intention is greater than Electronic Word of Mouth.
This indicates that although online reviews play an important role, direct information and interactions through the hospital's digital platform have a more dominant influence.
The profile of respondents who have sufficient digital access supports the effectiveness of this strategy, because they can optimally utilize digital media to obtain complete information before visiting.
Descriptive statistics confirm this, where patients consider the digital information provided very useful, so they feel more confident in using hospital services again.
These findings indicate that digital marketing serves not only as a promotional tool but also as a tool to strengthen patient decision-making.
Therefore, hospitals need to continuously develop and update digital strategies to remain relevant and effective.
Overall, the influence of digital marketing on patient revisit intentions at Sebening Kasih General Hospital can be explained through a combination of statistical test results, respondent profiles, and patient digital behaviour.
The high average digital marketing indicator indicates that patients are quite satisfied with the ease of access to information, digital interactions, and useful content.
Patient demographic profiles support this finding, as patients aged over 35, with secondary education, and high mobility are more responsive to digital communication.
The significant t-test results confirm that digital marketing significantly contributes to patient revisit intentions.
Therefore, hospitals need to maximize the use of digital platforms, provide relevant content, and maintain responsive interactions to build patient loyalty.
This strategy will strengthen Sebening Kasih General Hospital's position as a modern and easily accessible healthcare service of choice for patients.
Hypothesis It is suspected that E-WOM and digital marketing have a simultaneous influence on the return visit interest of general outpatients at the internal medicine polyclinic at Sebening Kasih Hospital.
42,805
Sig Conclusion Hypothesis Fig 2.
F Test Results Source: Processed primary data .
The F-test results show that Electronic Word of Mouth (E-WOM) and Digital Marketing variables simultaneously have a significant effect on Patient Revisit Intention.
The F-value of 42.
805 with a significance of 0.
001 (<0.
indicates that both independent variables together can significantly explain variations in patient revisit intention.
This indicates that the combination of E-WOM and digital marketing strategies has an important role in increasing patient loyalty in the internal medicine polyclinic of Sebening Kasih Hospital.
Thus.
Hypothesis 3 is accepted, confirming that the effectiveness of digital communication and online reviews simultaneously contribute to patients' decisions to re-use hospital services.
The https://ijhp.
International Journal of Health and Pharmaceutical simultaneous influence of E-WOM and Digital Marketing is also evident from the contribution of each variable in the multiple regression model.
Although Digital Marketing has a greater contribution individually.
E-WOM still provides a significant additional effect in building patient loyalty.
The respondent profile, which is dominated by patients aged over 35 years, indicates that this group considers digital recommendations and reviews more as part of the decision-making process.
Descriptive statistics confirm this, with an average E-WOM indicator of 3.
30 and a Digital Marketing indicator of 3.
22, both of which fall into the medium-high category.
This indicates that patients do not rely solely on a single source of information, but rather a combination of ensuring their decisions are With a simultaneous strategy, the hospital can maximize the positive influence of both variables on patients' return visit intentions.
The effectiveness of the simultaneous E-WOM and Digital Marketing strategy is also reflected in patient loyalty to the internal medicine polyclinic services at Sebening Kasih Hospital.
Patients who read positive reviews while simultaneously receiving clear digital information tend to feel confident and encouraged to return to the service.
The profile of respondents, who mostly have secondary education and are actively employed, makes it easier for them to access digital information Descriptive statistics show that the Digital Marketing and E-WOM indicators support this behavior, as patients consider both sources of information quite useful in decision-making.
This confirms that the combination of E-WOM and Digital Marketing not only influences patients' initial decisions but also strengthens return visit intentions.
Thus, a simultaneous strategy is an effective approach to increasing patient loyalty.
Overall, the simultaneous influence of E-WOM and Digital Marketing on patient return visit intentions demonstrates the importance of integrating both strategies in hospital The relatively high average E-WOM and Digital Marketing indicators confirm that patients actively seek information through online reviews and digital platforms before visiting.
PatientsAo demographic profiles support this influence, as the dominant patient group tends to be responsive to digital communications and information from other patients.
The significant F-test results confirm that both variables work simultaneously to influence patient revisit intention, with the right strategy, hospitals can maximize patient loyalty by providing relevant digital information and managing positive online reviews.
The combination of these two approaches is key to patient retention and improving the quality of services at Sebening Kasih General Hospital.
IV.
CONCLUSION
E-WOM has been shown to have a positive and significant impact on patient return visits to the internal medicine clinic at Sebening Kasih Hospital.
These findings indicate that patients are increasingly relying on online reviews to ensure service quality before deciding on treatment.
e-WOM serves as social validation that fosters patient confidence in choosing services.
Therefore, hospitals must optimize digital reputation management by responding quickly to reviews, both positive and negative, and encouraging satisfied patients to share their experiences online.
Digital Marketing also had a positive and significant impact on patient return visits to the internal medicine clinic at Sebening Kasih Hospital.
Digital channels that provide clear information about doctor schedules, types of services, and hospital facilities have been shown to increase patient comfort and perceptions of professionalism.
This strategy also facilitates access and reduces pre-visit uncertainty.
Therefore.
Sebening Kasih Hospital needs to improve the quality of informative digital content, develop interactive features such as service chat, and optimize social media channels for more personalized and responsive communication.
EWOM and digital marketing simultaneously influence patient return visits to the internal medicine clinic at Sebening Kasih Hospital.
The combination of positive online reviews and the right digital marketing strategy creates synergy in building patient trust and loyalty.
To address the decline in patient numbers, the hospital needs to implement an integrated strategy consisting of: .
strengthening patient engagement in the digital space, .
testimonial-based reputation campaigns, and .
utilizing digital data to personalize With this approach.
Sebening Kasih Hospital can not only retain existing patients but also attract new ones sustainably.
https://ijhp.
International Journal of Health and Pharmaceutical ACKNOWLEDGMENTS The researcher teams would like to express their deepest gratitude to the academic lecturer of Universitas Respati Indonesia, for their invaluable guidance and support throughout this research.
The appreciation goes to our colleagues and peers, whose stimulating discussions and collaborative spirit have enriched the research team process.
Their diverse perspectives and knowledge have been invaluable assets in navigating the complexities of this research.
REFERENCES