VISITOR RESPONSE AS THE IMPACT OF SERVICE QUALITY IN PRIVATE
HOSPITAL
Sayyida*1.
Alwiyah 2 Department of Management.
Faculty of Economics and Business.
Wiraraja University Indonesia Department of Accounting.
Faculty of Economics and Business.
Wiraraja University Indonesia sayyida@wiraraja.
id*, alwiyahmahdaly@wiraraja.
Received June 13th 2023
Revised Aug 17th 2023
Accepted Sept 30th 2023
ABSTRACT
Lately, there have been a lot of complaints from patients and their families who go to the hospital because they are not satisfied with the services provided by the hospital.
Hospitals are a service industry that is starting to become competitive because many private hospitals are competing.
This study aims to determine the effect of the response of hospital visitors on the quality of hospital services.
The research sample was the introduction of patients in three middle-class private hospitals in Surabaya, namely Adi Husada Hospital.
Siloam Hospital and Premier Hospital.
A total of 405 samples were divided into 2 groups, namely group 1 with 30 respondents and group 2 with 375 Data analysis of group 1 with Cronbach's Alpha aims to test the quality of the questionnaire before it is used to produce data analysis.
To answer the research objectives.
Structural Equation Model (SEM) analysis was carried out on the data in In this test, 5 data were detected as outliers so that the remaining 370 data were The results show that the loyalty of patients and their families to visit the same hospital is influenced by the expectations and satisfaction of patients and their families and is influenced by the quality of hospital services they feel.
Service quality has the greatest influence on patient and family loyalty.
Keywords: Expectations, service quality, loyalty, satisfaction INTRODUCTION Consumer satisfaction is a consumer response that must be considered for business people.
Consumer satisfaction is strongly influenced by service quality (Glemler et al, 2.
So that business people must pay attention to the quality of service.
addition to service quality, business people must also plan for business continuity in the future.
To maintain and improve the continuity of a business, customer loyalty is needed.
Consumer loyalty is influenced by consumer satisfaction .
an and Rya, 2.
The hospital is a service industry that also competes for its survival.
Like other service companies, hospitals must provide the best service.
The key to success in the service industry is high service quality (Meesala.
, at, al.
In today's era, many companies are starting to focus and improve the quality of their services to encourage customer satisfaction (Kumar, et al.
As a health service industry, hospitals must improve the quality of service in order to get a response from visitors so that visitors become loyal.
Ironically, the reality that surrounds us, we often hear complaints Visitor Response As The Impact A.
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from visitors about the low quality of hospital services that are considered not in accordance with the expectations of patients and families.
Currently, many private hospitals are referrals for patients who expect better services from regional This is the cause of high especially private hospitals lately (Raju and Lonial, 2.
In addition to the quality of service, the expectations of patients and their families also greatly affect their satisfaction and loyalty.
increases, consumer expectations and demands also increase (Ali et al.
, 2.
Hospitals as service companies must pay attention to patient expectations in order to increase visitor satisfaction and Fu, et al, .
have proven that consumer expectations affect consumer satisfaction which in turn has an impact on satisfaction.
Many studies examine the consumer response of a company, as well as the response of patients and families to a hospital.
Such as research on the quality of health services in India (Prabhakar, 2.
The quality of service is perceived by patients from various countries (Japan.
Myanmar.
Arabia, and Thailan.
ongrukmit, et al, 2.
Research that examines various conditions that cause patient loyalty in hospitals (Chie-Wet, et al, 2.
However, there is no linking patient loyalty with patient and family Because the expectations of patients and their families are very important in the health industry such as hospitals, the authors feel that the results of this study are very important to improve services for patients and their families and to maintain the survival of the hospital itself.
This study focuses on visitor responses as a result of service quality in private hospitals.
In this study want to see the effect of expectations on satisfaction, the effect of service quality on satisfaction, service quality on loyalty, and the effect of satisfaction on In accordance with the previous theory, the relationship and influence between expectations, service quality, satisfaction and loyalty is supported by the theory and previous research according to the following discussion.
Consumer Expectations Satisfaction marketing, it has been explained that consumer expectations are very important in the consumption process.
Expectation Confirmation (ECT) theory is one theory that evaluates customer satisfaction after making a purchase with (Oh.
Confirmation is done to customers to find out the initial expectations of consumers (Oliver, 1.
Consumer expectations lead to the creation of direct satisfaction, namely high expectations (Bhattacherjee, 2.
From the theory and previous research, it is hypothesized that the effect of expectations and consumer satisfaction is as follows.
H1 : Expectations have a positive effect on the satisfaction of hospital visitors.
LITERATURE
REVIEW
AND
HYPOTHESES DEVELOPMENT
Service Quality and Consumer Satisfaction Quality is the totality of features and characteristics of a product or service that depend on its ability to satisfy stated or implied needs (Kotler and Keller, 2.
Service quality refers to the expected service and consumer perceptions of the actual service (Parasuraman et al, 1.
Service quality starts from the needs of service Media Mahardhika Vol.
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1 September 2023 users and ends with the perceptions of service users, so that service quality depends on the ability of service providers or parties providing services to consistently meet the expectations of service users.
The concept of service quality is an assessment factor that reflects consumer perceptions of five specific dimensions of service performance.
(Parasuraman et al, 1.
concluded that there are five dimensions of ServQual (Quality of Servic.
used to measure service quality, namely tangible, reliability, responsiveness, assurance and empathy.
Concrete evidence is a facility that can be seen and used by the company in an effort to meet customer satisfaction, such as office buildings, office equipment, employee appearance and others.
Constraints (Reliabilit.
, namely the ability to provide services to customers as expected, such as the ability to keep promises, the ability to solve problems and the ability to Responsiveness, namely responsiveness, willing to listen to and respond to customers in an effort to satisfy customers, for example: being able to provide information correctly and appropriately, not showing a pretentious attitude and being able to provide immediate help.
Assurance, namely the ability of employees to generate trust and confidence in customers through knowledge, courtesy and respect for customer feelings.
While caring / Empathy (Empath.
is the ability or willingness of employees to provide personal attention, such as being friendly, understanding the needs and caring for their customers.
According to Kotler and Keller .
, satisfaction is a person's feelings of pleasure or disappointment arising performance of a product .
r outcom.
with their expectations.
Several researchers have proven the importance of the influence of service quality on consumer loyalty.
Farooq, et al, 2018 proved the influence of service quality on customer satisfaction of Malaysian Jiang, et al, 2016 have proven the effect of service quality on air transportation user satisfaction in China.
H2 : Service quality has a positive effect on the satisfaction of hospital visitors.
Service Quality And Consumer Loyalty Loyalty .
ervice loyalt.
is loyalty that shows the possibility of a customer or visitor to make repeat visits within a certain period of time (Kotler and Keller, 2.
Various studies have proven that loyalty is influenced by service quality, including Jiang and Zhang .
who prove that airline quality affects passenger loyalty in China.
Meesala, et al .
showed in their research that the quality of service in hospitals affects patient loyalty in India.
Faroog, et al .
prove that Malaysian airline consumers will be loyal if they get good service.
Dan Shi, et al, 2014 show that the quality of service in casinos makes their customers The theory and previous research are the basis for proposing the following H3 : Service quality has a positive effect on the loyalty of hospital visitors.
Customer Visitor Satisfaction and Loyalty Kepuasan pelanggan adalah dua variabel yang sering dikaitkan dalam riset pemasaran.
Banyak ilmuwan, khususnya ilmuwan pemasaran mengatakan bahwa kepuasan merupakan faktor yang menyebabkan konsumen menjadi loyal.
Banyak membuktikan hubungan antara kedua variabel tersebut.
Seperti penelitian di Visitor Response As The Impact A.
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Casino yang membuktikan bahwa kepuasan pelanggan membuat pelanggan loyal dan kembali lagi ke Casino .
Prentice.
and He.
Wei.
, 2.
Kepuasan konsumen meningkatkan loyalitas, rekomendasi dan pembelian kembali (Wilson, et al, 2.
Jiang.
Zhang .
membuktikan bahwa kepuasan maskapai di China membuat penumpang loyal.
Dalam penelitian pada maskapai lain, kepuasan penumpang selama transit juga penting untuk loyalitas penumpang (Fu, et al, 2.
Penelitian pada pasien rumah sakit di India juga menunjukkan bahwa kepuasan pasien merupakan faktor yang mempengaruhi loyalitas pasien tersebut terhadap rumah sakit (Meesala, et al.
Teori dan penelitian sebelumnya merupakan dasar untuk mengajukan hipotesis berikut.
H4 : Satisfaction has a positive effect on the loyalty of hospital visitors.
RESEARCH METHODS
This study focuses on private hospital services in Surabaya.
Three private hospitals in Surabaya were chosen because they are middle class Surabaya.
Respondents were randomly selected from the three hospitals to be used as The sample was selected based on age and education criteria.
The age of the respondent is at least 17 years with a minimum education of junior high This respondent criterion is very important to ensure that the respondent can and is able to fill out the questionnaire properly so that it produces good data as well.
The sample is divided into two groups, namely the first sample group of 30 respondents which aims to test the quality of the questionnaire and the second sample group for hypothesis testing.
The sample of group two with a quota of 375 respondents fulfilled the analysis needs with SEM.
Respondents are patients who come to three selected hospitals.
Questionnaires were distributed to 375 patients who were willing to contribute to the study.
The first group sample of 30 respondents was asked to fill out the initial questionnaire.
Data from the initial questionnaire was used to test the validity and reliability of the questions in the questionnaire.
Test the validity and reliability using Cronbach's Alpha with the help of SPSS software.
Valid and reliable questionnaires were used to obtain data from the second sample group of 375 respondents.
Data from the second sample group was then analyzed by SEM analysis using AMOS software.
Prior to the SEM analysis, a descriptive analysis was conducted to provide an overview of the data.
There are two models of analysis in SEM, namely first.
SEM analysis with a measurement model test which aims to test the indicators and variables being AMOS is software that is built with parametric principles so that the analyzed data must meet the assumption of normality in a multivariate manner.
After the assumption of normality is met.
CFA is carried out to confirm the quality of the data, namely to confirm the validity and reliability of the indicators.
The second test model is the structural model test.
In this structural model, the goodness of fit criteria are tested to ensure that the hypothesized data are sufficiently fit.
Furthermore, hypothesis testing is carried out and see the magnitude of the influence between variables, both direct, indirect and total
DATA ANALYSIS
The validity and reliability test aim to test the questions in the questionnaire whether it is valid and reliable to measure variables.
In this Media Mahardhika Vol.
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1 September 2023 study, validity and reliability tests were carried out for the first sample group.
The first 30 respondents were asked to fill out a questionnaire.
Data from 30 respondents was used to test the validity and reliability of the indicators in the The test results are presented in tables 1 and 2 below.
With the help of SPSS software, the results of data analysis showed that there were several invalid items.
The next stage invalid items are removed one by one while being retested so that all items are All valid items are shown in table 1 with the Corrected Item-Total Correlation value above 0.
Indicator Reliability test is a tool to measure the questions in the questionnaire which is an indicator of a variable or construct.
A questionnaire is said to be reliable if the answers are consistent or stable over time.
This can be tested with Alpha Cronbach.
The higher .
loser to number .
the value of Cronbach's Alpha, the more reliable the indicator in that variable.
Table 2 shows that the three variables have fairly good reliability because the Cronbach's Alpha value of the three variables shows numbers above 0.
Table 1.
Validity Test Corrected Item-Total Correlation 0,768 0,569 0,507 0,490 0,611 0,716 0,437 0,565 0,617 0,416 0,469 0,629 0,424 0,588 0,508 0,660 0,567 0,723 0,451 0,308 Description Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Table 2.
Reliability Test Variable CronbachAos Alpha Description Visitor Response As The Impact A.
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Expectation 0,825 Reliable Service quality 0,721 Reliable 0,783 Reliable 0,704 Reliable Valid and reliable questionnaires were then distributed to the second sample Questionnaires were distributed randomly to patients who were willing and willing to fill out the questionnaire.
A total of 375 respondents from three private hospitals were obtained for 10 days from 22-31 May 2022.
The results of this second sample group were analyzed by SEM.
Prior to the SEM analysis, a description of the respondent's characteristics is presented in the following descriptive analysis.
in the respondent data section which included gender, age and education The data regarding the characteristics of the respondents in this study are described in Tables 3, 4 and 5 Table 3 shows that of the 375 2% were male while 8% were female.
Thus, it can be concluded that the number of respondents who inaugurate patients in hospitals is almost the same between men and women.
Table 4 shows that of the 375 respondents who are inpatients, most are adults aged 36-45 years, as DESCRIPTIVE ANALYSIS many as 177 respondents or 47.
Data From the data above, there are rarely characteristics were obtained from patients who are less than 25 years old questionnaires filled out by respondents who are willing to be respondents.
Table 3.
Research Respondents by Gender Gender Total Man Woman Total Table 4.
Research Respondents by Age
Age
Total
< 25
26 - 35
36 - 45
> 45
Total Table 5.
Research Respondents Based on Visitor Status Education Total Junior high school Senior High School Media Mahardhika Vol.
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To ensure that respondents can read and understand the questionnaire well, the data used is data from respondents who have a minimum of junior high school education.
From the data in table 5, most of the respondents are patients who are introductory to higher education as many as 198 people from 375 respondents or 8% of the total respondents.
RESULTS
The statistical method used to test the hypothesis in this study uses structural equation modeling (SEM).
The choice of SEM analysis technique is because SEM has the ability to test data that cannot be measured directly, even complex test models that cannot be tested by OLS analysis.
In this study, all variables are variables that cannot be measured directly and there are direct and indirect effects between variables so that it is more effective when using SEM.
There are two test models in SEM analysis, namely the measurement model test or the measurement model and the structural model test.
Measurement model testing is part of the SEM model that describes the latent variables and indicators.
Testing the measurement model is one part of the test in SEM which aims to test the Testing measurement model can be tested separately for each latent variable or can be together by connecting two directions for each latent variable as proposed by Adedeji (Adedeji, at al, 2.
Normality and outlier tests are also available in SEM.
Because the SEM used in this study uses AMOS software, it must meet the normality assumption.
Measurement Model AMOS is a software for SEM that is parametric so that several assumptions must be met, including the data must be normally distributed.
The data is normally distributed if the cr .
ritical rati.
skeness or cr kurtus is 96 to 1.
ccording to the table value Z0.
If the data is not multivariately normal, then the outlier data is excluded based on skewness and kurtosis (Chahal, et al, 2.
The results of the processing of 375 data that were processed the multivariate cr value .
so that it was concluded that the data were not normally distributed.
Because the data is not normally distributed, then the outlier test was performed.
If p1 and p2 in the mahalanobis distance table are less than 0.
05, then the data is entered as an outlier.
From the results of the analysis, there are 5 data detected as Furthermore, the five data are removed gradually until the cr value is multivariately less than 2.
From 370 data, after eliminating five data that were detected as outliers, a multivariate cr value of 1.
565 was obtained, so it was concluded that the data were normally distributed and could be analyzed Construct Validity Test The construct validity test aims to see whether the indicator is valid or appropriate to measure the latent variable with the indicator.
Confirmatory factor analysis (CFA) is used to ensure that the indicators used in this study are valid enough to measure variables.
Testing using Confirmatory Factor Analysis (CFA) also aims to test the reliability and contribution of indicator variables in measuring latent variables.
Visitor Response As The Impact A.
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The indicator is said to be valid if the one indicator is omitted for further standard regression weight (SRW) is Further test results show that all more than 0.
5 and the CR value is more SRW and CR values meet the 96 or the probability is less than requirements so that all indicators are 05 (Chahal, et al, 2.
In this test valid for measuring variables.
The test there is one question item that measures results are shown in table 6.
satisfaction has a value of 0.
349 so that Table 6.
Construct Validity Test
SRW
<--Expectation 0,712 Valid <--Expectation 0,646 9,924 *** Valid <--Expectation 0,547 8,696 *** Valid <--Expectation 0,725 10,563 *** Valid <--Service quality 0,676 Valid <--Service quality 0,568 9,794 *** Valid <--Service quality 0,648 11,02 *** Valid <--Service quality 0,691 11,661 *** Valid <--Service quality 0,638 10,875 *** Valid <--Service quality 0,591 10,15 *** Valid <--Service quality 0,656 11,148 *** Valid <--Service quality 0,612 10,475 *** Valid <--Loyalty 0,674 Valid <--Loyalty 0,695 11,361 *** Valid <--Loyalty 0,714 11,609 *** Valid <--Loyalty 0,689 11,281 *** Valid <--Satisfaction 0,682 Valid <--Satisfaction 0,648 8,381 *** Valid <--Satisfaction 0,632 8,32 *** Valid Construct Reliability Test The second test is a reliable measuring instrument, namely an index that shows the extent to which the measuring instrument is reliable or Reliability is a measure of the consistency of these indicators, the indicator is said to be reliable in general if the AVE (Average Variance Extracte.
value is above 0.
6 (Nunnally, 1.
with the following formula:
expectation and service quality are 692, 0.
787, 0.
754 and 0.
From these results indicate that the four variables have an AVE value above 0.
5, so that the indicators of the four variables are reliable.
From the calculation using the above formula, the AVE values for the variables of satisfaction, loyalty.
Structural Model The next test is the structural model testing.
In this test, the model is described in accordance with the theory and hypothesized problems.
In this structural model, the influence between latent variables and the contribution of each indicator in compiling the latent variables is measured together.
Media Mahardhika Vol.
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OeyuI.
Figure 1 Structural Test Model Table 7.
Goodness of Fit
Name of category Name of index
Value Level of acceptance Absolute fit
Chi-square RMSEA
GFI
AGFI
P = 0,00
0,037
0,94
0,923
P > 0,05
RMSEA < 0,08
GFI > 0,9
AGFI > 0,9
CFI
TLI
0,964
0,959
CFI > 0,9
TLI > 0,9
NFI
Chi-square / df
0,903
1,517
NFI > 0,9
Chi-square / df < 5,0 Incremental fit Parsimonious fit The goodness of fit value to see the level of model feasibility can be seen from several measurements as shown in table 7 (Awang.
, 2.
Based on the goodness of fit value from the structural model test, according to the criteria of Awang.
, .
, all values in the table above are in accordance with the criteria except the Chi-square probability value which is below 0.
However.
Awang.
Z also explains in his book that the goodness of fit with Chi-square is very sensitive for the number of samples In this study, the number of samples that became the data analysis was 370, so the chi-square could not be used as a reference for fit.
Thus, the other match values are used as references.
Because all goodness of fit criteria are met except for chi-square, it can be concluded that the hypothesized model is quite fit.
The ratio between chi-squared and frequency degrees .
This number is far below 5, so the model we use is parsimony.
After it is proven that the hypothesized model is quite feasible, it can be seen the influence between Based estimation, the model can be written While the p-value can be seen whether the variable has a significant effect.
Based on the P value of the estimated coefficients in table 8.
Expectations have a significant effect on satisfaction with an estimated coefficient 344 and a p-value of 0.
00 so that hypothesis 1 which states that expectations have a positive effect on hospital visitor satisfaction can be Service quality has a significant effect on satisfaction with an estimated coefficient of 0.
313 and a pvalue of 0.
This proves that hypothesis 2 which states that service quality has a positive effect on hospital visitor satisfaction is accepted.
Table 8.
Estimation Coefficient Coefficient PEstimate value Label Satisfaction <--- Expectation ,344 *** Satisfaction <--- Service quality ,313 *** Loyalty <--- ,091 ,075 significant at 10% <--- ,893 *** Significant Service quality has a significant model can be formed mathematically as effect on loyalty, so hypothesis 4 satisfaction has a positive effect on Satisfaction = 0.
344 Expectation hospital visitor loyalty.
This is evidenced 313 service quality by the coefficient value of 0.
893 with a Loyalty = 0.
091 Satisfaction 0.
p-value of 0.
However, specifically service quality for the effect of satisfaction on loyalty, the significance level is 10% or the SEM analysis is also able to show confidence level is 90% because the Pthe effect of a variable with other value coefficient is 0.
075 greater than The influence can be in the 05 so it is not significant at 0.
05 but form of direct influence, indirect smaller than 0.
This shows that influence or total influence.
The total hypothesis 3, namely the quality of effect is the result of the sum of the direct service has a positive effect on the and indirect effects which are also loyalty of hospital visitors.
From the presented in table 9.
estimation results in table 8, the causal Table 9.
Effect between latent variables Direct Indirect Total Effects Effects effects service quality ==> Satisfaction service quality ==> Loyalty Expectation ==> Satisfaction Media Mahardhika Vol.
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The influence of service quality on loyalty directly is 0.
838 and indirectly is 0.
The total effect of service quality on loyalty is 0.
Expectations have a direct effect on satisfaction of 0.
381 and an indirect effect on loyalty of 0.
While satisfaction has a direct influence on loyalty of 0.
Overall, the biggest influence is the effect of service quality on loyalty.
It can be explained that the strongest influence on loyalty in this case is the quality of service.
DISCUSSION