The Effect of the Case Manager's Role to Patient Satisfaction
A Systematic Review
Lukman Hakim, Ah. Yusuf and Purwaningsih
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Case manager, Patient satisfaction, Service quality.
Abstract: Introduction: In Indonesia the implementation of the nursing case manager in the hospital has not been very
clear and how the implementation. The role of case managers include utility assessment, patient planning,
facilitation and advocacy, service coordination, process evaluation, post-discharge follow-up. One
indication of the role of the case manager in the inpatient ward is the long elapsed hospital day (ALOS) and
the patient complains. Methods: The literature search is performed in several major databases such as
proquest, sciencedirect, doaj, sagepub, medline, and google scholar with the time limits used are January
2008 to December 2018. Results: A total of fifteen studies raised in this study, all of which have almost the
same objectives of how to implement case manager in increasing patient satisfaction in each population.
From fifteen randomly selected respondents chose respondents. Conclusion: Significantly with patient
satisfaction, so it can be concluded that patient satisfaction actually refers to appearance or form of service,
that more perfect appearance of service, hence more perfect also quality or quality.
1 BACKGROUND
Nursing service is a form of professional service as
an integral part of health service that has big
leverage to health development (PPNI, 2012).
Nursing as a profession that is part of the society
will continue to change in line with the development
of society, one of which is the demands of the public
need for quality health services, so nurses are
expected to improve and develop professional skills
to provide the best nursing services to the
community (Nursalam, 2011) . The role of
professional nurses in the national health system is
to create a good health system, so that the health
service will be in accordance with the needs and
demands of society. Meanwhile, on the other hand,
the cost of health services in accordance with the
economic capacity of the community. However, the
nurse has not performed the role optimally. Herein
lies the problem, the provision of health services,
including nursing services in accordance with the
needs of society is not easy. Not surprisingly, at this
time many public complaints found to health care or
nursing in Indonesia (Nursalam, 2015).
Nurses are the largest human resources in
hospital health services, where nurses work 24 hours
a day in rotation and continuously to provide
comprehensive and professional nursing care and are
ready to help patients at all times. Nurses have a
vital position where it is always direct contact and
has the most time in interacting with the client so
that the high quality of health service in the hospital
is greatly influenced by nursing service because 90%
of hospital health services are provided by nurses
(Damayanti 2001); where the quality or quality of
health services provided will affect patient
satisfaction (Kucukarslan & Nadkarni, 2008). The
patient's dissatisfaction with the nursing service can
be influenced by several factors such as: product or
service quality, price or cost that must be paid by the
patient to the service received, place ie place or
facility given, promotion that is match between
product or services received with information
provided, processes or mechanisms of service and
people ie power or resources that provide services
(Wiyono, 2007). Measurement of health service user
satisfaction is one of the indicators to know the
quality of health services.
Satisfaction and dissatisfaction of customers on a
given product will affect behavioral patterns such as
buying interest in product (Kotler, 2004). The results
of the descriptive analysis found 39% of complaints
resulting from staff behavior, 26% complaints due to
clinical and other patient behavior, 16% complaints
Hakim, L., Yusuf, A. and Purwaningsih, .
The Effect of Case Manager’s Role to Patient Satisfaction.
DOI: 10.5220/0008325203550360
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 355-360
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
355

due to physical environment and facilities, Length of
Stay (LOS) and high cost issues, with stroke and
cerebrovascular diseases (Haw Camila, 2008). Based
on interviews with nurses and heads of nursing-
related case managers and their roles, that of four
nurses, there was one nurse who knew the case
manager, the role, and the impact of the case
manager on patient care, the three nurses said the
role of the case manager was the same as the head of
the room and of the 10 patients were hospitalized for
more than six days there were 5 patients.
Implementation of case manager in dr. R. Koesma
Tuban has been implemented since 2016 to date
with SK from the hospital director, as for the case
manager type applied there are three types of case
managers, the first case manager for nurse, case
manager for the patient and case manager for
administration. Role case manager in dr. R. Koesma
Tuban has been using guidance and tupoksi in
accordance with CMSA case manager standard, and
case manager organization structure has been
formed and the responsible is director of hospital,
but case manager implementation not yet supported
with standard operational procedure (SPO) this
research is expected to help optimize the role of case
manager as nursing service coordinator. Therefore
the hospital needs a design or strategy in order to
perform a continuous service process. One such
model is the case manager. Case manager with an
Islamic spiritual approach that is generally
responsible for the coordination and continuity of
patient care during hospitalization.
To know the quality of service felt real by
consumer, there are indicator size of consumer
satisfaction which is located in five dimension of
service quality. These five dimensions are: physical
evidence (tangibles), direct evidence covering
physical facilities, equipment and materials used by
hospitals and employee performance. Reliability
(reability), related to the ability of the hospital to
provide prompt and accurate service from the first
time without making any mistakes and satisfactory;
Responsiveness, in relation to the willingness and
ability of employees to assist patients and respond to
their requests with responsiveness, and inform
services appropriately; Assurance (ie assurance) that
includes knowledge, skills, courtesy, able to grow
the trust of his patients; Empathy (empathy) means
the ease of doing good communication, personal
attention in understanding the patient's needs as a
customer and acting in the interests of the patient.
2 METHODS
The literature search is done in several major
databases such as proquest, sciencedirect, doaj,
sagepub, medline, and google scholar by including
the keyword of patient satisfaction, quality of
management, service quality. The time limit used is
January 2006 to December 2016. Of the 1643
articles obtained, only 15 articles met the inclusion
criteria. The inclusion criteria of the article are: 1)
Hospital / Clinic, 2) measuring 5 indicators of
service quality, 3) sample is visitor or inpatient /
outpatient, and 4) parameter assessed is patient
satisfaction.
The parameters of patient satisfaction were
assessed using highly variable instruments. Fifteen
studies use dimensions of Responsiveness,
Assurance and Emphasis, while Tangible and
Reliability dimensions. Patient satisfaction is also
influenced by several factors, among others:
reliability, assurance, tangibility, empathy and
responsiveness. Reliability (reliability) is the ability
of officers to provide services to consumers with
appropriate. In the health service is the patient's
assessment of the ability of health personnel.
Assurance (assurance) ie the ability of officers to
provide services to consumers so trusted. In the
health service is the clarity of health workers
provide information about the disease and its
medicine to patients. Tangibility (physical evidence)
the availability of facilities and physical facilities
that can be directly perceived by consumers. In the
health service is the cleanliness of the treatment
room and toilet. Emphaty (attention) is the ability of
officers to build relationships, attention, and
understand the needs of consumers. And last
responsiveness (responsiveness) is the ability of
officers to provide services to consumers quickly. In
the health service is the length of time waiting for
patients starting from register to get health service
(Kotler, 2000).
Given the magnitude of the role and function of
health services as the first health service providers in
the community, the important thing to note is the
ability of officers to provide services to consumers
with precisely accompanied by awareness, skill and
discipline of service personnel in providing services
to effectively and efficiently, especially in waiting
time services so that patients feel satisfied with the
service in the health service.
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
356

3 RESULTS
3.1 Relation between Physical Evidence
and Patient Satisfaction
Based on the data, on good physical evidence, most
respondents are 71 respondents (72.4%) feel
satisfied, as many as 10 respondents (10,2%) feel
less satisfied. On the physical evidence is not good,
most respondents are 13 respondents (13.3%) feel
less satisfied and as many as 4 respondents (4.1%)
feel satisfied. Chi Square Continuity Correction
analysis results between physical evidence and
patient satisfaction obtained Asymp.sig (2-sided) or
p value of 0.000. If the p value is smaller than the
value α = 0.05. From the analysis results also
obtained value Odds Ratio (OR) = 23.075.
According Suryati et al (2006), aspects of physical
evidence becomes important as a measure of service.
The customer will use the sense of sight of an
attribute service quality of the variable. Good
physical evidence will affect customer perceptions.
At the same time this aspect of physical evidence is
also one source that can affect customer
expectations, because of good physical evidence,
customer expectations are higher. This study is in
line with Irfan et al (2012) in a study with 320
respondents about Patient Satisfaction and quality of
service in government hospitals in Pakistan found a
meaningful relationship between the dimensions of
physical evidence and other quality dimensions with
patient satisfaction. Lumintang (2012) in the study
observational on 86 patients about Factors Related to
Patient Satisfaction of Askes on Service of Inpatient
Installation B at RSUP Prof. Dr. R.D. Kandou
Manado found that the physical environment was a
significant factor in patient satisfaction (p = 0.03).
Similarly Susmaneli and Tyana in a study on 92
respondents who used cross sectional design on
Quality Dimension of Midwifery Service to Patient
Satisfaction.
The Jampersal Program at Rokan Hulu Hospital
Pekan Baru found that the physical evidence
dimension (p = 0.003) correlated significantly with
patient satisfaction (Susmaneli, 2014). Kambong et
al. (2013) in the study of the relationship between
nurse service and patient satisfaction at Talawaan
Health Center of North Minahasa Regency found an
association between nurse service in the dimensions
of physical evidence, reliability, assurance, concern
with patient satisfaction and no relationship between
nursing service in the dimension of responsiveness
with patient satisfaction. Simbala et al (2013) in an
analytic survey study with a cross-sectional design
of 100 respondents found that physical evidence was
significantly associated with patient satisfaction (p =
0.002). Meanwhile, a study by Calisir et al (2012) on
the effect of quality dimensions on patient
satisfaction and repeat visits of 292 respondents
using modified SERVQUAL method found that
physical evidence was an important factor for patient
satisfaction and influenced the decision to re-use
hospital services the. That physical evidence
correlates significantly with patient satisfaction, so it
can be concluded that patient satisfaction actually
refers to appearance / form of service that more
perfect appearance of service, hence more perfect
also quality/ quality.
In general, a person will see a potential hospital
initially from the physical condition. With a clean,
tidy, and orderly condition one would expect that the
hospital would perform its functions well. The
relationship of physical evidence to patient
satisfaction is: physical evidence has a positive and
significant influence on patient satisfaction. The
better the customer's perception of physical evidence
the higher the patient's satisfaction, and if the
patient's judgment of physical evidence is poor, the
patient's satisfaction is lower. Research conducted
by Lubis and Martin (2009) on the Influence of Price
and Service Quality on Satisfaction of Inpatient
Patients at RSU Deli Sumatera Utara, mention that
physical evidence variable have positive effect to
consumer satisfaction.
3.2 Relationship between Reliability
with Patient Satisfaction
Based on the data, on good reliability, the majority
of respondents are 71 respondents (72.4%) feel
satisfied and as many as 10 respondents (10,2%) feel
less satisfied. On the less good reliability, most
respondents are 13 respondents (13.3%) feel less
satisfied and as many as 4 respondents (4.1%)
satisfied. Chi Square Continuity Correction analysis
results between reliability and patient satisfaction
obtained Asymp.sig (2-sided) or p value of 0.000. If
the p value is smaller than the value α = 0.05 it
means that H1 is accepted or there is a relationship
between reliability and patient satisfaction. From the
analysis results obtained
also the value of Odds Ratio (OR) = 23.075.
Reliability is one of the five dimensions of service
quality, and according to Tjiptono (2006) that the
quality of service is closely related to satisfaction,
where good quality will provide experience for the
customer and will then invite them to come back for
the next visit and become a loyal customer.
The Effect of Case Manager’s Role to Patient Satisfaction
357

The better the customer's perception of reliability
the patient's satisfaction will be higher where if the
patient's perception of the bad reliability, the
patient's satisfaction will be lower. A study by
Rahman et al (2013) to identify service quality
factors that affected patient satisfaction in private
hospitals in Bangladesh with 390 respondents and
using 11 dimension quality variables showed that
reliability was significantly associated with patient
satisfaction. Likewise research from Faisal et al
(2013) about the relationship between nurse service
with patient satisfaction in Installation of Inpatient A
BLU RSUP Prof. Dr. R.D.Kandou Kota Manado
with 85 respondents found no significant
relationship between patient reliability and
satisfaction.
3.3 Relationship between Power
Response with Patient Satisfaction
Based on the data, on good responsiveness, most
respondents are as many as 75 respondents (76.5%)
feel satisfied and as many as 19 respondents (19.4%)
feel less satisfied. On the responsiveness is not good,
most respondents are as many as 4 respondents
(4.1%) feel less satisfied and no respondents are
satisfied. Chi Square Continuity Correction analysis
results between responsiveness and patient
satisfaction obtained Asymp.sig (2-sided) or p value
of 0.002. This study is in line with Simbala et al
(2013) in an analytic survey study with a cross-
sectional design of 100 respondents found that
responsiveness was significantly associated with
patient satisfaction (p = 0.002). Badri et al (2009) in
research on the quality of health services and factors
affecting patient satisfaction express responsiveness
as one of 12 indicators always included in various
studies related to service quality. In an analytical
study with 246 respondents comparing patient
satisfaction with services in public hospitals and
hospitals, it was found that private hospitals had
high satisfaction rates in responsiveness and
empathy, while government hospitals were least
valuable in the dimensions of responsiveness (
Brahmbhatt et al., 2011).
3.4 Relation of Responsiveness with
Patient Satisfaction
Relation of responsiveness with patient satisfaction
is responsiveness have positive and significant
influence to patient satisfaction. The better the
perception of the customer to the responsiveness of
the patient's satisfaction will be higher, and if the
patient's perception of the poor responsiveness, then
the patient's satisfaction will be lower. In accordance
with the opinion Leboeuf (2012), that the
responsiveness as an attitude of the employees to
serve when the patient needs is closely related to
customer satisfaction.
3.5 Relationship between Warranties
with Patient Satisfaction
Based on the data, on good guarantees, most
respondents are as many as 75 respondents (76.5%)
feel satisfied and as many as 19 respondents (19.4%)
feel less satisfied. On bad guarantees, 4 respondents
(4.1%) felt less satisfied and no respondents were
satisfied. Chi SquareContinuity Correction analysis
results between assurance and patient satisfaction
obtained Asymp.sig (2-sided) or p value of 0.002. If
the p value is smaller than the value α = 0.05.
Research on patient satisfaction at Jombang Hospital
by Ariyani (2009), also found that good guarantees
will increase patient satisfaction on hospital services,
thus making patients more likely to believe and
believe in every service performed by the hospital.
Mustofa (2008) in a cross-sectional analytic study of
30 respondents on the relationship between the
perceptions of patients on the quality dimensions of
nursing service found that there was a significant
relationship between the perceptions of patients on
the dimensions of the guarantee with patient
satisfaction. According to Tjiptono (2006), the
quality of health services for a patient can not be
separated from the satisfaction of the received health
services, where good quality is associated with
recovery from illness, improvement in health or
freshness, pleasant care environment, and
hospitality. Guarantees include the right knowledge
of the product / service appropriately, the quality of
hospitality, the attention and decency in providing
services, the skills in providing information, the
ability in providing security in utilizing the services
offered, and the ability in instilling customer
confidence in the company. Hospitality, comfort and
courtesy of the nurses are also included as an
indicator of variable assurance greatly affects
customer satisfaction assessment of hospital service
quality. Sayed et al (2013) in the study of patient
perception as an indicator of nursing service quality
in 90 respondents found that the assurance was
significantly related to patient satisfaction (p = 0.0).
Essiam (2013) who examined the quality of service
and patient satisfaction in health services with
quantitative methods on 400 respondents found a
significant relationship between assurance and
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
358

patient satisfaction (p <0.01). Each patient basically
wants to be treated well by the manager of the
hospital. The assurance that patients who come will
be served well by the manager of the hospital, will
provide a sense of security to the patient, so that the
patient's personal stability will increase. Thus, their
confidence in the hospital will increase.
3.6 Relationship Guarantee with
Patient Satisfaction
The relationship of assurance with patient
satisfaction is the assurance of having a positive and
significant influence on patient satisfaction. The
better the patient's perception of the guarantee the
patient's satisfaction will be higher, and if the
patient's perception of bad guarantees will lower the
patient's satisfaction. In line with the study, Winardi
et al. (2014), in a study entitled Influence of Service
Quality on Patient Consumer Satisfaction at SMC
Telogorejo Hospital that assurance related to patient
satisfaction so it can be concluded that good
guarantee is related to increasing patient satisfaction
and patient loyalty.
In a study on patient satisfaction in Selangor,
Malaysia, by Hayati et al. (2010) also found that
good guarantees will increase patient satisfaction
with hospital services, thus making patients more
likely to believe and believe in every service
performed by hospitals. Indiraswari and Damayanti
(2012), found also that significant guarantees
significantly in addition to improving patient
satisfaction for services, will also affect the patient's
assessment of other variables.
3.7 The Relationship between Empathy
and Patient Satisfaction
Based on the data, on the good attention, most
respondents are 72 respondents (73.3%) feel
satisfied and 13 respondents (13.3%) feel less
satisfied. On the less good attention, most of the
respondents are 10 respondents (10,2%) feel
dissatisfied 11 and 3 respondents (3,1%) feel
satisfied. Chi Square Continuity Correction analysis
results between attention and patient satisfaction
obtained Asymp.sig (2-sided) or p value of 0.000.
This is in line with research Puspitasari and Edris
(2011) about patient satisfaction in Installation
Hospitalization Healthy Hospital Pati who get that
attention variable is very dominant influence on
patient satisfaction. Muninjaya (2011) emphasized
the importance of the dimension of attention in
providing quality services. This is in line with
Rattoe's (2013) study on the relationship between
service quality and the resendation decision at
Bethesda Tomohon General Hospital which found
that the attention variable is very dominant for the
effect on patient satisfaction. Furthermore, research
from Sulianti (2010) and research from Rondonuwu
(2014), found that the attention variable is closely
related to the creation of quality services. Quality
services can provide a good experience for
customers and will invite them to come back and be
loyal customers. Quality services can provide a good
experience for customers and will invite them to
come back and be loyal customers.
4 DISCUSSION
These results suggest that patient satisfaction
actually refers to the appearance / form of the role of
case manager, that the more perfect appearance of
service, the more perfect also the quality / quality. it
also needs to pay attention to the number and
homogeneity of the subjects (age, sex, disability
level and time spent in the study) so as not to make
bias on the research results. Summary of the
research conducted systematic review, showed a
positive effect of the role of case manager and
excellent service quality to patient satisfaction.
There is relationship between nurse service quality
and patient satisfaction Health seen from dimension
of responsiveness, reliability, assurance, empathy
and physical proof.
5 CONCLUSIONS
Satisfaction is as the level of a person's feelings after
comparing the performance or the results he feels
with his expectations. The level of satisfaction is a
function of the difference between perceived
performance and expectations. If performance is
below expectations, then the customer will be very
disappointed. When performance is as expected,
then the customer will be very satisfied. Whereas if
performance exceeds expectations customers will be
very satisfied (Oliver, 1998 in Supranto, 2001).
Patient / customer satisfaction is a service response
to the conformity of the importance or expectation
of the customer before they receive the service after
the service they receive (Muninjaya, 2011).
Therefore, customer satisfaction is determined by
expectations compared to the reality received by the
customer. Customers include internal customers
The Effect of Case Manager’s Role to Patient Satisfaction
359

external customers, and intermediate customers.
Customer needs are endeavored to be satisfied in all
aspects, including price, convenience, security, and
timeliness. We also recommend that the hospital can
maximize the role of the case manager and develop a
patient satisfaction surveys program on a regular
basis so as to evaluate the performance of nursing
services by improving, improving and developing
the quality of services and making efforts to
maximize the patient satisfaction.
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360