Quality Evaluation of Pharmacy Services in the Outpatients at

Hospital in Jakarta

Aprilita Rina Yanti Eff

, Ayu Puspita Lena RTR

and Almira Ristizsa Shabrina Da Costa

Departement of Pharmacy Faculty of Health Sciences, Esa Unggul University,

Arjuna Utara Street, North Jakarta, Indonesia

Departement of Public Health, Faculty of Health Sciences, Esa Unggul University,

Arjuna Utara Street, North Jakarta, Indonesia

Keywords: Pharmaceutical Service, Drug Service Time, Satisfaction Level, Hospital.

Abstract: The pharmacy system in a hospital is maintained by a pharmacy unit, assigned to conduct, coordinate, arrange,

and supervise all the pharmacy services activities. The fundamental problems in the dimensions of medicine

time-serving and consumer satisfaction levels have become the primary indicator in guaranteeing the

credibility of pharmacy services for society. This research aims to evaluate the satisfaction level of patients

and the dimension of medicine time-serving in the outpatient pharmacy of the pharmacy installation at Rawa

Lumbu Hospital. This study was non-experimental with an observational design, which is precisely

descriptive using a quantitative approach. The number of respondents therein research is 171. The obtained

results based on the standard of pharmacy services are that the tangible aspect reached up to 85,35%, the

reliability aspect pursued 88,10%, the assurance dimension achieved 85,91%, the empathy dimension

obtained 80,94%, and in the responsiveness, perspective gained 78,46%. Meanwhile, the average serving of

medicines and medicines has met the standards according to the Indonesian Minister of Health No. 129/2008,

which shows that the prepared recipe can be served in no more than 30 minutes and the recipe for the

concoction will be ready within 60 minutes..

1 INTRODUCTION

Patient-oriented hospitals must provide one type of

minimum service, namely pharmacy services. Based

on Government Regulation of the Republic of

Indonesia No. 51/ 2009 pharmacy services are an

integral part of the hospital health care system that is

intact and oriented to patient services, provision of

quality medicine and clinical and affordable

pharmacy services for all levels of society

(Indonesian Ministry of Health, 2009). Pharmacy

services in a hospital are managed by a

pharmaceutical installation that is in charge of

organizing, coordinating, managing, and overseeing

all pharmacy service activities. Pharmaceutical

services, according to the Decree of the Minister of

Health of the Republic of Indonesia No. 197/2004 is

one of the hospital services to support quality health

services (Indonesian Ministry of Health, 2004).

The results of the study on pharmacy services

showed that 76.86% of the people wanted the

appearance of a good drug store, (Muslicnah, M, &

Syamsudin, 2010) 80.6% expected a friendly service

provider (Hariany, 2014), whereas according to

86.7% patients were satisfied if you get fast service

(Muslicnah et al., 2010). Excellent pharmacy services

at pharmacies are still unpracticed much and are still

optimally undone. The pharmacy that applies the new

pharmaceutical service standards is 47.63% - 56.16%

(Ginting, 2009).

At present, the community needs more qualified

and friendly health services that are oriented towards

their safety. Patient satisfaction using pharmacy

services is a reflection of the results of the quality of

health systems provided. These services range from

interactions with doctors, nurses, and pharmacists, as

well as interactions with administrative officers and

other health workers. Satisfaction using pharmacy

services represents the attitude of consumers in

determining the direction and intended destination in

the process of interpreting the proper use of drugs or

the purchase of a medicinal product so that patient

satisfaction using the pharmacy services can be used

as a benchmark to reflect how much patient

satisfaction the services provided (Ofili, 2014).

Eff, A., Rtr, A. and Shabrina Da Costa, A.

Quality Evaluation of Pharmacy Services in the Outpatients at Hospital in Jakarta.

DOI: 10.5220/0009566600830091

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 83-91

ISBN: 978-989-758-454-1

Rawalumbu Hospital remains a type C hospital,

with the primary task of providing medical services

to all levels of society who live in the Rawalumbu

area, East Bekasi. Rawalumbu hospital pharmacy

installation divides its activities into two main groups,

namely clinical and non-clinical pharmacy activities.

Prescription systems and drug information services

are part of clinical pharmacy activities.

Outpatient pharmacy facilities start at 07.30 pm-

21.00 am on Mondays to Fridays with an average of

300 sheets recipe per day. The number of workers on

duty is ten people consisting of one pharmacist as the

head of the installation, eight pharmacist assistants

and one service supervisor.

Based on the background above, we are interested

in examining the quality evaluation of pharmacy

services in the outpatients at the rawa lumbu hospital

Based on Pharmaceutical Service Standards on the

dimensions of drug service time and the level of

customer satisfaction.

2 MATERIAL AND METHODS

2.1 Subject of Research

The subject was all outpatients (n=171) who were

taking drugs at the Hospital Pharmacy Installation

that met the inclusion criteria: had taken drugs or

received pharmaceutical services at least once, 18-65

years old, able to communicate and read well and

willing to fill out questionnaires.

2.2 Research Design

This study is a non-experimental with an

observational and descriptive design with a

quantitative approach. The researcher preferred

descriptive research because we wanted to describe

the relevant forms regarding the practice of

pharmaceutical standards carried out at the

Rawalumbu Hospital pharmacy installation. The data

are obtained directly from the respondents in the

selected scope using a questionnaire (Kothari, 2004).

2.3 Research Subject

The population in this study was all outpatients who

were taking drugs at the Hospital Pharmacy

Installation. Samples are outpatients who meet the

inclusion criteria that are involved in the drug or

received service at least once, aged 18-65 years, able

to communicate and read properly and are willing to

fill out questionnaires. The sample in this study was

collected using accidental sampling technique.

Considering the population varies, the characters are

heterogeneous. Besides, the validity and reliability of

the questionnaire were previously tested with 30

different outpatients. The sufficient number of

respondents based on calculations adopting the Slovin

(Setiawan, 2007) formula comprise 171 people.

2.4 Research Instruments

Data were collected using a set of questions and

observation sheets. The questionnaire consisted of 25

questions that covered five dimensions of satisfaction

(tangibles, reliability, responsiveness, assurance,

emphaty). All questions in this used questionnaire

were naturally adapted from questionnaire

examinations in the Kautsar (2017) study.

Observation sheets are utilized to record the time of

each recipe service process from receipt of the

prescription by the official to the delivery of the drug

to the patient using a digital clock.

2.5 Evaluation of Research Instrument

The research instrument evaluation was conducted

through questionable validity and reliability testing.

The specific test was carried out by distributing initial

questionnaires to 30 outpatient respondents who were

taking drugs at the Rawalumbu hospital pharmacy

installation. A validity test is done by accurately

measuring the level of patient satisfaction using the

SERVQUAL questionnaire (Daniel & Berinyuy,

2010). The set of questions is declared validly if the

value of Corrected item-total Correlation 0.361.

Reliability tests were performed applying the

Cronbachα technique, and the data obtained were

statistically analyzed using IBM SPSS 22 software.

2.6. Data Analysis

2.6.1 Descriptive Statistical Analysis

This analysis was attempted to affect the distribution

of respondents' characteristics. Patient characteristics

noted consisted of gender, age, education level,

occupation, monthly income, and distance of the

house from the hospital. The data distribution is

presented in the form of tabel.

2.6.2 Gap Test

The gap is a mismatch between the services received

by customers with the services expected. Gap test

ICOH 2019 - 1st International Conference on Health

calculates the difference between the average

performances with the average expectation. The

difference figures illustrate the level of patient

satisfaction (Daniel & Berinyuy, 2010).The sentence

must end with a period.

2.6.3 Importance and Performance Analysis

Importance-Performance Analysis (IPA) represents

an analysis of the level of conformity between

customer expectations or interests and the

performance or reality received by the customer. To

find out the assessment score of the average level of

company performance and the grade of the level of

useful customer interest to correctly determine the

primary issue of increasing attributes that affect

satisfaction used Cartesian diagram, with the

following formula:

χ ̅ ΣXi Y ̅=ΣYi/n

(1)

Where χ ̅ = The average score of performance

appraisal of an attribute or service quality dimension;

Y ̅ = The average score of expectation rating of an

attribute or service quality dimension; and n= number

of respondents (Abalo, Varela, & Manzano, 2007)

3 RESULTS AND DISCUSSION

3.1 Evaluation of Research Instrument

The research instrument test was carried out by

distributing questionnaires to 30 selected

respondents. The results show that the reliable

questionnaire with Cronbach’s alpha is 0.745 for the

expectation level, and 0, 738 for the performance

level. In the validity, parameter obtained Corrected

item-total Correlation> 0.361. The instrument test

results show that the questionnaire is reliable and

valid and can be used in research.

3.2 Descriptive Statistical Analysis

Results of descriptive statistical analysis (patient

characteristic) can be seen in table 1. From table 1, it

can be seen that most of the research respondents

were female, that is, 54%. Some theories state that

women have a higher level of satisfaction compared

to men; women tend to be more satisfied with health

services than men (Gigantesco et al., 2019). Most of

the research respondents were aged 36 to 45 years at

30% while the least aged 65 years at 0.5%. At

productive age (adults), unwholesome habits

frequently occur because of unhealthy lifestyles,

shortage of rest, consuming unhealthy food, and lack

of physical activity. Age is present one of the

contributing factors that influence one's health

behavior. Age affects the way of thinking,

experience, and patient satisfaction. Respondents

aged 36-45 years are adults who want quality health

services (Deeks, Lombard, Michelmore, & Teede,

2009). At the education level, the majority of

respondents had a diploma and bachelor education

(56%). Zimmerman stated that educated community

groups more quickly accept themselves as sick people

if they experience a specific symptom. They are more

Table 1: Patient characteristic.

No Description Percentage (%)

1 Gender

- Women

- Man

2 Aged (year)

- <18

- 18-25

- 26-35

- 36-45

- 46-55

- 55-65

- >65

4.4

0.6

3 Education

- elementary school /

equivalent

- junior high school /

equivalent

- high school / equivalent

- diploma / bacelor

- master and doctor

4 Occupation

- Student

- College student

- Government employees

- Private employees

- entrepreneur

- state-owned enterprises

- Housewife

- Retired

5 Income (rupiah)

- 1,000,000

- 1,000,001-2,500,000

- 2,500,001- 5,000,000

- 5,000,001-10,000,000

- 10,000,001

6 distance of residence to the

hospital (km)

- <10

- 10 - 25

- > 25

Quality Evaluation of Pharmacy Services in the Outpatients at Hospital in Jakarta

active in seeking help from doctors than those with

lowly social status. Someone who is less educated

may because of ignorance will choose not to seek

treatment as long as he can still withstand the pain.

The higher level of education a person will also

increase the knowledge and information obtained. A

person's perception of health services is influenced by

several factors, namely, resources, knowledge,

education, and attitudes. External factors include

culture, socio-economy, family, and the situation at

hand (Zimmerman & Woolf, 2014).

From table 1, it can be seen that most of the

research respondents were female, that is, 54%.

Some theories state that women have a higher level of

satisfaction compared to men; women tend to be more

satisfied with health services than men (Gigantesco et

al., 2019). Most of the research respondents were

aged 36 to 45 years at 30% while the least aged 65

years at 0.5%. At productive age (adults),

unwholesome habits frequently occur because of

unhealthy lifestyles, shortage of rest, consuming

unhealthy food, and lack of physical activity. Age is

present one of the contributing factors that influence

one's health behavior. Age affects the way of

thinking, experience, and patient satisfaction.

Respondents aged 36-45 years are adults who want

quality health services (Deeks, Lombard,

Michelmore, & Teede, 2009). At the education level,

the majority of respondents had a diploma and

bachelor education (56%). Zimmerman stated that

educated community groups more quickly accept

themselves as sick people if they experience a

specific symptom. They are more active in seeking

help from doctors than those with lowly social status.

Someone who is less educated may because of

ignorance will choose not to seek treatment as long as

he can still withstand the pain. The higher level of

education a person will also increase the knowledge

and information obtained. A person's perception of

health services is influenced by several factors,

namely, resources, knowledge, education, and

attitudes. External factors include culture, socio-

economy, family, and the situation at hand

(Zimmerman & Woolf, 2014).

3.3 Assessment of Expectations on

Service Quality Attributes

The performance and quality of service expected by

patients are assessed using several dimensions,

namely, reliability, responsiveness, assurance,

empathy, and tangibility. The average value of

expectation on service quality attributes can be

referred to in table 2.

Table 2: The average value of expectation on service quality

attributes.

The attributes of Pharmaceutical

Services

Score

(mean)

Dimension of Realibity 3.5

Dimension of Responsiveness 3.38

Dimension of Assurance 3.46

Dimension of Emphaty 3.24

Dimension of Tangibles 3.36

Table 2 shows that the reliability dimension has

the tallest average (3.50) compared to other

dimensions, meaning that the highest level of

expectation is found in that dimension. The

dimension that has the lowest average value is present

the empathy dimension (3.24), meaning that the most

elementary level of expectation is found in that

dimension. So that patients feel that these attributes

do not affect the ongoing service. Within the empathy

dimension, the attribute of pharmaceutical service

quality that has the highest average value is that the

patient is convinced of the cure that will be achieved

in treatment. This attribute is considered essential by

patients because this is one form of attention carried

out by officers who will influence patients to recover

rapidly. The quality of pharmaceutical service

attributes in the dimension of responsiveness, which

has the highest average value, is how to obtain drugs

quickly. How to receive drugs easily is considered

essential because the ease inside receiving drugs will

increase the level of patient confidence in the service

at this hospital. In the assurance dimension, the

service quality attribute that has the highest average

value remains the drug given in good condition.

Medication dispensed with the right conditions is

considered necessary by the patient because the drug

obtains the most crucial element in the healing

process. If the drug is given in a condition that exists

not well, this will undoubtedly cause adverse effects

for patients and hospitals (M. A. Abujarad Alhuwitat

& Salem, 2017).

In the tangibles dimension, the service quality

attribute that has the highest average value remains a

pristine waiting room. A clean waiting room is

considered primary because this will cause comfort in

the patient.

3.4 Assessment of Performance Level

on Service Quality Attributes

Evaluation of the level of performance on service

quality attributes is done by filling out the

questionnaire conducted by respondents based on the

dimensions of reliability, responsiveness, assurance,

ICOH 2019 - 1st International Conference on Health

empathy, and tangible. The results of the evaluation

of the level of performance in the service quality

attributes can be seen in table 3.

Table 3: The average value of performance in the service

quality attributes.

The attributes of Pharmaceutical

Services

Score

(mean)

Dimension of Realibity 3.08

Dimension of Responsiveness 2.66

Dimension of Assurance 2.97

Dimension of Emphaty 2.62

Dimension of Tangibles 2.83

Table 3 shows that the reliability aspect maintains

the most elevated average level of satisfaction (3.08)

compared to other service dimensions. The Directors

of Rawalumbu Hospital always emphasize their

employees to be professional, work optimally, and

provide an excellent facility within a variety of

services, especially in drug services. This appropriate

attitude will convey the patient's confidence to seek

treatment and not switch to another hospital

consistently. The empathy dimension possesses the

deepest average level of satisfaction (2.66). This

value means the patient considers that the drug

service officer is still unable to satisfy the patient.

Officers have been unable to convince patients about

healing, and in providing services, officers still

distinguish patients. Overall, the level of conformity

obtained from the comparison between the level of

expectation and the level of performance against 25

attributes of pharmaceutical services at Rawalumbu

Hospital represent an appropriate category

(Saraswati, Kristina, & Zulkarnain, 2018).

3.5 Importance and Performance

Analysis

Importance and Performance Matrix is a diagram that

is divided into four quadrants, which are bounded by

two lines that intersect the perpendicular to the point

(X, Y). The X-axis (horizontal axis) will fill the

performance level score, while the Y-axis (vertical

axis) will provide the score for the level of

expectation (importance) (Abalo et al., 2007). The

position of 25 pharmacy service quality attributes can

be observed by using the Importance and

Performance Matrix based on the score of

expectation/importance and the reality/performance

score of 171 Rawalumbu Hospital patients. However,

before that, it is necessary to calculate the average

value of the expectation level score and the

performance level score, which will be plotted on the

Cartesian diagram. Patient satisfaction is known for

assessing the level of expectation and satisfaction

during the patient's treatment at Rawalumbu Hospital.

The mean score of importance (Y) and the average

score of satisfaction (χ) are totaled, then averaged

overall. The score of expectation and performance

assessment of each attribute can be seen in the

following table 4.

Table 4: The score of expectation and performance

assessment of each attribute.

No Quality Attributes of

Pharmaceutical Services

Average

Expectation

Score

Average

Level of

Performance

Score

Dimension of Realibity

1 How the use of drugs is

written clearly on the

packages of drugs

3,54 3,15

2 Drug wrapped neatly 3,44 3,17

3 Pharmacy staff provides

information on how to use

drugs

3.59 3.18

4 Prescription services easy

and straightforward

3,23 3,08

5 Pharmacists provide

information about the side

effects of drugs

3,59 3,14

6 Patients get the

appropriate dosage, how

to utilize it, and when to

merely take it

3,64 3,15

Dimension of Responsiveness

7 The time for waiting for

drugs is fast.

3,29 2,48

8 Medicine is easy to get. 3,53 2,91

9 Opening hours of service

on time

3,46 2,83

10 Officers are responsive to

patient problems

3,27 2,43

Dimension of Assurance

The pharmacy staff

provides consulting

services that satisfy.

3,40 2,55

Pharmacists serve recipes

politely.

3,57 3,06

Medication services are

well served when the

patient asks for an

explanation of the drug.

3,43 2,87

Patients receive proof of

payment of the drug.

3,25 3,09

Medications are given in

good condition

3,65 3,29

Quality Evaluation of Pharmacy Services in the Outpatients at Hospital in Jakarta

Table 4: The score of expectation and performance

assessment of each attribute (cont.).

No Quality Attributes of

Pharmaceutical Services

Average

Expectation

Score

Average

Level of

Performance

Score

Dimension of Emphaty

16 The patient's family

supervises regular drug

use.

3,26 2,70

17 Patients gain confidence

in the healing that will be

achieved in treatment.

3,31 2,58

18 Officers provide the same

service regardless of

patients.

3,15 2,58

Dimension of Tangibles

19 Pharmacy staff dressed

neatly

3,29 3,20

20 The waiting room is

clean

3,56 2,89

21 Seating in the lounge is

comfortable.

3,49 2,68

22 The atmosphere of the

waiting room is calm.

3,53 2,47

23 There are television

facilities in waiting room.

3,37 3,08

24 Spacious waiting room

with air conditioner

3,43 3,09

25 The waiting room

provides the latest

newspapers/magazines.

2,91 2,45

Overall average score

3,43 2,91

Importance and Performance Matrix is a diagram

that is divided into four quadrants, which are bounded

by two lines that intersect perpendicular to the point

(X, Y). The X-axis (horizontal axis) will fill up the

performance level score, while the Y-axis (vertical

axis) will fill the score for the level of expectation

(importance). In figure 1, it can be seen that the

Figure 1: Cartesian Diagram of Pharmaceutical Services

attributes at Rawalumbu Hospital.

location of the pharmaceutical service attributes

analyzed divided into four parts, namely quadrant A

(top priority), quadrant B (maintain performance.),

quadrant C (low priority), and quadrant D (excessive)

(Abalo et al., 2007) (Minta & Stephen, 2017).

The attributes of each dimension that are in

quadrant A indicate the attributes that are considered

to influence patient satisfaction. The handling of

attributes in this quadrant needs to be prioritized by

the hospital management because the existence of

these attributes is considered essential for patients but

cannot be fulfilled by the hospital. Attributes in this

quadrant indicate the weakness of the management of

Rawalumbu Hospital in meeting the needs of patients.

In figure 1 it can be seen that the attributes included

in this quadrant exist: medicine is easy to get, opening

hours of service on time, Medication services are well

served when the patient asks for an explanation of the

drug, the waiting room is clean, Seating in the lounge

is comfortable, and the atmosphere of the waiting

room is calm. Minta and Stephen states that quadrant

A is present the location of various aspects or

attributes of health services felt to be distinguished by

patients, but cannot be felt optimal by patients.

Quadrant A is an attribute position that possesses high

importance, low performance. From quadrant A, it

can be seen that the quality of service performance of

the attribute is still below expectations so that it

affects the patient's dissatisfaction with the attribute.

This dissatisfaction can cause the patient to switch to

another hospital. Customer satisfaction essentially

remains the goal of a business. The creation of

customer satisfaction can provide a satisfactory basis

for repeat purchases and the creation of customer

loyalty. It exists worth noting that customer

satisfaction is a long-term strategy that requires

commitment, both in terms of funds and human

resources (Minta & Stephen, 2017).

Attributes that are in quadrant B shows that need

to be maintained by the hospital in providing services

needed by patients. Carrying out of the attributes in

this quadrant has been considered in conformity with

patient expectations resulting in satisfaction.

Attributes that are in this quadrant are attributes that

are considered crucially essential and have been

implemented satisfactorily. As for the attributes

included in this quadrant are as follows: how the use

of drugs is written clearly on the packages of drugs,

Drug wrapped neatly, Pharmacy staff provides

information on how to use drugs Pharmacists provide

information about the side effects of drugs,

Pharmacists serve recipes politely. Medications are

given in good condition, Spacious waiting room with

air conditioner, The waiting room provides the latest

ICOH 2019 - 1st International Conference on Health

newspapers/magazines. The quality improvement

strategy for this quadrant is to maintain the

performance of these attributes. As explained by Minta

and Stephen that all aspects or attributes contained in

the quadrant B are attributes that are considered

fundamentally crucial by patients, and performance

has been above the average rating. Quadrant B is an

attribute position that has high importance, high

performance. This means that the quality of service

performance of these attributes is by patient

expectations so that it has an impact on patient

satisfaction. For this reason, the attributes in this

quadrant need to be maintained to create patient loyalty

and interest in repurchases (Minta & Stephen, 2017).

Quadrant C shows the service attributes that are

considered to be the expectations of the patient and

his family, where the hospital has run them. The

attributes included in this quadrant have not remained

the key priority to be corrected because the patient is

satisfied with what obtains presently, but will indicate

satisfaction if it is increased again. The attributes

included in the C quadrant are the time for waiting for

drugs is fast, Officers are responsive to patient

problems, the pharmacy staff provides consulting

services that satisfy, the patient's family supervises

regular drug use, Patients gain confidence in the

healing that will be achieved in treatment and

Officers provide the same service regardless of

patients. The quality improvement strategy for this

quadrant is to improve the performance of these

attributes after increasing the performance of the

attributes contained in quadrant A. As granting to

Deng and Pierskalla states, all aspects or attributes

contained in quadrant C are attributes that are

considered less important by patients. Attributes in

quadrant C need to be improved, but the priority is

still below the attributes contained in quadrant A.

Quadrant C is a position attribute that assumes limited

importance, low performance. This means the quality

of service performance of these attributes is still

below the average performance appraisal, thus

impacting on the patient's dissatisfaction with these

attributes. This dissatisfaction receives consequences

for the transfer of patients from other hospitals (Deng

& Pierskalla, 2018).

Quadrant D represents an attribute that is

considered less valuable by the patient, while the

implementation is proper, so it seems excessive but is

considered satisfactory. Attributes included in

quadrant C are as follows: prescription services easy

and straightforward, patients receive proof of

payment of the drug, pharmacy staff dressed neatly,

and there are television facilities in waiting room. The

attributes contained in quadrant D do not need a

quality improvement strategy. Quadrant D is an

attribute position that possesses low importance, high

performance. This means that the quality or

performance of the service attributes accordingly

outperforms patient expectations so that it impacts on

patient satisfaction. The attributes in this quadrant do

not need to be increased. They are sufficiently

maintained to encourage patient loyalty and patient

interest in rehearsing purchases (Abalo et al., 2007)

(Deng & Pierskalla, 2018).

3.6 Gap Analysis

The value of the gap will provide information about

how much a pharmaceutical service attribute at

Rawalumbu Hospital has fulfilled the expectations of

its patients. Part of the resulting difference is

negative, and the smaller the negative value, the

better. The possibility of a positive gap is unusually

slight. Gap analysis results presented in Table 5.

Tabel 5: Gap analysis between performance and

Expectation Level on Attributes Quality of Pharmacy

Services.

No Average

Performance

Average

Expectations

Gap

1 3,15 3,54 -0,39

2 3,17 3,44 -0,27

3 3,18 3,59 -0,41

4 3,08 3,23 -0,15

5 3,18 3,59 -0,41

6 3,15 3,64 -0,49

7 2,48 3,29 -0,81

8 2,91 3,53 -0,62

9 2,83 3,46 -0,63

10 2,43 3,27 -0,84

11 2,55 3,40 -0,85

12 3,06 3,57 -0,51

13 2,87 3,43 -0,56

14 3,09 3,25 -0,16

15 3,29 3,65 -0,36

16 2,70 3,26 -0,56

17 2,58 3,31 -0,73

18 2,58 3,15 -0,57

19 3,20 3,29 -0,09

20 2,89 3,56 -0,67

21 2,68 3,49 -0,81

22 2,47 3,53 -1,06

23 3,08 3,37 -0,29

24 3,09 3,43 -0,34

25 2,45 2,91 -0,46

Average -0,57

From table 5, it can be perceived that the attributes

that contain the enormous gap are the quiet waiting

room atmosphere (-1.06), pharmacists providing

Quality Evaluation of Pharmacy Services in the Outpatients at Hospital in Jakarta

satisfactory consulting services (-0.85), and officers

responding to patient problems (-0.84). These

attributes possess the deepest level of compatibility

between patient expectations and the performance of

the resulting service. These attributes must remain a

priority for performance improvement. As for the

attributes that contain the slightest gap represent the

appearance of neat pharmacy personnel (-0.09), proof

of payment of drugs given to them (-0.16), and

prescription services that are not convoluted (-0.15)

which means these attributes have the highest level of

conformity between patient expectations and the

performance of services produced by the hospital

(Daniel & Berinyuy, 2010).

3.7 Evaluation of Time Dimensions of

Drug Services

The time dimension in common is the drug service

from the patient submitting a prescription until they

receive the drug and drug information.

Pharmaceutical service is mentioned to be useful if

the length of the period the drug service from the

patient submits the prescription until the patient

receives the drug, and drug information is measured

by time. Determination of the time dimension in drug

service is intended so that patients feel comfortable

and not wait for a long time (Kautsar, Nurhayati, &

Gozali, 2017). Based on the RI Minister of Health

Decree No. 129 of 2008 concerning Hospital

Minimum Service Standards, indicators and

standards of service in pharmacy for finished drugs ≤

30 minutes and formulated medicines ≤ 60 minutes

(Indonesian Ministry of Health., 2008). The process

of receiving recipes and giving prices is done by

administrative staff. The clerk receives a prescription

from the patient, gives the serial number, checks the

availability of drugs, performs a price calculation, and

writes the price on the prescription. Most of the

process of receiving recipes and giving the price of

drugs takes 4 minutes (23.97%). This process uses a

computer so that if the computer experiences an

interruption, then this process will take about 1-9

minutes. In the payment process, the cashier calls the

patient to make a payment and provides a payment

receipt after the patient pays. This process is carried

out by one cashier clerk who requires the skills and

agility of officers to enter payment transactions into

computers, print receipts, swipe cards, both credit

cards or guarantee cards, and count money. Some of

these processes took 4 minutes (23.98%). During the

study period, researchers found that several

respondents who made the payment process took up

to 8 minutes. These respondents came from insurance

patients who, at the time, needed a long time due to

technical constraints on the machine and waited for

confirmation from the guarantor. The process of

supplying and compounding medicine is carried out

by two pharmacist assistants and a prescription

interpreter. This process requires the knowledge of

officers to determine the location of drugs along with

substitute drugs if the medicines written on the

prescription do not exist. Besides, it takes the skills

and ability of officers in choosing and preparing

concoction drugs. Most of the time of taking and

compounding the drug is 10 minutes (16.96%), where

the fastest time is 1 minute (7.02%), and the longest

time is 13 minutes (2.34%). This process takes time

because the staff needs to count the number of drugs

to be mixed, wrap, or put the medicine into capsules

one by one or put the mixture of medications into a

container. Officers also need to see a list of

guaranteed drugs and confirm to the doctor or patient

if the prescribed drug is not available. The process of

administering drug etiquette is carried out after the

officer checks the suitability of the drug with the

prescription. The observations showed that the

majority of drug etiquette time was 2 minutes

(31.58%), the fastest time was 1 minute (4.68%), and

the longest time was 9 minutes (1.75%). This process

requires the officers' skills in writing and sticking to

drug labels, checking the compatibility of drugs with

prescriptions, and making copies of medicines if

needed. The process of drug delivery is carried out

by the drug delivery officer. Officers bring drugs to

the drug delivery counter, call the patient, check the

suitability of the patient's identity with proof of

payment receipt, and provide an explanation of the

rules of use. The process of drug delivery takes 4

minutes (25.15%), with the fastest time is 1 minute

(4.10%), and the longest time is 9 minutes (0.58%).

4 CONCLUSION

1. Importance and Performance Analysis results

obtained 6 attributes whose roles are considered

the most important but the patient has not felt

satisfied performance, namely medicine is easy

to get, opening hours of service on time,

Medication services are well served when the

patient asks for an explanation of the drug, the

waiting room is clean, Seating in the lounge is

comfortable, and the atmosphere of the waiting

room is calm.

2. The results of the gap analysis showed that the

attributes of the most significant gap were the

attributes of a quiet waiting room atmosphere,

ICOH 2019 - 1st International Conference on Health

pharmacists providing satisfactory consulting

services, and officers responding to patient

problems.

3. The average serving of medicines has met the

standards, according to the Indonesian Minister

of Health No. 129/2008, which shows that the

prepared recipe can be served in no more than 30

minutes, and the recipe for the concoction will be

ready within 60 minutes.

REFERENCES

Abalo, J., Varela, J., & Manzano, V., 2007. Importance

values for Importance-Performance Analysis: A

formula for spreading out values derived from

preference rankings. Journal of Business Research,

60(2), 115–121.

Daniel, C. N., & Berinyuy, L. P., 2010. Using the

SERVQUAL Model to assess Service Quality and

Customer Satisfaction. An Empirical Study of Grocery

Stores in Umea. Umea School of Business, 1–78.

Deeks, A., Lombard, C., Michelmore, J., & Teede, H.,

2009. The effects of gender and age on health related

behaviors. BMC Public Health, 9, 1–8.

Deng, J., & Pierskalla, C. D., 2018. Linking importance-

performance analysis, satisfaction, and loyalty: A study

of Savannah, GA. Sustainability (Switzerland), 10(3).

Gigantesco, A., Fagnani, C., Toccaceli, V., Stazi, M. A.,

Lucidi, F., Violani, C., & Picardi, A., 2019. The

relationship between satisfaction with life and

depression symptoms by gender. Frontiers in

Psychiatry, 10(Jun), 1–9.

Ginting, A., 2009. Application of Pharmaceutical Services

Standards in Medan in 2008. Jurnal USU Medan.

Hariany, Z. (2014). Analysis of Community Satisfaction

Index (IKM) Towards Public Services at Puskesmas

Xxx. Jurnal Teknik Industri USU, 5(2), 17–21.

Indonesian Ministry of Health., 2004. Decree Of The

Minister of Health of The Republic Of Indonesia No

1197/MENKES/SK/X/2004.

Kautsar, A. P., Nurhayati, N. R., & Gozali, D., 2017. Effect

of prescription waiting time on patient satisfaction

mediated by service quality of pharmacy unit in public

hospital in Bandung city. National Journal of

Physiology, Pharmacy and Pharmacology, 7(11),

1230–1234.

Indonesian Ministry of Health., 2008. Decree of the

Minister of Health of the Republic of Indonesia No.

129/Menkes/SK/II/2008.

Kothari, R., 2004. Research Methodology, Methods and

Techniques. In C. Kotharr (Ed.), (2nd ed.). Jaipur: New

Age International.

M. A. Abujarad Alhuwitat, & Salem, F. S., 2017. The

Impact Of Pharmaceutical Services Quality On

Building A The Impact Of Pharmaceutical Services

Quality On Building A Strong Relationship Between

Pharmacists And Their Customers Introduction : As a

result of globalization , great changes on the economic.

International Journal of Pharmaceutical Sciences and

Research, Volume 8(July), 3138–3145.

Minta, N. K., & Stephen, O., 2017. Importance-

Performance Matrix Analysis (IPMA) of Service

Quality and Customer Satisfaction in the Ghanaian

Banking Industry. International Journal of Academic

Research in Business and Social Sciences, 7(7), 532–

550.

Muslicnah, M, W., & Syamsudin., 2010. The Influence of

Environmental Factors, Individual Factors, and

Marketing Communication Factors on the Purchase

Decision of Pharmaceutical Drugs between Pharmacy

in Sukoharjo Regency and Pharmacy in Surakarta City.

Jurnal USU, 11(7), 73–74.

Ofili, O., 2014. Patient Satisfaction In Healthcare Delivery–

A Review Of Current Approaches And Methods.

European Scientific Journal, 10(25), 25–39.

Indonesian Ministry of Health., 2009. Government

Regulation Of The Republic Of Indonesia Number 51

Of 2009 Concerning Pharmaceutical Work..

Saraswati, M. S., Kristina, S. A., & Zulkarnain, A. K., 2018.

Perceived Service Quality and Patient Satisfaction At

Pharmacy Department in Yogyakarta, Indonesia.

International Journal of Pharmacy and Pharmaceutical

Sciences, 10(2), 42.

Setiawan, N., 2007. Determination Of Sample Sizes Using

Formula Slovin And Krejcie-Morgan Table: Concept

And Its Application. Diskusi Ilmiah Jurusan Sosial

Ekonomi Fakultas Peternakan UNPAD, (November),

10.

Zimmerman, E., & Woolf, S. H., 2014. Understanding the

Relationship Between Education and Health. NAM.

Quality Evaluation of Pharmacy Services in the Outpatients at Hospital in Jakarta