Identification of Service Quality Factors and Patient Satisfaction

Level toward Specialist Doctor Treatment

Susanna Halim, Sri Lestari Ramadhani Nasution, Crismis Novalinda Ginting, and Ermi Girsang*

Faculty of Medical, Universitas Prima Indonesia, Indonesia

Keywords: Quality of service, Patient satisfaction, Tangibles, Responsiveness, Empathy, Control, Confirmation.

Abstract: One of the patient dissatisfaction problems in medical services is an ineffective communication between

patients and doctors which impacts on subsequent visits. To increase the patient satisfaction level, the quality

factors of a specialist doctors treatment are identified. This study used the cross sectional method with

quantitative analytic to the questionnaire of primary respondents. Respondent population are 191 outpatients

in specialist polyclinic unit with 66 samples. Sampling was done by non-random (non-probability) sampling

with purposive sampling. Logistic regression was used to analyze the respondent's data. The results of the

bivariate analysis showed good and satisfied results namely tangibles about 96.2%, responsiveness about

94.6%, empathy about 94.4%, control about 94.7%, trust about 81.2%, self-disclosure about 80.6%, and

confirmation about 96.4%. While the results of multivariate analysis showed that there were only 5 variables

that significantly affected patient satisfaction (p<0.05), namely the tangibles variable (OR=2.455),

responsiveness (OR=4.573), empathy (OR=4.841), control (OR=3.970), and confirmation (OR=3.656). The

highest result for bivariate was shown in the confirmation about 96.4% and for multivariate was on emphaty

with OR value 4.841.

1 INTRODUCTION

The basic nature of a hospital is the fulfillment of the

patients needs and demands in their health problems

solving. Patients always expect an excellent treatment

that is responsive, comfortable, ready and fast toward

patient illness complaints (Hatibie, 2015). Patients

have the right to choose a hospital based on the

quality of health services so that patients can satisfy

their needs as patients (Depkes R.I., 2013). If the

patient is dissatisfied (such as waiting too long, not

friendly, less skilled, less reliable), will make the

patient disappointed, such as research on outpatients

in several hospitals (Rensiner, 2018; Ariffin, 2017

and David, 2014). According to Aziati and Liddy,

almost all patients (94%) believe that waiting time

negatively affects daily life (Aziati, 2018; and Liddy,

2017; Hassan, 2015). Based on satisfaction factors,

patients can also create public perceptions about the

image of a hospital (Depkes R.I., 2014). The average

patient waiting time was 70.18 minutes and was

considered to be a long waiting time category (> 60

minutes) was shown by Laeliyah N., et al’ research in

the outpatient installation of Indramayu District

Hospital. The patient satisfaction level including

dimensions of tangibles, empathy, assurance, and

responsiveness are considered quite satisfied

categories, while the reliability dimension is

considered to be satisfied, based on the five

dimensions of service quality. So the waiting time for

outpatient services has a relationship with patient

satisfaction that is p about 0.042 or chi-square

correlation value about 4.135 (Laeliyah, 2017).

The success of a hospital is not only seen in the

completeness of the facilities that are superior, the

attitude and services of human resources are also

elements that have a significant effect on the services

produced and perceived by patients. Patients will turn

to other hospitals that meet their expectations, this is

because patients are a very valuable asset in

developing the hospital industry (Vonikartika, 2018;

Turnip et al, 2020; Wijaya et al, 2019). One of the

human resources who provide health services in a

hospital is a specialist doctor. However, medical

service arrangements, especially specialist doctors,

still have various obstacles, namely that specialist

staff are lacking and have not been evenly distributed

in various regions in Indonesia. An imbalance of

medical personnel, facilities and infrastructure,

various regulations that have not been implemented

Halim, S., Ginting, C. and Girsang, E.

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment.

DOI: 10.5220/0010282900050016

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 5-16

ISBN: 978-989-758-500-5

properly, and the behavior of doctors as medical

personnel cause problems such as lack of

communication between doctors and patients which

ultimately greatly affects the quality of hospital

medical services (Azwar B, 2005). Patients usually

always compare or ask others recommendations to

choose a doctor for treatment (therapy). Aspects

related to service quality include responsiveness,

reliability (Supartiningsih, 2017; Pathak, 2017;

Aliman, 2016; Hanggraningrum, 2017), empathy and

assurance (Tacoh, 2013), and the appearance of the

hospital (tangibles) (Parasuraman, 1994; Suaib et al.,

2011).

Patient satisfaction will be fulfilled if the doctor's

professional behavior in providing health services is

as expected by the patient or family. Stages of

specialist doctors providing health services include

history, physical examination, therapy, and

termination (E. Gusti, 2016). Specialists in providing

health services that are friendly, comfortable, caring

and able to accommodate the needs of patients are

demands that must be met by the hospital. Even

though in reality, the implementation of health

services is still oriented towards the interests of

providers rather than the interests of patients and the

community (Murtiana, 2016). Outpatient medical

facilities as one of the busiest in Malaysia found that

the highest patient satisfaction is in the service factor

or tangibles priority, especially technical quality,

accessibility, and comfort but satisfaction in terms of

service orientation by doctors is low, especially

communication during consultations, time spent with

doctors, and interpersonal behaviour (Ganasegeran,

2015; Baequny, 2009; Kaban, 2014).

According to the research of Lucas et al, about 70

to 80% of medical errors are strongly related to

human error (Lucas, 2017). Hamdan’s research on

service quality factors covering 4 dimensions, namely

infrastructure, procedures, interactions, and personal,

found that patient satisfaction greatly affects patient

loyalty (Hamdan, 2019). Some studies have argued

that patient satisfaction is needed to guide patient

loyalty (Singh, 2018, Meesala, 2018 and Yacob,

2016). Basic training on communication skills in

sustainably and patient activation programs must be

established to increase patient satisfaction (Azizam,

2015). Agustin N et al have tested the effect of service

quality with word-based communication in pleasing

patients, the results show that better quality will make

patients more satisfied. Satisfied patients will be

motivated to speak and this will increase the number

of patients (Agustin, 2018).

Research by Kashkoli SA et al on eight

dimensions of responsiveness (i.e, dignity,

communication, confidentiality, autonomy,

immediate attention, social support, quality of basic

facilities, and provider choice) and found that the

responsiveness of the hospital has a strong influence

on overall patient satisfaction. Health care facilities

should consider incorporating responsiveness efforts

into their strategic plans. It is recommended that

patients should be involved in their treatment process

and have the right to choose their doctor (Kashkoli,

2017). Research by Chandra S et al. about some factor

related to patient satisfaction with 410 outpatients, the

relationship between interpersonal skills, and

physician communication attitudes, patient trust and

patient satisfaction were found, but found no

relationship with waiting time. However, patients

state that to get a satisfactory consultation, it is worth

to be wait (Chandra, 2019; Mayasari, 2015). Other

studies have shown that patients who have a longer

waiting experience tended to perceive their health

services as less accessible and patients less able to

accept. In addition, spending more time receiving

care services does not always correlate with more

positive service perceptions. Although the waiting

problem is difficult to solve by actually reducing

waiting time, it could be possible to better manage it

such as how patients feel about the length of time they

have to wait and the amount of time they spend

receiving the service. Doctors and nurses can also be

encouraged to give empathy and respect to patients,

provide personal space for patients to talk with

doctors when needed, and treat patients family

members or friends in friendly ways (Xie, 2017).

In previous studies, the majority found discussion

related to patient satisfaction with service quality in

terms of waiting time, length of treatment, and

communication with doctors that included tangible,

responsiveness, reliability, assurance, and empathy.

In this study, the author examined the quality of

specialist doctor’s services and the relatioship

between patent satisfactions with doctors’ services in

the dimensions of tangible, responsiveness, empathy,

control, trust, self-disclosure, and confirmation were

evaluated with a case study by a specialist.

2 METHOD

Based on the Helsinki declaration, the research

protocol No. 004 / KEPK / UNPRI / 2019 has been

approved by the Health Research Ethics Commission

(KEPK), Universitas Prima Medan with KEPKKN

Registration Number: 1271012S Registered /

Accredited. The research was conducted with

quantitative analytics. Analytical research aims to

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

evaluate the factors that influence the quality of

treatments (services) and the patient satisfaction level

with the services of obgyn and pediatrician specialist

with case studies of outpatient in Royal Prima

General Hospital unit at 2019 (Figure 1). The author

choosed pediatrician and obstetrician because the

questionnaire was first tested for validity and

reliability in the pediatrician and obstetrician

Polyclinic Installation at Stella Maris Hospital, in

order to get the same type of categories for the

samples. The research design with cross sectional

method was supported by data directly through filling

the questionnaire. The respondent populations used

were 191 patients with sample of 66 patients.

Sampling was done by non-random (non-probability)

sampling, which sampling is not based on predicted

probability, but is solely based on mere practicality.

With a purposive sampling technique, the researcher

takes a sample based on a particular consideration

made by the researcher herself based on the

characteristics or traits of the population that have

been known beforehand without making comparisons

(Notoatmodjo, 2018).

The sample in this study is determined based on

the formula of determination sample for survey

research. The large sample was calculated using the

Slovin formula, as follows:



dN 1





(1)

Description: n = the number of samples; N = the number of

population; d = Precision 10 %.

Based on the calculation results that the number

of samples was 66 patients.

The inclusion patients criteria for selected sample

were handled by Obstetrics and Gynecology

specialists and Pediatricians, able to communicate

well (can read and write), willing to be respondents,

if they have a physically weak condition or children,

then those who fill out the questionnaire were their

families. While the exclusion patient criteria were

general practitioners, did not answer the

questionnaire in full (unable to read and write), were

not willing to be respondents, and patients who were

medical personnel. The data collection instrument

used was a questionnaire (observation form). In order

to be directed observation and to obtain the really

needed data, it is also necessary to conduct an

observation by using the list of questions like sheets

or checklists that provided in advance. The

requirements for the questionnaire are relevant to the

objectives and research hypotheses, easy to ask, easy

to answer, avoid interviewer bias, generate

standardized data and the data obtained is easily

processed.

As shown in Figure 2, primary data in this study

include the identity of respondents and the services of

specialist doctors consisting of direct evidence

(tangibles), responsiveness, empathy and patient

satisfaction (ie, in terms of empathy, control (guided),

trust, self-disclosure, and confirmation) obtained

through a questionnaire that has been prepared in

advance. A questionnaire was first tested for validity

and reliability to determine the extent to which the

questionnaire could be used as a measurement tool

that represents the cause and variable variables due to

the research. The questionnaire test was conducted on

20 outpatients in the pediatrician and obstetrician

Polyclinic Installation at Stella Maris Hospital.

Validity is an indzex to show a measuring

instrument capability of measuring well

(Notoatmodjo, 2018; Pohan, 2015). Validity test is

done by using the correlation technique with Pearson

Product Moment Correlation Coefficient (r),

determining the correlation between the questions

with the total construct score or variable. A construct

is declared valid if there is a positive and significant

correlation. The correlation value must be greater

than 0.03 or the value of the Corrected Indicator Total

Correlation in the SPSS output is greater than 0.30

(Ghozali, 2016). Reliability is an index that shows the

confidence level in a measuring instrument or the

level of reliability (Notoatmodjo, 2018; Pohan,

2015). To determine the reliability of a variable, a

statistical test was performed using the Cronbach's

Alpha coefficient with the reliability requirement in

the form of a Cronbach's Alpha value > 0.6.19

(Kaban, 2014). Reliability calculations are performed

only on questions that already have a validity test

(Notoatmodjo, 2018).

The questionnaire that had been tested for validity

and reliability was then filled in by 66 samples at the

Royal Prima Hospital. The process of processing data

by computer is carried out through the following

stages: editing, coding, data entry or processing, and

data cleaning (filtering) to find out the missing data,

data variation, and data consistency. The statistical

processing and analysis of data obtained was done by

computerization using Statistical Package for Social

Sciences (SPSS) tools. Initially the data was tested for

normality to determine the test performed.

Univariate analysis aims to explain or describe the

characteristics of each research variable

(Notoadmodjo, 2018), to get a description of the

frequency distribution of sociodemographic

characteristics, like sex, ages, educations,

occupations, and payment model.

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment

Bivariate analysis used quadratic kai test intended

to find out wheather there is or not a relationship

between the two variables namely the dependent

variable and the independent variable, reluctantly

using the chi square test with the significance level

(a=0.05), with the following criteria: Ho is rejected if

p<a (0.05) then there is a relationship between the

independent variable and the dependent variabel , Ho

is accepted if p>a (0.05) then there is no relationship

between the independent variable and dependent

variable (Sugiyono,2017). Quadratic test can be done

if the test requirements are met, i.e no more than 20%

of cells that have an expectation value of less than 5

withdrawal conclusions are carried out based on the p

value of Pearson Chi-Square (Trihendradi, 2013). If

the quadratic test requirements are not met, the

Fisher’s absolute test is used (Hastono&Sabri, 2010).

Conclusions drawn on the Fisher’s absolute test are

based on the p value of the Fisher’s Exact Test

contained in the exact Sig column (2-sided) (Dahlan,

2011). If p<a value is obtained, either from the square

test or Fisher’s absolute test, then it is said that there

is a significant relationship between the two variables

tested. (Dahlan, 2011).

Multivariate analysis was performed to see

whether there was an influence between the

independent variables together with the dependent

variable using logistic regression tests of significance

(a)=0.05,with the criteria: Ho was rejected if p<a

(0.05) then there is an influence between the

independent variables with the dependent variables.

Ho was accepted if p>a (0.05) then there is no

influence between the independent variables with the

dependent variables.

Figure 1: Respondents and data collection at the hospital.

Logistic regression is an approach to making

predictive models or commonly referred to as

Ordinary Least Squares (OLS) regression.

Researchers predict the dependent variable on a

dichotomy scale. The dichotomy scale in question is

a nominal data scale with two categories, for

example: Yes or No, Good or Bad, or High and Low

(Ghozali, 2016).

Figure 2: Scheme of Research Process.

3 RESULTS AND DISCUSSIONS

3.1 Validation and Reliability

The results of the validity test against tangibles and

responsiveness as in Table 1 shows that of the 10

questions that were tested for validity, 9 questions

were declared valid as seen from the value of r-count

(rc) > r-table (rt) (> 0.333) and there was 1 question

declared invalid (Cannot be used as a question in the

study because the calculated value < rtable (<0.333).

While the empathy validity test results show that 10

questions were declared valid since the value of rc >

rt.

Collecting Data

Processing Data

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Table 1: Test Results of Validity of Tangibles,

Responsiveness, and Empathy (rt = 0.333).

No

Tangibles Responsiveness Empathy

rc v rc v rc v

1 0.446 + 0.223 ‐ 0.865 +

2 0.566 + 0.517 + 0.665 +

3 0.855 + 0.575 + 0.750 +

4 0.381 + 0.727 + 0.797 +

5 0.701 + 0.875 + 0.738 +

6 0.786 + 0.785 + 0.787 +

7 0.297 ‐ 0.713 + 0.846 +

8 0.846 + 0.761 + 0.819 +

9 0.604 + 0.704 + 0.685 +

10 0.622 + 0.687 + 0.822 +

The results of the validity test as in Table 2 show

that from the 5 questions carried out it was found that

the five questions were declared valid on the control

variable, trust, self-disclosure and confirmation due

to rc > rt (> 0.333).

Table 2: Results of Full Validity, Trust, Self-disclosure, and

Confirmation Tests (rt = 0.444).

Control Trust

Self-

Confirmation

disclosure

rc v rc v rc v rc v

1 0.773 + 0.783 + 0.953 + 0.727 +

2 0.810 + 0.823 + 0.953 + 0.806 +

3 0.795 + 0.790 + 0.915 + 0.737 +

4 0.602 + 0.697 + 0.834 + 0.747 +

5 0.795 + 0.912 + 0.597 + 0.768 +

Based on Table 3 the reliability test results on

valid questions show that tangibles, responsiveness,

empathy, control, trust, self-disclosure and

confirmation are reliable because the Cronbach's

Alpha value > 0.6.

Table 3: Test Results of Tangibles, Reliability,

Responsiveness, Empathy, Control, Self-disclosure, and

Confirmation.

Variable Cronbach‘s

Alpha

N of

Items

Tangibles 0.753 11

Responsiveness 0.757 11

Empathy 0.778 11

Control 0.796 6

Satisfaction 0.810 6

Self-Openness 0.818 6

Confirmation 0.795 6

3.2 Measured Data using

Questionnaire

The questionnaire weight value from 66 samples are

shown in Table 4. The measured data are categorized

into two groups based on who is ordinal ie satisfied

or dissatisfied as in Table 4. . S is Sample, Ta is

Tangibles, R is Responsiveness, Em is Emphaty, Co

is Control, Tr is Trust, SD is Self Disclosure, and Cf

is Confirmation.

Test of ordinal scale from 10 questions service

quality of specialist doctor (tangibles, responsiveness

and emphaty), that is, the group called not good if the

the questionnaire weight value are between 9-27,

while the group called good if the value are between

28-50. Whereas for outpatient satisfaction variable

which has 5 questions namely control, trust, self

disclosure, and confirmation, it is also divided into

two ordinal scales, namely the group called not

satisfied if the questionnaire weight value is between

5-15, and the group called satisfied if the

questionnaire weight value is between 16-25.

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment

Table 4. The recorded data (questionnaire weight value)

from 66 respondents using questionnaire.

Description: S is Sample, Ta is Tangibles, R is

Responsiveness, Em is Emphaty, Co is Control, Tr is

Trust, SD is Self Disclosure, and Cf is Confirmation.

3.3 Univariate Analysis

Table 5 shows the univariate analysis about the

characteristics distribution of involved respondents in

the research. It was found that of the 66 observed

respondents, majority of respondents were female

about 78.8%. Respondents aged between 19-30 years

and 31-42 years were 39.4%. Respondents with high

school education were 40.9%, unemployed about

6.4%, treatment payments using the BPJS model were

72.7%.

Table 1: Test Results of Validity of Tangibles,

Responsiveness, and Empathy (rt = 0.333).

Variable n=66 %

Sex

Female

Male

78.8

21.2

Ages ( years )

19-30

31-42

43-54

55-70

39.4

12.1

9.1

Educations

No Education

Elementary

school

Middle School

High School

Diploma

Bachelo

3.0

1.5

3.0

40.9

15.2

36.4

Occupation

Unemployee

Employee

entrepreneur

Others

36.4

19.7

18.2

25.8

Payment Model

General

BPJS

Insurance

Compan

18.2

72.7

4.5

3.4 Bivariate Analysis

The Chi Square test with a significance level (α) =

0.05 was used to test the relationship between patient

satisfaction level and the quality with the services of

specialist doctors (Sugiyono, 2017). The purpose of

the bivariate analysis is to obtain a relationship

between the independent variables (service quality

which includes: tangibles, responsiveness, empathy

and control satisfaction, satisfaction of trust,

satisfaction of self-disclosure, and satisfaction of

confirmation) with the dependent variable (patient

satisfaction level). Table 6 is a cross tabulation

between all observed variables (i.e., Tangibles

qualilty, responsiveness, empathy, control, trust, self-

disclosure, and confirmation) towards patient

satisfaction level.

STaREmCoTrSDCfSTaREmCoTrSDCf

1363640202020203436364019202018

2383941202119173545454025252525

3393843212122203645454425252525

4383640202020203736415022222520

5363640202020203836365021202020

6363640202020203936364420202020

7374545202522214039404723222221

8444550202020204145454024202322

9363640202022244245454325252525

10 38 36 40 20 20 20 20 43 40 40 40 22 24 23 21

11 36 36 40 20 20 20 20 44 34 45 50 25 20 25 22

12 36 37 40 20 20 20 20 45 36 36 40 20 20 20 20

13 36 38 47 20 20 22 21 46 38 43 43 23 21 22 22

14 45 45 50 25 25 25 25 47 37 36 40 20 20 20 15

15 44 45 50 25 25 25 25 48 45 45 50 25 20 20 20

16 39 37 40 24 25 25 25 49 36 36 40 20 20 20 20

17 39 38 45 20 25 23 22 50 39 40 45 22 22 22 23

18 40 40 45 23 30 22 21 51 41 41 42 20 20 20 20

19 36 40 41 20 21 20 21 52 36 36 40 20 20 20 20

20 31 37 39 16 17 21 18 53 42 38 40 20 24 21 19

21 36 40 22 20 20 20 20 54 38 43 40 20 20 20 20

22 38 41 40 20 20 20 20 55 36 36 40 20 20 20 20

23 36 44 45 23 22 22 23 56 36 36 40 20 20 20 18

24 36 36 40 20 20 20 21 57 34 36 38 20 20 20 20

25 31 36 50 20 20 20 20 58 37 45 47 23 24 23 25

26 36 35 49 20 20 20 17 59 36 36 40 20 20 20 20

27 39 36 50 20 20 20 20 60 34 36 40 20 20 20 20

28 36 43 50 25 25 21 20 61 43 45 50 25 25 25 25

29 36 45 42 25 25 25 25 62 36 38 40 23 23 20 19

30 38 45 41 25 25 24 21 63 36 43 44 24 24 23 21

31 38 45 50 25 25 25 25 64 36 36 40 20 20 20 20

32 45 45 50 25 25 25 25 65 45 45 50 25 25 25 25

33 39 45 44 20 25 21 24 66 45 43 50 23 24 23 24

Subjet34‐66Subject1‐33

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

3.4.1 Tangibles Factors

From the 66 observed respondents, there were 52

respondents who rated the quality of tangibles as

good with 96.2% of whom were satisfied, while the

remaining 3.8% felt not satisfied with the service.

Furthermore, there were 14 people who rated the

quality of tangibles as not good with 71.4% of them

feel dissatisfied and the remaining 28.8% feel

satisfied with the service. In the results of analysis

with chi square obtained the p value of 0.001 (p < α),

it can be concluded that the variable quality of

tangibles had a significant relationship with patient

satisfaction towards the services of specialist doctors.

The data that obtained from questionnaire showed the

dimension of direct evidence (tangibles) is considered

good and the patient feels satisfied with the doctor

including appearance, friendliness, choice of

language (easy to understand or not), special

attention, touch, cleanliness, neatness and uniform

use, politeness, friendliness, and desire to help are

embodiment of the quality of service from doctors

that can be directly felt by patients. Whereas the

variable quality of tangibles that considered not good

but the patient was satisfied with the doctor's service

was about 28.8%, this is because the Hospital used in

this study had 2 different buildings in the same place

namely Building A and Building B . Building A is an

outpatient polyclinic located on the 2nd floor, while

Building B is on the 1st floor. Directions to the

outpatient installation polyclinic for both buildings

are oftenly illegible or rarely read by patients, so

patients or their families are oftenly confused looking

for the location of the separated polyclinic in the

building.

3.4.2 Responsiveness Factors

In the responsiveness quality, there were 56

respondents who rated the responsiveness well where

94.6% of them were satisfied, while the remaining

5.4% felt dissatisfied with the service. Furthermore,

there were 10 people who rated the responsiveness as

not good, where 90.0% of them felt dissatisfied with

the service, while the remaining 10.0% were satisfied

with the service. In the results of the analysis with chi

square obtained p value of 0.001 (p < α), it can be

concluded that the variable quality of responsiveness

had a significant relationship with patient satisfaction

towards the doctor's service. The questionnaire

results showed that the influence between the

dimensions of responsiveness (doctor's

responsiveness) is considered good with a good level

of satisfaction if able to examine patients

immediately, quickly provide treatment or action,

able to listen to and respond to every patient's

complaint, answer every question about a patient's

illness, take action accordingly procedures, provide

opportunities to ask patients, quickly serve when

patients need immediate help, able to respond quickly

to resolve patient complaints, provide clear and easy

to understand information, and always ask for patient

complaints (Muninjaya, 2011). The responsiveness

quality variable is not good but the level of patient

satisfaction is as much as 10%, this is due to the long

waiting time of the patient. Obstetricians often

perform cesarean section or delivery assistance in

childbirth patients which coincides with the clinic

schedule.

3.4.3 Emphaty Factors

In the empathy quality, there were 54 respondents

who rated the quality of empathy as good with 51

people (94.4%) of them were satisfied, while the

remaining 5.6% were less satisfied with the service.

Furthermore, there were 12 people who rated the

quality of empathy as not good with 75.0% of them

feel dissatisfied and only 25.0% who were satisfied

with the service. The results of analysis with chi

square obtained p value of 0.001 (p < α), which means

that the quality of empathy variables is significantly

related to the services of a specialist. The

questionnaire results showed that the influence of

empathy variables on specialist medical services on

the patient satisfaction level is caused by patients feel

care which includes explanation of the treatment to be

carried out, an explanation of the drugs to be taken,

an efforts to calm the patient's anxiety about his

illness, concern for each patient's complaint, giving

adequate service time, doctor's introduction to new

patients, providing guidance / consultation about the

disease and its prevention to patients, well

communication with patients, listening to patient

complaints with attention with a sense of willing to

help. This shows that there are patients who have

expressed good care for doctors and there are also

patients who have not expressed good care for a

doctor treatment. This can be seen in the empathy

quality variable is not good but the level of patient

satisfaction is as much as 25% satisfied.

3.4.4 Control Factors

In the Control quality, there were 57 respondents who

were satisfied with the guidance, of which 94.7%

were also satisfied with the service and only 5.3%

were less satisfied with the service. Furthermore,

there were 9 people (100 %) who rated dissatisfied

with the quality of control with overall feel

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment

dissatisfied with service. The results of the analysis

with chi square obtained p value of 0.001 (p < α),

which means that control satisfaction variables are

significantly related to the services of specialist

doctors. The questionnaire results showed that the

influence of the guided variable on the patient

satisfaction level occurs because the patient feels

satisfied with the ability to handle patient complaints

in appropriately, the ability to provide an explanation

of their illness, friendly and polite doctor's attitude,

the speed in taking action, readiness to serve at any

time.

3.4.5 Trust Factors

In the guided quality, there were 64 respondents who

were satisfied with trust where 52, 81.2% of them

were satisfied and 18.8% were not satisfied with the

quality of service. Furthermore there are 2

respondents who are satisfied with the sense of trust

with all of them feel dissatisfied with the quality of

service. In the results of analysis with chi square

obtained p value of 1,000 (p > α), which means that

trust has an unsignificant relationship with patient

satisfaction.

3.4.6 Self-disclosure Factors

In the self-disclosure quality, there were 62

respondents who were satisfied with self-disclosure

where 80.6% of them were satisfied and 19.4% were

dissatisfied with the service. Found 4 respondents

who were dissatisfied with self-disclosure who also

felt dissatisfied with the service. In the results of the

analysis with chi square obtained p value of 1.090 (p

> α), by mean the self-disclosure satisfaction variable

had an unsignificant relationship to the satisfaction of

specialist medical services.

3.4.7 Confirmation factors

In the confirmation quality, there were 56

respondents who were satisfied with the

confirmation, of which 96.4% were also satisfied and

3.6% were dissatisfied with the service. Furthermore,

there were 10 respondents who were dissatisfied with

confirmation who also felt dissatisfied with the

service. In the results of analysis with chi square

obtained p value of 0.001 (p < α), which means that

the satisfaction confirmation variable had a

significant relationship with the services. The

questionnaire results showed that satisfaction

confirmation is caused by the patient feel satisfied

with the speed at which the doctor arrives in the room,

satisfied with the delivery and request of patient's

approval for all given medical actions, honesty in

providing information about the patient's condition,

timeliness as promised to the patient, convenience to

be found and contacted when patients need it.

Table 6: Bivariate Analysis.

Patient Satisfaction

Level

value

Satisfy Not

Satisfy

% n %

Tangibles

Good 50 96.2 2 3.8 0.001

Not good 4 28.6 10 71.4

Responsiveness

Good 53 94.6 3 5.4 0.001

Not good 1 10 9 90

Emphaty

Good 51 94.4 3 5.6 0.001

Not good 3 25 9 75

Control

Good 54 94.7 3 5.3 0.001

Not good 0 0 9 100

Trust

Good 52 81.2 12 18.8 1

Not good 2 100 0 0

Self-disclosure

Good 50 80.6 12 19.4 1.09

Not good 4 100 0 0

Confirmation

Good 54 96.4 2 3.6 0.001

Not good 0 0 10 100

3.5 Multivariate Analysis

In multivariate analysis, what is involved is a variable

that has a bivariate value of p < 0.05. From the

bivariate test results, it is obtained that only the

variable quality of tangibles, responsiveness,

empathy, control satisfaction and confirmation can be

performed multivariate analysis. The variables that

have p values < 0.05 are considered influential in this

multivariate model. Table 7 shows the final model of

the influence of the variable quality of tangibles,

responsiveness, empathy, control satisfaction and

confirmation on the satisfaction of specialist doctors.

In Table 7, B is unstandardized beta, this value

represents the slope of the line between the predictor

variable and the dependent variable

(BrownMath.com). SE is Standard Error (estimated

parameter) of the standard deviation of its sampling

distribution (Everitt, 2003). Wald is constraints on

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

statistical parameters based on the weighted distance

between the unrestricted estimate and its

hypothesized value under the null hypothesis, where

the weight is the precision of the estimate (Fahrmeir,

2013; Ward, 2018). DF is degrees of freedom or the

number of values in the final calculation of a statistic

that are free to vary (Animated Software, 2008).The

p-value is the probability of obtaining results as

extreme as the observed results of a statistical

hypothesis test, assuming that the null hypothesis is

correct (Beers B, 2020). OR is Odd Ratio, the

measure of the relationship between exposure and an

outcome (Szumilas, 2010). The results show that all

variables have p-value < 0.05, so all independent

variables significantly influence the dependent

variable.

3.5.1 Quality of Tangibles

Based on the results of multivariate analysis with

logistic regression obtained variable quality of

tangibles significantly influence the services of

specialist doctors with p < 0.05. Tangibles is the

manifestation of services from doctors that can be felt

directly by patients. The tangibles service includes a

good appearance, friendliness to the patient, use of

language that is easily understood, special attention to

the patient, always checking the patient's condition,

cleanliness, neatness, and uniform harmony in

carrying out the task, providing polite service, always

giving a smile to the patient , friendly, greet politely

and want to help.

In the quality of tangibles, in providing services a

specialist doctor must be polite, patient, friendly, not

hesitant, attentive to sufferers, always provide help

given, fostering good relations with nurses who

handle patients, establishing good relations with

patients and their families in order to arise the

patient's trust in the doctor (Azwar A, 2010).

3.5.2 Quality of Responsiveness

Based on the results of multivariate analysis with

logistic regression obtained responsiveness quality

variables significantly influence the service of

specialist doctors with p < 0.05. The dimension of

responsiveness is the ability of doctors to help

patients and their readiness to serve patients in

providing services. Responsiveness services

measured in this study include the speed of

responding to the wishes of patients, giving responses

and good answers to patients, delivering clear

information. Based on the results of the analysis of

the effect between the quality of responsiveness of

specialist doctor services with the level of patient

satisfaction shows that there is an influence between

the dimensions of doctor service responsiveness with

the level of satisfaction. This means that the patient

has a good perception that is if the specialist doctor is

able to examine the patient immediately, be quick to

provide treatment or action, be responsive to every

patient's complaint, answer every question about the

patient's disease clearly, take action according to the

procedure, give the opportunity to ask the patient,

speed services when patients need help, the ability to

quickly respond to patient complaints, provide clear

and easy to understand information, and always ask

for patient complaints, then considered to have

quality service (Muninjaya, 2011).

3.5.3 Quality of Emphaty

Based on the results of multivariate analysis with

logistic regression obtained emphaty quality

variables significantly influence the service of

specialist doctors with p < 0.05. The results obtained

are supported by the results of a study conducted by

Tacoh (2013) about the relationship between doctor

services and the level of patient satisfaction using the

dimensions of service quality and other explanations

so that the results obtained that respondents who care

for good doctor's care by 87.5%. For health official

services, the quality of health services is more related

to the dimensions of staff care to meet patient needs,

good communication, concerns and hospitality in

serving, and / or healing patients' illnesses.

In the quality of empathy, the technical

competence of specialist doctors or other health

professions related to patients includes attention,

care, and the effects of health service outcomes.

Patients see quality health services as a health service

that can meet perceived needs and be organized in a

manner that is polite, timely, responsive and able to

cure complaints and prevent the development or

spread of disease (Azwar A, 2010).

3.5.4 Quality of Control

The results of multivariate analysis with logistic

regression of control satisfaction variables obtained a

significant relationship with the services of specialist

doctors with p <0.05. The doctor and patient

communicate is a health communication form of

interpersonal and complex. In evaluating

communication control patterns between doctors and

patients, they describe four basic forms of

relationships, namely: standard, paternalistic,

consumerist, and mutualistic. The standard

relationship is characterized by a lack of control on

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment

both sides (doctors and patients), and is far from ideal.

The paternalistic form is characterized by the

relationship of the dominant doctor while the patient

is passive, whereas consumerism is associated with

the opposite (focus on the rights and obligations of

the doctor to the patient). Finally, the form of

mutualistic relationships is characterized by sharing

in decision making, and often suggests the best type

of relationship to understand each other (Berry D,

2007). Creating a good interpersonal relationship is a

prerequisite for medical services.

3.5.5 Quality of Confirmations

Multivariate analysis using logistic regression

resulted that the satisfaction variable significantly

influenced the service of specialist doctors with p <

0.05. Confirmation is the display of individual

responses that indicate understanding and has been

given. Confirmation is a kind of feedback that makes

the process of interpersonal communication complete

with the feedback aspect that communication has

been understood and gives rise to an agreement in

agreement with messages. Conversely,

"confirmation" if the contents are not responded in

accordance with what is ordered is an antagonist to

the contents of the message. According to Northous

and Northouse, Confirmation is information that is

valued by sincere recognition of the quality of

communication that has been developed between

doctors and patients. Confirmation is a sincere

appreciation for the benefits of information that has

been given previously.

Table 7: Multivariate Final Model with Logistic Regression

Analysis.

Variables B S.E Wald Df

value

Quality of

Tangibles

1.510 0.961 5.106 1 0.001 2.455

Quality of

Respon

siveness

2.511 0.413 4.210 1 0.001 4.573

Quality of

Emphaty

2.744

0.620

6.230

0.031

4.841

Control

Satisfication

1.876

0.305

5.847

0.012

3.970

Confirmation

Satisfication

1.777

0.285

7.900

0.001

3.656

4 CONCLUSIONS

The examination results of each variable (i.e.,

Tangibles, responsiveness, empathy, control

satisfaction, and confirmation satisfaction) to the

regression coefficient (𝛽) or OR values are all

positive, which means that each variable has the

opportunity to increase patient satisfaction with the a

specialist doctor services about 2.455; 4.573; 4.841;

3.97; and 3.656 times higher when compared to the

variables quality that is not good.

The results of the bivariate analysis showed good

and satisfied results namely 96.2% for tangibles,

94.6% for responsiveness, 94.4% for empathy, 94.7%

for control, 81.2% for trust, 80.6% for self-disclosure,

and 96.4% for confirmation. While the results of

multivariate analysis showed that there were only 5

variables that significantly affected patient

satisfaction, namely the tangibles variable,

responsiveness, confirmation with p-value=0.001,

empathy (p-value=0.031), and control (p-value=

0.012).

REFERENCES

Agustin, N., Hernawati, S., Viphindrartin, S., 2018. Effects

of Service Quality on Word of Mouth through

Satisfaction in Outpatient at Sakinah Islamic Hospital

in Mojokerto Regency, Heal. Notions. 2(3): 311-315.

Aliman, N.K., Mohamad, W.N., 2016. Linking Service

Quality, Patients’ Satisfaction and Behavioral

Intentions: An investigation on Private Healthcare in

Malaysia, Elsevier Ltd. 224: 141-148.

Ariffin, F., Azraii, AB., Kamaruddin, KN., 2017. An

assessment of patient waiting and consultation time in

aprimary healthcare clinic. Malaysian Fam. Physician

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Off, J. Acad. Fam. Physicians Malaysia, Malaysia.

12(1): 14-21.

Aziati, A.H.N., Hamdan, N.S.B., 2018. Application of

queuing theory model and simulation to patient flow at

the outpatient department, International Conference on

Industrial Engineering and Operations Management,

3016-3028.

Azizam, NA., Shamsuddin, K., May-Jun., 2015. Healthcare

Provider – Patient Communicatio: A Statisfaction

Study in yhe Outpatient Clinic at Hospital Kuala

Lumpur, Malays J Med Sci. 22(3): 56-64.

Azwar A., 2010. Pengantar Administrasi Kesehatan

(Introduction to Health Administration), Binarupa

Aksara, Tangerang.

Azwar B., 2005. Menjadi Pasien Cerdas (Terhindar dari

Malpraktik) [Be a smart Patient (Avoid Malpractice)],

Kawan Pustaka. Jakarta.

Baequny A., 2009. Analisis Tingkat Kepuasan Peserta

Askes Sosial PT. Askes Terhadap Pelayanan Dokter

Keluarga di Kota Pekalongan Tahun 2009 (Analysis of

the Satisfaction Level of PT. Askes ‘s social Askes

Paticipants to the Service of Family Doctors in the city

of Pekalongan in 2009), University of Diponegoro,

Beers, B., P-Value Definition. https://investopedia.com.

Updated on 19th February, 2020.

Berry D., 2007. Health Communication: Theory and

Practice. McGraw-Hill Education, New York.

Chandra, S., Ward, P., Mohammadnezhad, M., July 2019.

Factors Associated with Patient Satisfaction in

Outpatient Department of Suva Sub-Divisional Health

Centre, Fiji, 2018: A Mixed Method Study, Frontiers in

Public Health. 7(183) : 1-10.

Dahlan., Sopiyudin., 2011. Statistik untuk Kedokteran dan

Kesehatan (Statistics for Medicine and Health),

Salemba Medika. Jakarta, 5

edition.

David., Hariyanti, T., Widayanti, E., 2014. Hubungan

Keterlambatan Kedatangan Dokter Terhadap Kepuasan

Pasien di Instalasi Rawat Jalan (Relationship of Late

Doctor’s Arrival to Patient Satisfaction in Outpatient

Installation), J. Kedokteran Brawijaya. 28 (1): 31-35.

Depkes R.I., 2013. Kualitas Pelayanan terhadap Pasien

Rawat Jalan (Quality of Care for Outpatients), diunduh

pada tanggal 16 Agustus 2019 dari

http://www.google.com

Depkes R.I., 2014. Konsep Rumah Sakit (Hospital

Concept), diunduh tanggal 16 Agustus 2019 dari

http://www.google.com

E, Gusti Sigar Maulana., Adhani, R., Heriyani, F., 2016.

Faktor yang mempengaruhi kehilangan gigi pada usia

35-44 tahun di kecamatan juai kabupaten balangan

(Factors Affecting Tooth Loss at the ages of 35-44

years in the District of Juai, Balangan Regency),

Dentino. 1: 98–103.

Everitt, B.S., 2003.The Cambridge Dictionary of Statistics.

CUP. ISBN978-0-521-81099-9.

Fahrmeir., Ludwig., Kneib., Thomas., Lang., Stefan.,

Marx., Brian., 2013. Regression, Models, Methods and

applications. Berlin: .Springer. 663. ISBN 978-3-642-

34332-2.

Ganasegeran, K., Perianayagam, W., Manaf, RA., Manaf,

RA., Jadoo, SAA., 2015. Al-Dubai, SAR. Patient

Satisfaction in Malaysia’s Busiest Outpatient Medical

Care, The Sciebtific World Journal. 1-6.

Ghozali, Imam., 2016. Aplikasi Analisis Multivariate

Dengan Program IBM SPSS 23 (Multivariate Analysis

Application with the IBM SPSS 23 Program),

Publishing by Univercity of Diponegoro. Semarang, 8

edition.

Glossary of Statistical Terms, Retrieved 21 August 2008.

Degrees of Freedom. Animated Software.

Hamdan, NS. , Musa, H., Selamat, AS., Rashid, N., 2019.

Investigating Factors of Service Quality Influencing

Patient Satisfaction towards Patient Loyalty,

International Journal of Aqdvanced Science and

Technology. 28(14): 452-459.

Hanggraningrum, MD., Hariyanti, T., Rudijanto, A., 2017.

The Effect of Service Quality on Outpatient

Satisfaction of Dr. Soegiri General Hospital Lamongan,

JAM. 15 (4): 643-649.

Hassan, H., Rahman, MS., Sade, AB., 2015. Contemporary

Healthcare Experience in Malaysia Hospitals, J. Appl.

Bus. Econ., 17(4): 89-94.

Hastono, S.P., & Sabri, L., 2010. Statistik Kesehatan

(Health Statistics), Rajawali Pers. Jakarta.

Hatibie, TWJ. , Rattu, AJ. , Pasiak, T., 2015. Analisis

Faktor-Faktor yang Berhubungan dengan Kepuasan

Pasien di Instalasi Rawat Jalan Bedah RSUP Prof. Dr.

R. D. Kandou Manado (Analysis of Factors related to

Patient Satisfaction in Outpatients Surgery of RSUP

Prof. Dr. R. D. Kandou Manado), J Public Health

Science Unsrat 5: 302–310.

Kaban R., 2014. Pengaruh Komunikasi Dokter Terhadap

Kepuasan Pasien di Rawat Inap Kelas III Rumah Sakit

Umum Haji Medan Provinsi Sumatera Utara Tahun

2013 (Influence of Doctor Communication on Patient

Satisfaction in Class III Inpatient at General Hospital

Haji Medan in the Province of North Sumatra in 2013),

Helvetia Medan’s High Health Sciences.

Kashkoli, SA. , Zarei, E., Daneshkohan, A., Khodakarim,

S., 2017. Hospital responsiveness and its effect on

overall patient satisfaction: A cross-sectional study in

Iran, Int. J. Health Care Quality Assurance. 30 (8): 728-

736.

Laeliyah, N., Subekti, H., 2017. Waktu Tunggu Pelayanan

Rawat Jalan dengan Kepuasan Pasien terhadap

Pelayanan di Rawat Jalan RSUD Kabupaten Indramayu

(The Relationship between Waiting Time to Patient

Satisfaction for Outpatient Services at Indramayu

Regency Onshore General Hospital), Jkesvo. 1(2). 102-

112.

Liddy, C., Poulin, PA., Hunter, Z., Smyth, C., Keely, E.,

2017. Patient Perspectives on wait times and the impact

on their life: A waiting room survey in achronic pain

clinic, Scand. J. Pain., 17: 53-57.

Lucas, A., Edwards, M., 2017. Development of Crisis

Resource Management Skills: A Literature Review,

Clin. Simul. Nurs. , 13 (8): 347 – 358.

Mayasari, F., 2016. Analisis Hubungan Waktu Pelayanan

dan Faktor Total Quality Service terhadap Kepuasan

Identiﬁcation of Service Quality Factors and Patient Satisfaction Level toward Specialist Doctor Treatment

Pasien di Poliklinik Kebidanan dan Kandungan RSIA

Anugerah Medical Centre Kota Metro Tahun 2015

(Analysis of the Relatioship of Service Time and Total

Quality Service Factors to Patient Satisfaction at the

Midwifery and Obstetric Clinic RSIA Anugerah

Medical Center Metro City in 2015), Jurnal ARSI. 214-

230.

Meesala, A., Paul, J., 2018. Service quality, consumer

satisfaction and loyalty in hospitals: Thinking for the

future, J. Retail. Consum. Serv. 40: 261-269.

Muninjaya G., 2011. Manajemen Kesehatan (Health

Management). Jakarta, Medical Book Publisher EGC.

Murtiana, E., Majid, R., Jufri, NN. Hubungan Mutu

Pelayanan Kesehatan kepada Kepuasan Pasien BPJS di

RSUD Kota Kendari Tahun 2016 (Relationship

between The Quality of Health Services to BPJS Patient

Satisfaction at the Kendari City General Hospital in

2016), JIMKESMAS. 1(4).

Northouse LL, Northouse PG., 1998. Health

Communication—Strategies for Health Professionals,

Stamford: Appleton & Lange, 3

edition.

Notoatmodjo, S., 2018. Metodologi penelitian kesehatan

(Methodology of Health Research), Publisher PT

Rhineka Cipta. Jakarta, 3

edition. 115-187.

Parasuraman A, Zeithaml VA, Berry LL, 1994.

Reassessment of Expectations as a Comparison

Standard in Measuring Service Quality: Implications

for Further Research, J Mark. 58: 111.

Pathak, P., 2017. An Analysis of Outpatients’ Perceived

Service Quality and Satisfaction in Selected Private

Hospitals of Kathmandu, J. Business and Social

Sciences Research (JBSSR). 2(1&2): 69-84.

Pohan, IS., 2015. Jaminan Mutu Layanan Kesehatan.

Dasar-Dasar, Pengertian dan Penerapan (Health

Service Quality Assurance. The Basics, Understanding

and Application), Publisher EGC. Hal, 76-77, 143-150.

Rensiner, Azwar, VY., Putra, AS., 2018. Analisa Faktor

Kualitas Pelayanan Terhadap Kepuasan Pasien Rawat

Jalan RSUD Dr.Acmad Darwis (Analysis of Service

Quality Factors on Outpatient Satisfaction of Dr.Acmad

Darwis Terrestrial General Hospital), J Kesehatan

Andalas. 7: 1-8.

Singh, B., Singhi, R., 2018. SERVQUAL impact on overall

satisfaction and brand loyalty: An empirical study in

Delhi-NCR hospital, Int. J. Healthc. Technol. Manag.,

17(1): 49-60.

Stats without Tears Statistics Symbol Sheet.

https://brownmath.com . 2018, 14 February.

Suaib, Indar, Jafar, N., 2011. Pengaruh Kualitas Pelayanan

Terhadap Kepuasan Pasien Di Ruang Rawat Inap Rsud

Syekh Yusuf Kabupaten Gowa (The Effect of Service

Quality on Patient Satisfaction in the Inpatient Room of

the Sheik Yusuf Ash- Land General Hospital Gowa

Districts), Universitas Hasanuddin. Makassar District,

2(4); 43-56.

Sugiyono, 2017. Statistika Untuk Penelitian (Statistics for

Research), Publisher Alfabeta. 28

edition. 389 pages.

Supartiningsih S., 2017. Kualitas Pelayanan dan Kepuasan

Pasien Rumah Sakit: Kasus Pada Pasien Rawat Jalan.

(Quality of Hospital Patient Satisfaction Services:

Cases in Outpatients), J Medicoeticolegal dan Manaj

Rumah Sakit 1018196/JMMR 2016. 6 (1): 9–15.

Szumilas, M., 2010. Explaining Odds Ratios, J Can Child

Adolesc Psychiatry. 19(3): 227-229.

Tacoh, T.S., Pangemanan, J.M., Rumampuk, J.F., 2013.

Hubungan Antara Pelayanan Dokter Dengan Kepuasan

Pasien Di Instalasi Rawat Inap A Badan Layanan

Umum Rumah Sakit Umum Pusat Prof. DR. R.D.

Kandou Kota Manado (The Relationship between

Doctor’s Service and Patient Satisfaction in the

Inpatient Ward A Public Service Agency Central

General Hospital Prof. Dr.D.R. Kandou, Manado City),

Universitas Sam Ratulangi Manado, Epub

Turnip, A., Andrian, Turnip, M., Dharma, A., Paninsari, D.,

Nababan, T., Ginting, C.N., 2020. An application of

modified filter algorithm fetal electrocardiogram

signals with various subjects, International Journal of

Artificial Intelligence, vol. 18, no., 2020.

Wijaya, C., Andrian, M., Harahap, M., Turnip, A., 2019.

Abnormalities State Detection from P-Wave, QRS

Complex, and T-Wave in Noisy ECG, Journal of

Physics: Conference Series, Volume 1230, (2019)

012015. doi:10.1088/1742-6596/1230/1/012015.

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical