Bayu Kumoro Jati 16591/PS/IKM/05 MASTER DEGREE PROGRAM ...

PATIENT’S PERCEPTION AND THEIR FAMILY TOWARDS SERVICE
QUALITY IN EMERGENCY UNIT BUDHI ASIH LOCAL HOSPITAL
PUBLICATION SCRIPT
To Fulfil a Part of Requirements of Master Degree
Main Interest of Hospital Management
Medical Science Study Program
Medical Sciences Department
Proposed by :
Bayu Kumoro Jati
16591/PS/IKM/05
To
MASTER DEGREE PROGRAM
DOCTORAL FACULTY
GADJAH MADA UNIVERSITY
YOGYAKARTA
2011

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PATIENT’S PERCEPTION AND THEIR FAMILY TOWARDS SERVICE
QUALITY IN EMERGENCY UNIT BUDHI ASIH LOCAL HOSPITAL
Bayu Kumoro Jati 1 , Agastya 2
ABTRACT
Backgrounds: Budhi Asih Local Hospital is one of the regional public
hospital in DKI Jakarta Province, type B hospital with 254 bed capacity,
serve health care for East Jakarta Population and surroundings. 80 %
inpatient comes from Emergency Unit Budhi Asih Local Hospital.
Acknowledge for providing health care services among poor people.
Through box suggestion and mass media there are complaints regarding
patient’s dissatisfaction. There has been no research in Budhi Asih Local
Hospital regarding the patient complaints.
Objectives: The purpose of this study is to analyze patient’s perception
level in order to give input for health care policy to preserve services
quality in Emergency Unit Budhi Asih Local Hospital.
Methods: This is a descriptive study with cross sectional prospective
design. Questionnaires which were used as measuring instruments were
adopted from SERVQUAL instruments (Parasuraman et al, 1988).The
health care services perception will be better if patient’s satisfaction levels
are higher.
Results: Overall patient’s perception and their family towards quality
services in Emergency Unit Budhi Asih Local Hospital is satisfying enough
with score 4,944 or 82,33%. Even though there is an aspect of
SERVQUAL dimension with the lowest score which is responsiveness
dimension: quick responds toward services to costumer. GAKIN status
patient has the highest score in all SERVQUAL dimension (112,74).
Conclusions: Management policy regarding to service quality in Budhi
Asih Local Hospital was satisfying enough. Maintenance and monitoring
policy of services quality should develop continuously, in order to have an
optimal standard of health care services.
Keywords: Budhi Asih Local Hospital, patient’s satisfaction, service
quality, patient’s perception.
1. Functional staff of Emergency Unit Budhi Asih Local Hospital
2. SE, MBA, MPM, Faculty of Public Health, Gadjah Mada University,
Yogyakarta

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INTRODUCTION
Budhi Asih Regional General Hospital is a type B non-educational
Regional General Hospital established by the Decree of the Minister of
Health of the Republic of Indonesia No. 434/Menkes/SK/IV/2007 April 10,
2007 and a Technical Implementation Unit of DKI Jakarta Health Agency.
Currently Budhi Asih Regional General Hospital has a capacity of 254
beds that provide various types of medical services consisting of the
Emergency Unit, which opened 24 hours continuously, specialists and
sub-specialists. Medical support services includes the Clinical Laboratory,
Radiology, Electro-medical, Operating Room, Pharmacy and Corpse
Conservation, all of it are ready to serve 24 hours.
Target of the Budhi Asih Hospital Services are to serve the people
of East Jakarta and surrounding areas, as a referral center for the area of
East Jakarta, and to carries out social mission as a service center for
patient of Poor Families (GAKIN) and GEPENG (vagrant and panhandler).
In accordance with these targets, Budhi Asih Regional General Hospital
serves a variety of walks of life, the average is from lower class to middle,
from low to high levels of education, so that the plurality provides its own
difficulties in serving the community as a customer.
Of all patients who check into Budhi Asih Regional General
Hospital, according to Budhi Asih Hospital Yearbook 2008, the Emergency
Unit (UGD) contributes a lot to the hospital because 80% of inpatients are
coming from the emergency unit. It is because this unit are open 24 hours
and automatically serve the patient after all polyclinic closed at noon. As
the spearhead and the frontline of hospital services, the services
contained in the emergency unit will reflect the image of service in the
Budhi Asih Hospital. Therefore, management in emergency unit requires
the handling is good and should get special attention from management of
Budhi Asih Hospital.
In practice, service of emergency unit in Budhi Asih Hospital
performed by medical and paramedical personnel with the basic

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knowledge and skills of nursing as well as trained medical knowledge, still
found a lot of complaints from customers. In accordance with the
standards of Emergency Unit, all emergency service personnel of Budhi
Asih Hospital have been specially trained to handle emergency cases.
However there is still dissatisfaction with the Emergency Unit service in a
suggestion box, the writings in both print and electronic media to the
service and performance of the Emergency Unit of Budhi Asih Hospital.
This dissatisfaction is not in accordance with the vision, mission and goals
of Budhi Asih Hospital that is capable of providing excellent service to the
people who come to the Emergency Unit of Budhi Asih Hospital.
Based on research background that has been described above, it
can be concluded that image of Regional General Hospital Budhi Asih
would be good if the patients who come to the Emergency Unit of the
Regional General Hospital Budhi Asih can be served as well, correct and
satisfactory.
RESEARCH METHODOLOGY
This study used design study of cross-sectional prospective study in
the Emergency Unit of Budhi Asih Hospital in East Jakarta to patients or
families who accompany, visit and treatment, with the following provisions:
1. Patient is alive and has a good awareness.
2. Patients are cooperative
3. If the patient is unconscious or uncooperative, then
the family who accompany may substitute as a
respondent.
4. Patients or their families came to the Emergency Unit
of Budhi Asih Hospital since the beginning, not to
other units or are being treated at this hospital.
This study aims to determine the relationship between perceptions
of patients or their families seeking treatment in the emergency unit of
Budhi Asih Hospital with an acceptable quality of service and patient

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satisfaction. Therefore it was used variables that consist of independent
and dependent variables. The dependent variable is level of satisfaction of
patients or families who accompany. As for the independent variable is a
factor / SERVQUAL Model attribute, those are: physical evidence (the
state or existing facilities) consists of four questions, reliability consists of 5
questions, responsiveness of officers consists of 4 questions, warranty of
service capabilities consist of 4 questions, and empathetic of care workers
consists of 5 questions.
The subjects in this study are respondents data, i.e. data
questionnaire that has been filled by patients or families who accompany,
they are who come for treatment in the Emergency Unit of Budhi Asih
Hospital. While the objects in this study is result of assessment of quality
service that has been processed by instrument of SERVQUAL Model.
Population used in this study were all patients who come for
treatment to the Emergency Unit of the Budhi Asih Hospital, East Jakarta,
who was aged adults (older or equal to 17 years) so as to be able to fill out
questionnaires, cooperative and well-consciousness (not fainting, shock or
coma).
Inclusion Criteria:
1. Patients or families of patients who were treated in the
Emergency Unit of Budhi Asih Hospital
2. Respondents know, understand and cooperative on
the question and fill out a questionnaire of the study
3. General condition of the patients or their family makes
it possible to perform filling out a questionnaire
4. Willing to follow the research and fill out
questionnaires
Exclusion Criteria:
1. Rather than patients or families of patients who were
treated in the Emergency Unit of Budhi Asih Hospital

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2. Respondents did not cooperate because of pain or
loss of consciousness and the patient's family did not
cooperate because of panicky
3. Illiterate
4. Not willing to follow the research and neither to fill out
questionnaires
This research was conducted by using a questionnaire on these
variables, translating variables in terms of assessment instruments and
appropriate questions according to the assessment instrument of
SERVQUAL Model. The research was conducted at the Emergency Unit
of Budhi Asih Hospital, East Jakarta, Jl. Dewi Sartika during the month of
September 2010. The research team has been formed by involving of all
nurses in the emergency room.
The next stage is perform approach and coordination to the
management party of Budhi Asih Hospital with a research permit, to make
this research as it should have permission, even integrated with quality
improvement programs of Budhi Asih Hospital.
Dividing questionnaire conducted by research staff who are
previously briefed beforehand about the purpose of research, how to fill
the data and its implementation plans.
The data has been collected will be analyzed by statistical methods
with test analysis of one-way different variants of F test (One Way
ANOVA) which is an analysis to determine differences of service quality
variables that are perceived and satisfaction of patients or families who
accompany them. Post-ANOVA test is to determine items differences of
inter-status dimensional quality of patient, and T-test is to determine
perception differences in the service quality among patients with health
insurances (ASKES), patients with social department insurances
(DINSOS), patients of poor families (GAKIN), and general patients.
RESEARCH RESULTS

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1. Characteristics of Respondents
This study was used a questionnaire to obtain data from 80
research subjects. Research subjects are patients or their families who
visit the Emergency Unit of Budhi Asih Hospital. The data contained
description of the characteristics of research subjects based on patient
status.
Table 1:
Status Patient Characteristics Based on Visitation to the Emergency
Unit of Budhi Asih Hospital
Number Patient Frequency Percentage (%)
1.
2.
3.
4.
ASKES
DINSOS
GAKIN
General
1
1
47
31
1.3
1.3
58.8
38.8
TOTAL 80 100
Number of patient ASKES is only 1 person or 1.3% of all research
subjects, as well as the number of patients DINSOS. Number of patients
GAKIN is 47 people or 58.8% which is the majority of research subjects.
And number of General patients is 31 people or 38.8% of all research
subjects.
2. Patient Perceptions on Quality of Service
Table 2:
Perceptions on Service Quality of Emergency Unit of Budhi Asih
Hospital
Number Dimension Average values
1.
2.
3.
4.
5.
Physical Evidence
Reliability
Responsiveness
Assurance
Empathy
4.92
4.90
4.89
5:00
5:01
Average 4944
Patient's or their family's assessment to Emergency Unit of Budhi
Asih Hospital service is in an average total of 4.944 or 82.33% of the Likert
scale with range 1-6. Based on the Likert scale it is known that the

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average of patient's perception on the service quality is 4.94 is in the
range rather agree to agree. The highest value found in the empathy
dimension of 5.01, while the lowest value found in the dimension of
responsiveness of 4.89. Patient's perceptions on the empathy include: (a)
Emergency Unit of Budhi Asih Hospital gives special attention to patients
and their families and there is a suggestion box, (b) doctors and nurses
give special attention (personal) over complaints of disease, (c) doctors
and nurses understand the needs of patients and their family, (d)
Emergency Unit of Budhi Asih earnest attention to the interests and
complaints of patients and their families, (e) Time of service in accordance
with the wishes of patients and their families.
3. Analysis of the patient's perception on the service quality
of each patient's status
Patient's assessment on service quality in the Emergency Unit of
Budhi Asih on the dimensions of physical evidence was viewed per item.
Item of modern equipment was ranked lowest by number 366 with an
average of 91.5. Facilities which are visual appeal have ranked the highest
with number 407 with an average of 101.75.
Patient's assessment on service quality in the Emergency Unit of
Budhi Asih on the dimensions of reliability is the highest that is equal to
411 with an average of 102.75 because it is open 24 hours and serve on
time. Item of time is promised to wait and get the services are kept in
accordance with the promise is the lowest that is 368 with an average of
92.
The highest patient's assessment on service quality in the
Emergency Unit of Budhi Asih on the dimensions of responsiveness is in
the item number 2 in which patients served immediately in the Emergency
Unit of Budhi Asih that is 402 with an average of 100.5. While the lowest
item is Emergency Unit of Budhi Asih informs exactly what time patient will
receives a service that is 371 with an average of 92.75.

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Patient's assessment on service quality in the Emergency Unit of
Budhi Asih on the dimensions of guarantees, the highest is in the item
both doctors and nurses are courteous in serving patients that is 410 with
an average of 102.5. While the lowest item is both doctors and nurses
seem to have the full support of the hospital leader that is 387 with an
average of 96.75.
Patient's assessment on service quality in the Emergency Unit of
Budhi Asih in the dimensions of empathy, the highest is in the item it is
open 24 hours and the time of service is in accordance with the wishes of
patients that is 407 with an average of 101.75. While the item of doctors
and nurses understand the needs of patients is the lowest that is 392 with
an average of 98.
4. Analysis of Patient's Perceptions on Service Quality to the
Patient of ASKES, DINSOS, GAKIN, and General Patient
The purposes of analysis are to compare the quality of care
received by patients, among patients with health insurance (ASKES),
patients with social department insurance (DINSOS), patients from poor
families (GAKIN), and public patients.
Table 3:
Perceptions Differences in Service Quality to Patients of ASKES,
DINSOS, GAKIN, and Public
Dimension ASKES DINSOS GAKIN Public
Physical Evidence 10 17 979 567
Reliability 21 25 1196 717
Responsiveness 21 20 949 575
Assurance 15 20 960 605
Empathy 26 25 1215 738
Total Score 93 107 5299 3202
The average score on the 93 107 112.74 103.29
number of respondents
There are differences between patients with health insurance
(ASKES), patients with social department insurance (DINSOS), patients of
poor families (GAKIN) and general patients in all dimensions. The results

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of the mean score obtained that GAKIN patients have a higher perception
value of the service quality compared to the status of the other patients in
all dimensions of SERVQUAL that is 112.74.
DISCUSSION
1. Characteristics of Respondents
Respondents in this study consisted of patients or families of
patients who were treated in Emergency Unit of Budhi Asih Regional
General Hospital. Emergency Nurses Association (2005) stated that the
main customers of the Emergency Unit in a hospital are the patients and
their family. The largest number of respondents in this study is come from
the status of GAKIN patients (58.8%). This is due to Budhi Asih Hospital is
a referral center for East Jakarta GAKIN. Since the beginning of the
hospital founding, ranging from "Taman Harapan", the Polyclinic of
Unemployment Home which has the mission of providing social services in
the areas of health care for displaced (poor) patients, especially for the
homeless drifter and panhandler (GEPENG) until it is formalized and
administered by health department of DKI Jakarta, Budhi Asih Hospital
serves patients with GAKIN status. And this is has long been known to the
surrounding community.
2. Patient's Perceptions on Service Quality
The average of patient's perception on the service quality in all four
groups of patients namely patients of ASKES, DINSOS, GAKIN, and
general patients are 4.94 in the Likert scale. This score is between rather
agree and agree. This may imply that the service provided by the Budhi
Asih General Hospital is good enough according to the patient's
perception that is 82.33%. This may be caused by management that
responds to increase quality of hospital services. Budhi Asih Hospital
evaluates the quality of health care through patient questionnaires and
morning report that is held every day.

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The highest element of quality dimension is the dimension of
empathy, followed by guarantee dimension. Empathy dimension includes,
among others, give individual attention to customers, employees treat
customers fully attention, earnestly give priority to the interest of
customers, employees understand customer's needs, and operating time
(hours) is comfortable. While the dimensions of assurance includes
employees who foster a sense of trust to customers, making customers
feel safe while doing the transaction, employees who are consistently
courteous, and employees are able to answer customer's questions.
The lowest element of the quality dimension is responsiveness. The
dimensions of responsiveness include, among others, inform the
customers about the certainty of service applying time, prompt service for
customers, willingness to help customers, and readiness to respond to
customer requests. The lowest element of this dimension is Emergency
Unit of Budhi Asih informs exactly what time the patient will receive
services. This is probably caused by the scale of priority (triage) on the
handling of patients in the Emergency Unit of Budhi Asih and the big
number of patients due to Budhi Asih Hospital is a referral hospital in East
Jakarta and surrounding areas. In addition, the lack of medical personnel
to serve the quota of patients in which sometimes is in great quantities at
certain times.
Currently the quality of health services must be attended. Because
it is ordered in Law no. 44 Year 2009 on the Hospital, as contained in
article 29 paragraph 1 point (b), each hospital has an obligation to provide
health care safety, quality, antidiscrimination, and effectively by priority the
interests of patients according to standard hospital care.
3. Patient's Perceptions on Service Quality to the Patients of
ASKES, DINSOS, GAKIN, and General
Based on the research results there are differences in perceptions
of quality of care among patients of ASKES, DINSOS, GAKIN, and

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general in all dimensions of quality of service that is physical evidence,
reliability, responsiveness, assurance, empathy, and the dimensions of
quality. Health care insurances for poor families (GAKIN) is a assurance of
health care provided to poor families and families who need health
services include outpatient and inpatient, as defined, both in the public
health center or a designated hospital in DKI Jakarta area. Patients of
social department referral are patients who include destitute, homeless,
panhandler and the inhabitants of the social institute under social
department of Jakarta are all referred by a covering letter from the Sub
Social Department, Social Department of DKI Jakarta and the Department
of Social Jakarta, all of which must be served free of charge in accordance
with the agreement between the Social Ministry and Local Government of
DKI Jakarta.
It is obtained that score of GAKIN patients is higher than other
patients. It is imply that GAKIN patients feeler the service provided by
emergency unit of Budhi Asih Regional General Hospital. This is in
accordance with the daily reality in which there are many grievances or
complaints from other patients, particularly public patients. This is the
result of a very necessary concern for all parties to be able to provide
optimum services for all groups of patients adjust to the expectations of
groups that deliver most of the complaints.
This is understandable because GAKIN patients who come from
poor families are more accepting of the situation and feel better with the
facilities provided by the hospital because there is not much demand in
accordance with their existence in the environment.
CONCLUSIONS AND SUGGESTION
Based on the results of research and discussion that have been
raised in the previous chapter, the conclusion can be drawn as follows:

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1. There is accurate data / information on the patient's
perception and their families to service quality in the
Emergency Unit of Budhi Asih General Hospital
2. There are differences in identification of key dimensions and
aspects within each dimension that requires quality
improvement
3. There are differences in expectations and the quality of care
received by customers
4. There is a relationship between SERVQUAL dimensions to
the level of patient satisfaction.
5. Reliability significantly influences the level of patient
satisfaction in the Emergency Unit of Budhi Asih Hospital.
6. Responsiveness significantly influences the level of patient
satisfaction in the Emergency Unit of Budhi Asih Hospital.
7. Assurance is significantly influence on the level of patient
satisfaction in the Emergency Unit of Budhi Asih Hospital.
8. Empathy is significantly influence the level of patient
satisfaction in the Emergency Unit of Budhi Asih Hospital.
9. Physical evidence is significantly influences on the level of
patient satisfaction in the Emergency Unit of Budhi Asih
Hospital.
The advice can be given:
1. Management of the hospital set a new policy regarding the
services that is refer to patient satisfaction and disseminated
to all doctors, nurses, and all parties involved in services
2. The management of the hospital continuously monitor the
quality of service either by filling out a checklist for each
patient's home that is attached on the status or by
conducting interviews

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3. For uniformity of service management need to standardize
the service performance process and doing a good training
of personnel
4. Encourage motivation to staff to improve service quality
through policies that can support quality of service.
5. Make similar studies in both Inpatient and Outpatient Unit so
as to the hospital has data service quality as a whole.
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