Analysis Satisfaction of Geriatri Outpatients Assessed From The Quality of Service, Perception, and Response Time in Karangploso Public Health Center, Malang District

Published : May 2


INTRODUCTION
Patient assessment of nurse services comes from patient experience. Aspects of patient experience can be interpreted as a treatment or action from a nurse who is or has been, is felt and borne by someone who uses nurse services (Jatmiko, 2013).
There are many problems regarding the lack of satisfaction from health care workers, one of them is due to the long response time which causes the patient's perception to be bad. A number of phenomena are often encountered due to the large number of health workers' agendas, internal and external factors that cause officers to override the response time which should not be more than 60 minutes, patients have to wait a long time for the presence of these health workers starting from the waiting time spent in the administration to the the inspection queue must wait again. So that this

MATERIALS AND METHODS
In this study, researchers used a quantitative analytic design with a cross sectional approach, namely a study to know the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data at once (point time approach). The study was only observed once and measurements were made of the character status or subject variables at the time of examination. This does not mean that all research subjects were observed at the same time (Soekidjo, 2017). This research will analyze Outpatient satisfaction in terms of service quality, perception and response time at Karangploso Public Health Center, Malang District.
The total population were 152 respondents and a sample of 105 respondents who were taken using the Accidental Sampling technique. Data was analyzed by using Linear Regression test. This research has passed the ethical test with SK number: 1892 / KEPK / III / 2020 Based on the results of Linear Regression analysis, it shows that the p-value is 0.029 <0.05, then H0 is rejected and H1 is accepted, so it is concluded that partially there is influence response time outpatient satisfaction geriatrics at the Karangpploso Public Health Center, Malang District.

Simultaneously
Based on the results of the Multiple Linear Regression analysis, it shows that with a p-value of 0.000 <0.05, H1 is accepted so it can be concluded that simultaneously there is influence service quality, perception and response time to outpatient satisfaction geriatrics at the Karangpploso Public Health Center, Malang Disrict with the amount of influence of 84%.

Quality of Health Care Workers at Karangploso Health Center, Malang Regency
The results showed that most of the respondents had a good service quality category as many as 58 respondents (55.2%). Meanwhile, a total of 47 respondents (44.8%) had poor service quality category.
Service is an activity or a series of tools that are invisible (cannot be felt), which occurs as a result of interactions between consumers and employees or other things provided by service providers that are intended to solve consumer problems (Winarsih, 2015).
People as consumers certainly want quality service. Service quality is defined as the level of excellence expected and control over that level of excellence to meet customer desires. Service quality can be interpreted as an effort to fulfill the needs and desires of consumers and the accuracy of its delivery in balancing consumer expectations (Oktafani, 2014).
One of the services that is widely used by the community is health services. Utilization of health services by means of the use of service facilities provided in the form of outpatient care, inpatient care, home visits by health workers or other forms of activity from the utilization of these services which are based on the availability and continuity of services, community acceptance and fairness, easily accessible to the community. affordable and good quality (Anwar, 2014).
Good service is health service that is available in the community (acceptable) as well as sustainable. This means that all types of health services needed by the community are found and their presence in the community is available at any time of need. Health services must be appropriate and acceptable by the community. This means that health services can overcome health problems faced, do not conflict with customs, culture, beliefs and beliefs of the community, and are unnatural, are not a good health service condition.
The location is easy to reach by the community, so the distribution of health facilities is very important. Reach helper facilities to determine effective demand. If the facility is easily accessible by means of available transportation, this facility will be widely used. Past user levels and trends are the best indicators of short and long term changes in future demand.
The services provided are affordable (affordable) by the community, where efforts are made for the cost of these services in accordance with the economic capacity of the community. Expensive health services may only be enjoyed by some people. And shows the level of perfection of health services provided (quality) and shows the cure and safety measures that can satisfy service users in accordance with predetermined standards.
From the research results, the researcher argues that health services must have various basic requirements, namely basic requirements that give influence to the community in determining their choice of the use of health services. Services that are needed by the community in general are health services that are available in the community and are sustainable, health services must be reasonable and acceptable to the community, the location is easily accessible to the community, the services provided are affordable and the perfection of health services provided. With good service it will attract people to want to use health facilities properly and wisely.
In the research results, it was found that most of the respondents had a good quality service category, but almost half of the respondents considered that the quality of service provided by health workers to patients was in the poor category. Where this is because patients consider that health workers are not responsive to immediately providing health services so they tend to be slow. In addition, it is also because patients consider that health workers are less concerned with patient complaints where officers are less concerned with patients.

Perceptions of Geriatric Outpatients at the Karangploso Public Health Center, Malang District.
The results showed that most of the respondents had a good category perception of 58 respondents (55.2%). Meanwhile, a number of 47 respondents (44.8%) had a poor perception category.
Service is an activity or a series of invisible (intangible) tools, which occurs as a result of interactions between consumers and employees or other things provided by service providers intended to solve consumer problems (Ratminto and Winarsih, 2015) .
People as consumers certainly want quality service. Service quality is defined as the level of excellence expected and control over that level of excellence to fulfill customer desires (Dimas and Oktafani, 2014). Service quality can be interpreted as an effort to fulfill the needs and desires of consumers and the accuracy of their delivery in balancing consumer expectations (Dimas and Oktafani, 2014).
Good service is health service that is available in the community (acceptable) as well as sustainable. This means that all types of health services needed by the community are found and their presence in the community is available at any time of need. Health services must be appropriate and acceptable by the community. This means that health services can overcome health problems faced, do not conflict with customs, culture, beliefs and beliefs of the community, and are unnatural, are not a condition of good health services (Suryono, 2013).
The goals of outpatient services include providing consultation to patients who require the opinion of a specialist, whether or not to take medication and to provide follow-up for inpatients who have been discharged but whose health conditions still need to be controlled Outpatient care should have a comfortable and pleasant environment for patients. This is important to note because it is from outpatient care that the patient gets the first impression about the puskesmas. A good outpatient environment should be spacious enough and have good air circulation, comfortable seating, attractive furniture and no disturbing noises.
Based on the results of the study, it was found that many respondents had perceptions in the poor category. Where this is because the patient's expectations do not match the reality of the services provided by health workers. According to respondents, several things that must be improved are related to the patient's trust in the ability of health workers, where most respondents do not believe in the abilities of health workers. This is also because officers are considered to be slow in responding to complaints made by patients. So that the services provided are not in accordance with patient expectations.

Response Time Of Health Officer at Karangploso Public Health Center, Malang District
The results showed that most respondents had a fast response time category as many as 92 respondents (87.6%). While a number of 13 respondents (12.4%) had a long response time category.
Waiting time is the time used by patients to get health services from the registration point to entering the doctor's examination room. Patient waiting time is one component that has the potential to cause dissatisfaction. The length of the patient's waiting time reflects how the hospital manages the service components that are tailored to the patient's situation and expectations (Depkes RI, 2010).
The category of distance between waiting time and examination time that is estimated to be satisfactory or unsatisfactory for the patient includes, among others, when the patient arrives, starting from registering at the counter, queuing and waiting for a call to the general polyclinic to be analyzed and examined by a doctor, nurse or midwife for more than 90 minutes ( old category), 30-60 minutes (moderate category) and ≤ 30 minutes (fast category). Waiting times in Indonesia are determined by the Ministry of Health (Kemenkes) through minimum service standards. Every hospital or health center must follow the minimum service standards regarding this waiting time. The minimum standard of outpatient services based on the Ministry of Health Number 129 / Menkes / SK / II / 2008 is less or equal to 60 minutes (Ministry of Health, 2013).
The speed and accuracy of assistance provided to patients who come to the Puskesmas require standards according to their competence and abilities so that they can guarantee a health care treatment with a fast response time and appropriate handling. This can be achieved by improving facilities, infrastructure, human resources and management of Public Health Center according to standards (Kepmenkes, 2009).
The Canadian of Association Emergency Physicians (2012) wrote that the incidence of the lack of stretchers for the management of acute cases has a serious impact on the arrival of new patients who may be in a very critical condition. The American College of Emergency Physicians (2013) writes that in Puskesmas that are experiencing problems with the abundance of patients who want to get services, placing a doctor in the triage area can speed up the process of returning patients or discharge for minor patients and help initiate treatment for patients whose conditions are more ill. Green, et.al. (2014) who argue that very small and simple changes in staffing have an impact on delays in handling.
Response Time (response time) is a service standard that must be owned by a health service. Researchers also concluded that the Response Time is an element of Responsiveness which is one of the factors of patient satisfaction at the Public Health Center. The achievement of the standard nurse response time in the service at the Public Health Center is influenced by the availability of infrastructure, human resources and a good Puskesmas management system. With a good arrangement, the Public Health Center can provide services with the right time accuracy and be able to provide good service even though there are many patients who come.
From the results of the study, the researcher argues that the response time given by health workers is at Karangploso Public Health Center, Malang District overall in the fast category. This can happen because the management system implemented at the public health center is well organized, where the functional positions are very professional. The response time tends to be faster during the day, while in the morning it is less fast due to technical problems related to the health center policy which requires every employee to do a morning report. However, despite this policy, all patients can be served in less than 60 minutes.

Geriatric Outpatient Satisfaction at Karangploso Public Health Center, Malang District
The results showed that most of the respondents had a satisfied category of satisfaction as many as 60 respondents (57.1%). While a number of 45 respondents (42.9%) have a category satisfaction is not satisfied.
Understanding the patient's needs and wants is an important thing that affects patient satisfaction. Satisfied patients are a very valuable asset because if patients are satisfied they will continue to use the services of their choice, but if patients are unsatisfied they will tell others about their bad experiences. To create patient satisfaction, health facilities must create and manage a system to obtain more patients and the ability to retain patients (Hendrawan, 2015).
Patients are sick people who are treated by doctors and other health workers at the practice (Yuwono, 2017). Meanwhile, satisfaction is a person's happy feeling that comes from a comparison between pleasure in an activity and a product with expectations (Nursalam, 2016). Nursalam (2016) states that satisfaction is a feeling of happiness or disappointment for someone who appears after comparing their perceptions or impressions of the performance or results of a product and their expectations. Tjiptono (2014) argues that customer satisfaction is an emotional response to experiences related to certain products or services purchased, retail outlets, or even behavior patterns (such as shopping behavior and buyer behavior), as well as the whole market.
According to Yamit (2017), customer satisfaction is the perceived outcome of the use of products and services, equal to or exceeding the desired expectations. Meanwhile, Pohan (2014) states that patient satisfaction is the level of patient feelings that arise as a result of the health service performance he gets, after the patient compares to what he expects. Another opinion of Mamik (2015) that patient satisfaction is an evaluation or assessment after using a service, that the service chosen at least meets or exceeds expectations.
According to Wijono (2014) several things that affect patient satisfaction, namely the approach and behavior of officers, especially during the first visit, the quality of information provided, appointment procedures, waiting time, health checks and drug taking, public facilities in health facilities and the results of treatment received .
Patient satisfaction is a measure that the services provided by health workers are good or not. In patient satisfaction it is influenced by various things, namely the suitability between the patient's expectations and the reality that the patient meets in the field, the second form of service during the service process is provided by health workers, personal behavior of health workers to patients, the atmosphere and physical conditions of the environment that are arranged. by puskesmas officers, costs or prices to be paid by patients and promotions or advertisements in accordance with reality.
From the results of the study, it was found that almost half of the respondents were unsatisfied with the services provided by health workers because of the incompatibility of the patient's reality and expectations of the health services provided. While most patients are satisfied with the services provided by health workers at Karangploso Public Health Center, Malang District because health workers are able to serve patients very well, health workers hear patient complaints and respond to them that they do not differentiate between JKN and non-JKN patients. In addition, the facilities and infrastructure available at Karangploso Public Health Center, Malang District are complete and have an environment that is clean maintained.

Influence Service Quality Towards Geriatric Outpatient Satisfaction in Public Health Center Karangploso, Malang District
Based on the results of Linear Regression analysis, it shows that the p-value is 0.000 <0.05, then H1 is accepted, so it can be concluded that partially there is influence quality of service on outpatient satisfaction geriatricsat the Karangploso Public Health Center, Malang District.
Health services are an important factor in improving the health and welfare of every person around the world. According to Law No. 36 Article 19 of 2009 concerning health, explains that everyone has the right to obtain health services and the government is responsible for the availability of all forms of quality, safe, efficient and affordable health efforts by all levels of society. One of these efforts is to increase the availability and distribution of basic health facilities such as health centers in each region (Bappenas, 2013).
Service quality can be identified by comparing consumers' perceptions of the service they receive to the service they really expect for the service attributes of a company. Service quality is perceived as good and satisfying if the service received or perceived (perceived service) is as expected, if the service received exceeds consumer expectations, then the service quality is perceived to be very good and quality. The quality of service is perceived as bad if the service received is lower than expected (Amrizal, 2014). The quality of health services refers to the level of perfection in the appearance of health services that can satisfy every user of health services in accordance with the average satisfaction level of the population.
Service quality can be identified by comparing consumers' perceptions of the service they receive to the service they really expect for the service attributes of a company. Service quality is perceived as good and satisfying if the service received or perceived (perceived service) is as expected, if the service received exceeds consumer expectations, then the service quality is perceived to be very good and quality (Wijoyo, 2012).
Researchers argue that understanding the needs and wants of patients is an important thing that affects patient satisfaction. Satisfied patients are a very valuable asset because if patients are satisfied they will continue to use the services of their choice, but if patients are dissatisfied they will tell others twice as much about their bad experiences. To create patient satisfaction, the puskesmas must create and manage a system to obtain more patients and the ability to retain patients. With a good arrangement, the puskesmas can provide services with the right time accuracy and be able to provide good service even though there are many patients who come.

Influence Perceptions of Outpatient Satisfaction at Karangploso Public Health Center, Malang District
Based on the results of Linear Regression analysis, it shows that the p-value is 0.000 <0.05, then H0 is rejected and H1 is accepted, so it is concluded that partially there is influence perceptions of outpatient satisfaction at Karangploso Public Health Center, Malang District.
The role of health workers in providing health services is very important, especially as health service implementers, so it is natural that the ability and performance of health workers are one of the determinants of success in health services. Health workers should be able to have a rational attitude as well as have a high spirit of dedication, be creative, innovative, disciplined, knowledgeable and skilled and can uphold the ethics of the health workforce profession.
Health service is a form of professional service that is an integral part of health services based on health knowledge and tips for individuals, families, groups or communities, both healthy and sick. Public health center officers are required to complete tasks properly so that patient satisfaction is maintained. To handle patients who come to visit, officers must be skilled and able to carry out their duties properly. One of the factors driving the performance of health workers is motivation.
The quality of puskesmas services can be seen from the performance and ability of the puskesmas health workers. The ability of a health worker is the ability of a person to do something with certain expertise in a health center or organization that is expected to be able to carry out their responsibilities in order to achieve a goal. The ability of health workers is one of the elements of maturity related to abilities or skills that can be obtained from education, training and experience, every health worker must have certain abilities and skills to help communities, groups and individuals (Thoha 2008).
According to Wijono (2014), several things affect patient satisfaction, namely the approach and behavior of officers, especially during the first visit, the quality of information provided, appointment procedures, waiting time for drugs, medical examinations and drug taking, public facilities in hospitals and the results of treatment received. . Patient satisfaction is a measure that the services provided by health workers are good or not. In patient satisfaction it is influenced by various things, namely the suitability between the patient's expectations (perceptions) and the reality that the patient meets in the field, the second form of service during the service process is provided by health workers, personal behavior of health workers to patients, the atmosphere and physical conditions of the environment. which is arranged by the health center officer, the cost or price to be paid by the patient and promotions or advertisements that are in accordance with reality.

Influence Response Time Towards the Satisfaction of Geriatric Outpatients at the Karangploso Health Center, Malang Regency
Based on the results of Linear Regression analysis, it shows that the p-value is 0.029 <0.05, then H0 is rejected and H1 is accepted, so it is concluded that partially there is influence response time outpatient satisfaction geriatricsat the Karangploso Health Center, Malang District.
A person's satisfaction with services is related to the ability of the service provider to provide satisfaction. Consumer satisfaction can be defined as big quality or broad quality (satisfaction broadly). This broad satisfaction is related to overall quality concerning service quality, financing, distribution channels, safety assurance of use and aspects of morality / performance of employees of a health service organization. Community satisfaction in utilizing outpatient services is influenced by several factors, including the response time of health workers to patients (Depkes RI, 2018).
Outpatient service (ambulatory service) is one form of existing medical services. In simple terms, outpatient services mean medical services provided to patients not in the form of inpatients. In terms of outpatient care, this includes not only those organized by commonly known service facilities such as hospitals, health centers or clinics, but also those held in patient homes (Depkes RI, 2018).
Public Health Center in carrying out its function as a center for health-oriented development, community empowerment center, primary community health service center, and primary individual health service center, public health center is obliged to provide compulsory health efforts at Puskesmas and development health efforts, including: Health Promotion Efforts, Environmental Health Efforts, Efforts Maternal and Child Health and Family Planning, Efforts to Improve Nutrition, Efforts to Prevent and Eradicate Communicable Diseases, and Treatment Efforts (MOH, 2017).
Health service standards are part of the health service itself and play an important role in overcoming problems with the quality of health services. If a health care organization wishes to provide quality health services in an obedient or consistent manner, that desire must be translated into a health service standard or operational procedural standard. Health service standards are an organizational tool to translate the quality of health services into operational terms so that all people involved in health services will be tied to a system, whether patients, health service providers, health service providers, or health service organization management, and will be responsible accountable in carrying out their respective duties and roles (Imbalo, 2015).
Response Time (response time) is a service standard that must be owned by a health service. Researchers also concluded that the Response Time is an element of Responsiveness which is one of the factors of patient satisfaction at the Public Health Center. The achievement of the standard nurse response time in the service at the public health center is influenced by the availability of infrastructure, human resources and a good management system. With a good arrangement, the public health center can provide services with the right time accuracy and be able to provide good service even though there are many patients who come.