Determinants of Satisfaction of Inpatients in Hospitals

Background: Patient satisfaction can have an impact on the development of the health system, increasing the fulfillment of service needs, continuity of service, and will ultimately provide better health outcomes. Patient satisfaction investigation is a method of assessing the quality of care from the patient's perspective. This study aims to determine the determinants of patient satisfaction in hospital. Subjects and Methods: This research is a literature review research. The research subjects were hospitalized patients. The databases used are: Google scholar, PubMed, and ScienceDirect. The keywords used included: age OR gender OR education OR profession OR residence OR insurance OR “type hospital” OR “quality of care” OR “length of stay” OR “facilities hospital” OR “hospital environment” AND “patient satisfaction” OR “inpatient satisfaction” AND “observational design”. The research used is from 2016 to 2021. Data analysis uses PRISMA flow diagrams. Results: The number of articles is 10 journals, the journals reached are national and international journals. The international journals covered are China (2 journals), Kazakhstan, Ethiopia (2 journals), and America, while the locations of journals conducted in Indonesia include Surakarta (2 journals), Papua, and Yogyakarta. There are 22 variables examined with 14 variables related positively and significantly. These variables are age, gender, education, occupation, quality of health services, doctor's work period, insurance ownership, urban location, length of stay, hospital accreditation status, perception of facilities, number of annual operations, nurse/bed ratio. Conclusion: determinants of inpatient satisfaction in hospitals, namely age, gender, education, occupation, quality of health services, doctor's work period, insurance ownership, urban location, length of stay, hospital accreditation status, perception of facilities, number of annual operations, nurse ratio /bed.


INTRODUCTION
Reforms in the health sector are manifested in patient safety and patient-centred services (Sulistyo et al., 2019). Health care has begun to emphasize the provision of superior health services due to increasing competition between hospitals (Manzoor et al., 2019). Health services are all efforts carried out in the form of an organization to improve public health through preventive, curative and rehabilitative activities (Sudirman, 2016). The improvement of health services has become a priority for all health care providers with the aim of achieving an optimal level of patient satisfaction.
Satisfaction is one of the key factors related to government policies through the delivery of excellent service quality which results in increased satisfaction (Manzoor et al., 2019). Based on Law Number 44 of 2009 concerning Hospitals, it is explained that the new paradigm of health services in Indonesia requires hospitals to provide quality services by referring to the professional code of ethics and in accordance with patient needs. (Law No. 44 of 2009). The quality of healthcare is becoming a global issue, causing the healthcare industry to undergo a rapid transformation to meet the ever-increasing needs and demands of its patient population (Asamrew et al., 2020).
According to the American Nursing Association (ANA), patient satisfaction with nursing care is defined as the patient's value and attitude towards the health services they receive during their stay in the hospital. Mulugeta et al. (2019). The service consists of aspects such as; art of care, technical quality of care comfort, cost, physical and environmental organization, availability of resources, continuity of care, facilities, privacy settings, interpersonal service providers and outcomes (Mulugeta et al., 2019;Sulistyo et al., 2019). Patient satisfaction can have an impact on the development of the health system, increasing the fulfillment of service needs, continuity of service, and will ultimately provide better health outcomes. (Kurniawan, Tamtomo, & Murti, 2019).
Research by Mulugeta et al. (2019)in Ethiopia, stated that the estimated level of patient satisfaction with nursing care in Ethiopia was 55.15% (95% CI = 47.35 to 62.95). In addition, research byAsamrew et al (2020), stated that as many as 46.2% (95% CI = 41.2% to 51.1%; p 0.001) patients were satisfied with the services they received at the hospital in terms of quality of doctor services, availability of laboratory and radiology services, pain management services, pharmacy services, toilet cleanliness, room availability for accommodation and dietary services. However, the quality of health services in the era of the National Health Insurance (JKN) still needs to be studied further. Based on a study by Widiastuti et al. (2015) in Bali there are differences in the level of patient satisfaction with First Level Health Facilities (FKTP). The highest satisfaction is felt by patients who come to general practitioners and puskesmas, while the lowest level of satisfaction is found in private clinics (Aryoseto, Tamtomo, & Murti, 2019).
Patient satisfaction is an important component that will be taken into account in evaluating the quality and outcomes of health services in developed and developing countries, including Indonesia (Kurniawan et al., 2019). Patient satisfaction is achieved when the patient has a positive perception of the health service received, satisfying, and according to what is expected. Patient satisfaction investigation is a method of assessing the quality of care from the patient's perspective (Liu et al., 2018). Assessment of the level of patient satisfaction can have an impact on the development of the health system, increasing the fulfillment of service needs, continuity of service, and will ultimately provide better health outcomes.This study aims to determine the determinants of patient satisfaction in hospital.

SUBJECT AND METHOD 1. Study Design
This research is a literature review research. Research data is searched from a systematic and comprehensive electronic database from several indexes. The databases used are: Google scholar, PubMed, and ScienceDirect. The keywords used included: age OR gender OR education OR profession OR residence OR insurance OR "type hospital" OR "quality of care" OR "length of stay" OR "facilities hospital" OR "hospital environment" AND "patient satisfaction" OR "inpatient satisfaction" AND "observational design".

Population and Sample
Articles are searched taking into account the feasibility of using PICO. The study population was hospitalized patients with an outcome in the form of patient satisfaction.

Inclusion Criteria
The inclusion criteria of this study used an observational study design with a measure of the Odds Ratio (OR) relationship. The research was started from 2015 to 2021.

Exclusion Criteria
The exclusion criteria for this study were that the primary study was experimental and published articles other than English and Indonesian.

Variable Operational Definition
The independent variable is an inpatient is an inpatient in a hospital. The dependent variable is the determinant of patient satisfaction isa method of assessing the quality of care from the patient's perspective.

Data analysis
Qualitative data analysis using PRISMA flow diagram.

RESULTS
The number of articles is 10 journals, the journals reached are national and international journals. The international journals covered are China (2 journals), Kazakhstan, Ethiopia (2 journals), and America, while the locations of journals conducted in Indonesia include Surakarta (2 journals), Papua, and Yogyakarta. The article search process can be seen in the PRISMA flow diagram in Figure 2.
The following variables were found about the determinants of inpatient satisfaction in hospitals in 10 journals that had been reviewed, there were 22 variables found, 15 statistically significant variables were determinants of inpatient satisfaction.