Analysis of Factors Affecting the Motivation of Health Officers in Regional Public Services Agency Sumenep Regency Hospital

Hospital services as a service industry are a form of socio-economic health service effort, which is a business that, although social in nature, is endeavored to keep profits by means of professional management. The purpose of this study is to analyze the influence of the work environment, reinforcement and leadership on the motivation of health workers at the Regional Public Service Agency of Sumenep Regency Hospital. The design of this research is an observational quantitative research with a cross sectional approach with the focus of the research being directed at analyzingthe influence of the work environment, reinforcement and leadership on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital. The total population of 175 respondents and a sample of 122 respondents were taken using the Simple Random Sampling technique. In the study, it was found that almost half of the respondents had a sufficient working environment category as many as 48 respondents (40.5%). Almost half of the respondents have sufficient reinforcement category as many as 48 respondents (40.5%). Almost half of the respondents have leadership in the moderate category as many as 49 respondents (41.4%). Most of the respondents have a high category of motivation as many as 86 respondents (73.3%). Based on the results of Multiple Linear Regression analysis shows that with a p-value of 0.000 < 0, 05, then H1 is accepted, so it can be concluded that simultaneously there is an influence of the work environment, reinforcement and leadership on the motivation of health workers at the Regional Public Service Agency of Sumenep District Hospital with an effect of 83.9%. It is hoped that health workers will be able to be more oriented to the work itself in providing results, impacts, and benefits for the community and for other employees.


INTRODUCTION
Hospital services as a service industry are a form of socio-economic health service effort, which is a business that, although social in nature, is endeavored to keep profits by means of professional management. Hospitals are very complex institutions and are diverse in nature. For this reason, a modern form of management of the health care system is needed for each work area or work unit so that the service system at each hospital needs to be reviewed to anticipate competition at the world level.
Public demand for quality health services is an issue and a very important competitive challenge. From this competition, hospitals are required to prepare their resources, one of which is human resources. In hospital institutions, competent human resources (HR) have a major role in achieving the goals or vision and mission of a hospital, one of which is the achievement of hospital service quality. The quality of hospital services will be good or bad depending on human resources. According to Nawawi (2013), the notion of human resources is people who work or become members of an organization called personnel, employees, employees, workers, labor and others.
Employee productivity is the center of attention in its efforts to improve performance which affects the efficiency and effectiveness of the organization. An analysis that concentrates more on performance will emphasize two main factors, namely the motivation of employees and the ability of employees to work (Sulistiyani et.al. 2014).
In order to be able to place employees according to their expertise, hospitals usually group their staff into 4 (four) namely medical personnel, nursing personnel, medical support personnel and non-medical personnel, (UU No. 44 of 2014 in the Minister of Health 2014). In hospital services, nurses are one of the health professionals who play an important role in caring for and serving sick people directly in their daily duties in a rescue effort.
Government and private agencies, not only expect capable, capable and skilled employees but most importantly they are willing to work hard and want to achieve optimal work results. For this reason, leaders should try to make employees have high motivation to carry out their duties or work (Hasibuan, 2014).
Employee achievement motivation in good organizational work will bring success that supports individual performance. Therefore, in order for employees to have a positive attitude towards the organization, good working conditions must be created and maintained. Realizing an organizational success cannot be separated from challenges, both challenges to get employees to work together effectively and challenges to encourage employees so that they want to carry out work with enthusiasm and enthusiasm (Robbins, 2011).
Motivation is very important because with motivation it is expected that every employee will work hard and be enthusiastic to achieve high work productivity. Motivation will provide inspiration, encouragement, morale for employees so that good working relationships are established between employees and leaders so that organizational goals can be achieved optimally (Hasibuan, 2014).
The theory of motivation and the factors that influence a person's motivation are widely found, one of them by Herzberg. According to Herzberg (in Siagian, 2013) the factors that drive aspects of work motivation consist of intrinsic factors and extrinsic factors. Which includes intrinsic factors, namely rewards, opportunities for growth, responsibility, and work autonomy. Which includes extrinsic factors, namely salary receipts, environmental conditions, institutional policies, and supervision.
Based on the results of Maryam's research (2017) it is known that there is a relationship between the provision of incentives, working conditions and interpersonal relationships with increasing employee motivation at the Sidrap District Health Office. Research on motivation was also carried out by Budiman (2014) regarding the analysis of the dominant factors of nurses' work motivation in the inpatient installation of RSU Bayu Asih Purwakarta concluded that the most dominant factors on the level of motivating nurses' work were income factors and career paths, namely the variables of opportunity to advance/promotion and the internal conditions of the work, namely the fair treatment variable.
The results of research by Budiman (2018) regarding the analysis of factors related to employee work motivation at the Labakkang Health Center, Pangkep Regency, it can be concluded that there is a relationship between incentives, working conditions, recognition, and achievement achievement with employee work motivation at the Puskesmas. The results of research by Gamayanti (2018) also conclude that there is a relationship between working conditions, compensation, and relationships with colleagues and the work motivation of health workers at the Banggae II Health Center, Majene Regency, West Sulawesi Province. Based on the above conditions, the authors are interested in researching the analysis of factors that influence the motivation of health workers at the Regional Public Service Agency of Sumenep District Hospital.

MATERIALS AND METHODS
In this study, the researcher used an observational quantitative design with a cross sectional approach, which is a study to study the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data all at once (point time approach), that is, each subject The study was observed only once and measurements were made on the status of the character or variable of the subject at the time of examination. This does not mean that all research subjects are observed at the same time (Soekidjo, 2012). This research will analyzethe influence of the work environment, reinforcement and leadership on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital. The total population of 175 respondents and a sample of 122 respondents were taken using the Simple Random Sampling technique. Data analysis using Linear Regression test. This research has gone through the ethical test phase with the number SK: 2280/KEPK/III/2021. 1. Partial a. Influence work environment on motivation Based on the results of Linear Regression analysis shows that the p-value is 0.002 <0.05 then H1 is accepted so it is concluded that partially there is the influence of the work environment on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital. b. Influence reinforcement on motivation Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it is concluded that partially there is the effect of reinforcement on the motivation of health workers in the Regional Public Service Agency of Sumenep Regency Hospital c. Influence leadership on motivation Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it is concluded that partially there is influence leadership on the motivation of health workers at the Regional Public Service Agency at the Sumenep Regency Hospital

Simultaneous
Based on the results of Multiple Linear Regression analysis shows that with a pvalue of 0.000 <0.05 then H1 is accepted so it can be concluded that simultaneously there is the influence of the work environment, reinforcement and leadership on the motivation of health workers at the Regional Public Service Agency of Sumenep District Hospital with an effect of 83.9%.

A. Work Environment of Health Officers at the Regional Public Service Agency of Sumenep Regency Hospital
The results showed that almost half of the respondents had a sufficient working environment category as many as 48 respondents (40.5%). In addition, 43 respondents (36.2%) have a good working environment category. while a number of 28 respondents (23.3%) have a poor working environment category.
The work environment in a company is very important for management to pay attention to. Although the work environment does not carry out the production process in a company, the work environment has a direct influence on the employees who carry out the production process. The work environment is an atmosphere where employees carry out daily activities. A conducive work environment provides a sense of security and allows employees to work optimally. If the employee likes the work environment in which he works, then the employee will feel at home at work, carrying out his activities so that work time is used effectively. On the other hand, an inadequate work environment will reduce employee performance.
The work environment is something that exists in the workers' environment that can influence themselves in carrying out tasks such as temperature, humidity, ventilation, lighting, noise, cleanliness of the workplace and whether or not work equipment is adequate. (Isyandi, 2014) According to (Simanjuntak, 2013) the work environment can be interpreted as the entire tooling faced, the surrounding environment in which a person works, the method of work, as the influence of his work both as individuals and as groups. Meanwhile, according to (Mardiana, 2005:78) the work environment is an environment where employees do their daily work.
The work environment is everything that is around the workers/employees that can affect employee job satisfaction in carrying out their work so that maximum work results will be obtained, where in the work environment there are work facilities that support employees in completing tasks assigned to employees in order to improve work. employees in an institution, especially health.

B. Reinforcement Health Officer at the Regional Public Service Agency of Sumenep District Hospital
The results showed that almost half of the respondents had sufficient category reinforcement as many as 48 respondents (40.5%). in addition, a number of 42 respondents (35.3%) had a good category of reinforcement. Meanwhile, a number of 29 respondents (24.1%) had less reinforcement in the category.
In general, appreciation has a positive influence on human life, because it encourages and improves a person's behavior and increases his business. It's not uncommon for someone to want to be the best and get compliments, of course within reasonable limits. You can imagine what will happen to sports athletes if they don't compete and get awards (Rahayu, 2015).
In accordance with the basic meaning of the word "strong", reinforcement implies adding strength to something that is considered not so strong. The meaning is addressed to individual behavior that needs to be strengthened. "strengthened" means to be established, alternate appearances, not intermittently appearing, not appearing once, so many sinking. In the behavioral change-oriented educational process, the main goal to be achieved in the learning process is the occurrence of good behavior, behavior that is accepted as often as possible in accordance with the usefulness of its appearance. Reinforcement is a response to a positive behavior that can increase the likelihood of the behavior repeating itself (Berta, 2012).
Reinforcement according to Skinner (2014), one of the psychologists of behavioristic learning. Interpreting this reinforcement as any consequence or impact of behavior that strengthens certain behavior.
According to researchers, reinforcement can be implemented effectively if it considers the conditions, including providing reinforcement immediately after the action or behavior takes place without delay, choosing the most appropriate reinforcement for the behavior performed, choosing the most appropriate time, determining the number of reinforcements to be given according to its portion, choosing the best reinforcer, and manage the schedule of giving reinforcement well. If the leader does this, the results of work behavior will be better.

C. Leadership Health Officer at the Regional Public Service Agency of Sumenep District Hospital
The results showed that almost half of the respondents had leadership in the sufficient category as many as 49 respondents (41.4%). In addition, 41 respondents (34.5%) have leadership in the good category. While a number of 29 respondents (24.1%) have leadership in the less category.
An organization automatically has a leader or a leader. Quality leaders are leaders who can provide direction to the efforts of all workers in achieving organizational goals. Without leadership or guidance, the relationship between individual goals and organizational goals may become tenuous (weak). This situation creates a situation of individuals working to achieve their own personal goals, while the whole organization becomes inefficient in achieving its goals (Rendra, 2014).
A leader according to Hariyani (2011) is someone who uses his authority and leadership to direct others and is responsible for that person's work in achieving a goal, while according to Kartono (2010) a leader is a person who has the skills and advantages, especially skills. and advantages in one area so that he is able to influence others to jointly carry out certain activities for the achievement of one or several goals.
Leadership plays a very important role in an organization. Experts in the field of organization generally propose their own understanding of leadership. Leadership is defined in terms of individual characteristics, habits, ways of influencing others, interactions, positions in administration, and perceptions of legitimate influence (Kartono, 2010).
The existence of a leader can be seen as a determining factor in organizational life. Even so, it is still realized that the central position of leadership does not mean ignoring the existence of other people, namely subordinates. In leadership there is a relationship between humans, namely the influencing relationship of the leader and the relationship of obedience and obedience from subordinates because it is influenced by the authority of the leader (Timpe, 2012).
Effective leadership will be able to persuade people to stop doing something that is being done, and then do something different according to the shared view. Leadership uses change to make progress. Leadership contains everything needed to stimulate constructive change. Good leadership in an organization plays a very dominant role in the successful implementation of various activities (Timpe, 2012).
A leader in an institution or organization must have the skills, emotional intelligence, assertiveness and so on to condition its members so that they can harmonize program plans that must be implemented by an organization. Effective leadership can encourage members so that members will make minimal mistakes that are visible or invisible to others. In this study, the researcher concludes that the leadership carried out in the category is sufficient so that the current leader is able to coordinate his members well but there are still some shortcomings that must be studied again as a leader.

D. Motivation of Health Officers at Regional Public Service Agency of Sumenep Regency Hospital
The results showed that most of the respondents had a high category of motivation as many as 86 respondents (73.3%). while a number of 33 respondents (26.7%) have a low motivation category.
Motivation is what causes and supports a person. According to Mashlow (2010) in Sunaryo (2013), individuals will be motivated to fulfill what needs are strongest in themselves at a certain time. If it is said that the emergence of a person's behavior at any given moment is determined by a need that has high power then it is important for every manager to have knowledge of the needs that are felt to be most important to their subordinates.
According to Ngalim Purwanto (2010) motivation is everything that encourages someone to do something. Motivation is to provide stimulation or encouragement or an excitement to a person or group to want to work properly and enthusiastically. With its ability to achieve goals in an efficient and effective manner (Wijono D, 2012).
According to Sunarya in a psychology book for nursing (2013), motivation is the desire and need of the individual, to motivate the individual to fulfill his needs and direct behavior towards everything he is aiming for. According to Nancy Stevenson (2011) motivation is all verbal, physical, or psychological things that make someone do something in response. And according to Suwarno, sw (2010) motivation refers to the process of movement, including encouraging situations that arise from within the individual, behavior evoked by the situation and the ultimate goal of the movement or action.
Someone wants to work because of the encouragement of various needs. This need is tiered or tiered if one basic need has been met, it will increase to a higher need and so on. This need for everyone is not the same and the difference is very far, with these circumstances it will lead to a perception of a need and will affect changes in work behavior at work. So that a person's motivation to work will have a significant impact. If someone has motivation to work, he will be active in work even though the job is classified as a difficult job. On the other hand, someone who does not have the motivation to work will tend to underestimate his work and be less active at work.

E. The Influence of the Work Environment on the Motivation of Health Workers in the Regional Public Service Agency at the Sumenep Regency Hospital
Based on the results of Linear Regression analysis shows that the p-value is 0.002 <0.05 then H1 is accepted so it is concluded that partially there is the influence of the work environment on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital.
Government and private agencies, not only expect capable, capable and skilled employees but most importantly they are willing to work hard and want to achieve optimal work results. For this reason, leaders should try to make employees have high motivation to carry out their duties or work (Hasibuan, 2014).
Employee achievement motivation in good organizational work will bring success that supports individual performance. Therefore, in order for employees to have a positive attitude towards the organization, good working conditions must be created and maintained. Realizing an organizational success cannot be separated from challenges, both challenges to get employees to work together effectively and challenges to encourage employees so that they want to carry out work with enthusiasm and enthusiasm (Robbins, 2011).
Motivation is very important because with motivation it is expected that every employee will work hard and be enthusiastic to achieve high work productivity. Motivation will provide inspiration, encouragement, morale for employees so that good working relationships are established between employees and leaders so that organizational goals can be achieved optimally (Hasibuan, 2014).
The theory of motivation and the factors that influence a person's motivation are widely found, one of them by Herzberg. According to Herzberg (in Siagian, 2013) the factors that drive aspects of work motivation consist of intrinsic factors and extrinsic factors. Which includes intrinsic factors, namely rewards, opportunities for growth, responsibility, and work autonomy. Which includes extrinsic factors, namely salary receipts, environmental conditions, institutional policies, and supervision.
Based on the results of Maryam's research (2017) it is known that there is a relationship between the provision of incentives, working conditions and interpersonal relationships with increasing employee motivation at the Sidrap District Health Office. Research on motivation was also carried out by Budiman (2014) regarding the analysis of the dominant factors of nurses' work motivation in the inpatient installation of RSU Bayu Asih Purwakarta concluded that the most dominant factors on the level of motivating nurses' work were income factors and career paths, namely the variables of opportunity to advance/promotion and the internal conditions of the work, namely the fair treatment variable.

F. The Effect of Reinforcement on the Motivation of Health Officers at the Regional Public Service Agency at the Sumenep Regency Hospital
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it is concluded that partially there is the effect of reinforcement on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital.
Hospital services as a service industry are a form of socio-economic health service effort, which is a business that, although social in nature, is endeavored to keep profits by means of professional management. Hospitals are very complex institutions and are diverse in nature. For this reason, a modern form of management of the health care system is needed for each work area or work unit so that the service system at each hospital needs to be reviewed to anticipate competition at the world level.
Public demand for quality health services is an issue and a very important competitive challenge. From this competition, hospitals are required to prepare their resources, one of which is human resources. In hospital institutions, competent human resources (HR) have a major role in achieving the goals or vision and mission of a hospital, one of which is the achievement of hospital service quality. The quality of hospital services will be good or bad depending on human resources. According to Nawawi (2013), the notion of human resources is people who work or become members of an organization called personnel, employees, employees, workers, labor and others.
Employee productivity is the center of attention in its efforts to improve performance which affects the efficiency and effectiveness of the organization. An analysis that concentrates more on performance will emphasize two main factors, namely the motivation of employees and the ability of employees to work (Sulistiyani et.al. 2014).
In order to be able to place employees according to their expertise, hospitals usually group their staff into 4 (four) namely medical personnel, nursing personnel, medical support personnel and non-medical personnel, (UU No. 44 of 2014 in the Minister of Health 2014). In hospital services, nurses are one of the health professionals who play an important role in caring for and serving sick people directly in their daily duties in a rescue effort.
The results of research by Budiman (2018) regarding the analysis of factors related to employee work motivation at the Labakkang Health Center, Pangkep Regency, it can be concluded that there is a relationship between incentives, working conditions, recognition, and achievement achievement with employee work motivation at the Puskesmas. The results of research by Gamayanti (2018) also conclude that there is a relationship between working conditions, compensation, and relationships with colleagues and the work motivation of health workers at the Banggae II Health Center, Majene Regency, West Sulawesi Province.

G. The Effect of Leadership on the Motivation of Health Workers in the Regional Public Service Agency at the Sumenep Regency Hospital
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it is concluded that partially there is influence leadership on the motivation of health workers at the Regional Public Service Agency at the Sumenep Regency Hospital Leadership plays a very important role in an organization. Experts in the field of organization generally propose their own understanding of leadership. Leadership is defined in terms of individual characteristics, habits, ways of influencing others, interactions, positions in administration, and perceptions of legitimate influence (Kartono, 2010).
The process of influencing or giving examples from leaders to followers in an effort to achieve organizational goals is an understanding of leadership. Kartono (2010) states that leadership is an activity to influence people so that they want to work together to achieve the desired goals. Meanwhile, according to Simamora (2014) states that employee performance is actually assessed on five dimensions including: quality; quantity; project completion; cooperation; leadership. In addition, Anwar (2015) said that the factors that affect the performance of the hospital are the ability and motivational factors contained in a leader that can affect the performance of the organization.
Motivation is something that causes and supports a person. According to Mashlow (2010) in Sunaryo (2013), individuals will be motivated to fulfill what needs are strongest in themselves at a certain time. If it is said that the emergence of a person's behavior at any given moment is determined by a need that has high power then it is important for every manager to have knowledge of the needs that are felt to be most important to their subordinates.
According to Ngalim Purwanto (2010) motivation is everything that encourages someone to do something. Motivation will provide a stimulus or impetus or an excitement to a person or group to want to work properly and enthusiastically. With its ability to achieve goals in an efficient and effective manner (Wijono D, 2012).
In working in a field of heavy work, an individual, especially an employee, needs motivation to motivate himself to meet his needs and direct his behavior towards everything he aims and dreams of. At work, a person will be motivated to change the behavior of the leadership or other employees in accordance with the wishes of the leadership, to increase employee enthusiasm, to improve employee discipline, to maintain employee stability, to improve employee welfare, to improve employee performance, to enhance employee morale, to improve employee performance. sense of responsibility of employees in their duties, to increase productivity and efficiency.

CONCLUSION
1. Almost half of the respondents have a sufficient working environment category as many as 48 respondents (40.5%). 2. Almost half of the respondents have sufficient reinforcement category as many as 48 respondents (40.5%). 3. Almost half of the respondents have leadership in the moderate category as many as 49 respondents (41.4%). 4. Most respondents has a high category of motivation as many as 86 respondents (73.3%). 5. There is the influence of the work environment on the motivation of health workers in the Regional Public Service Agency of Sumenep District Hospital. 6. Ada the effect of reinforcement on the motivation of health workers in the Regional Public Service Agency of Sumenep Regency Hospital 7. There isinfluence leadership on the motivation of health workers at the Regional Public Service Agency at the Sumenep Regency Hospital

For Respondents
It is hoped that health workers will be able to be more oriented to the work itself in providing results, impacts, and benefits for the community and for other employees.

For Educational Institutions
It is hoped that educational institutions can use the results of this study as learning input in the analysis of factors that influence the motivation of health workers at the Regional Public Service Agency of Sumenep District Hospital and can be developed again for further research to be more useful for readers and researchers.

For Further Researchers
It is hoped that further research needs to be deepened and added more specific research on Factors that affect the performance of health workers at the Regional Public Service Agency at the Sumenep Regency Hospital

ACKNOWLEDGMENT
I solemnly declare that to the best of my knowledge, in this thesis there is no scientific work that has been submitted by another person to obtain an academic degree at a university, and there is no work or opinion that has been written or ordered by anyone. others, except those quoted in this manuscript and mentioned in the citation sources and bibliography.