Readiness Analysis of Recommendation System for Digital-Based Clinic Operations in Nganjuk District

Licensing services provided by the government to the community ideally facilitate the community in its implementation. However, many people still complain about the current state of public services. Licensing services as a form of public service are still considered by the community to be too complicated in applying for permits, because of the many procedures that must be passed so that it takes a long time. The purpose of this research is to exploreanalysis of the readiness of a digital-based clinical operating permit recommendation system in Nganjuk Regency. The design of this study is a qualitative research with a phenomenological approach with the focus of the research directed at exploring the analysis of the readiness of a digital-based clinic operating permit recommendation system in Nganjuk Regency by triangulation. In addition, with a qualitative approach, it is hoped that the situation and problems encountered in these activities can be disclosed. The readiness of the community, especially for those who want to establish clinics and clinic owners in welcoming the application of the recommendation for a digital-based clinic operating permit, is quite good. Where the community is enthusiastic about this program, it can be realized immediately where this digital-based system can make it easier for individuals to apply for a clinic operating permit. Apart from the individual aspect, it is also necessary to prepare education or publication in the form of audio-visual related procedures for conducting digital-based operational permits, as well as related agencies must prepare the system as well as possible. Informants are expected to welcome this digital-based clinic operational permit recommendation program with high enthusiasm and it is hoped that if it is implemented in the future, it will be able to implement it properly and at the same time provide constructive criticism if the program still has shortcomings.


INTRODUCTION
Licensing is one part of public administration which is included in administrative services. Licensing is one form of implementing the regulatory and controlling functions that are owned by the government on activities carried out by the community. According to the Regulation of the Minister of Home Affairs Number 24 of 2006 the implementation of One Stop Integrated Services is an activity of licensing and non-licensing whose management process from the application stage to the document issuance stage is carried out in one place. The Minister of Home Affairs Regulation Number 24 of 2006 also explains that the establishment of the One Stop Service and Investment Service is to encourage economic growth through the amount of investment, by giving greater attention to the role of microenterprises, small and medium. The government's concern is to provide licensing services for micro, small and medium enterprises.
Licensing services provided by the government to the community ideally facilitate the community in its implementation. However, many people still complain about the current state of public services. Licensing services as a form of public service are still considered by the community to be too complicated in applying for permits, because of the many procedures that must be passed so that it takes a long time. A simple licensing procedure will help people's interest in applying for a business license. This can be done by simplifying licensing services. Service simplification is an effort to shorten the time, procedure and cost of granting permits and non-licensing.
Establishment permits are granted for a period of 6 (six) months, and can be extended for a maximum of 6 (six) months if they have not met the requirements. To obtain an operational permit, the clinic operator must meet the technical and administrative requirements. Technical requirements include requirements for location, buildings, infrastructure, personnel, equipment, pharmaceuticals, and laboratories. Administrative requirements include a permit to establish and a recommendation from the district/city health office. The operational permit is granted for a period of 5 (five) years and can be extended again as long as it meets the requirements (Ministry of Health, 2014).
Health Service Facility is a tool and/or place used to organize health service efforts, whether promotive, preventive, curative or rehabilitative carried out by the Government, regional government, and/or the community. Health Service Facilities were established to provide promotive, preventive, curative and rehabilitative health services. Health Service Facilities provide health services in the form of individual health services and/or public health services. Clinics as a type of health service facility in their operation are required to have an establishment permit and an operational permit. Establishment permits are granted by the district/city government. The operational permit is granted by the district/city local government or the head of the district/city health office.
In the Regulation of the Minister of Health of the Republic of Indonesia Number 26 of 2018 concerning Electronically Integrated Business Licensing Services for the Health Sector, it is stated that to accelerate and increase investment and business in the health sector, it is necessary to implement an electronically integrated Business Licensing service. This regulation refers to Government Regulation Number 24 of 2018 concerning Electronically Integrated Licensing Services. Permits regulated in these regulations include clinical operating licenses.
Based on the results of a meeting of representatives from the Nganjuk District Health Office, representatives of the Head of the Nganjuk District Health Center and the Management of the Indonesian Health Facility Clinic Association, input was obtained that the process of issuing operational permit recommendations should be carried out through a digital process or by application. This is intended so that the issuance of recommendations can run openly and reduce the physical contact of the applicant with the Health Service officer. In addition, the application is expected to speed up the process of issuing operational permit recommendations.
The concept of readiness proposed by Holt et al., (2007) where at this stage the beliefs and attitudes of organizational members are changed or manipulated so that they see change as something that needs to be done and have a strong tendency to succeed. This can be interpreted that efforts to create readiness are carried out from change and are intended so that organizational members as change agents have behavioral tendencies that support change which will increase the success rate of implementing the change.
Based on the above background, the researchers are interested in conducting research with the theme of analyzing the readiness of a digital-based clinic operational permit recommendation system in Nganjuk Regency.

METHODS
Research design is a strategy to achieve research objectives that have been set and used as a guide or guide for researchers throughout the research process. Judging from the type of data, the research approach used in this study is a qualitative approach. As for what is meant by qualitative research, namely research that intends to understand the phenomenon of what is experienced by the research subject holistically, and by way of description in the form of words and language, in a special natural context and by utilizing various scientific methods (Moleong, 2003). 2012). The design of this study is a qualitative research with a phenomenological approach with the focus of the research directed at exploring the analysis of the readiness of the digital-based clinical operating license recommendation system in Nganjuk Regency by triangulation. In addition, with a qualitative approach, it is hoped that the situation and problems encountered in these activities can be disclosed. This research has gone through an ethical test with the number SK: 2484/KEPK/VIII/2021.

Accuracy To Make Changes In Digital-Based Clinic Operational Permit Recommendation System in Nganjuk Regency
The licensing system in clinical operations in general still uses a manual system, namely by submitting other files using face-to-face then the file submitted is still a hard file so it is often difficult when there is a revision when applying for a permit. Therefore, by implementing a recommendation for a digital-based clinic operational permit, it can make it easier for clinics to be able to apply for permits to the relevant agencies so they don't spend a lot of time on trips and repeated revisions.

Confidence in Self-Ability to Change in the Recommendation System for a Digital-Based Clinic Operational License in Nganjuk District
The readiness of the individual in the process of recommending a digital-based clinic operating license is the main factor for the success of the program. Because it's basically a new program where not many individuals know the procedure or how to submit it when it changes from conventional to digital. So that human resources need to be given training and education in advance regarding procedures for applying for permits using digital procedures or via applications or via internet links.

Management Support in the Recommendation System for Digital-Based Clinic Operation Permits in Nganjuk District
In every activity carried out by the health agency, it is very necessary to have a recommendation or permit from the health office or related agency. Like the establishment of a health facility either managed by the government or managed by the private sector. Licensing requests will get various requirements to be fulfilled by the agency that will establish a health facility, so that it can make a health facility able to fulfill all aspects of the best service to be provided to the wider community.

Benefits for Individuals in the Recommendation System for Digital-Based Clinic Operational Permits in Nganjuk District
The application of a digital-based clinic operating license recommendation system will provide many benefits to all groups, both for clinic owners and for related agencies. The application of this digital-based permit system is to answer the problems often experienced by clinic owners in applying for operational permits, which are time inefficient and also the many inhibiting factors that make the permit process take longer.

A. The Accuracy of Making Changes in the Recommendation System for a Digital-Based Clinic Operational Permit in Nganjuk District
The licensing system in clinical operations in general still uses a manual system, namely by submitting other files using face-to-face then the file submitted is still a hard file so it is often difficult when there is a revision when applying for a permit. Therefore, the implementation of a recommendation for a digital-based clinic operational permit can make it easier for clinics to be able to apply for permits to the relevant agencies so they don't spend a lot of time on trips and repeated revisions.
In addition, with the implementation of a digital-based permit recommendation procedure, the submitted file or data can be stored in the system, at the same time when a clinic that wants to apply for a new permit can easily get a copy of the file from another clinic that is in accordance with the guidelines. Then also with the implementation of digitization, it is easier for files to be verified directly by the relevant agencies, so there is no need to go through other sections that can hinder the process of applying for a clinical permit.
The development of services from what was previously manual to digital-based is indeed very appropriate because in the future all transactions will lead to digital as well, only sooner or later it all starts. So that the sooner it is better to start the digital era and introduce digital procedures in every service system that can facilitate all the work of each sector.
Especially during the current pandemic, with the implementation of a digital system, it will greatly help the success of the health protocol program to break the chain of spreading COVID-19 by reducing face-to-face contact with other people. This digital method really helps all the licensing process from start to finish.
Licensing is one part of public administration which is included in administrative services. Licensing is one form of implementing the regulatory and controlling functions that are owned by the government on activities carried out by the community. According to the Regulation of the Minister of Home Affairs Number 24 of 2006 the implementation of One Stop Integrated Services is an activity of licensing and non-licensing whose management process from the application stage to the document issuance stage is carried out in one place. The Minister of Home Affairs Regulation Number 24 of 2006 also explains that the establishment of the One Stop Service and Investment Service is to encourage economic growth through the amount of investment, by giving greater attention to the role of micro-enterprises, small and medium. The government's concern is to provide licensing services for micro, small and medium enterprises.
Health Service Facility is a tool and/or place used to organize health service efforts, whether promotive, preventive, curative or rehabilitative carried out by the Government, regional government, and/or the community. Health Service Facilities were established to provide promotive, preventive, curative and rehabilitative health services. Health Service Facilities provide health services in the form of individual health services and/or public health services. Clinics as a type of health service facility in their operation are required to have an establishment permit and an operational permit. Establishment permits are granted by the district/city government. The operational permit is granted by the district/city local government or the head of the district/city health office.

B. Confidence in Self-Ability to Change in the Recommendation System for a Digital-Based Clinic Operational License in Nganjuk District
The readiness of the individual in the process of recommending a digital-based clinic operating license is the main factor for the success of the program. Because it's basically a new program where not many individuals know the procedure or how to submit it when it changes from conventional to digital. So that human resources need to be given training and education in advance regarding procedures for applying for permits using digital procedures or via applications or via internet links.
Providing education or training to individuals so that they can be comprehensive can be provided in stages by making tutorials in the form of audio visuals that can be easily accessed by the entire general public. Because the ease of getting information is also an important factor that can improve the ability of human resources in carrying out digital-based clinic operational permits.
Existing human resources are able to easily adjust license changes from conventional to digital programs, because basically humans are easy to accept changes, it just takes time and is given education gradually so that individuals can understand the procedures for recommending good and correct digital-based clinic operating permits. .
The concept of readiness proposed by Holt et al., (2007) where at this stage the beliefs and attitudes of organizational members are changed or manipulated so that they see change as something that needs to be done and have a strong tendency to succeed. This can be interpreted that efforts to create readiness are carried out from change and are intended so that organizational members as change agents have behavioral tendencies that support change which will increase the success rate of implementing the change.
Employees who are ready to change will believe that the organization will progress if the organization makes changes, besides that they have a positive attitude towards organizational change and have a desire to be involved in implementing organizational change (Armenakis, Harris & Mossholder, 2013). Conversely, if employees are not ready to change, then they will not be able to keep up and feel overwhelmed by the speed of organizational change that is happening (Hanpacern et al, 2013).

C. Management Support in the Recommendation System for Digital-Based Clinic Operation Permits in Nganjuk District
In every activity carried out by the health agency, it is very necessary to have a recommendation or permit from the health office or related agency. Like the establishment of a health facility either managed by the government or managed by the private sector. Licensing requests will get various requirements to be fulfilled by the agency that will establish a health facility, so that it can make a health facility able to fulfill all aspects of the best service to be provided to the wider community.
In particular, a private health facility in the form of a clinic that stands between the existence of a puskesmas or hospital which actually is in accordance with the needs of the community. However, because of demographics or because of the density of the population, assistance for additional health facilities is needed by the community.
A person's readiness to establish or operate a clinic is closely related to the assistance of the relevant health department. In general, the relevant agencies provide procedures for applying for permits in a manual way, i.e., they must come to the office with the required documents, once there is a revision, they must return on another day until the files requested are in accordance with the requirements submitted. With the renewal of the recommendation program for digital-based clinical operating licenses, it is clear that it is very helpful for health practitioners to be able to establish or operate a clinic.
So far, the relevant agencies have helped many health business actors to be able to develop a health clinic business to be able to help the community get quality health services. With the implementation of a digital system, it will be much easier for clinic owners to be able to obtain operational permits or develop types of clinical services that are more in line with the wishes of the community.
Licensing services provided by the government to the community ideally facilitate the community in its implementation. However, many people still complain about the current state of public services. Licensing services as a form of public service are still considered by the community to be too complicated in applying for permits, because of the many procedures that must be passed so that it takes a long time. A simple licensing procedure will help people's interest in applying for a business license. This can be done by simplifying licensing services. Service simplification is an effort to shorten the time, procedure and cost of granting permits and nonlicensing.
Establishment permits are granted for a period of 6 (six) months, and can be extended for a maximum of 6 (six) months if they have not met the requirements. To obtain an operational permit, the clinic operator must meet the technical and administrative requirements. Technical requirements include requirements for location, buildings, infrastructure, personnel, equipment, pharmaceuticals, and laboratories. Administrative requirements include a permit to establish and a recommendation from the district/city health office. The operational permit is granted for a period of 5 (five) years and can be extended again as long as it meets the requirements (Ministry of Health, 2014).
In the Regulation of the Minister of Health of the Republic of Indonesia Number 26 of 2018 concerning Electronically Integrated Business Licensing Services for the Health Sector, it is stated that to accelerate and increase investment and business in the health sector, it is necessary to implement an electronically integrated Business Licensing service. This regulation refers to Government Regulation Number 24 of 2018 concerning Electronically Integrated Licensing Services. Permits regulated in these regulations include clinical operating licenses.

D. Benefits for Individuals in the Recommendation System for Digital-Based Clinic Operational Permits in Nganjuk District
The application of a digital-based clinic operating license recommendation system will provide many benefits to all groups, both for clinic owners and for related agencies. The application of this digital-based permit system is to answer the problems often experienced by clinic owners in applying for operational permits, which are time inefficient and also the many inhibiting factors that make the permit process take longer.
In general, applications for clinical operating permits are still manual, it is hoped that the implementation of a digital-based system can cut down the bureaucracy that must be carried out by clinic owners to be able to obtain operational permits. that can help improve the quality of public health as a whole.
Another benefit of this digital-based system is flexibility in managing clinical operational permits, which can be done anywhere, not in a certain place. In addition, reducing the intensity of face-to-face meetings so as to help comply with health protocols during the COVID-19 pandemic or in the future if there is another pandemic outbreak, service activities can continue to run normally because the system is digital-based.
Licensing is the granting of legality to a person or business actor or certain activity, either in the form of a license or a business registration certificate. Permits are one of the most widely used instruments in administrative law, to guide the behavior of citizens (Ridwan, 2016). In addition, permission can also be interpreted as a dispensation or release or exemption from a prohibition.
Marbun and Mahfud (2011) define a permit as if the regulator in general does not prohibit an act as long as it is carried out in accordance with the applicable provisions. The act of the State Administration that permits the act is a permit (Adrian, 2011).

CONCLUSION
The readiness of the community, especially for those who want to establish clinics and clinic owners in welcoming the application of the recommendation for a digital-based clinic operating permit, is quite good. Where the community is enthusiastic about this program, it can be realized immediately where this digital-based system can make it easier for individuals to apply for a clinic operating permit. Apart from the individual aspect, it is also necessary to prepare education or publication in the form of audio-visual related procedures for conducting digital-based operational permits, as well as related agencies must prepare the system as well as possible.

Share Informants
Informants are expected to welcome this digital-based clinic operational permit recommendation program with high enthusiasm and it is hoped that if it is implemented in the future, it will be able to implement it properly and at the same time provide constructive criticism if the program still has shortcomings.

For Educational Institutions
It is hoped that educational institutions can use the results of this research as learning input in the readiness of a digital-based clinical operating license recommendation system in Nganjuk Regency and can be redeveloped for further research to be more useful for readers and for researchers.

For Further Researchers
It is hoped that further research needs to be deepened and added more specific research on the influencing factors readiness of a digital-based clinical operating permit recommendation system in Nganjuk Regency

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.

CONFLICT OF INTEREST
In this study, there is no interest whatsoever regarding myself or with other institutions other than the Indonesian Strada Institute of Health Sciences, Kediri City.