E-ISSN: 2963-3699
P-ISSN: 2964-0121
Homepage: https://return.publikasikupublisher.com
This work is licensed under CC BY-SA 4.0
THE MEDIATING EFFECT OF PATIENT SATISFACTION IN THE EFFECT OF
SERVICE QUALITY ON PATIENT LOYALTY
(Patient Survey at Hermina Hospital Bandung Pharmacy Installation)
Aurora Rahyu Pasya
Universitas Kristen Krida Wacana, Jakarta, Indonesia
aurora28rp@gmail.com
ABSTRACT
Background: Pharmaceutical services are a form of health service that directly connects patients with
pharmaceutical preparations. The quality of service greatly determines the level of patient satisfaction.
Service quality and patient satisfaction are factors that influence patient loyalty. Method: The data
analysis technique that will be used to test this research uses the Partial Least Square (PLS) method
which is operated using SMARTPLS 4.0. Results: Service quality has a significant effect on patient
satisfaction and patient loyalty, patient satisfaction has a significant effect on patient loyalty, and service
quality has a significant effect on patient loyalty which is mediated by patient satisfaction. Conclusion:
When a hospital provides better quality service than before, it will have an impact on high patient
satisfaction and patient loyalty. The more positive patient satisfaction is, the more patient loyalty will
increase. When service quality is improved, a positive perception of patient satisfaction arises, which
can encourage increased patient loyalty.
Keywords : Patient Satisfaction; Service Quality; Patient Loyalty; Mediating Effect;
Pharmacy Installation
INTRODUCTION
Welfare is a right and business for every Indonesian citizen. According to the second
paragraph of Article 27 of the 1945 Constitution, the right to health is protected, and every citizen
has the right to work and a humane livelihood. In view of the foregoing, all residents have equal
rights in daily life, welfare and employment. The right to meet material needs, such as adequate
food, clothing, and shelter, as well as spiritual, health, and other needs, is referred to as this
livelihood. Because health is the basic capital needed by all individuals to be able to carry out
activities in accordance with their respective duties and responsibilities, in order to produce
something useful for themselves and their families, health is an investment for society. However,
assuming your illness is at risk, it is not impossible that all of your wealth and wealth will be used
for something like obtaining such welfare.
According to Hardiman (2013:204) in (Corlesla, 2016), her condition of health service
system in Indonesia is not good. Hospitals have not been able to guarantee the quality of health
services, such as: doctors often arrive late, so patients have to wait a long time to get service, have
not provided a comfortable waiting room, there is no continuity of service, cannot guarantee the
delivery time of drugs and have not been able to make an online prescribing system via computer.
Hospitals in Indonesia have not been widely oriented to consumers / patients (consumer oriented),
have not provided easy access to services for patients to seek treatment at the hospital”.
Just like the study carried out, Sulastomo (2014: 145) is explained in (Bangun, 2017)
Hospital hallways, waiting rooms and hospital cleanliness are quite poor besides that in patient
order still seems crowded and chaotic, and there are still difficulties in services for parking patient
vehicles. This reality makes the image of hospitals in Indonesia lag behind compared to abroad,
such as Singapore. Such conditions are recorded in a study on the readiness of Indonesian
hospitals to respond to the era ofglobalization carried out by the Center for Health Development
Studies".
The competitive atmosphere in serving patients in several hospitals in the city of Bandung
such as Boromeus Hospital, Advent, requires Hermina Bandung Hospital to be ready to offer the
type of quality assistance and can meet patient assumptions. Therefore, the board must be properly
completed thanks to the contribution of various components, for example the actual appearance,
individual contact services (specialists, nurses/medical advisors, staff of research facilities,
radiology, drug stores, organizations and funds including the condition of leaving the vehicle)
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
77
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
that influence the decision of the patient to come and take advantage of the advertised
administration. The quality of administration really determines the level of satisfaction of buyers.
Satisfaction is a feeling of pleasure or disappointment of a consumer that arises from comparing
the perceived performance of services against consumer expectations” (Kotler & Keller, 2016). The
higher the quality of service, the higher the satisfaction received by consumers. Consumers must
be satisfied because if they are not satisfi they will leave the company and become consumers of
competitors will be bad for the development of the company” (Paramita et al., 2020).
Today, the progress of clinic development undergoes major changes when hospitals are in
a global and serious climate. Hospital services that are an important concern in this global
competition include medical services, paramedics, and medical support, which is no exception
for medical support services in the pharmaceutical sector. Good service will provide satisfaction
to its customers. Satisfaction can shape perceptions, and this can position a company's products
in the eyes of its customers. The hospital needs to know the quality of services that have been
provided, and to what extent it affects customer satisfaction. This is important as a reference in
improving service quality, so that the services provided can provide satisfaction at an optimal
level” (Alfina, 2019).
Drug administration is a type of immediate and reliable welfare provision to patients
associated with drug regulation. It is hoped that the implementation of good pharmaceutical
services will improve the quality of patients' life. The main role of pharmaceutical services is in
the provision of Pharmaceutical Preparations, Medical Devices, and Medical Consumables that
have good quality and must be affordable for all levels of society" Permenkes, (2016) in (A. K.
Susanto, 2017). “Pharmacists must manage pharmacies in an orderly, orderly and business-
oriented manner” (Yuliani, 2017). Quality pharmaceutical installation services are health services
that can satisfy every use of services in accordance with the level of patient or consumer
satisfaction, as well as their implementation in accordance with the code of ethics and service
standards that have been established” (Pareraway, 2016), Because 25% of patient recovery is
expected to be obtained from the convenience and good service of pharmacies, while 75% comes
from the drugs used by patients” (Grant et al., 2015).
“Satisfaction is a person's feeling of pleasure or disappointment obtained from the
impression of the performance or results of a product with its expectations” (Kotler & Keller, 2016,
p. 205). Judging from this definition, fulfillment is an element of impression and assumption of
implementation. "New patients will feel satisfied if the performance of the health services they
get is the same or exceeds their expectations and vice versa, dissatisfaction or feelings of
disappointment of patients will arise if the performance of the health services they get is not in
accordance with their expectations” (Sofiana et al., 2020). The buyer's view of the drug company's
unfavorable administration will cause inconvenience to the drug company from a business point
of view because the buyer will move elsewhere. "The impact that arises not only to the consumers
concerned but this bad impression will be told to others so that the image of pharmaceutical
installations, especially their officers, including pharmacists will be negative / bad" (Ingerani,
2012: 205). Therefore, "good consumer perception of services must be cultivated continuously
and continuously with an orientation to the customer itself so that satisfied patients tend to be
loyal and can increase their interest in repurchasing the same product or service” (Hudaya & Masri,
2015).
Hermina Pasteur Hospital is a private hospital (domestic investment) managed and is a
group of Hermina Hospital Group operating in Bandung. The hospital's assets are entirely owned
by PT Medikaloka Pasteur, a legal entity in the form of a PT established by Notarial Deed No. 10
dated August 5, 2003. Hermina Hospital Group started from a maternity home in East Jakarta
under the name RB Djatinegara. Established in 1967 with a capacity of 8 beds which was later
formed into RSB. HERMINA on April 25, 1985. The date was later remembered as the
anniversary of Hermina Hospital. Hermina Bandung Hospital is coordinated on these two things,
namely focusing on fulfilling tolerance, and this means turning patient protests into capital to
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
78 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
further develop services and fellowships, and it means that every activity carried out depends on
the normal interests between emergency clinics and staff and patients.
This conflict is not only within the framework of assessment innovation, but is a more
serious competition, namely special competition in quality welfare services. Hermina Bandung
Hospital does not yet have a short-term treatment recording framework that is not recovered by
the introduced pharmacies, so from the results of the Hermina Bandung Hospital management
data framework report for January 2022 - December 2022, the number of drug purchases with
treatment is compared and the number of short-term visits assuming each visit to get a drug, a
measure of reclaimed drug levels at Hermina Bandung Hospital Pharmacy is obtained as shown
in Figure 1 below Ini.
Figure 1
Number of Outpatients and Number of Prescription Pharmacy Purchases
Source: Hermina Bandung Hospital Pharmacy Installation (2022)
Based on Figure 1 above, there is a gap, where there is a very large difference between the
number of short-term visits compared to the number of short-term patients who are interested in
buying drugs and there is a decrease. in the quantity of doctor's drug acquisition at the
Establishment of Hermina Bandung Hospital Pharmacy every month.
The decrease in the number of visits to the drug site is known to occur because the level of
patient satisfaction with the drug services provided has not met the buyer's assumptions. This
continuous reduction in demand can result in a lack of payment from the drug company, therefore
the estimated loss of payment from internal settlements made outside the drug company Hermina
Bandung Hospital is something that must be suppressed so that payments from the drug company
can increase.
Signs that drug companies at Hermina Hospital Bandung experience problems with
buyback expectations are also supported by the findings of the pre-overview results conducted by
the author on 30 patient respondents regarding buyer buybacks for the last 1 year, with the number
of repeat purchases for the last 1 year made by patients at Hermina Hospital Bandung pharmacies.
The respondents were patients who had filled medicine at the pharmacy about once. The pre-
review results showed most respondents made purchases under twice i.e. 18 people or 60%. Then
those who made purchases 2 to 2 times as many as 8 people or 26.67%, and those who made
purchases more than 6 times were only 4 people or 13.33%. From this picture, it is obtained that
the repurchase behavior of buyers at the Hermina Bandung Hospital drug place is still very low.
This information states that there is expected to be a problem in the purpose of the buyback.
The elements that affect loyalty must be seen that the fulfillment factor and quality of
service are not too large. This can be seen from the officers are less polite and friendly, officers
do not answer patient questions, the appearance of pharmacy officers is sometimes not neat and
1318
1239
1192
979
749
901
970
908
837
849
860
853
740
854
675
752
694
665
695
617
575
514
523
508
Jumlah Pasien Umum Jumlah Resep Umum
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
79
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
clean, and patients get drugs with significant delays. This of course must be pursued through
improving the quality of service and administration, in order to balance the fulfillment of patients
at the Hermina Bandung Hospital Pharmacy Installation.
This result are supported by the results of perceptions and meetings conducted with patients
at the pharmacy of Hermina Hospital Bandung. There have been protests with respect to patient
assistance in daily activities, with respect to significant delays, fragmented medicines, expensive
medicines, and limited seating areas. What's more, the lack of entertainment is due to the lack of
fans/air conditioners, and the lack of magazine offices. Given the large role of drug stores as a
source of hospital assets, as well as the increasing number of drugstore competitors around
Hermina Bandung Hospital, it is appropriate for hospitals to focus more on working on the nature
of hospital pharmacy benefits so that patients do not switch to purchasing prescriptions at drug
stores. Other.
Striving for the nature of good assistance do not only come from Hermina Bandung
Hospital, but also must be in accordance with the patient's point of view. Hermina Bandung
Hospital must also know the wants and needs of its patients, so the quality of service provided
must be really considered. By improving the quality of administration, it is believed that trust will
increase consumer loyalty. Believe that the achievement of high satisfaction will bring great
changes and benefits to specialist cooperatives. Therefore, Hermina Bandung Hospital must know
the longings and needs of patients at this time, because patients who are not satisfied with the
services provided by the hospital will generally look for other specialist cooperatives that can
provide better services and administration.
Quality provides motivation to clients to lay down areas of strength to cooperate with
specialist cooperatives. In the long run, attachments like these empower specialist cooperatives
to understand clients' assumptions and their needs. Therefore, specialist cooperatives can increase
consumer loyalty through efforts to increase pleasant client encounters and limit or eliminate bad
patient encounters.
Based on of things that can affect repurchase interest and patient satisfaction, researchers
are interested in looking further at what causes reduced patient repurchase interest. The title of
the proposed study are: The Effect of Patient Satisfaction Mediation on the Effect of Service
Quality on Patient Loyalty (Patient Survey at Hermina Hospital Pharmacy Installation Bandung
City).
RESEARCH METHOD
The object of research is a concern in research for the reason that object of examination is
the goal to be achieved to get answers and answers to the problems that occur. The object of the
study is "quality of service, patient satisfaction and patient loyalty." The population of this study
is patients, patients at the Hermina Bandung Hospital Pharmacy Installation.The sample used in
this study numbered 100. The data collection techniques used are, putakaan studies and field
studies, while what is done by researchers is observation of patient satisfaction perceptions of
service quality, patient satisfaction and patient loyalty at the Hermina Bandung Hospital
Pharmacy Installation. Interview, conducted to the Head of Pharmaceutical Installation and staff
at Hermina Bandung Hospital Pharmacy Installation.Questionnaire, the survey was completed by
all research subjects including inclusion criteria at Hermina Bandung Hospital Pharmacy
Installation. The research questionnaire was scored using the Likert scale. Where the Likert scale
is used to measure the attitudes, opinions, and perceptions of a person or group of people about
social phenomena” (Sugiyono, 2020, p. 86).
The data analysis technique carried out in this study is Partial Least Square (PLS) which is
operated using SMARTPLS 3.0. "This research is a quantitative research data analysis where the
measurement of this study identifies or describes the subject (or object) not only on the possession
of an attribute but also by the number or degree to which the subject can be characterized by that
attribute” (Jr. et al., 2018).
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
80 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
RESULT AND DISCUSSION
Outer Model Test (Evaluation of Measurement Models)
1. Validity Test
a. Convergent Validity Test
The Loading Factor value obtained from the estimated SmartPLS 4.0 calculation can
be seen in the attached picture:
Figure 2
PLS Algorithm 1 Results (Loading Factor Value of Each Indicator)
The following are the results of the validity test "service quality, patient satisfaction, and patient
loyalty", including:
Table 1 Validity Test Results Using Loading Factor Value
Indicator
Loading Factor Value
> 0,5
Information
Quality of
Service
Patient
Satisfaction
Patient
Loyalty
KL-1
0,425
< 0,5
Invalid
KL-2
0,548
> 0,5
Valid
KL-3
0,528
> 0,5
Valid
KL-4
0,056
< 0,5
Invalid
KL-5
0,464
< 0,5
Invalid
KL-6
0,470
< 0,5
Invalid
Indicator
Loading Factor Value
> 0,5
Information
Quality of
Service
Patient
Satisfaction
Patient
Loyalty
KL-7
0,671
> 0,5
Valid
KL-8
0,705
> 0,5
Valid
KL-9
0,474
< 0,5
Invalid
KL-10
0,710
>0,5
Valid
KP-11
0,400
< 0,5
Invalid
KP-12
0,790
> 0,5
Valid
KP-13
0,800
> 0,5
Valid
KP-14
0,733
> 0,5
Valid
KP-15
0,705
> 0,5
Valid
LP-16
0,649
> 0,5
Valid
LP-17
0,444
< 0,5
Invalid
LP-18
0,532
> 0,5
Valid
LP-19
0,732
> 0,5
Valid
LP-20
0,689
> 0,5
Valid
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
81
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
Source: SmartPLS Data Processing Data 4 (2023)
“Based on Figure 2 and Table 1 of the PLS Algorithm 1 outer loadings output above,
indicators that have a loading factor value of less than 0.50 should be removed from the
model and then the model analyzed again. Indicators that have a loading factor of less than
0.50 are 7 indicators consisting of KL-1, KL-4, KL-5, KL-6, KL-9, KP-11, and LP-17.”
The following is the output of the 2nd algorithm after deducting indicators that have
a loading factor below 0.50, which is as follows:
Figure 3 PLS Algorithm 2 Results (Loading Factor Value of Each Indicator)
The following are the results of the validity test of "service quality, patient
satisfaction, and patient loyalty" after the change, which are as follows:
Table 2 Validity Test Results Using Loading Factor Value
Indicator
Loading Factor Value
> 0,5
Information
Quality of
Service
Patient
Satisfaction
Patient
Loyalty
KL-2
0,618
> 0,5
Valid
KL-3
0,564
> 0,5
Valid
KL-7
0,722
> 0,5
Valid
KL-8
0,730
> 0,5
Valid
KL-10
0,701
>0,5
Valid
KP-12
0,809
> 0,5
Valid
KP-13
0,808
> 0,5
Valid
KP-14
0,749
> 0,5
Valid
KP-15
0,701
> 0,5
Valid
LP-16
0,664
> 0,5
Valid
LP-18
0,505
> 0,5
Valid
LP-19
0,751
> 0,5
Valid
LP-20
0,733
> 0,5
Valid
Source: SmartPLS Data Processing 4 (2023)
“Based on Figure 3 and Table 2 of the PLS Algorithm 1 outer loadings output above,
indicators that have a loading factor value of less than 0.50 should be removed from the
model and then the model analyzed again. Indicators that have a loading factor of less than
0.50 are 7 indicators consisting of KL-1, KL-4, KL-5, KL-6, KL-9, KP-11, and LP-17".
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
82 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
2. Discriminant Validity Test
Table 3 Validity Test Results Using Cross Loading
Indicator
Patient Satisfaction
Quality of Service
Patient Loyalty
KL-2
0,300
0,618
0,413
KL-3
0,262
0,564
0,166
KL-7
0,522
0,722
0,416
KL-8
0,426
0,730
0,383
KL-10
0,352
0,701
0,297
Indicator
Patient Satisfaction
Quality of Service
Patient Loyalty
KP-12
0,809
0,513
0,569
KP-13
0,808
0,537
0,530
KP-14
0,749
0,392
0,488
KP-15
0,701
0,289
0,447
LP-16
0,431
0,379
0,664
LP-18
0,265
0,308
0,505
LP-19
0,476
0,448
0,751
LP-20
0,561
0,276
0,733
Source: SmartPLS Data Processing 4 (2023)
“Based on the results of the discriminant validity test seen in Table 3 by looking at
the correlation on each indicator which is part of service quality, patient satisfaction, and
patient loyalty has a higher correlation compared to others. This shows that each latent
construct reflects each indicator in their block better than the indicators in other blocks, can
be seen from the confidence variable with the indicator or statement is greater than the
other indicators, and it is also the same for each variable.
In addition to Cross Loading testing, discriminant validity testing can also be seen
using Fornell-Larcker criteria, which states that if the AVE value is higher than the
correlation between other constructs, it can be concluded that the construct has a good level
of discriminant validity”.
Table 4 Validity Test Results Using Interconstruct Correlation Values with Fornell-Larcker
Testing
Variable
Patient
Satisfaction
Quality of
Service
Patient
Loyalty
Information
Patient Satisfaction
0,768
Valid
Quality of Service
0,578
0,670
Valid
Patient Loyalty
0,666
0,523
0,670
Valid
Source: SmartPLS 4 Data Processing (2023)
“Based on the data in Table 4, can be seen that the square root value of the Average
Variance Extracted (AVE) of each variable (0.768; 0.670; 0.670) is greater than the
correlation of each construct, this shows that the three variables in this study are
discriminantly valid, that is, each construct indicator is not highly correlated with other
constructs used in measuring this study.”
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
83
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
Reliability Test
“Instrument reliability is the level of accuracy or consistency of a research instrument. An
instrument is said to be reliable if it has a Composite Reliability of > 0.7 and Cronbach Alpha >
0.6 for all constructs (Hussein, 2015). Table 5." here are the reliability test results:
Table 5 Composite Reliability Test
Konstruk
Cronbach's Alpha
Composite
Reliability
Conclusion
Quality of Service
0,769
0,852
Reliabel
Patient Satisfaction
0,697
0,802
Reliabel
Patient Loyalty
0,590
0,762
Reliabel
Source: SmartPLS Data Processing 4.0 (2023)
"Composite reliability aims to determine whether a construct has high reliability or
not. A composite reliability value greater than 0.7 indicates that the construct is reliable.
Based on the values in Table 5, all values meet the composite reliability requirement of >
0.7 and all variables have values greater than 0.7 so it can be said that the latent variable
has high reliability.
In addition, reliability can also be seen through Cronbach Alpha, where the Cronbach
Alpha value is used to determine the reliability of a construct. The closer to one, the more
reliable the construct will be in making measurements. According to Sekaran &; Bougie,
(2016) the value of Cronbach Alpha must be greater than 0.60 for a study to be good. In
Table 5. It can be seen that the variables of service quality, and satisfaction have a Cronbach
Alpha value of more than 0.60 so it can be said that the variables in this study have a
relatively good reliability, while the loyalty value has a Cronbach Alpha value of less than
0.60.”
Inner Model Test (Structural Model Evaluation)
1. Koefisien Determinasi (R
2
)
The R
2
value is used to observe the degree of variation in changes in exogenous
variables over endogenous variables. The acquisition of R
2
using SmartPLS 4.0 in this
study is:
Table 6 Value of Coefficient of Determination
Variabel
R-square
R-square adjusted
Kepuasan Pasien (R1
1
)
0,334
0,327
Loyalitas Pasien (R2
2
)
0,472
0,461
Source: SmartPLS Data Processing 4.0 (2023)
"Based on the calculation results of SmartPLS 4.0 software, the calculation results as
presented in Table 6 above, it can be known that R2 of the patient satisfaction variable is
0.334, which means that the patient satisfaction variable is influenced by the service quality
variable of 33.4% and the remaining 66.6% is influenced by other variables.
The R
2
result of the patient loyalty variable showed a value of 0.472, which means
that the patient loyalty variable can be influenced by the service quality variable and the
patient satisfaction variable, which is 47.2% and the remaining 52.8% is influenced by
other variables that were not studied in this study."
2. Goodness of Fit Index (GoF)
"The calculation results of goodness of fit can be used to determine the amount of
contribution given by exogenous variables to endogenous variables. In PLS analysis,
goodness of fit results is obtained through q-square (Q²), calculation results that exceed 0
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
84 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
are considered to have good predictive values". How much of the expectation value created
by the model and its limit meter in this exploration will be shown from the Q² calculation:
Q2 = 1 – (1 – R1
2
) x (1 – R2
2
)
Q2 = 1 – (1 – 0,334) x (1 – 0,472)
Q2 = 1 - 0,666 x 0,528
Q2 = 0,648
Information:
Q
2
: Predictive Relevance value
R1
2
: R-Square value of the patient satisfaction variable
R2
2
: R-Square value of the patient loyalty variable
“The calculation results of 0.648 or 64.8%, this result indicates that the diversity of
data that can be explained by the model is 64.8% and the remaining 35.2% is explained by
other variables that are not yet contained in the model and errors.”
Hypothesis Testing
Given the side effects of testing the inside and outer models that have been done before,
the model has fulfilled the need for speculative testing. Through estimation with the help of
SmartPLS4.0 programming, the following model was formed:
Figure 4 Construct Model
Source: SmartPLS 4.0 Data Processing (2023)
a. Direct Influence Testing
The follow-up effects of direct impact speculation testing were resolved by involving
the path coefficient values introduced in Table 7. as follows:
Table 7 Path Coefficients
Original
Sample (O)
T-statistics
(|O/STDEV|)
P values
Quality of Service → Patient
Satisfaction
0,578
8,213
0,000
Quality of Service → Patient Loyalty
0,207
2,024
0,043
Patient Satisfaction → Patient Loyalty
0,546
7,216
0,000
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
85
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
Source: SmartPLS 4.0 Data Processing (2023)
H
1
: Quality of Service Positively Affects Patient Satisfaction
“The effect of service quality on patient satisfaction is formulated in Hypothesis 1.
From the results of the analysis obtained the value of t-statistics (8.213) with p < 0.05 (0.000)
and positive path coefficients (0.578). The results of t-statistics have a value greater than the
t-table (1.96) and the value of p value has a value smaller than 0.05, so in this study the
quality of service has a significant influence on patient satisfaction. The path coefficients
value shows a positive number of 0.578 which indicates that the quality of service has a
positive influence on patient satisfaction, so in this study, Hypothesis 1 is accepted because
the quality of service has a positive and significant influence on patient satisfaction. This
result means that the higher the quality of service, the higher the patient satisfaction at the
Hermina Hospital Pharmacy Installation in Bandung”.
H
2
: Quality of Service Positively Affects Patient Loyalty
“The effect of quality of care on patient loyalty is formulated in Hypothesis 2. From
the results of the analysis, the value of t-statistics (2.024) with p < 0.05 (0.043) and positive
path coefficients (0.207). The results of t-statistics have a value greater than the t-table (1.96)
and the p value has a value smaller than 0.05, so in this study the quality of service has a
significant influence on patient loyalty. The value of path coefficients shows a positive
number of 0.207 which indicates that the quality of service has a positive influence on patient
loyalty, so in this study, Hypothesis 2 is accepted because the quality of service has a positive
and significant influence on patient loyalty. This result means that the higher the quality of
service, the higher the patient loyalty at the Hermina Hospital Pharmacy Installation in
Bandung City.”
H
3
: Patient Satisfaction Positively Affects Patient Loyalty
“The effect of patient satisfaction on patient loyalty is formulated in Hypothesis 3.
From the results of the analysis obtained the value of t-statistics (7.216) with p < 0.05 (0.000)
and positive path coefficients (0.546). The results of t-statistics have a value greater than the
t-table (1.96) and the value of p value has a value smaller than 0.05, so in this study patient
satisfaction has a significant influence on patient loyalty. The value of path coefficients
shows a positive number of 0.546 which indicates that patient satisfaction has a positive
influence on patient loyalty, so in this study, Hypothesis 3 is accepted because patient
satisfaction has a positive and significant influence on patient loyalty. This result means that
the higher the patient satisfaction, the higher the patient loyalty at the Hermina Hospital
Pharmacy Installation in Bandung."
b. Indirect Influence Testing
The following are the results of testing the indirect effect of service quality on patient
loyalty mediated by patient satisfaction, namely:
Table 8 The Value of Indirect Influence (Mediation)
Original
Sample (O)
T-statistics
(|O/STDEV|)
P values
Quality of Service → Patient
Satisfaction → Patient Loyalty
0,315
4,879
0,000
Source: SmartPLS 4.0 Data Processing (2023)
H
4
: Patient satisfaction mediates the effect of quality of care on patient loyalty
“The results of the analysis showed that the value of t-statistics (4.879) with p < 0.05
(0.000) and positive path coefficients (0.315). The results of t-statistics have a value greater
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
86 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
than t-table (1.96) and p value has a value smaller than 0.05, so in this study service quality
has a significant influence on customer loyalty. Indirect influences are declared significant
if both direct influences that make them up are significant. The direct influence of service
quality on patient satisfaction and the direct influence of patient satisfaction on patient
loyalty, both have a significant influence, it can be concluded that there is a significant
indirect influence between the indirect influence of service quality on patient loyalty through
patient satisfaction, this means that Hypothesis 4 is accepted. Mediating patient satisfaction
on the effect of service quality on patient loyalty is partial mediation.
Hypothesis 4 shows that in this study there is a mediating variable in the form of
patient satisfaction. According to Solimun (2017), if the influence of variable X (independent
variable) on variable M (variable mediation) is significant, the influence of variable M on
variable Y is significant, and the influence of variable X on Y is significant, then it is included
in partial mediation. The quality of service (X) in this study has a significant effect on patient
satisfaction (Y), patient satisfaction has a significant effect on patient loyalty (Z), and the
quality of service (X) has a significant effect on patient loyalty (Z). Thus, the patient
satisfaction variable can be said to be a partial mediation variable”.
c. Hypothesis Test Results
In view of the direct impact and reverse impact tests carried out in this examination.
The following is an outline of the results of the general speculation test presented in Table
9:
Table 9 Hypothesis Test Results
Path Coefficients
T-statistics
P values
Information
Significance
H
1
0,579
8,148
0,000
Accepted
Significant
H
2
0,317
2,823
0,005
Accepted
Significant
H
3
0,386
4,233
0,000
Accepted
Significant
H
4
0,224
3,257
0,001
Accepted
Significant
Source: SmartPLS 4.0 Data Processing (2023)
Information:
H
1
: “Service quality has a significant effect on satisfaction patient.”
H
2
: “Quality of service has a significant effect on loyalty patient.”
H
3
: “Patient satisfaction has a significant effect on patient loyalty.”
H
4
: “Quality of service has a significant effect on loyalty patient satisfaction mediated by
patient satisfaction”.
The study showed "that quality of care has a significant positive influence on patient
loyalty mediated by patient satisfaction, where the variable patient satisfaction is partially
mediated. This happens because the quality of service has a significant influence on patient
satisfaction, the variable of patient satisfaction has a significant influence on patient loyalty,
and the quality of service has a significant influence on patient loyalty.”
Discussion
1. The Effect of Service Quality on Patient Satisfaction
“The results of the hypothesis test that have been carried out show that the higher the quality
of service, the higher the patient satisfaction at the Hermina Hospital Pharmacy Installation in
Bandung. This result is in line with previous research conducted by Colgate and Danaher (2018)
in (Kincl & Štrach, 2018) examining that service quality affects satisfaction asymmetrically, where
poor service has a greater impact on customer satisfaction than good service. This is also in line
with previous research by Oh (2012) which states that service quality has a positive influence on
achieving customer satisfaction. Providing satisfaction to patients is not easy, there are often gaps
in service quality and service performance perceived by patients or companies.”
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
87
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
Susanto (2011) “which examines five variables that hospital management can use to
achieve quality of service and increase patient trust in the hospital. The five variables are service
quality, image, patient satisfaction, trust, and patient loyalty. The quality of service is formed by
several indicators such as nurses' understanding of patients, patient trust in treatment,
administrative staff and quick handling by administrative staff. Related to image, this dissertation
is measured by indicators of the hospital's willingness to provide information and trained
employees, so that this image also affects patient satisfaction. So, the better the image that is built,
the more patient satisfaction will increase. Quality of service and patient satisfaction will be built
when there is a competitive advantage of the company with competitors, in addition to the
argument that excellence in the services or products offered will establish a successful
relationship". Yuliarmi and Riyasa (2007) in (Hartono et al., 2023) "that all dimensions of service
quality, namely tangible, reliability, responsiveness, assurance and certainty, empathy have a
significant effect on customer satisfaction”.
2. The Effect of Service Quality on Patient Loyalty
“The results of the hypothesis test that have been carried out show that the higher the quality
of service, the higher the patient loyalty at the Hermina Hospital Pharmacy Installation in
Bandung City". This is the same as the study conducted by Zeithaml et al., (2018)
“which states that 80% of customers report being loyal (intend to reuse the service and
recommend the service to their relationships." "There is relationship between service delivery
system and customer loyalty where indicated by 80% of customer to make a report loyal and they
will repurchase and refer other". Olsen in 2016 "conducted a study to compare and make the link
between service delivery and customer loyalty. From the results of the study, it was found that
between service delivery and loyalty has a positive and quite significant relationship". Olsen
(2016): “The result indicates a relatively strong positive relationship between service delivery and
customer loyalty”.
“One competitive strategy so that the sales of a service are superior to its competitors is to
provide quality service, so that customers will feel satisfied and tend to use the services offered
by the company again.” According to Usmara, (2013) in Arisio (2019). “Minimizing service
deficiencies to customers greatly benefits the company. In fact, research shows that it is a more
profitable strategy than increasing market share or lowering costs" Meinanda (2014: 15) "lack of
services received by customers will have a strong influence on company profits rather than
production scale, loyalty, market share, unit cost and many other factors that are usually
associated with competitive advantage." Budiarto (2012) "providing support for service quality
has a direct and positive relationship with consumer loyalty in the health service industry".
Anderson & Lehman (2013) "High-performance service is service that is able to satisfy customer
needs. Previous research suggests there is a positive relationship between perceived quality and
customer loyalty” (Nafisa & Sukresna, 2018).
3. The effect of patient satisfaction on patient loyalty
The acquisition of the hypothesis test that has been carried out shows that the higher the
patient satisfaction, the higher the patient loyalty at the Hermina Hospital Pharmacy Installation
in Bandung. Anderson (Anderson & Weitz, 1992; Fornell & Wernerfelt, 1987) “that customer
satisfaction occupies an important position in practice in the business world because of the
benefits it can bring to the company. First, many researchers agree that satisfied consumers are
more likely to become loyal." "Consumers who are satisfied with the goods and services they
consume will have a tendency to repurchase from the same producers. This desire to repurchase
as a result of satisfaction is the desire to repeat a good experience and avoid a bad one." "Second,
satisfaction is a factor that will encourage positive word-of-mouth communication" explained
Solomon, (2010) in (Ernawati, 2021).
“This form of word-of-mouth communication delivered by a satisfied person can take the
form of recommendations to other potential customers, encouragement to colleagues to do
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
88 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
business with providers where consumers are satisfied, and saying good things about service
providers where they are satisfied” (Zeithaml et al., 2018). “The final factor of the effect of
consumer satisfaction on behavior is that satisfied consumers tend to consider satisfactory service
providers as the first consideration if they want to buy the same product or service. Satisfaction
has a significant impact on customer loyalty which will lead to commitment in business
relationships” (Burnham et al., 2013), “Therefore will influence customers to make repeat
purchases” (Morgan & Hunt, 1994). “Indeed, the impact of satisfaction on commitment and
retention varies in relation to industry, product or service, environment, and others”.
“Customer satisfaction and loyalty are highly correlated” (Athanassopoulos et al., 2001:
Hallowell, 2006: Silvestro dan Cross, 2010) “by forming two different constructions” (Oliver,
2010). “Customer satisfaction with the company is a great basis for loyalty” (Bloemer & Odekerken-
Schröder, 2002), “while not guaranteeing that, since satisfied customers are likely to switch to
another company" (Nordman, 2004), "one of the important reasons to switch is price" (Colgate
and Hedge, 2001). "Therefore, the company has launched a customer loyalty program that
provides incentives to customers. Although the effectiveness of loyalty programs has been
examined, studies have shown that they have significant, positive impacts on customer retention,
service use, and/or customer purchase share" (Bolton et al., 2010: Verhoef, 2013).
“Some researchers agree that the presence of satisfied customers is conducive to
customer loyalty" (Silvestro and Struart, 2010). "Customers who are satisfied with a product or
service are more likely to buy back if they have the opportunity to buy. Second, customer
satisfaction also results in a positive referral. Third, satisfied customers will be willing to pay
more for the benefits they receive and will most likely be more tolerant of price increases”. (Fornell
& Wernerfelt, 1987)
Jones and Sasser (2014: 745) "Customer loyalty is an endogenous variable caused by a
combination of satisfaction so that customer loyalty is a function of satisfaction. If the relationship
between satisfaction and patient loyalty is positive, then high satisfaction will increase patient
loyalty.”
4. Patient satisfaction mediates the effect of quality of care on patient loyalty
Side effects from completed speculative trials suggest that patient fulfilment mediates the
impact of quality administration on persistent reliability. The quality of good assistance will make
patients feel satisfied, so that the fortitude of patients at the Hermina Emergency Clinic
Establishment of Drug Stores in Bandung City will also increase. Kotler and Keller (2016)
"providing quality service and consumers feel satisfied it will create consumer loyalty", Sviokla
(2018) "states that the quality of service provided by the company can create a positive perception
of consumers towards the company and produce consumer satisfaction and loyalty. The quality
of service displayed by a company is one of the stimuli that makes consumers make transactions
again with the service company.”
Expanding patient satisfaction is essential to keep pace with the presence of health services
to remain competitive. Assuming the patient is happy with the assistance obtained, it will provide
benefits for specialist hospitals, one of which shows the fulfillment of controls that can encourage
devotion. Kulsum (2017), "High satisfaction will increase patient loyalty. Satisfactory and quality
service will form customer loyalty, and satisfaction is closely related to word of mouth, so
satisfactory service will also bring new customers” (Kuntoro & Istiono, 2017).
Ngo & Nguyen (2016), “Customer satisfaction can be confirmed as mediating the
relationship between service quality and customer loyalty”. Shandra & Murwatiningsih (2016),
“states that service quality indirectly affects consumer loyalty, through customer satisfaction as a
mediating variable". While Wiharyo and Budiarti (2017), “There is an indirect effect of service
quality on passenger loyalty through satisfaction which means that satisfaction can mediate the
relationship between service quality and loyalty”. Fatima (2018) “states that satisfaction and
loyalty are tied to each other and satisfaction can build patient loyalty.”
“Developing and maintaining patient loyalty will bring benefits to patients by improving
their health” (Rundle‐Thiele & Maio Mackay, 2001). “Loyal patients will also continue to use
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
89
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
medical services, follow the entire treatment plan and maintain relationships with health care
providers” (MacStravic, 2014). “The better the quality of service provided, the higher the level of
customer satisfaction and loyalty” (Kaura et al., 2015). Caruana and Fenech (2005) “To increase
patient satisfaction, a doctor must be able to improve the perception of quality of service”.
Having loyal patients is the sure goal of a medical clinic, as patient reliability can guarantee
the progress of the medical clinic in the long run. In essence, dependence on patients can be
interpreted as a person's constancy towards something. The term patient loyalty actually comes
from brand dedication that reflects the patient's reliability towards a particular brand. Client
dedication is a proportion of a patient's relationship with a brand. This action can give an idea of
whether a patient can switch to another service brand, if there is a change in product brand, both
in terms of price and quality different. Patient loyalty is the patient's obligation to a brand, the
image of a medical clinic, in an encouraging perspective and reflected in a calm and stable return.
One example of the positive outlook given by patient patients is repurchase, trying to find goods
from one emergency clinic service even though they are in a distant place and also considering
other brands to buy in addition to the usual brand of goods purchased.
CONCLUSION
Service quality has a positive influence on patient satisfaction, so when the hospital
provides better service quality than before, it will have an impact on high patient satisfaction at
the Hermina Hospital Bandung Pharmacy Installation. Service quality has a positive influence on
patient loyalty, so when the hospital provides new or better service quality than before, it will
have an impact on patient loyalty at the Hermina Hospital Bandung Pharmacy Installation. Patient
satisfaction has a positive influence on patient loyalty, it can be interpreted when the more
positive patient satisfaction is, the more patient loyalty will increase at the Hermina Hospital
Bandung Pharmacy Installation. Patient satisfaction mediates the effect of service quality on
patient loyalty. The results of the study proved that when the quality of service is improved, it
causes a positive perception of patient satisfaction, which can encourage to increase patient
loyalty at the Hermina Hospital Pharmacy Installation in Bandung City.
REFERENCES
Alfina, T. A. (2019). Analisis Muu Pelayanan Kesehatan di Rumah Sakit Tingkat IV Kota Madiun
tahun 2019 [Skripsi, tikes Bhakti Husada Mulia Madiun]. http://repository.stikes-
bhm.ac.id/id/eprint/580 Google Scholar
Anderson, E., & Weitz, B. (1992). The Use of Pledges to Build and Sustain Commitment in
Distribution Channels. Journal of Marketing Research, 29(1), 18–34.
https://doi.org/10.1177/002224379202900103 Google Scholar
Arisio, J. (2019). Pengaruh Peningkatan Kualitas Pelayanan Hotel Apple Green Kota Batu
Terhadap Kepuasan Konsumen [Skripsi]. Universitas Tribhuwana Tunggadewi Malang.
Google Scholar
Bangun, J. B. (2017). Pengaruh Kualitas Pelayanan Kesehatan terhadap Kepuasan
serta Implikasinya pada Word of Mouth (Suatu Survei Pada Pasien BPJS Rawat Jalan
Santosa Hospital Bandung Central) [Thesis, Universitas Pasundan].
http://repository.unpas.ac.id/id/eprint/31368 Google Scholar
Bloemer, J., & Odekerken-Schröder, G. (2002). Store Satisfaction and Store Loyalty Explained
Customer and Store-Related Factors. Journal OfConsumer Satifaction, Dissatisfaction and
Complainining Behavior, 15, 68. Google Scholar
Caruana, A., & Fenech, N. (2005). The effect of perceived value and overall satisfaction on
loyalty: A study among dental patients. Journal of Medical Marketing, 5(3), 245–255.
https://doi.org/10.1057/palgrave.jmm.5040236 Google Scholar
Corlesla, G. J. (2016). Pengaruh Konflik Kerja, Stres dan Motivasi terhadap Kinerja Dokter
Wanita di Klinik Evitderma Wilayah DKI Jakarta [Thesis, Universitas Pasundan].
http://repository.unpas.ac.id/id/eprint/11948 Google Scholar
The Mediating Effect of Patient Satisfaction in The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
90 Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
Ernawati, N. (2021). Stimulus Iklan, Positive Electronic Word of Mouth (eWOM) dan Belanja
Impulsif: Dampak Mediasi Motif Hedonis Pembelanja Online. INOBIS: Jurnal Inovasi
Bisnis Dan Manajemen Indonesia, 4(3), 346–360. Google Scholar
Fatima, T., Malik, S. A., & Shabbir, A. (2018). Hospital healthcare service quality, patient
satisfaction and loyalty. International Journal of Quality & Reliability Management, 35(6),
1195–1214. https://doi.org/10.1108/IJQRM-02-2017-0031 Google Scholar
Fornell, C., & Wernerfelt, B. (1987). Defensive Marketing Strategy by Customer Complaint
Management: A Theoretical Analysis. Journal of Marketing Research, 24(4), 337–346.
https://doi.org/10.1177/002224378702400401 Google Scholar
Grant, J. D., Lynskey, M. T., Madden, P. A. F., Nelson, E. C., Few, L. R., Bucholz, K. K.,
Statham, D. J., Martin, N. G., Heath, A. C., & Agrawal, A. (2015). The role of conduct
disorder in the relationship between alcohol, nicotine and cannabis use disorders.
Psychological Medicine, 45(16), 3505–3515. https://doi.org/10.1017/S0033291715001518
Google Scholar
Hartono, R. S., Nuraini, S., & Sanubari, P. (2023). Pengaruh Kualitas Pelayanan Publik terhadap
Kepuasan Pelanggan di Perusahaan Daerah Air Minum (PDAM) Tirta Patrot Kota Bekasi.
Governance: Jurnal Ilmu Pemerintahan , 11(2), 162–178. Google Scholar
Hudaya, A., & Masri, Z. A. H. (2015). Analisis ekonomi usaha budidaya Ikan Kerapu Di Pulau
Tidung Kepulauan Seribu DKI Jakarta. Jurnal Academia, 1(1), 1–12. Google Scholar
Jr., J. F. H., Black, W. C., Babin, B. J., & Anderson, R. E. (2018). Multivariate Data Analysis. In
Neuromarketing in India: Understanding the Indian Consumer.
https://doi.org/10.4324/9781351269360 Google Scholar
Kaura, V., Durga Prasad, Ch. S., & Sharma, S. (2015). Service quality, service convenience, price
and fairness, customer loyalty, and the mediating role of customer satisfaction. International
Journal of Bank Marketing, 33(4), 404–422. https://doi.org/10.1108/IJBM-04-2014-0048
Google Scholar
Kincl, T., & Štrach, P. (2018). Gender Differences in Online Customer Satisfaction: The
Asymmetric and Nonlinear Effect. Services Marketing Quarterly, 39(3), 157–174.
https://doi.org/10.1080/15332969.2018.1471954 Google Scholar
Kotler, P., & Keller, K. L. (2016). Marketing Management (15th edition). Pearson Education.
Google Scholar
Kulsum, U., & Syah, T. Y. R. (2017). The effect of service quality on loyalty with mediation of
patient satisfaction. International Journal of Business and Management Invention, 6(3), 41–
50. Google Scholar
Kuntoro, W., & Istiono, W. (2017). Kepuasan Pasien Terhadap Kualitas Pelayanan di Tempat
Pendaftaran Pasien Rawat Jalan Puskesmas Kretek Bantul Yogyakarta. Jurnal Kesehatan
Vokasional, 2(1), 140. https://doi.org/10.22146/jkesvo.30327 Google Scholar
MacStravic, S. (2014). Patient Loyalty To Physicians. Journal of Hospital Marketing, 10(1), 51–
61. Google Scholar
Morgan, R. M., & Hunt, S. D. (1994). The Commitment-Trust Theory of Relationship Marketing.
Journal of Marketing, 58(3), 20–38. https://doi.org/10.1177/002224299405800302 Google
Scholar
Nafisa, J., & Sukresna, I. M. (2018). Analisis pengaruh kualitas layanan, harapan kinerja dan citra
perusahaan terhadap loyalitas pelanggan melalui kepuasan pelanggan sebagai variabel
intervening (Studi pada Rumah Sakit Islam Sultan Agung Semarang). Diponegoro Journal
of Management, 7(4), 78–104. Google Scholar
Ngo, M. V., & Nguyen, H. H. (2016). The Relationship between Service Quality, Customer
Satisfaction and Customer Loyalty: An Investigation in Vietnamese Retail Banking Sector.
Journal of Competitiveness, 8(2), 103–116. https://doi.org/10.7441/joc.2016.02.08 Google
Scholar
Olsen, C., Pedersen, I., Bergland, A., Enders-Slegers, M.-J., Jøranson, N., Calogiuri, G., &
Ihlebæk, C. (2016). Differences in quality of life in home-dwelling persons and nursing
The Mediating Effect of Patient Satisfaction In The Effect of Service Quality on Patient Loyalty (Patient
Survey at Hermina Hospital Bandung Pharmacy Installation)
91
Return: Study of Management, Economic And Business, Vol 3 (1), January 2024
home residents with dementia – a cross-sectional study. BMC Geriatrics, 16(1), 137.
https://doi.org/10.1186/s12877-016-0312-4 Google Scholar
Paramita, W., Septianto, F., & Tjiptono, F. (2020). The distinct effects of gratitude and pride on
donation choice and amount. Journal of Retailing and Consumer Services, 53, 101972.
https://doi.org/10.1016/j.jretconser.2019.101972 Google Scholar
Pareraway, D. C. (2016). Analisis Kepuasan Pasien Rawat Jalan dalamPelayanan Kefarmasian di
Instalasi Farmasi RSUP Prof. Dr. D. Kandou Manado. Pharmacon, 5(4), 273–279.
https://doi.org/https://doi.org/10.35799/pha.5.2016.14050 Google Scholar
Rundle‐Thiele, S., & Maio Mackay, M. (2001). Assessing the performance of brand loyalty
measures. Journal of Services Marketing, 15(7), 529–546.
https://doi.org/10.1108/EUM0000000006210 Google Scholar
Shandra, M. P. K., & Murwatiningsih, M. (2016). Kepuasan Konsumen sebagai Media Pengaruh
Kualitas Pelayanan, Brand Image, dan Harga terhadap Konsumen. Management Analysis
Journal, 5(1), 36–43. http://maj.unnes.ac.id Google Scholar
Sofiana, M., Wahyuni, R., & Supriyadi, E. (2020). Studi Komparasi Kepuasan Pasien BPJS Dan
Non BPJS Pada Mutu Pelayanan Pendaftaran Puskesmas Johar Baru Jakarta Pusat.
Abiwara : Jurnal Vokasi Administrasi Bisnis, 1(2), 93–110.
https://doi.org/10.31334/abiwara.v1i2.797 Google Scholar
Sugiyono, S. (2020). Metode Penelitian Administrasi (Edisi Revisi). CV. Alfabeta. Google
Scholar
Susanto, A. K. (2017). Evaluasi Penyimpanan dan Pendistribusian Obat di Gudang Instalasi
Farmasi Rumah Sakit Advent Manado. Pharmacon Jurnal Ilmiah Farmasi –UNSRAT, 6(4),
87–96. Google Scholar
Susanto, S. (2011). Pengaruh Kualitas Layanan dan Citra terhadap Kepuasan Pasien dan
Kepercayaan serta Loyalitas Pasien Rawat Inap pada Rumah Sakit Umum Daerah di Daerah
Istimewa Yogyakarta [Disertasi]. Program Pascasarjana Universitas Airlangga Surabaya.
Google Scholar
Wiharyo, S., & Budiarti, A. (2017). Kepuasan sebagai Mediasi Pengaruh Kualitas Layanan dan
Harga terhadap Loyalitas Penumpang Citilink. Jurnal Ilmu Dan Riset Manajemen , 6(3), 1–
22. Google Scholar
Yuliani, K. F. (2017). Efektivitas Program Pelayanan Kesehatan Gratis (P2KM) di Kota
Bandarlampung [Skripsi, Universitas Lampung]. http://digilib.unila.ac.id/id/eprint/26694
Google Scholar
Zeithaml, V. A., Bitner, M. J., & Gremler, D. D. (2018). Services marketing: Integrating customer
focus across the firm. McGraw-Hill. Google Scholar
