DESCRIPTION OF PATIENT SATISFACTION HEALTH SOCIAL SECURITY AGENCY (BPJS) OUTPATIENT TO PHARMACEUTICAL SERVICES AT KANUDJOSO DJATIWIBOWO HOSPITAL BALIKPAPANWITH IMPORTANCEPERFORMANCE ANALYSIS (IPA) METHOD
Siti Jubaidah*, Heri Wijaya, Eka Siswanto Syamsul, Rifky Wijayanto
Institute of Health Science of Samarinda, AW Syahranie Street, Number 226 Samarinda, East Borneo, Indonesia
*Corresponding Author’s Email: ida_mapro13@yahoo.com
ABSTRACT
Introduction: Consumer satisfaction (patient) is the result of an evaluation in the form of an emotional response (feeling happy and satisfied) to consumers because reality exceeds the expectations or desires of consumers. Objective: The purpose of this study was to describe the satisfaction of outpatient health social security agency (BPJS) patients with pharmaceutical services at RSUD Dr. Kanujoso Djatiwibowo Balikpapan for the period March-April 2019. This research is non-experimental research with descriptive data analysis. The object of research in this study is a description of patient satisfaction at the Dr. Kanudjoso Djatiwibowo Hospital Balikpapan for the period March 2019. The sample in this study were patients or families of outpatient health social security agency (BPJS) patients who used pharmaceutical services at the Dr. Kanudjoso Djatiwibowo Hospital Balikpapan for March 2019. Determination of the number of samples used in the Morgan and Krejcie tables. Results: Based on the results of the research, the satisfaction level of outpatient health social security agency (BPJS) patients at Kanudjoso Hospital, Balikpapan, from 5 dimensions of service quality, two dimensions have a level of suitability more than the overall suitability level, namely the dimensions of reliability and assurance so that it can be concluded that these dimensions are satisfactory for the patient. While the other three dimensions, namely Responsiveness, Empathy, and Tangible, have a level of conformity that is less than the overall level of suitability, it can be concluded that these three dimensions are not satisfactory for patients. Based on the priority of quality improvement, the question element The speed of time for the patient to wait for the drug according to the standard (concocted medicines ≤ 60 minutes) and (non- concocted drugs ≤ 30 minutes) is the priority because it has the most minor level of conformity, while the question element for drug delivery according to the queue number is the last priority. Because it has the most significant degree of conformity. Based on the IPA (Importance-Performance Analysis) analysis, two dimensions satisfy patients in pharmaceutical services: Reliability and Assurance. Based on the Cartesian diagram, an important priority improved performance is the speed with which the patient waits for the drug according to the standard, and the staff is always on time according to the schedule.
Keywords: Satisfaction; Hospital; BPJS; IPA Method
INTRODUCTION
One of the supporting factors for hospital services in the Hospital Pharmacy Installation. The Hospital Pharmacy Unit is the only unit in the Hospital that is responsible for medicine management or, more precisely, pharmaceutical activities (Novaryatiin, Ardhany & Aliyah, 2018). Pharmacy installation is a place for pharmaceutical services to carry out pharmacy practices by pharmacists and distribute pharmaceutical preparations to the public (Sari, Astuti, & Susilowati, 2019). Good pharmaceutical services are directly oriented in using the medicine, aiming to ensure the safety, effectiveness, and rationality of medicine use by applying science and function inpatient care. The demands of patients and society for the quality of pharmaceutical services require a shift in the service paradigm from the old paradigm that is oriented towards medicinal products to a new paradigm that is patient-oriented (Bertawati, 2013).
Satisfaction is a function of performance and expectations. If the performance is below expectations, the consumer is not satisfied. On the contrary, if the performance meets expectations, the consumer will be satisfied, and the consumer will be very satisfied if the performance exceeds expectations (Arab et al., 2012 & Tjiptono, 2011). Consumer satisfaction is likely to affect the image of the pharmacist and pharmacy profession. Efforts should not only be made to track consumer satisfaction with pharmacy services but also to improve it where needed (Oparah & Kikanme, 2006). The quality of a health service is closely related to health service users' satisfaction, namely patients (Mosodeghrad, 2013). The patient’s opinion is becoming more important in the improvement process of a health care delivery system. Patient satisfaction is the state of pleasure or happiness that the patients experience while using a health service. Thus, patient care is the basic function of every health service provider (Li et al., 2012).
Patient satisfaction is a renowned standard to evaluate the effectiveness of health services being provided in hospitals. Patient satisfaction is an important measuring stick by which the delivery of health care service is the measure (Ganasegeran et al., 2015). Hence, the evaluation of health service delivery from the patients’ perspective has received greater attention and has become a core attribute of any health system as it serves as a valuable indicator to measure the success of a service provision, especially in public sector hospitals (Mohd & Chakravarty, 2014).
The indicator that who can use to determine the quality of health services is to measure the satisfaction of consumers of health services (Moore et al., 2013). According to the Regulation of the Minister of State Apparatus Empowerment and Bureaucratic Reform of the Republic of Indonesia Number 14 of 2017 concerning Guidelines for Preparing Community Satisfaction Surveys for Public Service Providers, the Community Satisfaction Survey (SKM) can be measured by nine elements, which include requirements, technical and administrative, systems, mechanisms, and procedures, settlement time, fees or rates, product specifications for the type of service, executive competence, implementer behavior, complaint handling, suggestions and input, facilities and infrastructure. There are five service quality elements related to patient satisfaction: tangibles, reliability, responsiveness, assurance, and empathy, called the SERVQUAL method (Konerding et al., 2019).
Dr. Kanujoso Djatiwibowo hospital is one type of general hospital which on March 3, 2017, is classified as a type B hospital class. The average visits of outpatients who seek treatment per day are around 200-300 people, and 90% are Patient Satisfaction Health Social Security Agency (BPJS). There are seven Pharmacy Technical Workers in the outpatient unit at the Kanujoso Djatiwibowo hospital, two pharmacists, two administrative officers, and two racik interpreters. The total number of employees on duty in the outpatient unit is twelve.
METHODOLOGY
The design of this study was used a non-experimental prospectively approach with a descriptive analysis. The research object in this study is a description of patient satisfaction at dr. Kanujoso Djatiwibowo Balikpapan hospital. This study's sample was patients or families of outpatient Health Social Security Agency (BPJS) who used pharmaceutical services at dr. Kanujoso Djatiwibowo Balikpapan hospital. Determination of the number of samples using the Morgan and Krejcie tables. The sampling technique used was accidental sampling. The data analysis used in this study was the Importance-Performance Analysis (IPA) method. The IPA method is used to describe or describe the level of expectation and reality of outpatient Health Social Security Agency (BPJS) for pharmaceutical services in dr.Kanujoso Djatiwibowo Balikpapan hospital. The data are grouped into four quadrants, namely quadrants A, B, C, and D, on the Cartesian diagram to prioritize improving service quality.
RESULTS
Description of Respondent Characteristics
The respondents' characteristics in this study were divided into five groups, namely gender, age, education, occupation, and survey hours. Based on the study results, the largest number of respondents based on gender was male, with 90 respondents (53%), while the total number of female respondents was 79 respondents (47%). The results of this study show that most respondents based on age are adult respondents, with a total number of 89 people (53%). They were followed by early elderly with a total number of 40 respondents (24%), followed by late elderly with a total number of 37 respondents (21%), followed by adolescents with a total number of respondents only four people (2%). Based on the educational background of most respondents are respondents with senior high school education background with total number respondents as many as 90 people (53%), followed by respondents with a bachelor's education background with a total number respondents many as 33 people (20%), followed by respondents with a junior high school education background with a total number of respondents as much as 31 people (18%), and finally followed by respondents with a background of primary school education with a total number of respondents as many as 15 people (9%). In this study, the results of the respondent data obtained based on the background of work were mostly respondents with entrepreneurial occupations with a total number of respondents as many as 65 people (39%). Followed by respondents with the same private occupation and housewives who had a total number of 36 people (21%), and finally followed by respondents who work as state civil servants with a total number of respondents as many as 32 people (19%). According to the results of the study, the most data collection time was in the morning with a total number of respondents with 74 people (44%). Then continued with the most patients' data collection time during the day with a total number of respondents with 73 people (43%). Finally, the least time for data collection was in the afternoon, with The total number of respondents was 22 people (13%).
Table 1: PerceptionValue, Conversion Interval Value, Service Qualityand Service Unit Performance
NILAI PRESEPSI
NILAI INTERVAL (NI)
NILAI INTERVAL KONVERSI (NIK)
MUTU PELAYA NAN (x)
KINERJA UNIT PELAYANAN
(y)
1
1,00-
2,5996
25,00-64,99
D
Tidak Baik
2
2,60-3,064
65,00-76,60
C
Kurang Baik
3
3,0644-
3,532
76,61-88,30
B
Baik
4
3,5324-
4,00
88,31-100,00
A
Sangat Baik
Research Results Based on the Calculation of Community Satisfaction Index per Service Element
According to the Regulation of the Minister of Administrative Reform No. 14 of 2017 concerning Guidelines for Preparing Community Satisfaction Surveys for Public Service Provider Units, the calculation of this study uses the calculation of the Community satisfaction index. The questionnaire used as a tool in this study amounted to 20 items containing nine elements of the Community Satisfaction Survey (SKM) related to the five service quality dimensions. We can see the results of the calculation of the patient satisfaction index in table 2. After obtaining the index value, calculating the value after being converted is 83.75, then seen in table 2— perception Value, Conversion Interval Value, Service Quality and Service Unit Performance. So obtained outpatient Health Social Security Agency (BPJS) patient satisfaction at Dr Kanujudjoso hospital according to the Community Satisfaction Survey (SKM), namely the quality of service B and the performance of service unit B.
Table 2: Results of Calculation of Patient Satisfaction Index per Service Element
Research Results Based on Comparison of Expectation Levels and Reality Levels Using the Importance-Performance Analysis (IPA) Method.
To find out the description of outpatient Health Social Security Agency (BPJS) patient satisfaction with pharmaceutical services at the dr. Kanudjoso Djatiwibowo Hospital Balikpapan using the Important-Performance Analysis (IPA) method calculating the suitability level of the elements of reality and expectations. The calculation of the level of conformity can be explained in table 3.
Table 3: Calculation of the level of conformity
Based on table 3. The suitability level of each element, each dimension's suitability level, and the overall suitability level are obtained. Furthermore, each component's suitability level and the level of suitability of each dimension are compared with the overall suitability level as a total mean to obtain a conclusion on patient satisfaction. Suppose each element's suitability level and dimension is greater than the overall suitability level as the total mean. In that case, it can be concluded that the patient's satisfaction per question element and dimension.
Sequence of Quality Improvement Priorities
After knowing the level of suitability of the question elements, then the priority order of improving the elements' performance is determined, sorted from the smallest to the greatest suitability level. What can see it in table 4. Based on table 4, information regarding the priority order of quality improvement is obtained. The question element when the patient waits for the drug according to the standard (concocted medicines ≤ 60 minutes) and (non-concocted drugs ≤ 30 minutes) is the priority because it has the smallest suitability level. The question element Delivery of medicines according to the queue number is the last priority because it has the greatest suitability level. After obtaining the priority order of quality improvement, the analysis is continued with a Cartesian diagram to determine each question element's grouping to implement a service quality improvement strategy.
Table 4: Sequence of Quality Improvement Priorities
Expectation and Reality Level Cartesian Diagram
To find out the strategy for improving the quality of outpatient Health Social Security Agency (BPJS) services at dr. Kanudjoso Djatiwibowo Hospital, Balikpapan, an analysis was carried out through Importance Performance Analysis (IPA). IPA is an analytical technique used to identify what important performance factors an organization must demonstrate in meeting service users' satisfaction (consumers) (Suhendra, 2016). Through the importance-performance analysis method, it can also be seen the location of the implementation of each dimension of service quality that affects the patient so that it can be used as a consideration for improving the quality of service. The Cartesian diagram consists of 4 quadrants, namely quadrant A (High Importance, Low Performance), quadrant B (High Importance, High Performance), quadrant C (Low Importance, Low Performance) and quadrant D (Low Importance, High Performance).
Based on table 5, it is found that the distribution of the question elements studied and the hospital can determine the service rating according to patient satisfaction and hospital performance. Also, identify what actions the hospital management needs to take through the elaboration of all elements of service quality questions into a Cartesian diagram. Based on table 5, it is found that the dimensions of service quality are divided into four quadrants, namely:
Table 5: Cartesian diagram
DISCUSSION
Quadrant A (High Importance, Low Performance)
The service element in this quadrant shows the location of the hospital management's weakness, dr. Kanudjoso Djatiwibowo, towards pharmaceutical services. Based on the Cartesian diagram, it can be seen that the question elements included in this quadrant are the time the patient waits for the drug according to the standard, the officer is always on time according to the schedule (Res3). The standard waiting time for finished medicine services is the grace period from the time the patient submits the prescription to receiving the finished medicine with the minimum standard set by the Ministry of Health is ≤ 30 minutes, while the waiting time for concocted medicine service is the time from the time the patient submits the prescription to receiving the concocted medicine, which is ≤ 60 minutes (Kepmenkes, 2008).
Quadrant B (High Importance, High Performance)
In the Cartesian diagram, it can be seen that the attributes included in this quadrant are the completeness of the prescribed drugs is always available, the delivery of medicines according to the queue serial number, the officer always explains information on medicine use (efficacy and medicine side effects), the officer always uses a uniform / complete identity ( badge name), how do you understand the condition of the medicine given is good (not damaged, not yet expired, the packaging is still good) and accompanied by clear etiquette, pharmacists carry out medicine delivery, officers use language that is easy to understand when explaining medicines information, officers always be patient in serving patients, pharmacy officers always look neat/clean, comfortable waiting room facilities such as TV, fan, and clean room. The quality improvement strategy for this quadrant is by maintaining the performance of the question element. So this element needs to be maintained to create patient loyalty and patient interest in returning to treatment (subscribing).
Quadrant C (Low Importance, Low Performance)
The question element in this quadrant shows the location of the hospital management's weakness, dr. Kanudjoso Djatiwibowo, regarding pharmaceutical services in meeting patient needs. However, at this time, it is still not considered important. In the Cartesian diagram, it can be seen that the elements included in this quadrant are officers who are always alert and responsive in handling patient complaints, pharmacy officers provide the opportunity to ask patients, easy and straightforward services, officers are always polite, friendly, smile and greet when patients arrive. The officer always tries to calm the anxiety / worry about the patient's illness. The officer gives hope for a recovery to the patient. The number of seats in the waiting room for the medicine is sufficient; the counters' arrangement is good with a regular queue line. The strategy suggested by the researcher is that it is necessary to improve the quality of service even though the patient thinks that the elements of service above are not too important. This was done to create patient loyalty and patient interest in returning to treatment (subscribing).
Quadrant D (Low Importance, High Performance)
The question element, which is located in this quadrant, is an element that the patient considers less important. Still, the implementation has been good, so that it seems excessive but is considered satisfactory. In the Cartesian diagram, it can be seen that there is no question element included in this quantity, meaning that the quality of service performance of the question element is not in the excessive category.
CONCLUSION
Based on the research results, the outpatient Health Social Security Agency (BPJS) was 83.75 with good service quality. Based on the IPA (Importance-Performance Analysis) method, two dimensions satisfy pharmaceutical services patients: Reliability and Assurance. Based on the Cartesian diagram, the important priority for improved performance is the speed with which the patient waits for the drug according to the standard. The staff is always on time, according to the schedule. For the hospital, dr. Kanudjoso Djatiwibwo Balikpapan to improve the performance of pharmaceutical services based on the priority order of improving the performance of the elements that have been obtained in this study. And it is hoped that it can maintain good service and improve services that are still not good.
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