THE EFFECT OF SERVICE QUALITY ON OUTPATIENT SATISFACTION OF DR . SOEGIRI GENERAL HOSPITAL LAMONGAN

Recently, tight competition requires hospitals to provide the best service and quality. Quality services may cause satisfaction to the patient. This study aims to determine the effect of quality service on satisfaction of outpatients at Hospital Dr. Soegiri Lamongan simultaneously and partially. This study utilizes cross sectional approach which involves 235 respondents of simultaneous outpatients. The instrument uses a questionnaire by employing independent and the dependent variables of satisfaction on quality service. The sample was taken by applying proposed sampling method. The data were analyzed using multiple linear regressions. The results of this study indicate that the service quality influence outpatients’ satisfactions.

Hospital is one of institutions which are engaged in health services and responsible for providing medical treatment and medical care, concern on healing customers, and provide a healthy life for society as well as possible (Kaihatu, 2012).According to PERMENKES (Regulation of the Minister of Health of the Republic of Indonesia) no.340/ MENKES/ PER/ III/ 2010, hospital is a health care institution that provides full-scale personal health services including inpatient, outpatient and emergency care services.
The increase in the number of hospitals leads patients to have more choices and demand better service quality.Service quality of hospital can be assessed through customer perception (Tjiptono, 2000).Customer perception about the quality of service can affect customer satisfaction (Kaihatu, 2012).Customer satisfaction begins with service given when a customer first arrives until the customer or patient leaves the hospital.Hospital service is formed based on 4 principles of service quality, namely speed, accuracy, friendliness and comfort of service (Wiyono, 2006).
Dr. Soegiri General Hospital Lamongan is a non-educational type B hospital, which has been accredited with 16 services.The hospital is located in the middle of Lamongan city, which provided 268 beds.Based on the type of service, the most visited polyclinics in outpatient installation are internal disease polyclinic, heart polyclinic, and nerve polyclinic.The following is a description of patient visits in Table 1.
Table 1 show that there is a decrease in patient visits in heart polyclinic.Demands arise from hospital customers, both patients and patients' family, not only on the availability of medicines and medical personnel but also including good care and relationship, which are also believed to help the recovery process of patients' condition.Patients expect the convenience of service, speed of service, and good service quality.
The quality of good hospital services will lead to patient satisfaction (Kaihatu, 2012).Data of patients' complaint in Dr. Soegiri General Hospital Lamongan obtained in the last three years are about; infrastructure, health personnel, management and services.From the data, the ones obtaining most complaints are health workers.
In the last three years, in Dr. Soegiri General Hospital Lamongan, society can express their complaints through suggestion and criticism box as well as through media.Most complaints are about health workers, infrastructure, and management.

METHOD
This research used cross sectional method to use independent variables and dependent variable.Independent variables are tangibles, responsiveness, reliability, assurance, empathy, and dependent variable is satisfaction.This study was conducted in July 2016.The respondents are patients who visited outpatient department at Dr. Soegiri General Hospital Lamongan more than twice.Population in this research is not known (infinite), Sampling technique used this research is purposive sampling.
In this study, the data was collected by using questionnaires.The answers were measured by using Likert scale, consisting of five answer options.Questionnaires had been prepared to obtain complete information from respondents (Amrullah, 2013).The research instrument is qualified if the instrument is valid and reliable (Sujarweni, 2015).
The result of validity test shows that all statement items produce correlation value greater than cut off value of 0.3.In this study, all items are declared to be valid.The result of reliability test in this study shows that all variable items have cronbach's alpha () > 0.6, which are declared to be reliable.

Characteristics of Respondents
The majority of respondents are 41 -60 years old (42.1%), female (63.3%), married (79.6%), high school graduates (37.4%), housewives (37.4%); distance between the house of majority of respondents and hospital is 10 km (46.4%); and majority of respondents pay medical treatment cost with insurance (34.0%).Respondents who were taken in this study are patients who had used health services at Dr. Soegiri General Hospital Lamongan.

The Influence of Service Quality on Outpatient Satisfaction of Dr. Soegiri General Hospital Lamongan
The results of multiple linear regression test show the influence of tangibles, responsiveness, reliability, assurance, and empathy on patient satisfaction, which can be seen in the following The test results (Table 3) show that tangibles, responsiveness, reliability, assurance, empathy have a positive effect on patient satisfaction simultaneously (F count = 123.480,with probability 0.000).Positive and significant effect statistically exists in variable of tangibles on satisfaction of outpatient service at Dr. Soegiri General Hospital Lamongan (t count amounted to 2.257, with probability of 0.025).Positive and significant effect statistically exists in variable of responsiveness on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan (t count amounted to 3.517, with probability of 0.001).Positive and significant effect statistically exists in variable of reliability on outpatient satisfaction Dr. Soegiri General Hospital Lamongan (t count amounted to 5.888, with probability of 0.000).Positive and significant effect statistically exists in variable of assurance on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan (t count amounted to 3.806, with probability of 0.000).Positive and significant effect statistically exists in variable of empathy on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan (t count amounted to 2.306, with probability of 0.022).The test results also show that variable of service quality contributed 72.4% to outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.

Characteristics of Respondents
Respondents in this research are patients who use health facility in outpatient department of Dr.
Soegiri General Hospital Lamongan with more than one visit; therefore, the researchers determine some characteristics of respondents in this study.The first characteristic is patients' age.Most of the respondents in this study aged 41-60 years old; the percentage reaches 42.1%.Respondents' age influences the decision process; the older a person, the better his response to a product (Renatha, 2013).In addition, according to Budiman (2016), older patients will be satisfied compared with younger patients.This is because older patients ask health workers about their physical condition more frequently; it meets their need for knowledge and understanding of health.Changes in mindset will have an impact on efforts to obtain information that is beneficial to the customer (Herlambang et al, 2011).
The next characteristic is sex.The majority of respondents in this study are female.In this case, women have behavior related to patient satisfaction (Notoatmojo, 2003).In line with the research which was conducted by Lumenta (1989) and Budiman, Suhat (2010), female is a predisposing factor that influences behavior.Meanwhile, according to Kartajaya (2010), young women who have internet connection play a strategic role in decision making.Women have an influence of 80% in using goods or services that will be used.This is because women tend to go shopping more than men and women can decide goods or services to be used more freely, Magnadi and Indriani (2013).This is in line with the opinion of Budiman and Lumenta (1989) in Suhat (2010) that sex affects satisfaction; women are more easily satisfied than men.In this case, men demand greater satisfaction.The next characteristic is marital status.Most of the respondents in this study are married (187 people or 79.6%).This is because family affects the process of attitude, perception, and behavior (Ainda, Tristiawan 2014).Family is defined as two or more persons who are linked by blood relations, marriage, or adoptions, who live together (Schiffman and Kanuk, 2008).Family is an external factor in the direct or indirect influence on the behavior and attitude of consumer in purchase decision (Kotler and Armstrong, 1996).
The next characteristic is education Most of the respondents involved in this study finished senior high school (88 people or 37.4%).Based on the Law of the Republic of Indonesia number 20 of 2003 on the national education system states, high school education is included in the group of secondary education.Having finished secondary education makes a person has sufficient understanding in making decisions.Wendha, Rahyuda, G and Atmosphere (2013) suggest that people with high education tend to be more rational in choosing services to be used, so respondents with higher education tend to choose services that provide more satisfaction and security.
The next characteristic is job.Most of respondents in this study are housewives (87 people or 37.0%).This is because a housewife has 7 roles to do, 1) as a parent, 2) as a wife, 3) role in the household, 4) role in kinship, 5) personal role, 6) role in community, and 7) role in work.Housewife has a role to support the head of household (husband) in meeting the need of family to realize prosperous family (Tjokrowinoto, 1986in Muhibat 1994).Magnadi and Indriani (2013) argue that housewives have more time to interact with others, and act as influencers and decision makers in purchasing a product/ service including the decision to choose health services.
Furthermore, the researchers pay attention to another important characteristic i.e. distance of patients' house with Dr. Soegiri General Hospital Lamongan.Researchers found that respondents who live more than 10 km away from the hospital are 109 people or 46.4%.This percentage is close to 50% and gives enough reason that long distance is not a constraint of respondents to use health facilities of Dr.Soegiri General Hospital.
The next characteristic is the cost of treatment.The number of respondents who do not use insurance to pay the cost of treatment is 80 or 34.0%.There are also 64 respondents or 27.2% patients paying the cost of treatment directly by cash.This is because insurance payment system will increase the satisfaction of patients in receiving services, the service of administration service or medical services/ care (Nurjanah, 1997 andBudi, HS 2010).

Tangibles, responsiveness, reliability, assurance, and empathy has a simultaneous effect on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
The results of this research show that tangibles, responsiveness, reliability, assurance, and empathy contribute 72.4% to outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.The results of this study indicate that hospital that has superior quality and consistency can foster patient satisfaction (Sugiharto, Sugianto, 2013).In addition, simultaneously patients also consider the convenience of the environment, the speed of service, the politeness of medical staff in performing their duties, the trustworthiness of medical staff, and the sympathy shown by medical staff of Dr. Soegiri General Hospital Lamongan as a place for medical treatment.This is in line with a research which was conducted by Kaihatu (2012), stating that the quality of service is proven to have positive and significant effect on patient satisfaction.The research which was conducted by Zeithaml & Bitner (1996) also supports the results of this study; it states that satisfaction is influenced by the quality of service provided, so that the better the service quality shown, the higher the satisfaction of patients.Meanwhile, in their study, Putra et.al (2013) state that the higher the quality of service, the more positive the perception perceived by patients.High patients' perception of the quality of a service will lead to high the satisfaction of patients.
The results of this study indicate the direct effect of service quality on patient satisfaction.The results of this research are in line with previous study which was conducted by WU (2011) and Kaihatu (2012), showing a positive and significant effect of service quality and patient satisfaction.Trarintya (2011) states that service quality has a positive and significant effect on outpatient satisfaction.Service quality has a positive and significant effect on word of mouth (WOM) of outpatients.Satisfaction has a positive and significant effect on word of mouth (WOM) of outpatient.WOM can convey the positive side of customer satisfaction of the quality of service, customer value and the superiority of product or service offered (Sugiharti, 2010).

Tangibles influences outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
The result of descriptive analysis shows that variable of tangibles has a positive effect on patient satisfaction.It indicates that patients choose to get medical treatment of Dr. Soegiri General Hospital Lamongan when they are sick, by considering the infrastructure and facility provided, modern equipment, trusted service, and comfortable environment.This indicates that the patients have a perception of four reasons simultaneously in using health facilities of Dr. Soegiri General Hospital Lamongan.Tangibles are physical manifestations that include existing equipment, existing medical personnel, comfortable treatment rooms, adequate facilities, and comfort during treatment.Tangibles (physical evidence) is the ability of a company to show its existence to external parties.Appearance of office and employees, the condition of facilities and physical infrastructure of the company (including communication facilities), as well as the surrounding environment of the services provided to the patient.The appearance of service is not only limited to the physical appearance of the building, but also the appearance of the medical staff and the availability of supporting infrastructure (Lupiyoadi, Rambat (2006), Darmawansyah, Alwy (2013)).

Responsiveness influences outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
The results of research and statistical analysis show that responsiveness has a positive effect on patient satisfaction of Dr. Soegiri General Hospital Lamongan.The influence of responsiveness on patient satisfaction can be seen from the decision of respondents to choose Dr. Soegiri General Hospital Lamongan for it provides quick service, responsiveness, prioritizes the interest of patients, has awareness and desire to help customers, and provide services quickly.
The results of this study indicate that respondents will feel satisfied with the medical service if the medical staff has a good responsiveness.Responsiveness is a willingness to help and provide prompt and proper service to customers by delivering clear information.Letting patients or customers wait without a clear reason leads to negative perception of service quality (Tjiptono, F 2001).

Reliability affects outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
The results of research and statistical analysis show a positive effect on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.Respondents choose Dr. Soegiri General Hospital Lamongan by considering the quick service, punctuality of service time, ease in making appointment for medical treatment, the politeness of the medical staff in conducting their duty.In this case, reliability can affect patient satisfaction and lead to patient loyalty.Reliability is the ability of the company to provide services in accordance with the service that has been offered accurately and reliably.Service reliability includes quick and accurate patient admission procedure, good and useful service procedures (not complicated), prompt service and time, and error-free services provided by the medical personnel (Tjiptono, F 2001).

Assurance affects outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
The results of research and statistical analysis show that assurance has a positive effect on patient satisfaction of Dr. Soegiri General Hospital Lamongan.In this study, respondents' assessment of assurance shows that medical personnel are clean and tidy, record medical history of patients accurately, trustworthy, treat patients safely, deliver clini-cal regulations politely, and have adequate knowledge.Assurance (guarantee) is knowledge, politeness, courtesy, and the ability of the employees of a company to cultivate customers' trust to the company, including knowledge, ability, courtesy, credibility, and safety, which can affect customer satisfaction (Darmawansyah and Alwy, 2013).

Empathy affects outpatient satisfaction of Dr. Soegiri General Hospital Lamongan
Empathy (attention) is the fifth variable in this research.The results of research and statistical analysis show that empathy has a positive effect on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.In this case, the respondents chose Dr. Soegiri General Hospital Lamongan because the medical staff shows the place of service, give information needed easily, show sympathy, understand the need of the patient, pay much attention to patients, and are willing to help.Empathy (attention) consists of a sense of care to give individual attention to customers, understand customer needs, and accessibility (ease of contact), Imbalo (2007), Tjiptono (2005).
Hariyanto, Resti (2013) states that one of the factors that determines the success rate of a company is the ability of the company in providing quality service to customers, in order to achieve satisfaction.Quality is a dynamic condition associated with products, services, people, processes, and environment that meet or exceed customer expectation.Quality has a close relationship with customer satisfaction.Satisfaction is the feeling of pleasure or disappointment of a person, derived from the comparison between the impression and expectation of the service/ product and the performance perceived, Tjiptono 2005 and Kotler, 1997in Sugiarto & Sugiharto (2013).Kotler, Zeithaml, Bitner (2000) on M.B.Pontoh, L.Kawet, W.A.Tumbuan (2014) say that satisfaction is the feeling of someone who is satisfied or otherwise after comparing the reality and expectations of a product or service.Service quality has partial and simultaneous effect on patient satisfaction in hospital.It is assumed that service quality is one of main consideration for using this hospital ser-vice.Quality of service has a positive effect on satisfaction, if service quality is good, then consumer satisfaction will increase, Tumpal, (2012).Satisfaction will never stop at one point; it is moving dynamically and following the level of quality of its products and services, with customers' expectations which is increasing from time to time.Patient expectation is influenced by patients' previous experiences, advice from friends and colleagues, as well as promises and information given by marketers and competitors, Palilati. A (2007).
Based on the results of this research, it can be concluded that there is effect of tangibles, responsiveness, reliability, assurance, and empathy on outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.Reliability gives the biggest contribution to outpatient satisfaction of Dr. Soegiri General Hospital Lamongan.

CONCLUSION AND SUGGESTION CONCLUSION
Quality of service affects outpatient satisfaction of Dr. Soegiri General Hospital Lamongan simultaneously and partially.In this research, the most dominant dimension is reliability.

SUGGESTION
Based on the findings obtained in this study that the most dominant variable is reliability and the one needs to be improved is empathy, the researcher suggests Dr. Soegiri General Hospital Lamongan to supervise medical staff by monitoring them to smile, greet, and wish patients to be well soon, in accordance with the motto of Dr. Soegiri General Hospital Lamongan.