The Influence of External Service Quality and Satisfaction on Patient Loyalty in Surabaya Islamic Hospital

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INTRODUCTION
Hospitals have the function of providing medical treatment and health recovery services by hospital service standards.The era of globalization is not only an opportunity but also a threat to the development of hospitals, where competition between hospitals will be higher (Rahmawati, 2014).To survive and develop, hospitals must strive to improve services to patients by the provisions or standards of hospital services (Badriyah, Wibowo, and Sumaryanto, 2020).Measuring the performance of a hospital's services can be known through several indicators.By the Regulation of the Minister of Health of the Republic of Indonesia Number 129 of 2008 concerning Minimum Hospital Service Standards (Ministry of Health of the Republic of Indonesia, 2009).These service quality indicators can be used to measure the quality of services in hospitals.The quality of hospital services has two components: compliance with predetermined quality standards and fulfillment of customer satisfaction.The quality of health services refers to the level of perfection of the appearance of health services that are held on the one hand to satisfy service users.And on the other hand, the procedures for implementing them are by the professional code of ethics and established standards (Subiyantoro &Ambarwati, 2017).
External service quality plays an essential role in determining whether customers are satisfied when seeking treatment.If the customer is satisfied, it is hoped that it will lead to patient loyalty to the hospital.Many researchers have realized that the values of service quality and customer satisfaction are interrelated because service quality and customer satisfaction have a significant relationship (Tuhu Hidayat, 2016).Saputra (2021), argues that there are external service quality factors in service quality that affect satisfaction and loyalty.
The creation of customer satisfaction can provide several benefits, including a reasonable basis for repurchasing and creating customer loyalty and forming a word-of-mouth recommendation that is profitable for the company (Tjiptono, 2011).Based on research conducted (by Jihan and Made, (2018), satisfaction does not entirely affect patient loyalty.Hospitals should pay attention to this because satisfied patients are only sometimes loyal to the services provided by the hospital.Loyalty generated by satisfaction does not necessarily produce the highest level of loyalty (Gunawan, 2013).Loyalty has several levels, and the hospital must know at what level of loyalty the patient has been given satisfaction.
Although service satisfaction at the Surabaya Islamic Hospital is on average to the provisions of hospital policy, it is also necessary to analyze the level of patient loyalty at the Surabaya Islamic Hospital (Bouranta, Chitiris, and Paravantis, 2009).Not all patients who are satisfied with the services received can be at a good level of loyalty to the services provided by the hospital (Puryanti, 2021).
Based on research that researchers in the previous year carried out regarding the effect of service quality (Badriyah, Wibowo, and Sumaryanto, 2020), perceived service quality on the level of patient loyalty in this study researchers will add the satisfaction variable as an intermediate variable.So the research topic that researchers will raise is external service quality analysis and satisfaction with the level of patient loyalty (Rizan, Prasetya, and Kresnamurti, 2014).

METHOD
This research is descriptive-analytic research with a cross-sectional design, namely, the research variables are measured only once at a particular time.Data was collected using a questionnaire with Likert's summated rating method on external service quality questions.This research was conducted at the Surabaya Islamic Hospital.This research activity will be carried out in November -December 2022.This research is done by processing secondary data in the Public Relations Unit of the Surabaya Islamic Hospital as many as 365 visitors filled out a customer satisfaction survey.Service quality is an essential component of customer perception because it contains information about quality and customer satisfaction.Service quality can be seen from two perspectives, namely internal service quality and external service quality.External service quality is used to assess service quality and satisfaction from the consumer side.Meanwhile, internal service quality is used to assess service quality and satisfaction from the employee side (Kotler &Keller, 2016).Loyalty can be defined as loyalty.However, this loyalty is taken without coercion, arising from past selfconsciousness.Efforts made for creating consumer satisfaction are more likely to influence the attitudes of consumers, here is Customer Loyalty at Surabaya Islamic Hospital.The creation of customer satisfaction can provide several benefits, including a good basis for repurchasing and creating customer loyalty and forming a word-of-mouth recommendation that is profitable for the company (Tjiptono, 2011).Based on research conducted (by Jihan and Made, (2018), satisfaction does not entirely affect patient loyalty.Hospitals should pay attention to this because satisfied patients are only sometimes loyal to the services provided by the hospital.Loyalty generated by satisfaction does not necessarily produce the highest level of loyalty (Gunawan, 2013).Loyalty has several levels, and the hospital must know at what level of loyalty the patient has been given satisfaction.
This greatly determines the policies to be taken by the hospital (Sektiyaningsih, Indria Sukma;Haryana, Arif;Rosalina, 2019).Although service satisfaction at the Surabaya Islamic Hospital on average is to the provisions of hospital policies, it is also necessary to analyze how the level of patient loyalty in Surabaya Islamic Hospital.Not all patients who are satisfied with the services received can be at a good level of loyalty to the services provided by the hospital (Puryanti, 2021).

CONCLUSION
Characteristics of patients at the Surabaya Islamic Hospital are primarily women aged <25 years with BPJS patient guarantees who live 5-10 Km with a long history of knowing the Surabaya Islamic Hospital for >20 years while in customer assessment External service quality, which includes the product, organizational image, safety, empathy, reliability, responsiveness at Surabaya Islamic Hospital is good and there is a relationship External service quality and satisfaction significantly influence patient loyalty at Surabaya Islamic Hospital.

Table 1 .
Identification of the patient characteristics of the Surabaya Islamic Hospital https://doi.org/10.33086/jhs.v16.i01.3984Puryanti -The Influence of External Service Quality and Satisfaction on Patient Loyalty in Surabaya Islamic Hospital RESULT

Table 3 .
Identification of patient loyalty at Surabaya Islamic Hospital

Table 4 .
Identification of satisfaction in Surabaya Islamic Hospital.

Table 5 .
The Effect of External Service Quality and Satisfaction on patient loyalty at the Surabaya Islamic Hospital https://doi.org/10.33086/jhs.v16.i01.3984Puryanti -The Influence of External Service Quality and Satisfaction on Patient Loyalty in Surabaya Islamic Hospital