Analysis of Health Service Quality and Patient Satisfaction on Patient Loyalty in the Outpatient Installation of Aulia Blitar General Hospital

Quality of service is an important thing in services, especially health services in hospitals to provide satisfaction to patients and families. Satisfaction is the result of the good quality of the services provided so that there will be a feeling of comfort and safety for returning to the hospital or health service. The return of patients to the hospital for treatment is one proof of patient loyalty and patient loyalty to the hospital because they are satisfied with the quality of services provided. This study aims to determine the effect of quality of health services and patient satisfaction on patient loyalty in outpatient installations at Aulia Blitar General Hospital. This type of research uses observational analytic with cross sectional design. Samples were taken based on purposive sampling, totaling 100 respondents who were treated at the outpatient installation at Aulia Blitar General Hospital. Data collection used a questionnaire on service quality, patient satisfaction and loyalty questionnaires using a likert scale.


BACKGROUND
The hospital is a means of providing health services. In carrying out health services, it is necessary to have policies and standard operating procedures (SOPs ) to ensure good quality health services. According to Hantiningtiya, Bunga (2016) "Quality is something that is decided by the customer, meaning that quality is based on the customer's or consumer's actual experience of a product or service that is measured based on requirements. Quality of service and patient loyalty is one of the factors that influence patient loyalty patient loyalty to the hospital. The better the quality of the services provided and the increasing patient satisfaction will make the patient loyal to return to the hospital the.
The Aulia Blitar general hospital is a type C private hospital in the Blitar district with adequate outpatient polyclinic services, but there are some poor data regarding the quality of service at the Aulia Blitar general hospital. From data on outpatient visits in the second semester of 2020 at the Aulia Blitar General Hospital there were 15,256 patients and in the second semester of 2021 there were 12,145 patients, experiencing a significant decrease of 3,111 patients. From a survey of 10 patients seeking treatment at the outpatient installation of RSU Aulia Blitar, 6 people expressed disappointment with the service ( the doctor often came late, the staff was not friendly, the toilet was not clean). Similarly, from the data obtained from social media, many complaints have been made regarding the quality of health services at the Aulia Blitar general hospital, especially in the outpatient installation, where patients and their families often complain about the long waiting time for examinations due to the accumulation of patients and doctors. late arrival, uncomfortable waiting room, less clean toilets, and some unfriendly staff. This can reduce the quality of service, satisfaction and loyalty of patients in the Aulia Blitar General Hospital.
Therefore it is necessary to analyze the quality of health services and patient satisfaction on outpatient loyalty at the Aulia Blitar General Hospital, to maintain the quality of service, patient satisfaction and loyalty at the Aulia Blitar General Hospital.

METHODS
This research is an observational analytic research approach cross sectional study namely an approach to obtain information from respondents through the sample studied in a certain period of time. Activities carried out include the collection of independent variable data and dependent variable. This research was conducted at the outpatient installation at the Aulia Blitar General Hospital on 26-31 October 2022 with a sample of 100 patients within 7 days or according to the quota being met.
The data collection process was carried out by distributing questionnaires to outpatients at Aulia Blitar General Hospital, the questionnaire consisted of 25 questions with a value range of 1-5. After the data has been collected, the data normality test, multicollinearity test, heteroscedasticity test and linearity test are carried out using multiple liner tests.

Description of the effect of the quality of health services on patient loyalty in the outpatient installation of RSU Aulia Blitar
On variable quality of health services have meaning that how much good service which owned by the outpatient installation at the Aulia Blitar General Hospital, which was seen from the speed of service, the friendliness of the service, the exact time of service and the complete facilities that support the service are described in 18 questions which are measured by questionnaire which own score evaluation 1-4, with score highest 72 and score minimum 18 with long intervals 26 Long intervals 72 -18 = 26

Description of the effect of patient satisfaction on patient loyalty in the outpatient installation of RSU Aulia Blitar
On variable patient satisfaction have meaning that how much patient satisfaction with service which given by the outpatient installation at the Aulia Blitar General Hospital, which was seen of satisfaction with services, facilities and tariffs which are described in 3 questions that are measured by questionnaire which own score evaluation 1-4, with score highest 12 and score minimum 3 with long intervals 2 Long intervals 12 -3 = 2.25/2

Description of the effect of quality of health services and patient satisfaction on patient loyalty in the outpatient installation of RSU Aulia Blitar
On variable patient loyalty have meaning that how much patient loyalty service which given by the outpatient installation at the Aulia Blitar General Hospital, which was seen from routine patient visits, sharing service information with friends and relatives, feeling proud to have been served well and not interested in other health services is described in 4 questions as measured by questionnaire which own score evaluation 1-4, with score highest 16 and score minimum 4 with long intervals 3 Long intervals 16 -4 = 3

The Effect of Health Service Quality on Outpatient Loyalty at Aulia General Hospital Blitar
Based on results processing data and analysis use SPSS on chapter IV that is test t could showed that Ha be accepted which it means there is influence positive and significant relationship between the quality of health services and patient loyalty in the outpatient installation at the Aulia Blitar General Hospital. Thing this could seen from magnitude significant t which more small from alpha. With thus so could said that the more the quality of the health services provided so will the more could increase patient loyalty to seek treatment at the outpatient installation at the Aulia Blitar General Hospital.
Based on data descriptive about quality of health services on patient loyalty in the outpatient installation of the Aulia Blitar General Hospital could stated that the quality of health services in the outpatient installation at the Aulia Blitar General Hospital is good. While only a few, namely 2 people, assessed that the health services at the outpatient installation at the Aulia Blitar General Hospital were not good.
In study this could is known that good quality health services increase patient loyalty to seek treatment at the outpatient installation at the Aulia Blitar General Hospital. Thing this because good quality health services is what patients expect in addition to facilities and easy access. The more good quality health care then will the more tall also patient loyalty to seek treatment again, informing the services available at the Aulia Blitar General Hospital installation.
Thing this corresponding with theory which put forward Aaker (in Joko Riyadi 1999: 58) "Consumers will be loyal to a product if they get satisfaction from the product. Therefore, when consumers try several kinds the product exceeds the product satisfaction criteria or not. If after trying the response is good, it means that the consumer is satisfied so he will decide to buy the product the in a manner consistent throughout time. This means has created consumer loyalty to the product the." Where if the quality of service is good, then patient loyalty or loyalty will increase. Vice versa, if the quality of service is not good, then patient loyalty or loyalty will decrease. So that the quality of service has a significant influence significant effect on patient loyalty. If the quality of service continues to be improved, loyalty will be created for patients seeking treatment at the outpatient installation at the Aulia Blitar General Hospital.

The Effect of Patient Satisfaction on Outpatient Loyalty at Aulia General Hospital Blitar?
Based on results processing data and analysis use SPSS on chapter IV that is test t could showed that Ha be accepted which it means there is influence positive and significant relationship between patient satisfaction and patient loyalty in the outpatient installation of Aulia General Hospital Blitar. Thing this could seen from magnitude significant t which more small from alpha. With thus so could said that the more Patient satisfaction with the health services provided so will the more could increase patient loyalty to seek treatment at the outpatient installation at the Aulia Blitar General Hospital. Based on data descriptive about patient satisfaction on patient loyalty in the outpatient installation at the Aulia Blitar General Hospital could stated that most patients at the outpatient installation at the Aulia Blitar General Hospital were satisfied and some were even very satisfied as many as 24 people, there were also 2 patients who were dissatisfied and none who were dissatisfied at all. In study this could is known that the satisfaction level of patients who are satisfied or very satisfied can increase patient loyalty to seek treatment at the outpatient installation at the Aulia Blitar General Hospital. Thing this because high patient satisfaction is what patients expect, even at a high price. The more high level of satisfaction then will the more tall also patient loyalty to seek treatment again, informing the services available at the Aulia Blitar General Hospital installation.
Thing this corresponding with theory which put forward Aaker (in Joko Riyadi 1999: 58) "Increased patient loyalty can be caused by one of the factors that influence loyalty patient that is satisfaction patient." Where if the level of satisfaction is high, then patient loyalty or loyalty will increase. Vice versa, if satisfaction is low or dissatisfied, then patient loyalty or loyalty will decrease. So that patient satisfaction has a significant influence significant effect on patient loyalty. If satisfaction continues to increase, loyalty will be created for patients seeking treatment at the outpatient installation at the Aulia Blitar General Hospital.

The Effect of Health Service Quality and Patient Satisfaction on Outpatient Loyalty at Aulia General Hospital Blitar
Based on results processing data using SPSS on chapter IV on test F which states that Ha is accepted, namely "there is a significant positive effect Among service quality and patient satisfaction on the loyalty of outpatients at Aulia Public Hospital blitar. This can be seen from significant F which more small from alpha.
In the test of the coefficient of determination, a percentage of 33.1% was obtained This indicates that there are still many factors beyond service quality and patient satisfaction which could influence patient loyalty no including in the study this in region work Outpatient installation at Aulia General Hospital, Blitar. Good quality of service provided and high patient satisfaction with the services received push patient for more loyal and loyal to Aulia Blitar General Hospital.
Thus, it can be concluded that the better the quality of services provided and high patient satisfaction with the services received push patient for more loyal and loyal to Aulia Blitar General Hospital . Thing this in accordance with Hasan's theory, (2014) which states that in theory there are eight factors that influence loyalty, 2 of which are service quality and customer satisfaction. Results This research is also supported by previous research conducted by Muhammad Ibnu Fajar and Rahman Hasibuan (2016), who states that there is a significant relationship between patient satisfaction and loyalty.

CONCLUSION
Based on discussion from analysis results study this, so could concluded as following: 1. There is influence positive which significant Among health service quality to on the loyalty of outpatient installation patients at Aulia General Hospital Blitar. Which means the better the quality of health services received by patients so will could help increase patient loyalty in outpatient installation at Aulia Public Hospital Blitar. 2. There is influence positive which significant Among patient satisfaction to on the loyalty of outpatient installation patients at Aulia General Hospital Blitar. Which means the higher the level of patient satisfaction, the will could help increase patient loyalty in outpatient installation at Aulia Public Hospital Blitar. 3. There is influence positive which significant Among quality of health services and patient loyalty to on the loyalty of outpatient installation patients at Aulia General Hospital Blitar. Which means the better the quality of health services received by patients and the higher patient satisfaction , the will could help increase patient loyalty in outpatient installation at Aulia Public Hospital Blitar.