Level of Patient Satisfaction with Antenatal Services at Tutun Sehati Clinic

ABSTRACT


INTRODUCTION
Quality service and also quality of course can be one of the causes of customer satisfaction which has become a necessity and a very important issue. This arises from discourse on the management and business side that has existed since the 1980s. Research on satisfaction from customers and also awards for companies that also score the highest in the satisfaction index which contributes to the importance of customers being satisfied with the quality and quality they receive [22].
Improving public services is one of the important points in the reform process in Indonesia. The quality and also the quality of public services today is still in a condition that requires attention and even tends to be apprehensive. The quality and quality that is still underdeveloped is indeed proven by the many complaints and also the heartache of the people who complain about public services. And public service reform itself is one of the steps that can be used to improve these public services.
Reform in the field of public services can be started from several aspects such as quite profound aspects such as the changing mindset of public service providers in the midst of society. This change is of course one of the shifts in the pattern of public service delivery. Public services in Indonesia were initially oriented towards the government which functions as a provider. Then public services turned into services that are oriented to the needs of the community who act as users based on the rules of the [12] Regarding satisfaction and also dissatisfaction from consumers, it has a general meaning as a difference between performance and also expectations felt by the public. This can fulfill consumer satisfaction with the products and services expected by consumers. Based on the narrative from [22], it is said that service quality has a close relationship with the level of satisfaction of customers. [6] conducted a  55 study which concluded that satisfaction from customers is a mediator that appears in the relationship between the quality of service and also the intention of behavior.
In the health sector, of course, people ask for quality and quality public services. Especially those related to maternal and child health which must experience improvement from year to year. In the health sector, especially medical personnel and also midwives must provide quality quality so that people continue to choose them as service providers to meet their needs in the field of maternal and child health. Midwives as well as other medical personnel must try to improve their capabilities and also the quality of service to the community. Services in the health sector, of course, must provide the demands and expectations of the community regarding the quality and good quality of health services.
Of course it needs to be realized that there are differences in perceptions of quality among the public and also consumers who are providers of health services. Consumers or society have their own meaning regarding patient satisfaction. This satisfaction is a level of feeling from patients that arises from the performance of health services obtained from a comparison between the expectations of patients and also the reality on the ground. Service providers mean that health services have quality as services that are in accordance with standards. This difference in perception is often one of the results of complaints and dissatisfaction from customers or patients in the health sector.
The quality of health services can be seen from various aspects that also have an influence on this assessment. There are 4 aspects of quality that serve as a reference and benchmark for improving the quality of health, which consist of: 1. Clinical Aspect This aspect will concern midwifery services and also have links with medical techniques 2. Efficient and effective Efficient and effective services in the health sector are services that are inexpensive and effective and can provide satisfaction to patients 3. Patient Safety Aspects An aspect whose duty is to provide protection to patients 4. Patient satisfaction This aspect has a close relationship with the sector of comfort, friendliness and also the speed of service that can provide satisfaction to customers or patients Patient satisfaction is a subjective value of the quality and service that patients receive. Even though it is subjective, it still has an objective basis where the assessment will be based on several things and aspects of past experience. Including education and also the psychological situation and also the condition of environmental influences at that time. According to the narrative of [18] that the assessment of patient satisfaction with health services has a very important role to know because of the close relationship with the marketing world of these health services.
The antenatal service from the Tutun Sehati Clinic is one of the strategic programs as well as a breakthrough that fits the objectives, which consist of: 1. Improving the quality of services to the public, especially people who seek treatment or want health services at the clinic. 2. Increasing the professionalism of medical personnel so that they can provide far better and quality services 3. Develop leadership for medical and health personnel in providing services to the community 4. Increase the coverage of health services regarding reproduction and also family planning 5. Accelerating the reduction of mortality and morbidity in mothers and children which is also one of the government programs at both the central and regional levels. The active role of medical or health workers and midwives in reproductive health services and also family planning really helps the community to get education and information about the world of health. From year to year there are requests from the public regarding the active role of medical personnel and also midwives in providing and presenting health services which continues to increase. This is one of the proofs that this existence is very helpful in the midst of a society that will continue to gain trust, recognition and appreciation. From this, it will then be required to always try to improve capabilities and also maintain and improve the quality of services including Family Planning and Reproductive Health services. By means of quality and also the best and affordable services provided by medical personnel, of course it can provide satisfaction to the community.
Improving the quality of service at the Tutun Sehati Clinic will provide satisfaction to customers by minimizing unpleasant experiences for the public. And also can improve a much better experience and can provide satisfaction to patients. Practically with this assumption can give hope to the patients will be much more satisfied with the services provided. And in the future it can generate public trust and loyalty to service providers, including medical and health workers to midwives.
Especially services for pregnant women that must get attention and also be improved. Pregnancy for women is an experience that certainly cannot be forgotten for the rest of their lives. Practically requires research and research in order to provide an unforgettable experience for patients. Likewise with Antenatal Care services which will make it easier for patients to make contact and also visits so that patients can gain experience and be able to evaluate the services of medical staff in a much more comprehensive manner.
Satisfaction according to the narrative from KBBI or the Big Indonesian Dictionary is a feeling of pleasure and satisfaction that is owned by someone. Satisfaction itself is a feeling of relief that belongs to someone who is caused to consume something or experience pleasant events or experiences from using a service. Oliver in [2] states that this satisfaction is the level of feelings of someone who compares performance and also the results they get from the expectations and expectations they have.
The level of satisfaction of this person is a function of the differences in the performance they get and also find what is in line with expectations. If the performance is far below expectations, of course disappointment will surface. However, if the performance is in accordance with expectations or expectations, then a sense of satisfaction will appear and also stick to the surface. The expectations and expectations of these customers can be formed from past experiences as well as comments and remarks from relatives, family and other people regarding the information conveyed to individuals. Customers who feel satisfied with the service, of course, will be loyal and also will not move to another heart. And they will be faithful much longer. They no longer think about price and only want to get the best service.
Based on the narrative of [15] that satisfaction is an advanced level of pleasure from someone after doing a comparison of performance and also the results obtained and also felt are comparable to expectations and expectations. So this feeling of satisfaction and dissatisfaction is a conclusion that arises from the interaction between experience and also expectations after using a service or services provided. Efforts to realize this satisfaction is not a very easy thing. Total customer satisfaction will not be possible, even if only temporarily [22]. Understanding what consumers need and also want, in this case, of course, patients is very important in influencing patient satisfaction. Satisfied patient. Being a very valuable asset because if the patient is satisfied, of course these patients will return to use the service without the need to think about other things. However, if the patient is not satisfied or their expectations and expectations are not in accordance with the experience obtained, then the patient will be reluctant to return. And even they will circulate this information 2 times greater than the experience they receive.
In order to create patient satisfaction, a system must be created and managed that can provide good service and quality to patients. This is of course to provide the ability to keep patients in the clinic or hospital. And efforts to improve or perfect this satisfaction can be done with a variety of strategies that can be used to attract patients to want to use their services.
Thoughts from [23] stated that consumer satisfaction regarding the products used and also the performance of the services obtained and felt by consumers, can be an important value in consumer assessment. If the performance and quality of the service or product is high, then the consumer's expectation to return to buy or use the service will be even greater due to the satisfaction experienced by the consumer.
Likewise with the narrative from [10] that there are 3 conditions of satisfaction that can be felt by consumers. These three conditions, namely the same expectations and needs with the services provided, automatically consumers will feel satisfied. If service to consumers is lacking or below expectations, consumers will feel dissatisfied and also have the possibility not to use it again. Consumer satisfaction itself is a comparison of expectations and also expectations and experiences from the reality received and obtained by consumers.
Consumers who experience satisfaction with a product or service can be classified into community, individual and institutional consumers. While the patient himself is also a consumer who uses the services of a clinic or hospital. Patients are individuals who have limitations, namely physically weak or mentally weak due to health conditions. They hand over the process of care and supervision to a second party, namely a hospital or clinic. Patients must obtain and also receive health services and treatment implemented by health workers.
According to the ideas of [1] patients are individuals who are treated in hospitals or clinics. And patients will get a feeling of satisfaction and also happy if their hopes and expectations are fulfilled to the fullest. There are several aspects and factors that can influence patient satisfaction, and these include: 1. Quality of services and or products Patients will certainly be satisfied if the results of the evaluation shown to the product or service used show good quality and quality. Consumers have a perception of the quality of services and products that will get influence from the actual reality and also the interaction of companies in the promotion of the products and services they make.

Service quality
The quality of hospital or clinic services certainly has a very important role in providing quality and also quality to patients. Patients will feel satisfied if they are able to get excellent service and also according to their expectations or expectations.

Emotional factor
Emotional factors should not be underestimated. Patients will feel confident in choosing a hospital or clinic if they have received good service or experience that meets their expectations beforehand. This emotional factor will bind the patient to a service regardless of price or economy.

Price
Price is one aspect to consider. And in determining the quality to achieve satisfaction and also the pleasure level of the patients, price has a role. This aspect influences the patient in terms of costs incurred. If the price incurred is large enough, then the care and service received by the patient is of course far greater than expectations or expectations. Meanwhile, if the price issued is quite cheap, then the service and treatment will be very different. But there are also patients who are more concerned with the price side than service. Practically the patient's expectations and expectations will be lower.

Cost
In order to get a product or service, of course, patients who do not need additional expenses and also do not waste time in providing services will tend to be satisfied with these services. The quality of health services is the level of perfection of health services in which one party can lead to satisfaction in each patient according to the level of satisfaction of the average population and also other parties. And of course the code of ethics and professional service standards have been well defined. Quality and also service quality is indeed difficult to define where all of these aspects will depend on the way of looking at the problem. There are several limitations regarding the quality of service consisting of: 1. Quality is the level of perfection of the appearance of something that is observed 2. Quality is a property possessed by a program 3. Quality is satisfaction with predetermined standards 4. Quality is the totality of the form and characteristics of a product or service that contains a sense of fulfillment and security of the users. 5. Quality is compliance with predetermined standards. Health services that have good quality have measurements that include an assessment of patient satisfaction with the performance and quality of clinical or hospital services. In general, the more effective the service, the higher the quality of service provided to patients. While the indicator itself is a way to assess the appearance of an activity that uses the instrument in it. Indicators themselves are variables used in the assessment of a change. For this health service indicator, it will have very important benefits for the manager of the health service. This benefit can be used as a tool to implement control management and a tool to support decision making in planning activities.
The indicators used in assessing the quality of services and services are: This tangible is evidence of the appearance and physical condition of the facilities, services to medical staff and communication equipment 2. Reliability -Reliability Ability to perform promised services consistently and accurately 3. Responsiveness -Responsiveness Willingness to help customers in the provision of services and services 4. Certainty -Assurance Knowledge and friendliness of employees and their ability to inspire trust and confidence 5. Empathy Understanding in giving attention to customers so that communication and interaction can run optimally so that customer needs can be met properly.

METHODS
The research carried out is observational or non-intervention research where this research will carry out an approach using a cross sectional technique. This method is a study that studies the relationship between the correlations between the dependent variable and also the independent variables that can be observed at a certain time or the same time. And each subject of this study will be observed once in one study [13-14-15].
Tutun Sehati Clinic itself is a Mother and Child clinic that provides services to pregnant and giving birth mothers. And the level of patient satisfaction with the Antenatal Care service is the average view of the respondents or informants regarding the services provided by the Tutun Sehati Clinic to patients. Since patients come to get care and services from medical personnel, especially in the second and third trimesters of pregnancy. Then the services provided until the inspection is complete are in accordance with the perceptions and expectations of the community or not. This is one of the aspects included in the research.
The level of satisfaction of the patients was measured using questionnaires and interview questions regarding the level of satisfaction in a way that is based on the satisfaction variable by decomposing it into 5 sub-variables consisting of: 1. Reliability Dimension 2. responsiveness 3. Guarantee 4. Empathy 5. Physical evidence These sub-variables will later be broken down into a number of questions that will be asked of the respondents or informants. From this question a sample will be taken regarding the data provided by the respondent or informant. The population of this study were all pregnant women who made antenatal care visits at the Tutun Sehati Clinic.
The samples from this study were all pregnant women who had entered the second and third trimesters where these pregnant women had their pregnancy checks at the Tutun Sehati Clinic within 1 month when this study was conducted. And the sample uses the Accidental Sampling technique to obtain the necessary research data. The research instrument has been included in trials from several respondents or informants which were carried out on the level of patient satisfaction regarding satisfaction with antenatal care services. This analysis uses the correlation between person product moment. This test of reliability uses the formula from Alfa Croncbach where the statements will be called valid. The validity test is carried out and the results of the reliability coefficient on patient satisfaction with antenatal care services are 0.975. With the relatively high results of the instrument reliability test, overall this research trial was very reliable for use in the study. The analytical technique used is used to find out the difference in the level of patient satisfaction with antenatal care services at the Tutun Sehati Clinic by using the t test formula. From the table data above, information was obtained from respondents or informants that quite a lot of recent education was high school education with a record of 28 people or 56%. Meanwhile, pregnant women who are pregnant with their second child have the highest number of respondents with a record of 23 people or 46%. Then for the most ANC behavior in the third trimester with a record of 28 people or 56%. From these data which were conducted on respondents or informants of pregnant women at the Tutun Sehati Clinic, several answers were obtained from the responses of very dissatisfied, dissatisfied, satisfied and also very satisfied from the 50 respondents.
From the data obtained, it is known that about 25 patients expressed satisfaction with the services and performance of the medical staff and midwives at the Tutun Sehati Clinic. This means that around 30% of the respondents or informants stated that they were satisfied with the quality and quality of the service. Meanwhile, about 19 people or about 38% of the respondents or informants who answered through questionnaires and interviews were very satisfied with the quality and service quality of the Tutun Sehati Clinic. Meanwhile, 5 people stated that they were dissatisfied with the service and 1 person stated that they were very dissatisfied with the service.
Statements of dissatisfaction from respondents as well as informants were due to poor quality. This is because the services provided by the Tutun Sehati Clinic did not meet the expectations of the respondents and also pregnant women who had high expectations for this service. Likewise with respondents who stated very dissatisfied. On average and also the data obtained from the respondents or informants, they are quite satisfied with the service and quality of the Tutun Sehati Clinic. From the table above, it was found that all respondents or informants answered questions regarding reliability, attention, responsiveness, guarantees and physical clinical conditions, namely pregnant women with a population of 50 people. From the data above it was found that on average the respondents were satisfied or quite satisfied. Meanwhile, only a few are dissatisfied.
In the Responsiveness question, there were 7 questions posed by the researcher to the respondents or informants. Regarding the question of the ability of medical staff to detect complaints of pregnant women, only 2 were recorded who were not or were not satisfied. While 19 felt quite satisfied, 20 people felt satisfied and those who claimed to be very satisfied were around 9 people. It was noted that on average the respondents were satisfied with the ability of medical workers to detect complaints of pregnant women.
While the second question discussed the ability to deal with complaints from pregnant women, only 1 respondent felt unsatisfied. While 25 people said they were satisfied. Three people felt very satisfied and 21 people said they were quite satisfied. There were around 98% of the respondents or informants who were satisfied with the services of these medical officers. Then for the explanatory question about nutrition in pregnant women, 100% of respondents stated that they were satisfied. No one feels dissatisfied. Likewise with explanatory questions about drug consumption and also preparations for childbirth. Then for the question of explaining the danger signs of pregnancy and repeat visits for pregnant women, there were 1 respondent and 2 respondents who expressed dissatisfaction respectively. However, for an explanation regarding repeat visits for pregnant women, there were around 20% of the respondents or 10 people who were very satisfied.
On the Reliability side, there are 5 questions posed to the respondents or informants. Questions regarding information for pregnant women which was very clear and easy, it was recorded that around 30% stated that they were very satisfied. Namely 15 respondents. Meanwhile, only 1 person was dissatisfied or unsatisfied. The rest claimed to be quite satisfied and also satisfied. While the skills in the inspection process noted that there were around 13 respondents who said they were very satisfied. Which means that there are around 26% of respondents who are very satisfied with the performance of the Tutun Sehati Clinic. Then when asked about the thoroughness of the medical staff in the pregnancy examination process, no one felt dissatisfied. On average they were satisfied with the services of Tutun Sehati Clinic. In fact, it was recorded that 22% of respondents or 11 people said they were very satisfied.
For questions on the Attention sub-variable, there were 5 questions asked to the respondents. And only 1 question contained 1 respondent who was dissatisfied with the services of the Tutun Sehati Clinic, namely the question regarding service regardless of the patient's social strata. While 10 people said they were quite satisfied, 25 people were satisfied and 14 people said they were very satisfied. Then for the other 4 questions there were no respondents who were dissatisfied with the performance and services of the Tutun Sehati Clinic.
The question regarding attention to complaints of pregnant women was dominated by respondents who were very satisfied. It was recorded that there were 20 people or 40% of the respondents. While attention to every problem of pregnant women and also the friendly attitude of the medical staff, there were 11 respondents who were very satisfied. In the question of security in service, there were 17 respondents who were very satisfied.
In the Assurance sub-variable questions, there are about 4 questions. And there were 2 questions where none of the respondents felt unsatisfied. Secret questions for guaranteed pregnant women and the safety of drugs consumed during pregnancy, no one felt unsatisfied from the respondents. While from the two questions respectively there were 7 and 10 respondents who were very satisfied.
Then 2 other questions, namely safe medical equipment and also the friendly and polite attitude of the medical staff, only 1 respondent felt dissatisfied each. Meanwhile, for respondents who were very satisfied, there were 10 respondents on each of these questions. Meanwhile, for respondents who were satisfied, there were around 27 respondents for a friendly and polite attitude and 26 respondents for medical equipment that was safe to use.
In the question of the Clinical Physical Conditions sub-variable, there were 5 questions presented to the respondents. Questions regarding the comfort of the clinic facilities, the cleanliness of the clinic, the complete facilities and the cleanliness of the equipment and the neatness of the medical staff, were the questions presented. Complete equipment facilities in the clinic there are 3 respondents who feel unsatisfied. While 10 respondents said they were very satisfied. As for the cleanliness and tidiness of the medical staff, the respondents or informants stated that they were satisfied and there was not the slightest bit of a respondent who felt unsatisfied.
From these data it was obtained and also showed that the medical and health workers at the Tutun Sehati Clinic could improve the quality and service quality of medical staff to serve patients, especially pregnant women. And the response from pregnant women to the services of the Tutun Sehati Clinic has also been very good and has given a positive response. Research from Cronin and Taylor states that service quality has a very significant effect on satisfaction and also the views of consumers towards services. This is of course due to consumer perceptions that arise due to service quality and service quality that is comparable to the expectations and expectations of consumers. If consumers' perceptions of service quality have a fairly good value and are also in line with the expectations and expectations of consumers, of course it can increase the level of satisfaction of these consumers.
This research shows that the quality of service that continues to be improved and improved from time to time can provide satisfaction to consumers. And this can be a standardization for the quality of antenatal care services for midwives who practice at the Tutun Sehati Clinic. And this practice can be felt by patients which will make it easier for patients to get the service they want.