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Patient satisfaction is a key indicator of health service quality in the National Health Insurance era. Outpatient services for BPJS members still face problems regarding waiting time, communication, and facilities. This study aimed to analyze factors affecting BPJS patient satisfaction with outpatient service quality at Malahayati Islamic Hospital Medan in 2026. A cross-sectional analytic design was applied to 150 respondents selected through consecutive sampling. Data were collected using a validated questionnaire (r>0.361; α=0.876) and analyzed by Chi-square and multiple logistic regression. Results showed that waiting time (p<0.001), staff competence (p<0.001), staff attitude (p<0.001), drug availability (p=0.032), facility comfort (p<0.001), administrative ease (p=0.003), and information clarity (p=0.008) were significantly associated with satisfaction. Multivariate analysis revealed waiting time as the most dominant factor (OR=5.42; 95% CI: 2.31–12.71), followed by staff competence (OR=4.18), facility comfort (OR=2.87), and staff attitude (OR=2.42), with Nagelkerke R²=0.512. Hospital management should optimize service flow and adopt digital queuing systems to enhance patient satisfaction.

Breast cancer has a high global incidence and is the most prevalent cancer among women. Chemotherapy is a primary treatment option, but it may cause various physical and psychological side effects that can reduce patients’ quality of life. This study aimed to describe the characteristics of breast cancer patients undergoing chemotherapy and examine the relationship between chemotherapy side effects and quality of life at the outpatient unit of Ciremai Hospital. A cross-sectional analytical observational design was applied, with 30 patients receiving chemotherapy between May and July as the sample. Data were collected from medical records and the Indonesian version of the WHOQOL-BREF questionnaire, then analyzed using Spearman rank correlation. Most patients were aged 40–60 years, had a senior high school education, were housewives, and were in the 2nd or 5th chemotherapy cycle. Frequently reported side effects included nausea, vomiting, decreased appetite, early satiety, dizziness, sleep disturbances, body pain, and alopecia, mostly categorized as moderate. Most patients had a relatively poor quality of life. The analysis indicated a strong positive correlation between chemotherapy side effects and patients’ quality of life, with a Spearman correlation coefficient of 0.604 (p = 0.000 < 0.05), demonstrating a significant and strong relationship.

Breast cancer has a high global incidence and is the most prevalent cancer among women. Chemotherapy is a primary treatment option, but it may cause various physical and psychological side effects that can reduce patients’ quality of life. This study aimed to describe the characteristics of breast cancer patients undergoing chemotherapy and examine the relationship between chemotherapy side effects and quality of life at the outpatient unit of Ciremai Hospital. A cross-sectional analytical observational design was applied, with 30 patients receiving chemotherapy between May and July as the sample. Data were collected from medical records and the Indonesian version of the WHOQOL-BREF questionnaire, then analyzed using Spearman rank correlation. Most patients were aged 40–60 years, had a senior high school education, were housewives, and were in the 2nd or 5th chemotherapy cycle. Frequently reported side effects included nausea, vomiting, decreased appetite, early satiety, dizziness, sleep disturbances, body pain, and alopecia, mostly categorized as moderate. Most patients had a relatively poor quality of life. The analysis indicated a strong positive correlation between chemotherapy side effects and patients’ quality of life, with a Spearman correlation coefficient of 0.604 (p = 0.000 < 0.05), demonstrating a significant and strong relationship.

Nurse workload is the total number or volume of tasks that must be completed by nurses during their professional practice in hospitals, including both physical and mental responsibilities in providing nursing care to patients. Meanwhile, nurse burnout is a condition of emotional and mental fatigue experienced by nurses due to prolonged work pressure and the high intensity of emotional demands in the hospital environment. However, workload problems are still commonly found in hospitals, with one of the main contributing factors being work stress caused by excessive job demands and continuous pressure during work activities. The population in this study were outpatient, inpatient and emergency nurses at Ibnu Sina Islamic Hospital, Bukittinggi in 2025 This study used a quantitative method with a cross-sectional approach, analyzing the relationship between one variable and another. This study had 130 samples consisting of outpatient nurses, inpatient nurses, and emergency room nurses. Sampling was carried out using a total sampling technique. The results of this study indicate a significant relationship between workload and burnout at a significance level of 0.00 (≤ 0.05). There is a significant relationship between workload and nurse fatigue at Ibnu Sina Islamic Hospital Bukittinggi in 2025.

Clean water availability is an essential component of hospital hygiene and sanitation operations, including hand hygiene, environmental cleaning, linen management, food sanitation, and infection prevention. RSUD Sumbersari Bantul Metro Selatan still relies on one bore well and has limited water storage without a permanent backup source. This study aimed to analyze the adequacy of clean water quantity and quality in supporting hygiene and sanitation operations at RSUD Sumbersari Bantul Metro Selatan in 2026. This study used a descriptive analytic design. Data were collected through observation, interviews, water discharge and consumption measurement, document review, and laboratory examination of clean water samples. The analysis compared water availability, water demand, unit-based distribution needs, and water quality with the standards of Ministry of Health Regulation Number 2 of 2023. The results showed that during January-March 2026, the hospital served 154 inpatients and 1,028 outpatients and had 151 staff members. The total clean water requirement was 715.44 m3/90 days, while the available water was only 414.00 m3/90 days, fulfilling 57.87% of the required amount. The average daily need was 7.95 m3/day, compared with the availability of 4.60 m3/day. High-risk service units, particularly inpatient care, emergency services, intensive care, CSSD, isolation, maternity care, laundry, and nutrition services, require priority water distribution. Laboratory testing found Escherichia coli and total coliform at 19 CFU/100 ml each, exceeding the required standard of 0 CFU/100 ml. In conclusion, the quantity and microbiological quality of clean water at RSUD Sumbersari Bantul have not adequately supported optimal hygiene and sanitation operations.

Prolonged outpatient waiting time remains a major challenge in public hospitals and reflects inefficiencies in service process management. Internal medicine clinics are characterised by high service complexity and patient volume, making them particularly vulnerable to process waste that contributes to extended waiting times. Objective: This study aimed to develop an outpatient service flow model based on the Lean Hospital approach to reduce waiting time in the internal medicine clinic of RSUD Balaraja. Methods: A qualitative case study design was employed. Data were collected through direct observation of outpatient service processes, document review, and Focus Group Discussions (FGD) with relevant stakeholders. Process analysis was conducted using Value Stream Mapping (VSM) to identify value-added and non–value-added activities, while Fishbone Diagram analysis was applied to explore the root causes of process inefficiencies. All findings were integrated to develop a future-state outpatient service flow model. Results: The findings indicate that prolonged outpatient waiting time is primarily influenced by inefficient service flow design, repetitive administrative processes, and weak coordination among service units. The proposed service flow model demonstrates a more streamlined, integrated, and patient-centred process, with potential reductions in waiting time through systematic waste elimination and process improvement. Conclusion: The Lean Hospital approach provides an effective framework for developing outpatient service flow models in public hospitals. The proposed model offers a practical basis for improving outpatient service efficiency in complex clinical settings such as internal medicine clinics.

Services in the health sector are a form of public service that must be implemented properly by the government. In the context of health services, the importance of effective and efficient implementation cannot be ignored because this has a direct impact on people's quality of life. In order for health services to achieve their goals, various requirements must be met, including the availability of adequate facilities and infrastructure, a harmonious relationship between patients and service providers, easy accessibility, and high quality. The aim of this research is to determine the description of the service quality of administrative staff. at the Kelapa Gading Community Health Center. The method used is descriptive with a quantitative approach which produces univariate results. This research was conducted at the Kelapa Gading Community Health Center with a total of 150 respondents. The variables in this research are Service Procedures, Completion Time, Service Costs, Service Products, Facilities and Infrastructure, Accreditation of Service Officers. The population in this study were all 1.216 outpatients with a sample of 150 respondents.

The quality of interaction between physicians and patients plays a crucial role in the healthcare system, as it directly affects patient satisfaction. Ineffective communication by physicians may reduce patient satisfaction and increase the risk of complaints and medical disputes. This study aims to analyze the relationship between doctor–patient communication patterns and patient satisfaction in outpatient services. This research employed a quantitative approach with an observational analytic design using a cross-sectional method. The study population included all outpatient patients, with a sample of 110 respondents selected through accidental sampling. The independent variable was doctor–patient communication, while the dependent variable was patient satisfaction. Data were collected using a questionnaire, and analysis was performed using the Chi-Square test with a 95% confidence level. The results showed that the majority of respondents rated doctor–patient communication as good (80.9%) and reported high levels of satisfaction (75.5%). The analysis revealed that among respondents who experienced good communication, 84.3% reported high satisfaction, whereas the proportion of high satisfaction decreased significantly in the groups with moderate and poor communication. In conclusion, there is a significant relationship between the quality of doctor–patient communication and patient satisfaction in outpatient services, where improvements in communication quality are consistently associated with increased patient satisfaction.

Patient revisit intention is a key indicator of hospital success in maintaining patient loyalty. In the digital era, the use of digital marketing and the quality of nurse communication play important roles in shaping patients’ perceptions of service quality and their decisions to return. This study aimed to analyze the effect of digital marketing utilization and nurse communication on patient revisit intention, with service quality as an intervening variable at Cabangbungin Regional General Hospital, Bekasi Regency.This research used a quantitative survey design with purposive sampling of outpatient participants. Data were analyzed using index analysis with the three-box method and hypothesis testing through Structural Equation Modeling–Partial Least Squares (SEM–PLS).The findings revealed that digital marketing utilization and nurse communication have a positive and significant effect on both service quality and patient revisit intention. Additionally, service quality was proven to mediate the relationship between digital marketing, nurse communication, and revisit intention. These results highlight the importance of integrating effective digital marketing strategies with empathetic and clear nurse communication to enhance perceived service quality.In conclusion, strengthening digital-based patient engagement, improving communication systems among healthcare professionals, and promoting empathetic service behavior are essential strategies to increase patient loyalty and revisit intention. This study provides practical insights for hospital management in optimizing service quality through digital transformation and communication improvement.

Occupational accidents are unexpected events. Incident of occupational accident often happened to health officer especially nurse. Therefore, it is necessary efforts to foster the implementation of occupational safety and health (OHS) in order to avoid occupational accident. The aim of this research is to analyze the effect of implementation occupational health and safety (OHS) (knowledge, attitude, training, promotion and supervision) of the incidence of occupational accidents for nurses at Hospital X in 2025.The research is quantitative analytic survey research using Cross-sectional Analitics. The Population is all nurses from Outpatient room and  Inpatient room at Hospital X. Its amounted to 164 people, using technique of total population. Data analysis with univariate analysis, bivariate analysis with chi square test, multivariate analysis with multiple logistic regression test. The results of the reaserch showed that effect occupational accidents are attitude p value 0,001, training p value 0,001, promotion p value 0,001 and the confounding is a knowledge variable to training variable. The conlusion of the research is to make the implementation of occupational health and safety become the most important for nurse. Recommended to the Hospital X along with occupational health and safety committee to improve the knowledge of nurses on occupational health and safety through socialization, training, and internal meeting of the periodic.  

Prescription service wait times are an indicator of pharmacy service quality that directly impacts patient satisfaction and the Hospital Minimum Service Standards (SPM). The Kraton Regional General Hospital in Pekalongan Regency has implemented an electronic prescribing system (e-prescribing) to improve efficiency and reduce prescribing errors. However, with prescription volumes reaching hundreds per day, periodic evaluation is necessary to ensure that services remain in compliance with standards. This study aims to evaluate the waiting time for electronic prescription services among outpatients at the Pharmacy Department of RSUD Kraton, Pekalongan Regency, and to compare it with the Ministry of Health’s standards. This is a descriptive observational study using a quantitative approach. The study sample consisted of 300 prescriptions (74 compounded prescriptions and 226 non-compounded prescriptions) selected via simple random sampling from medical records for the period August–October 2025. Research instruments included an observation sheet and an interview guide to support observational data. Data analysis was conducted descriptively to calculate the average service waiting time. The results showed that the average service time for non-compounded prescriptions was 7 minutes and 42 seconds, while for compounded prescriptions it reached 28 minutes and 11 seconds. All samples examined met the established waiting time standards, namely ≤30 minutes for non-compounded prescriptions and ≤60 minutes for compounded prescriptions, in accordance with Ministry of Health Regulation No. 4 of 2019 and Ministry of Health Decree No. 129/2008. The electronic prescription service at Kraton District General Hospital in Pekalongan Regency has been operating very efficiently and meets the Minimum Service Standards (SPM). The implementation of e-prescribing technology has significantly contributed to maintaining the speed and quality of pharmaceutical services on an ongoing basis.

The hospital laundry installation is a non-medical supporting unit with a high risk of occupational health and safety (OHS) hazards due to direct exposure to chemicals, machinery, and contaminated linen. Potential hazards in this unit include physical (heat, noise), chemical (detergents and disinfectants), biological (viruses and bacteria from linen), and ergonomic (improper working posture) risks. This study is a descriptive quantitative research with a semi-quantitative approach. The aim is to identify, assess, evaluate, and control OHS risks in the laundry unit. Data were collected through observation, interviews, and document review with seven laundry staff members. Risk assessment was conducted using a risk matrix based on the AS/NZS 4360:2004 standard. The results show that several risks ranged from low to very high levels, including infection from linen, chemical exposure, noise, and injury from machinery. Risk control measures implemented include applying the hierarchy of controls, starting from elimination, substitution, engineering controls, Administratif controls, and the use of personal protective equipment (PPE). It is concluded that improvements in supervision, staff training, and facility upgrades are necessary to minimize occupational accidents in the laundry installation.

Digital transformation in healthcare services is a strategic approach to improve access, efficiency, and service quality, particularly within Indonesia’s National Health Insurance (JKN) system. BPJS Kesehatan has introduced an online queue feature through the Mobile JKN application to minimize manual queuing and reduce waiting times in outpatient services. However, despite the widespread ownership of the application, its actual utilization for online queuing remains relatively low, including in a regional public hospital (RSUD) in West Bandung. This condition reflects a gap between the availability of digital health technology and patients’ actual usage behavior, highlighting the need to examine factors influencing adoption.This study aims to analyze the effects of perceived ease of use, social influence, and facilitating conditions on the actual use of the Mobile JKN online queue, with behavioral intention as an intervening variable among outpatients. A quantitative cross-sectional design was applied, involving 255 JKN outpatient participants selected through purposive sampling. Data were collected using structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS version 24, based on the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Data analysis included descriptive statistics, validity and reliability testing, normality assessment, goodness-of-fit evaluation, Three Box Method, and hypothesis testing.

Hypertension has become a chronic disease known as the silent killer because it often does not show symptoms but can cause serious complications such as stroke, heart disease, and kidney failure. According to WHO, hypertension is one of the leading causes of death worldwide and its prevalence continues to rise. Sleep disturbances can increase sympathetic nervous system activity and stress hormones, which impact blood pressure elevation. Depression is characterized by prolonged feelings of sadness, loss of interest, and decreased energy. Physiologically, depression can increase stress hormones and cause autonomic nervous system imbalance, leading to elevated blood pressure. To determine the relationship between sleep pattern disturbances and depression levels with blood pressure in hypertensive patients in the outpatient department of RS Permata Medika Semarang. Quantitative research with a correlational design using a cross-sectional approach. The sampling technique used was consecutive sampling with a sample size of 79 respondents. The instruments used are the PSQI questionnaire for sleep pattern disturbances and the DASS-42 for depression levels. Ethics test no 03/EC-LPPM/UWHS/II-2026. Data analysis used the Spearman Rank test. The research results show that there is a significant relationship between sleep pattern disturbances and blood pressure in hypertensive patients (p=0.000; rho=0.826). Respondents with poor sleep patterns mostly have high blood pressure, indicating a very strong and positive relationship, where the worse the sleep pattern, the more uncontrolled the blood pressure tends to be. Additionally, there is a significant relationship between the level of depression and blood pressure (p=0.000; rho=0.808). Respondents with severe and very severe depression mostly have high blood pressure, which means that the higher the level of depression, the more the blood pressure increases or becomes uncontrolled. There is a relationship between sleep pattern disturbances and depression levels with blood pressure in hypertensive patients in the outpatient department of Permata Medika Hospital Semarang.

The increasing competition in the healthcare industry requires hospitals to establish effective relationship strategies to enhance patient loyalty. This study aims to examine the effect of Customer Relationship Management (CRM) on patient loyalty, with brand salience and customer engagement behavior (CEB) as mediating variables. The research adopts a quantitative approach using Partial Least Squares Structural Equation Modeling (PLS-SEM). Data were collected from 155 outpatients at Cengkareng General Hospital (RSAR) who had experienced CRM-related services, using a structured questionnaire measured on a four-point Likert scale. The findings reveal that CRM has a significant positive effect on brand salience, customer engagement behavior, and patient loyalty. Among these relationships, CRM demonstrates the strongest influence on customer engagement behavior, indicating that relationship-based strategies effectively encourage active patient involvement. Furthermore, customer engagement behavior significantly affects patient loyalty, suggesting that patients who are more engaged—through feedback, recommendations, and participation—are more likely to develop stronger loyalty toward healthcare providers. In contrast, brand salience does not have a significant effect on patient loyalty, indicating that brand awareness alone is insufficient to drive loyalty in the healthcare context. Mediation analysis shows that customer engagement behavior partially mediates the relationship between CRM and patient loyalty, whereas brand salience does not act as a mediator. These results suggest that CRM enhances patient loyalty not only directly but also indirectly through strengthening engagement behavior. This study contributes to healthcare marketing literature by integrating relationship marketing and customer engagement perspectives, highlighting engagement as a more critical mechanism than brand salience in fostering sustainable patient loyalty.

In response to the evolving landscape of public healthcare services, hospitals are expected not only to maintain operational efficiency but also to adapt to the shifting needs and expectations of patients as healthcare consumers. The presence of non-BPJS patients in regional public hospitals plays a strategic role not only contributing to revenue diversification but also reflecting service quality, institutional competitiveness, and shaping public perception. The declining trend in outpatient visits by general patients at RSUD Balaraja over the past three years highlights the need to understand the factors influencing consumer behavior in determining revisit intentions. This study examines the effect of co-creation and hospital image on the revisit intention of outpatient general patients at RSUD Balaraja, with patient experience as a mediating variable. The research employed a quantitative explanatory design involving 278 outpatient general patients selected through purposive sampling. Data were collected via structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results indicate that patient experience plays a significant mediating role in shaping revisit intention among general outpatients at RSUD Balaraja. These findings confirm that patient experience serves as a central factor in post-service evaluation processes, which ultimately drive patients’ intention to return. Therefore, hospitals need to enhance patient involvement in service processes (co-creation), improve public perception of institutional image (hospital image), and develop patient-centered service systems as a key strategy to increase revisit intention among general outpatients.

The implementation of Patient Safety Goals remains a major challenge in hospital management, particularly in ensuring consistent compliance among nurses. This study aims to analyze the influence of nurses’ knowledge and motivation on the implementation of Patient Safety Goals, with clinical leadership positioned as a mediating variable. A quantitative cross-sectional design was employed in a general hospital in Jakarta, Indonesia. Data were collected from 119 nurses across inpatient, outpatient, emergency, and operating units using structured questionnaires. The data were analyzed using Structural Equation Modeling (SEM) with AMOS, supported by the Three-Box Method to assess the level of variable achievement. The results indicate that nurses’ knowledge and motivation have a significant direct effect on clinical leadership. Clinical leadership also demonstrates a significant positive effect on the implementation of Patient Safety Goals. Furthermore, clinical leadership plays a significant mediating role in the relationship between both nurses’ knowledge and motivation and the implementation of Patient Safety Goals. The model explains 76.67% of the variance in Patient Safety Goal implementation, highlighting the strategic role of clinical leadership in translating individual competencies into safe clinical practices. These findings contribute to healthcare management literature by reinforcing the importance of clinical leadership as an organizational mechanism that strengthens patient safety performance. From a managerial perspective, the study emphasizes that improving patient safety outcomes requires not only enhancing nurses’ knowledge and motivation, but also systematically developing clinical leadership competencies. Hospital management is encouraged to invest in leadership development programs, supportive supervision, and non-punitive incident reporting systems to ensure sustainable implementation of Patient Safety Goals.

The waiting time for outpatient pharmacy services at Permata Jonggol Hospital had not met the minimum service standards, potentially reducing service quality and patient satisfaction. This issue was suspected to be influenced by human resource (HR) competence, service regulations, and the utilization of the Hospital Management Information System (HMIS). This study aimed to analyze the effect of HR competence and service regulations on pharmacy waiting time, with HMIS utilization as an intervening variable. The study used a quantitative approach with a cross-sectional design. Data were collected at a single point in time using instruments that had been tested for validity and reliability. The data were analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results showed that HR competence, service regulations, and HMIS utilization simultaneously had a significant effect on pharmacy waiting time. Partially, HR competence and service regulations significantly affected HMIS utilization and waiting time. HMIS utilization also significantly influenced waiting time and mediated the relationship between HR competence, service regulations, and pharmacy waiting time. In conclusion, improving pharmacists’ competence, strengthening service regulations, and optimizing HMIS utilization in an integrated manner were important strategies to reduce waiting time and improve service efficiency and quality

The development of Digital Marketing and Electronic Word of Mouth (eWOM) has encouraged hospitals to adopt digital communication strategies to attract patients’ visit intentions. However, in public hospitals, the effectiveness of these strategies in influencing patient behavior still requires empirical validation. This study aims to analyze the influence of Digital Marketing and eWOM on patient visit intention, with Brand Awareness as an intervening variable at RSUD Cengkareng.This research employed a quantitative approach with an explanatory design. Data were collected from November to December 2025 from 100 general outpatient respondents selected using the Slovin formula and a simple random sampling technique. The data were gathered through structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS software.The results show that Digital Marketing and eWOM have a positive and significant effect on Brand Awareness. Both variables also significantly influence patient visit intention, with eWOM demonstrating the strongest effect. These findings indicate that information shared through digital platforms and patient recommendations plays an important role in shaping potential patients’ decisions to visit the hospital. However, Brand Awareness does not have a significant effect on patient visit intention and does not mediate the relationship between Digital Marketing, eWOM, and visit intention. This suggests that, in the context of RSUD Cengkareng as a public hospital, patients’ visit decisions are more directly influenced by digital information exposure and the credibility of online recommendations rather than by brand recognition alone.

Patient safety is one of the key elements in providing quality health services. Patient safety is a top priority because it has become a global issue in hospital health services. This study aims to determine the relationship between workload and the implementation of patient safety among nurses in the Outpatient Room of Grha Permata Ibu Hospital in 2025. This study is a quantitative, analytical study. This quantitative research uses a cross-sectional design. The population in this study consisted of 40 nurses in the Outpatient Room of Grha Permata Ibu Hospital. Therefore, the sample in this study consisted of 40 respondents using a total sample technique. The instrument used in this study was a questionnaire. Data analysis was performed using univariate and bivariate analysis with the chi-square test. Based on the statistical test results, the p-value was 0.023, meaning that p-value < α (0.05). Therefore, it can be concluded that there is a relationship between workload and the implementation of patient safety among nurses in the Outpatient Ward of Grha Permata Ibu Hospital in 2025. The hospital is advised to ensure fair task distribution, provide facilities, and offer training and psychological support to manage stress.