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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.

Purpose: This study examines the effect of service communication on usage intention of Holistic Homecare for Elderly services, with customer trust serving as a mediating variable. Design/Methodology/Approach: Employing a quantitative explanatory approach with cross-sectional survey design, this research involved 120 family respondents with elderly members (≥60 years) in urban areas of Jakarta and Bandung, selected through stratified purposive sampling. Data were collected using structured questionnaires with 5-point Likert scales that had been tested for validity (Pearson correlation > 0.30) and reliability (Cronbach's Alpha > 0.70). Data analysis utilized Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4.0 to examine measurement and structural models, along with bootstrapping mediation tests. Findings: Service communication demonstrated significant positive effects on customer trust (β = 0.712; t = 12.456; p < 0.001) and usage intention (β = 0.324; t = 4.213; p < 0.001). Customer trust significantly influenced usage intention (β = 0.498; t = 6.847; p < 0.001) and functioned as a partial mediator (indirect effect = 0.354; BootCI [0.248; 0.471]). Originality/Value: This research integrates Commitment-Trust Theory and Social Support Theory within the context of home-based elderly care services in a developing country, revealing the critical role of empathetic, responsive, and transparent communication as the foundation for trust-building that subsequently drives service adoption. Practical Implications: The findings emphasize the necessity of therapeutic communication training for caregivers and information transparency to establish a trustworthy homecare service ecosystem in Indonesia.

This study examines the impact of personality and work engagement on Organizational Citizenship Behavior (OCB), with work motivation serving as a mediating variable, among inpatient nurses at South Jakarta Type B Hospital. OCB is crucial for enhancing organizational performance and service quality, especially in healthcare settings, where nurses' extra-role behaviors significantly contribute to patient care. The research utilized a quantitative approach with a survey design, involving 143 nurses from infection and critical inpatient wards. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results indicate that personality positively influences both work motivation and OCB. Work engagement also positively impacts work motivation and OCB. Additionally, work motivation significantly affects OCB and partially mediates the relationship between personality, work engagement, and OCB. These findings suggest that fostering nurses' work engagement and motivation, supported by positive personality traits, can enhance OCB, leading to better organizational performance and improved healthcare service quality.

The implementation of Electronic Medical Records (EMR) has become an important element in improving healthcare service quality, efficiency, and patient safety in hospitals. However, the benefits of EMR depend not only on system availability but also on the quality of the information provided and how actively the system is used by healthcare professionals. This study aims to analyze the influence of electronic medical record content and perceived ease of use on the net benefits of EMR, with actual system use acting as an intervening variable. The research applied a quantitative approach with a cross-sectional design conducted at RSM Hospital. The population consisted of all general practitioners and specialist doctors working at the hospital, totaling 51 respondents, and the study used a total sampling technique. Data were collected through structured questionnaires measured using a Likert scale and analyzed using the Structural Equation Modeling–Partial Least Squares (SEM-PLS) method. The results show that EMR content and perceived ease of use significantly influence the net benefits of EMR. Both variables also significantly affect the actual use of the system, while actual use significantly influences the benefits obtained. Furthermore, actual use mediates the relationship between EMR content, ease of use, and net benefits, indicating that better information quality and usability can encourage greater system utilization and maximize the advantages of EMR implementation.

Patient safety culture is an essential component in improving the quality of healthcare services and preventing medical errors in hospitals. However, the implementation of patient safety culture is often influenced by several organizational and individual factors, including situational awareness, availability of hospital infrastructure, and the balance between effort and rewards experienced by healthcare workers. This study aims to analyze the influence of situational awareness and hospital infrastructure on patient safety culture, with effort–reward imbalance acting as a mediating variable. The research was conducted at RSIA Tiara and involved healthcare workers as respondents. A quantitative approach with a cross-sectional design was applied in this study. Data were collected through structured questionnaires distributed to healthcare professionals and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The results show that situational awareness has a significant positive effect on effort–reward imbalance and patient safety culture. Hospital infrastructure also significantly influences effort–reward imbalance and patient safety culture. Furthermore, effort–reward imbalance significantly affects patient safety culture and mediates the relationship between situational awareness, hospital infrastructure, and patient safety culture. These findings indicate that improving healthcare workers’ situational awareness and ensuring adequate hospital infrastructure can help reduce work imbalance and strengthen patient safety culture. In conclusion, hospital management should prioritize training programs to enhance situational awareness, improve supporting facilities, and implement fair reward systems to promote a sustainable and positive patient safety culture in healthcare organizations.

The transition toward sustainable energy systems requires the transformation of renewable energy marketing strategies, particularly for waste-based energy. This study aims to analyze the effects of green marketing, stakeholder collaboration, and technological innovation on the marketing effectiveness of waste-based energy, with customer satisfaction as an intervening variable. A quantitative approach with a survey design was used. Data were collected from 300 respondents, comprising consumers and stakeholders at PT PLN (Persero) ’s waste-based energy processing units. Structural Equation Modeling (SEM) was used to analyze the data. The results indicate that green marketing, stakeholder collaboration, and technological innovation significantly influence customer satisfaction and the effectiveness of marketing. Furthermore, customer satisfaction significantly mediates the relationship between independent variables and marketing effectiveness. These findings emphasize the importance of integrating sustainable marketing strategies, multi-stakeholder synergy, and innovative technologies to enhance the competitiveness of waste-based energy products in the market. This study contributes to the theoretical development of renewable energy marketing models and provides practical implications for policymaking and green energy marketing strategies in Indonesia.

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.

Indonesia harbors extraordinary linguistic diversity with over 700 regional languages representing approximately 10% of the world's languages within 1.3% of global land area. However, this diversity faces existential threat from language shift toward Indonesian, urbanization, education policies favoring the national language, and globalization. UNESCO classifies 146 Indonesian languages as endangered, with several dozen facing imminent extinction as last speakers age without intergenerational transmission. This study documents the current vitality status of Indonesian regional languages, analyzes factors driving language endangerment and shift, evaluates existing conservation efforts, and proposes evidence-based strategies for language revitalization and maintenance. A multi-phase approach was employed: vitality assessment of 150 regional languages using UNESCO's Language Vitality and Endangerment framework with surveys involving 2,400 speakers; ethnographic case studies in 12 speech communities; policy analysis; evaluation of 25 revitalization programs; and predictive modeling of language shift trajectories. Of 150 surveyed languages, only 23 (15.3%) classified as safe with robust intergenerational transmission; 48 (32.0%) were vulnerable; 42 (28.0%) definitely endangered; 28 (18.7%) severely endangered; and 9 (6.0%) critically endangered. Key endangerment drivers included Indonesian-only education (92.3% of schools), urban migration (67.8% of youth), negative language attitudes (54.2% of parents), and lack of written traditions (73.4% of languages lacking orthographies). Modeling projected that without intervention, 40% of currently vulnerable languages will become definitely endangered within 20 years. Successful revitalization demands community-owned interventions, mother-tongue-based multilingual education, new digital language domains, and attitude change campaigns. Indonesia's linguistic diversity represents invaluable cultural and scientific heritage requiring urgent, coordinated conservation action.

High-dimensional clinical data exhibit complex and non-linear relationships among patient attributes, where outcomes are often influenced by feature interactions rather than isolated variables. However, many existing machine learning models prioritize predictive performance while providing limited interpretability and insufficient insight into interaction structures. This study aims to address this limitation by developing an interpretable and robust framework for feature interaction mining in clinical data. We propose a hybrid tree–neural modeling framework that explicitly captures and ranks feature interactions while maintaining stable predictive performance. Tree-based ensemble models are employed to identify non-linear interaction patterns, while neural representations enhance learning flexibility and generalization. The framework integrates interaction importance analysis, cross-validation–based stability assessment, and evaluation across multiple data splits to ensure robustness and interpretability. Experiments conducted on a real-world high-dimensional clinical dataset demonstrate that the proposed approach achieves consistent predictive performance, with AUC values ranging from 0.628 to 0.641 across five cross-validation folds (mean AUC ≈ 0.633). Performance remains stable under varying train–test splits, indicating strong generalizability. Interaction analysis reveals that a small number of dominant feature interactions—such as age combined with length of hospital stay and medication count combined with diagnostic information—consistently contribute to model predictions, appearing in over 80% of validation folds. Ablation studies further confirm that removing interaction-aware components leads to noticeable performance degradation, highlighting their importance.  In conclusion, this study demonstrates that explicit feature interaction modeling enhances interpretability, stability, and generalization in clinical prediction tasks. The proposed hybrid framework provides a reliable foundation for developing trustworthy and transparent clinical decision-support systems

Digital transformation has significantly altered early childhood learning patterns. Platforms such as YouTube have become dominant media consumed by preschool children. Exposure to digital content during the golden age potentially affects moral development, as children remain in a critical phase of imitation and value internalization. This study aims to conceptually analyze the role of parents in assisting early childhood moral development amid YouTube exposure from an Islamic education perspective. The research employs a qualitative approach using a systematic literature review of reputable national and international journals published between 2020–2026. The analysis involves identification, inclusion-exclusion selection, thematic categorization, and critical synthesis. Findings reveal that effective moral development is strongly influenced by parental mediation patterns, including active mediation, screen-time limitation, Islamic value-based content selection, reflective dialogue, and digital role modeling. The study proposes an integrative Islamic-based digital parenting model combining modern moral development theory and Islamic tarbiyah principles. Theoretically, this study contributes by integrating family digital literacy with Islamic moral education within contemporary educational discourse.

Government and government transparency on community participation, with government accountability as an intervening variable. The study used a quantitative approach based on Partial Least Squares Structural Equation Modeling (PLS-SEM). Data were obtained through questionnaires distributed to the community of Maladum Mes District, Sorong City. The results show that government transparency and public perception of the government's role have a positive and significant effect on government accountability. In addition, government transparency, public perception, and government accountability have a positive and significant effect on community participation. The mediation test results show that government accountability partially mediates the effects of government transparency and public perception of the government's role on community participation. These findings confirm that increasing community participation depends not only on information disclosure and positive perceptions, but also on the extent to which the government is accountable to the public for its performance. This study offers theoretical implications for strengthening the concept of good governance and practical implications for local governments in designing participatory policies.

This study aims to estimate coal resources using the kriging method at PT. Inti Bara Perdana, Taba Penanjung, Bengkulu. Geostatistical analysis was applied to evaluate spatial variability of coal quality parameters, including total moisture (TM), inherent moisture (IM), ash content (ASH), volatile matter (VM), fixed carbon (FC), and calorific value (CV). The research utilized drilling data with an average spacing of 80 meters. Variogram modeling was conducted using SGeMS software, employing spherical models to determine nugget, sill, and range parameters. The results show a low nugget effect (0%) indicating strong spatial continuity. The obtained ranges vary between 180–1296 meters depending on the parameter. Blo./ck kriging estimation was performed using block dimensions of 25 × 25 × 8 meters and a coal density of 1.3 ton/m³. The total estimated coal resource up to an elevation of 230 m is 253,500 tons. These findings demonstrate that kriging provides reliable resource estimation and supports mine planning optimization. This research contributes to improving coal resource evaluation accuracy and operational decision-making in open-pit mining.

This study investigates the effects of safety leadership and work environment on patient safety culture, with work motivation as an intervening variable among nurses at Hospital X in Jakarta. A quantitative approach using a cross-sectional design was employed, with data collected from 111 nurses through structured questionnaires. The data were analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results show that safety leadership and work environment have significant positive impacts on nurses’ work motivation. Additionally, work motivation directly influences patient safety culture. The study also finds that work motivation partially mediates the relationship between safety leadership and patient safety culture, as well as between work environment and patient safety culture. These findings suggest that both leadership practices and environmental conditions affect patient safety culture directly and indirectly by enhancing nurses’ motivation. The study highlights the importance of safety leadership and supportive work environments in promoting a sustainable patient safety culture through improved nurse motivation. From a practical perspective, hospital management should focus on fostering effective safety leadership practices and creating conducive work environments to enhance patient safety culture. This research contributes to the literature on patient safety and management by providing empirical evidence on the role of work motivation in strengthening safety culture in hospitals.

Healthcare organizations are increasingly required to preserve the sustainability of their institutional values by ensuring high-quality services, operational efficiency, and rigorous adherence to risk governance frameworks. RSUD dr. Chasbullah Abdulmadjid Bekasi City continues to face considerable challenges in this regard, particularly due to the limited internalization of core organizational values, disparities in the cultivation of an adaptive culture, and inconsistent employee compliance with established risk management procedures. These issues highlight the necessity for a leadership paradigm grounded in service, empathy, and empowerment.This study investigates the extent to which servant leadership influences the creation and protection of corporate values, while examining the mediating roles of strong adaptive culture and employee compliance doing the implementation of risk management. Employing a quantitative explanatory survey design, the research collected responses from 153 hospital employees, and data were analyzed through Structural Equation Modeling (SEM) to evaluate both direct and mediated causal pathways among variables.The findings reveal that servant leadership significantly strengthens creation and protection of corporate values, not only through direct influence but also by enhancing cultural adaptability and reinforcing compliant behavior in risk-related practices. Leaders who embody service-oriented principles are shown to cultivate work environments that foster mutual trust, organizational learning, and value-based decision-making.This study contributes meaningful empirical evidence to the discourse on leadership, organizational culture, and compliance within public hospital settings. Institutional strategies should prioritize continuous leadership development and comprehensive risk governance training to secure long-term performance excellence and reputational resilience.

Patient loyalty is an important indicator of success in healthcare services because it reflects patients’ tendency to reuse healthcare services and recommend them to others. Patient loyalty in healthcare facilities is influenced by various factors, including doctor availability, cost bearer systems, and patient experience during the service process. This study aims to analyze the effect of doctor availability and cost bearer on patient loyalty with patient experience as a mediating variable among patients at the Dental Clinic of Hermina Galaxy Hospital.This research used a quantitative approach with a survey design. Data were collected through questionnaires using a Likert scale from 150 patients at the Dental Clinic of Hermina Galaxy Hospital selected through purposive sampling. Data analysis was conducted using Structural Equation Modeling (SEM) with the assistance of AMOS software to examine both direct and indirect relationships among the research variables.The results showed that doctor availability and cost bearer have a positive and significant effect on patient experience. Patient experience was also found to have a positive and significant effect on patient loyalty. In addition, doctor availability and cost bearer have a direct influence on patient loyalty and an indirect influence through patient experience as a mediating variable.In conclusion, improving patient loyalty can be achieved by enhancing doctor availability, managing financing systems effectively, and creating positive patient experiences. Hospital management should optimize these factors to improve service quality and maintain patient loyalty

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 experience reflects patient’s comprehensive perceptions of service quality, the physical environment, and communication with healthcare providers. This study was motivated by the need to foster positive patient experience in the Pharmacy Installation of Graha Sehat Hospital, Probolinggo through improvements in service quality, servicescape, and effective communication. The objective of this research was to analyze the effects of service quality and servicescape on patient experience, with effective communication serving as an intervening variable. A quantitative approach was employed using Structural Equation Modeling (SEM) with AMOS. A total of 180 outpatient pharmacy patients were selected through voluntary sampling, with the sample size determined based on Hair’s method. The findings indicate that service quality, servicescape, and effective communication simultaneously exert a positive and significant effect on patient experience. Partially, service quality has a positive and significant effect on patient experience, while servicescape does not have a direct significant effect on patient experience. Effective communication, however, demonstrates a positive and significant influence on patient experience. Furthermore, effective communication significantly mediates the relationship between servicescape and patient experience, but it does not mediate the relationship between service quality and patient experience. The managerial implications for hospital management highlight the need to strengthen service quality improvement strategies, optimize spatial layout and environmental comfort in the pharmacy setting, and establish concise communication standards that include essential medication counseling points. Such measures are necessary to ensure that communication quality remains consistent, even during peak patient volume periods with limited-service time.

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

Compliance with clinical pathways is a critical component in ensuring quality of care, patient safety, and cost efficiency in hospitals. However, its implementation continues to face challenges related to management systems and the work behavior of Healthcare Providers (HCPs). This study aimed to analyze the effect of performance-based remuneration systems and organizational support on clinical pathway compliance, with work discipline serving as an intervening variable among HCPs at Cabangbungin Regional General Hospital.This research employed a quantitative approach with an explanatory research design. Data were collected using structured questionnaires and analyzed through Structural Equation Modeling (SEM) with a Partial Least Squares (PLS) approach, supported by the three-box method analysis. The findings indicate that performance-based remuneration systems and work discipline have a significant positive effect on clinical pathway compliance. Furthermore, work discipline was found to strengthen the relationship between performance-based remuneration and compliance, confirming its mediating role. In contrast, organizational support did not show a significant direct or indirect effect on clinical pathway compliance.The study concludes that compliance with clinical pathways is more strongly influenced by performance control mechanisms and clinical work discipline than by general organizational support. These findings provide evidence-based insights for hospital management in designing sustainable strategies and policies to enhance clinical pathway adherence and improve service quality.

Digital transformation in public health services requires cadres to possess adequate digital literacy and technology adaptation skills. This study aims to analyze the influence of digital literacy and technology adaptation on the effectiveness of cadre performance, with digital competence as an intervening variable in Pekalongan Regency. The study population was health cadres in Pekalongan Regency, with a sample of 90 respondents selected using a technique that was part of the total population of 285 respondents. Sampling used simple random sampling. Data collection was carried out using a questionnaire that had been tested for validity and reliability. Data analysis used [analytical methods, for example: Structural Equation Modeling (SEM) or Path Analysis] to examine direct and indirect relationships between variables. The research results are expected to provide an overview of: (1) the influence of digital literacy on the effectiveness of cadre performance, (2) the influence of technology adaptation on the effectiveness of cadre performance, (3) the influence of digital literacy on digital competence, (4) the influence of technology adaptation on digital competence, (5) the influence of digital competence on the effectiveness of cadre performance, and (6) the role of digital competence as an intervening variable in the relationship between digital literacy and technology adaptation on the effectiveness of cadre performance. The findings of this research are expected to serve as a basis for developing training programs and increasing the capacity of health cadres in the digital era, particularly in Pekalongan Regency.