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Chronic Kidney Disease (CKD) is a growing global health concern that significantly affects patients’ quality of life. At Bhakti Asih General Hospital, Tangerang, the number of hemodialysis patients increased by 20.42% and dialysis procedures by 25.06% between 2023 and 2024. Despite this service expansion, preliminary findings revealed that 32% of patients reported poor quality of life, 31% experienced low engagement in care, 34% demonstrated low self-efficacy particularly in dietary and fluid management and 32% faced accessibility barriers. These findings indicate a gap between increased service volume and patient-centered outcomes. This study aimed to analyze the effects of patient engagement and self-efficacy on the quality of life of hemodialysis patients, with healthcare accessibility as a mediating variable. A quantitative cross-sectional design was employed. Active hemodialysis patients were selected using purposive sampling. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling (SEM).The results demonstrated that patient engagement and self-efficacy had significant positive effects on quality of life, both directly and indirectly through accessibility. Accessibility also significantly influenced quality of life and strengthened the relationships between patient engagement, self-efficacy, and quality of life.These findings highlight the importance of integrating patient engagement strategies, strengthening self-efficacy through education, and improving service accessibility to enhance quality of life among hemodialysis patients

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.

The management of essential drug inventory is a strategic component of hospital pharmaceutical services because it directly influences service continuity, cost efficiency, and the overall quality of healthcare delivery. Poor inventory control can result in excessive stock accumulation, increased risk of drug expiration, inefficient budget utilization, and potential drug shortages that may compromise patient care. This study aims to evaluate the effectiveness of essential drug inventory control at Pekerja General Hospital by applying the ABC-VEN, Economic Order Quantity (EOQ), and Reorder Point (ROP) methods. It also examines differences in inventory management efficiency between 2024 and 2025 based on inventory value, cost of goods sold (COGS), and Inventory Turnover Ratio (ITOR). A mixed-methods approach with a sequential explanatory design was used. Quantitative analysis involved a paired sample t-test comparing inventory data from 2024–2025, while qualitative data were collected through in-depth interviews and analyzed thematically using NVivo. The findings reveal a significant improvement in inventory management in 2025 (p < 0.05), reflected in reduced inventory value and COGS, along with an increased ITOR. However, the implementation of ABC-VEN, EOQ, and ROP methods has not been fully integrated, and challenges such as limited human resources and procurement bureaucracy persist.In conclusion, although inventory control became more efficient in 2025, further integration of inventory methods and strengthening of human resource capacity are necessary to ensure sustainable improvements.

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.

This study aims to design and develop a functionally efficient and operationally effective Internet of Things (IoT)-based air quality monitoring system for radiology departments. The system utilises a DHT22 sensor integrated with an ESP32 microcontroller to monitor the temperature and humidity of diagnostic rooms in real time, and to display the data via the UdaraKu mobile application. The research method employed a quantitative experimental approach focused on measuring system performance, specifically the accuracy of the temperature and humidity sensors. The research model used was the Research and Development (R&D) method, aimed at transforming conventional air quality monitoring in radiology into a real-time digital system based on IoT. The research results indicate that the IoT-based monitoring system is capable of maintaining room temperature and humidity stability within the ideal range, namely 22–24°C and 50–60% RH, in accordance with international standards. This improvement in environmental stability has a direct impact on reducing noise in digital radiography images, as evidenced by an increase in the Signal-to-Noise Ratio (SNR). Instrument validation demonstrated a high level of reliability with a Cronbach’s Alpha value of 0.848, reinforcing the reliability of the data and the system. Overall, the IoT-based air quality monitoring system has proven effective in controlling noise in digital radiography images, improving the quality of diagnostic services, and supporting patient safety principles and operational efficiency within radiology departments.

This study aims to analyze the marketing strategies of maternal and child healthcare services in hospitals to enhance patient experience, emphasizing a shift from traditional promotional approaches toward the creation of a positive and empathetic patient experience. This research employs a systematic literature review of relevant studies published between 2021 and 2025, with analysis conducted through identification, selection, and thematic synthesis to determine key factors influencing patient satisfaction and loyalty. The findings indicate that the quality of interpersonal interactions and the efficiency of service processes are the primary determinants of patient experience, where factors such as staff empathy, clear communication, reduced waiting times, and well-structured service flows have a greater impact than the technical aspects of medical care. Hospitals should therefore prioritize people- and process-oriented strategies by implementing empathy training, enhancing communication effectiveness, and regularly measuring patient satisfaction, while also integrating digital services, ensuring cost transparency, and developing continuity of care programs to strengthen the patient experience holistically. This study proposes a holistic marketing framework that integrates empathy, efficiency, data-driven personalization, and environmental sustainability, highlighting a shift from a purely clinical orientation to an experiential marketing approach that places human values at the core of a hospital’s competitive advantage.

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.

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.

Law Number 17 of 2023 concerning Health (the 2023 Health Law) serves as a fundamental regulation governing various aspects of health services in Indonesia, including the operations of private hospitals. For private hospitals whose shares are listed on the Indonesia Stock Exchange (IDX), the implementation of the 2023 Health Law has brought significant changes in both legal and operational dimensions. This study aims to examine the legal aspects of implementing the 2023 Health Law on the operations of IDX-listed private hospitals. Employing a normative legal research method with statutory and conceptual approaches, this study analyzes relevant regulations and doctrines. The results indicate that the 2023 Health Law expands the scope of hospitals' legal liability, comprehensively regulates the obligations and rights of both hospitals and patients, and imposes stricter sanctions for violations. Furthermore, the implementation of this regulation impacts the business and financial aspects of listed private hospitals, including expansion opportunities, shifts in cost structures, and stock market responses. However, challenges remain in its application, such as diverse interpretations of certain provisions and hospitals' readiness to comply with the established requirements.

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.

Pharmaceutical services initially focusing solely on drug management (Drug Oriented) to comprehensive services that include clinical pharmacy services and medication services aimed at improving patients' quality of life (Patient Oriented). Clinical pharmacy services in pharmacies are part of pharmaceutical services that are directly responsible to patients in relation to pharmaceutical preparations, medical devices, and disposable medical supplies. This study aims to determine the implementation of clinical pharmacy services in pharmacies in the Gedong Tataan District of Pesawaran Regency. The research approach used was quantitative descriptive with a simple random sampling technique. The sample in this study consisted of 16 pharmacies and pharmacy staff working in pharmacies in the Gedong Tataan District, Pesawaran Regency, who met the inclusion and exclusion criteria. Data collection was carried out by conducting with guided interviews using questionnaires and observation on the implementation of clinical pharmacy services by pharmacy staff. The results showed that the clinical pharmacy services implemented in pharmacies in Gedong Tataan District, Pesawaran Regency, were prescription assessment and services by 74% with a good category (61-80%), dispensing by 95% with a very good category (81-100%), and drug information services (PIO) obtained a percentage of 72% with a good category (61-80%). Clinical pharmacy services were mostly carried out by Pharmacy Vocational Personnel (TVF) at 37.5%. Clinical pharmacy services in pharmacies throughout the Gedong Tataan District of Pesawaran Regency have not been fully implemented in accordance with the standards of pharmaceutical services in pharmacies according to Permenkes No. 73 of 2016, as there are still several aspects that have not been carried out.

Drug stockouts in hospitals pose significant risks to service quality, patient safety, and operational efficiency. This study aimed to analyze how drug demand planning and procurement processes at Johar Baru Regional General Hospital contribute to stockout occurrences and to develop data-driven recommendations based on supply chain management principles. A qualitative descriptive design was employed using data triangulation. Data were collected through in-depth interviews with the Head of the Pharmacy Installation, procurement staff, and warehouse pharmacists, complemented by direct observation and analysis of 2024 planning and procurement documents. Thematic analysis was conducted with the support of NVivo software to identify patterns and relationships among key variables, including drug demand planning, procurement, and inventory management.Findings reveal that stockouts stem from interconnected weaknesses in planning accuracy, procurement coordination, and inventory control systems. Effective stock management depends not only on increasing supply but also on improving data quality, integrating inventory information systems with operational workflows, and enhancing cross-functional collaboration. Recommended strategies include implementing a minimum stock alert system integrated with the Hospital Management Information System (HMIS), strengthening standard operating procedures for stockout response and procurement confirmation, improving integration between HMIS, the National Formulary, and budgeting systems, and applying consumption based planning methods combined with ABC VEN analysis to optimize inventory control.

Hyperemesis gravidarum is a common complication in early pregnancy characterized by excessive nausea and vomiting that can negatively affect maternal health and quality of life. Although pharmacological management is widely used, concerns regarding medication safety during pregnancy have increased interest in complementary and non-pharmacological interventions. One such approach is aromatherapy, particularly the use of lavender essential oil, which is known for its calming and antiemetic properties. This study aimed to evaluate the effectiveness of lavender aromatherapy in reducing the frequency of hyperemesis gravidarum among pregnant women at RSUD Tikep. This research employed a quantitative quasi-experimental design with a pretest–posttest approach. A total of 30 first-trimester pregnant women experiencing hyperemesis gravidarum were selected using purposive sampling. The intervention involved inhalation of lavender aromatherapy administered for a predetermined duration and frequency. The frequency of nausea and vomiting was measured before and after the intervention using observation sheets and self-reported records. Data were analyzed using SPSS software, including descriptive statistics, normality tests, and paired sample t-tests. The results demonstrated a significant reduction in the mean frequency of hyperemesis gravidarum following the administration of lavender aromatherapy. Statistical analysis revealed a p-value of less than 0.05, indicating a significant difference between pre-intervention and post-intervention measurements. These findings suggest that lavender aromatherapy effectively reduces the frequency of nausea and vomiting in pregnant women. In conclusion, lavender aromatherapy is a safe, low-cost, and effective complementary therapy for managing hyperemesis gravidarum. Its integration into routine antenatal care may enhance maternal comfort and support holistic, patient-centered maternity services, particularly in regional healthcare settings.

The healthcare sector is increasingly confronted with a VUCA environment (Volatility, Uncertainty, Complexity, and Ambiguity), requiring hospitals to adopt adaptive, resilient, and innovative strategies. This study aims to systematically review the evidence on smart hospital strategies in responding to uncertainty, particularly in improving service quality, operational efficiency, and patient satisfaction. A systematic literature review was conducted using major academic databases, including Scopus-indexed sources, Google Scholar, and Semantic Scholar, covering publications from 2020 to 2026. Articles were selected based on predefined inclusion criteria focusing on hospital management strategies in dynamic and uncertain environments. A total of 10–15 relevant studies were included and analyzed using thematic synthesis. The findings indicate that key strategies in addressing VUCA challenges include digital transformation (e.g., electronic medical records and telemedicine), adaptive and transformational leadership, agile management approaches, and patient-centered care. Digital technologies significantly improve efficiency and decision-making processes, while agile and adaptive leadership enhances organizational responsiveness and resilience. However, several studies highlight that technological advancement alone is insufficient without integrating humanistic values such as empathy, communication, and trust. In conclusion, the most effective hospital strategies in a VUCA world are those that integrate technological innovation with human-centered care. Hospitals must develop flexible, data-driven, and patient-oriented systems to ensure sustainability and competitiveness in uncertain environments. Future research should focus on longitudinal and experimental designs to strengthen causal evidence and explore the integration of digital systems with humanistic healthcare values.

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.

Prescription waiting time is a key indicator of pharmacy service quality that directly influences patient satisfaction and hospital efficiency. Data from the Outpatient Pharmacy Installation of Pelabuhan Jakarta Hospital show average waiting times of 30.49 minutes for non-compounded medications and 35.93 minutes for compounded medications. Although these figures are still within national standards, they have not met the hospital’s internal targets, indicating inefficiencies that require systematic improvement.This study aimed to analyze prescription waiting times and identify waste in outpatient pharmacy services using Lean Hospital and Continuous Improvement approaches. A qualitative analytical method with a case study design was applied. Data collection involved participatory observation, in-depth interviews with key informants (head of pharmacy, pharmacists, and technicians), and document review. Analysis utilized Lean tools such as Value Stream Mapping (VSM), identification of Value Added (VA) and Non-Value Added (NVA) activities, bottleneck analysis, fishbone diagram, and Failure Mode and Effects Analysis (FMEA).The findings revealed that service processes were dominated by non-value-added activities, especially during prescription receipt, verification, packaging, and dispensing. Major wastes included waiting, motion, and overprocessing. Contributing factors were uneven staff distribution, suboptimal e-prescribing systems, incomplete prescriptions, and lack of standardized procedures. The proposed future state VSM demonstrated potential improvements in reducing waiting time and enhancing service efficiency.

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

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.

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.