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Malfam Bioktava

Jurnal Riset Rumpun Ilmu Sosial, Politik dan Humaniora 2026 Pusat Riset dan Inovasi Nasional

The establishment of national territorial boundaries is a strategic priority to safeguard sovereignty, maintain security stability, and strengthen bilateral relations between Indonesia and Malaysia as well as Timor-Leste. As of 2024, there remain nine Outstanding Boundary Problems (OBP) with Malaysia and two unresolved segments with Timor-Leste. These issues stem from the continued relevance of outdated colonial agreements, limited diplomatic capacity, weak inter-agency coordination, and minimal support from modern surveying technology. Based on an analysis of four policy alternatives using the criteria of effectiveness, efficiency, and long-term impact, the Strengthening of Intensive Bilateral Diplomacy has been identified as the priority policy. Implementation is directed to the Badan Nasional Pengelola Perbatasan (BNPP) as the main coordinator, supported by regulatory frameworks, diplomatic resources, and cross-ministerial/institutional coordination. Through this strategy, the resolution of pending boundary segments can be accelerated, legal certainty over national territory can be strengthened, security stability in border areas can be improved, and bilateral relations can become closer. Furthermore, Indonesia needs to strengthen diplomatic strategies, leverage technology, and enhance inter-agency coordination to accelerate the resolution of national border disputes. This policy directly contributes to achieving territorial sovereignty and sustainable development toward Indonesia Vision 2045.

Pratama Suhendro; Roza Fitriawati

Riset Ilmu Manajemen Bisnis dan Akuntansi 2026 Asosiasi Riset Ilmu Manajemen Kewirausahaan dan Bisnis Indonesia

This study aims to analyze the effect of Return on Asset (ROA), Current Ratio (CR), Net Profit Margin (NPM), and Total Asset Turnover (TATO) on company value as measured by Price Book Value (PBV) in property and real estate sector companies listed on the Indonesia Stock Exchange for the 2019–2023 period. This research adopts a quantitative method with a causal associative approach. The data was obtained from the financial reports of eight companies that met the purposive sampling criteria. Data analysis was conducted using multiple linear regression with the help of SPSS software. The results show that, partially, ROA and CR have a significant negative effect on PBV, while NPM does not have a significant effect on PBV, and TATO has a significant negative effect on PBV. Simultaneously, all four independent variables significantly affect PBV, with an R² value of 12.3%, indicating that most of the PBV variations are explained by other factors outside the research model. These findings provide insights for investors and company management regarding the importance of asset management and operational efficiency in enhancing firm market value.

Rizky Dwi Utami; Ahmad Nafhani; Agung Pratama

Jurnal Riset Rumpun Ilmu Sosial, Politik dan Humaniora 2026 Pusat Riset dan Inovasi Nasional

The development of financial technology has led to the emergence of cryptocurrency as a decentralized digital instrument that enables fast and cross-border financial transactions. While this technology offers efficiency and flexibility in digital financial activities, it also creates opportunities for misuse in various forms of crime, including terrorist financing. This study aims to analyze the use of cryptocurrency as a means of financing terrorist activities in Indonesia, examine the existing legal framework governing terrorist financing, and identify the challenges faced in law enforcement. This research employs a normative legal method using statutory, conceptual, and case study approaches. The findings indicate that the use of cryptocurrency as a medium for terrorist financing still fulfills the elements of a criminal offense as regulated under Law Number 9 of 2013 concerning the Prevention and Eradication of Terrorism Financing. However, the characteristics of cryptocurrency, such as anonymity, decentralization, and cross-border transactions, create significant challenges in the processes of evidence gathering, transaction tracing, and identification of perpetrators. In addition, there is a regulatory gap between the recognition of crypto assets as economic commodities and the supervision of their potential misuse for terrorist financing. Therefore, stronger regulations are needed to explicitly integrate crypto assets into the terrorist financing prevention regime, along with improving the capacity of law enforcement agencies in blockchain transaction analysis and strengthening international cooperation to enhance the effectiveness of law enforcement in the digital economy era.

Muspirah Muspirah; Sapriadi Sapriadi; Zulkifli Said; Basri Basri

Merkurius : Jurnal Riset Sistem Informasi dan Teknik Informatika 2026 Asosiasi Riset Teknik Elektro dan Informatika Indonesia

Marriage confirmation services are often hampered by manual procedures, leading to delays and administrative errors. This study aims to design and implement a web-based Marriage Confirmation Information System to facilitate registration, document uploads, and online monitoring of verification status and court schedules. The system was developed using the PHP programming language and MySQL database using the Waterfall method, encompassing analysis, design, implementation, and testing. The results show that the system is capable of optimally performing all managerial functions, from document validation to report automation. Black Box testing confirmed that all features functioned as expected and were easy to use. In addition to improving bureaucratic efficiency, the system ensures data security through login encryption and provides transparency through real-time status tracking. The presence of this platform significantly saves time and transportation costs for the public, as bureaucratic processes can be monitored from anywhere. In conclusion, this system successfully supports the digitalization of public services and improves the quality of administration within the Office of Religious Affairs (KUA) and Religious Courts, thereby realizing more effective, efficient, accountable, and modern governance for all levels of society

Harlin Harlin; Basri Basri; Sapriadi Sapriadi

Saturnus: Jurnal Teknologi dan Sistem Informasi 2026 Asosiasi Riset Teknik Elektro dan Informatika Indonesia

The distribution of Village Fund Direct Cash Assistance (BLT) is a government program aimed at alleviating the economic burden on affected communities. However, the data collection, verification, distribution, and reporting processes are still largely manual, potentially leading to data errors, duplication, and distribution delays. This study aims to design and implement a web-based BLT Village Fund information system that can simplify recipient data management, monitor distribution, and generate accurate reports. The methods used include database design, module implementation for sub-district administrators, village operators, treasurers, and village officials, and system testing using the Black Box method to evaluate functionality. The system is equipped with features for managing recipient data, verifying eligibility, sending data to the treasurer, inputting proof of transfer, uploading proof of distribution, recapitulating distribution, and printing reports. The test results show that all modules run according to specifications, are able to handle various input conditions, and produce accurate output. Field trials show that the system is easy to use, improves administrative efficiency, accelerates the distribution process, and supports transparency and accountability. In conclusion, the Village Fund Direct Cash Assistance (BLT) information system is effective as a tool for data management and aid distribution, minimizing errors, and supporting the smooth operation of the BLT program at the village level.

Husni Husni; Reski Idrus; Sapriadi Sapriadi; Basri Basri

Merkurius : Jurnal Riset Sistem Informasi dan Teknik Informatika 2026 Asosiasi Riset Teknik Elektro dan Informatika Indonesia

Correspondence administration is vital for supporting operational efficiency in schools. However, manual management often leads to issues such as data retrieval delays, recording errors, and the risk of lost archives. This research aims to design and develop a Web-Based Administration Data Monitoring Information System using QR Codes at UPTD SMAN 3 Majene. The study employs the Research and Development (R&D) method with the Waterfall model, encompassing requirements analysis, system design, implementation, testing, and maintenance.The system involves three primary users: Admin/Administrative Staff, Teachers, and the Principal. QR Codes are implemented as digital identities to facilitate easier archive tracking and retrieval. Results indicate that the system enhances effectiveness and efficiency in correspondence management, accelerates letter request services, and simplifies data monitoring for school management. This system is expected to provide a solution for achieving orderly administration at UPTD SMAN 3 Majene. Furthermore, QR Code integration ensures document validity and digital archive security, supporting a more modern, transparent, and sustainable school governance transformation.

Indah Damayanti; Kiromim Baroroh; Isroah Isroah

Jurnal Manajemen dan Ekonomi Bisnis 2026 Pusat Riset dan Inovasi Nasional

This paper examines the shift in the economic paradigm in Indonesia through digitalization, driven by the Fourth Industrial Revolution and the transition towards Society 5.0. The people's economy based on SMEs faces significant new challenges and opportunities in this era. Using a literature approach and case studies, this article highlights how information technology plays a role not only as a marketing tool but also as an instrument to strengthen economic sovereignty in accordance with the mandate of Article 33 of the 1945 Constitution. The findings indicate that the success of digital transformation depends on the synergy between supportive government policies, private sector innovation, and the adaptability of SME actors. In facing global challenges, the proposed strategy includes strengthening digital literacy for all levels of society and protecting the domestic market from the influx of foreign products that could threaten the sustainability of SMEs. This is crucial to ensure the future resilience of the national economy while also promoting the sustainable growth of the SME sector. Thus, digitalization is not only an efficiency solution but also a key factor in reinforcing Indonesia's people-based economy in the globalization era.

Meylani, Putri Nazwa; Desmira , Desmira; Lestari, Nurma; Rivaldan, Muhammad; Septiani, Reva Lina Putri +1 more

Teknik: Jurnal Ilmu Teknik dan Informatika 2026 LPPM Sekolah Tinggi Ilmu Ekonomi - Studi Ekonomi Modern

This study discusses the design and simulation of an automatic lighting system based on a photodiode sensor using an Arduino Uno microcontroller as the main controller. The system is designed to detect changes in ambient light intensity and automatically control the lamp without human intervention. The photodiode sensor is used as a light detector that converts light energy into an analog electrical signal, which is then processed by the Arduino to determine bright or dark conditions. The output from the Arduino subsequently controls a relay module that functions as an electronic switch to connect or disconnect the current to the light bulb. The research method employed is an experimental approach, which includes system planning, hardware design, software programming, simulation using Proteus, and system performance testing. The simulation results indicate that the system operates as expected, where the lamp automatically turns on when the light intensity decreases and turns off when the ambient brightness increases. This system is expected to improve electrical energy efficiency and provide ease of operation for lighting control, particularly in public facilitiesand workplace environments.

Sabet Ati Gunung; Fajrin Fajrin

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

The coal mining industry requires accurate stockpile volume measurements for inventory and production reporting. Conventional methods have limitations in accuracy, efficiency, and safety. This study compares the accuracy and efficiency of coal stockpile volume measurements using a Terrestrial Laser Scanner (TLS) Leica MS60 and an Unmanned Aerial Vehicle (UAV) DJI Matrice 4E, validated by the ASTM D6172-98 standard. Conducted on five Run of Mine (ROM) coal stockpiles covering 13,500 m² at PT XYZ, Lahat, South Sumatra, the TLS method used 43 scan positions, while the UAV employed 430 aerial images with specific flight parameters. Data were processed using Leica Infinity, Surpac, and Agisoft Metashape. The results showed volumes of 94,076 m³ (TLS) and 94,965 m³ (UAV), with a difference of 889 m³ (0.95%). Volume deviations ranged from 0.48% to 1.89%, with an average of 1.42%, all within the ASTM tolerance (<2%). Time efficiency analysis revealed that the UAV method required 200 minutes (3.33 hours), saving 63.3% (approximately 6.17 hours) compared to the TLS method (570 minutes). The largest efficiency gain occurred during field data acquisition, with an 85% reduction in time. This study confirms UAV photogrammetry as a valid, accurate, and efficient alternative for coal stockpile volume measurement in mining.

Dedi Achyadi; Kartono Wibowo; Soedarsono Soedarsono

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

Time delays and cost overruns remain major problems in building construction projects, particularly in concrete structural works that dominate project duration and cost. This study aims to evaluate the application of re-engineering in concrete structural work methods on the time and cost performance of multi-storey building projects. A quantitative approach using a case study method was employed through comparative analysis between the existing method and alternative methods. The analyzed alternatives include ready-mix concrete with Sika Viscocrete 8007 admixture and semi-system formwork as Alternative I, ready-mix concrete with system formwork as Alternative II, and ready-mix concrete with Sika Viscocrete 8007 admixture combined with system formwork as Alternative III. The results show that all alternatives perform better than the existing method with a duration of 243 days. Alternative I reduced the duration to 208 days with cost efficiency of IDR 55,781,730 or 0.214 percent. Alternative II reduced the duration to 203 days with cost efficiency of IDR 187,553,261 or 0.724 percent. Alternative III achieved the best performance with a duration of 168 days, accelerating 75 days and providing the highest cost efficiency of IDR 243,334,991 or 0.941 percent. The study concludes that re-engineering effectively improves project time and cost performance, with Alternative III as the optimal method.

Kharisma Maula Aditya Basri; A.A Ngurah Ade Dwi Putra Yuda; Dian Junita Arisusanty; Samsul Huda

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

This research is motivated by the importance tank cleaning process on tankers to prevent cargo contamination, maintain cargo quality, and ensure crew safety. MT. Marina Prosperity, a chemical/oil tanker, uses the Butterworth system as the primary method for tank cleaning at every cargo change. However, in practice, technical and operational constraints are still found that affect the results of tank cleaning. The research method used is descriptive qualitative with data collection techniques through direct observation on the ship, interviews with the Chief Officer and Boatswain, and documentation studies in the form of log books and SOPs. Data were analyzed by focusing on three aspects, namely work efficiency, work safety, and operational procedures for using Butterworth. The results show that the use of Butterworth can increase time and energy efficiency compared to manual methods, with an average cleaning time of 2–4 hours per tank depending on the type of cargo. From a safety aspect, Butterworth reduces the need for crew to enter the tank, thereby reducing the risk of exposure to chemicals and hazardous atmospheres. However, work effectiveness and safety are greatly influenced by the condition of the equipment, the stability of water pressure, and the crew's discipline in implementing the SOP. On several occasions, steps such as nozzle cleaning, manual mopping, and safety meetings were not consistently performed, resulting in residual load in certain areas. With routine equipment maintenance, close supervision, and ongoing crew training, Butterworth can be optimized to produce more effective, safe, and standards-compliant tank cleaning process.

Putu Eka Utama Putra; I Wayan Sukadana

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

This study aims to analyze the technical and economic impact of power evacuation work on the 20 kV distribution system at PT PLN (Persero) UP3 East Bali. The main problem studied is the high losses and poor voltage profile on the downstream side of the Kintamani feeder. The method used is load flow simulation using ETAP software with a comparative approach to conditions before and after power evacuation. The results showed that the active losses decreased from 1.017 MW to 0.626 MW (efficiency 38.45%), accompanied by an increase in the end voltage from 16.32 kV to 18.72 kV and 19.38 kV, thus meeting the SPLN 1:1995 standard. The reduction in losses resulted in energy savings of 3,425,160 kWh/year. From the economic side, a payback period (PBP) of 1.40 years was obtained, which shows that the project is financially feasible. In addition, the improvement of network performance also contributes to the reliability of the distribution system and the continuity of the distribution of electrical energy to customers. Thus, power evacuation work has been proven to be effective in improving power distribution efficiency, improving voltage quality, and providing significant economic benefits.

Jonatan Hutapea; Nur Rohmat; Hasky Bambang Kurniawan

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

The increasingly complex global energy problem drives the need for efficient, low-cost, and environmentally friendly energy storage systems. This study aims to analyze the power performance of two symmetric supercapacitor prototypes using Nitrogen-doped Graphene-Like Carbon (N-GLC) as the electrode material and 1 M  as the electrolyte, with different electrode substrates: aluminum and copper. Both prototypes were tested through charging and discharging processes using resistive loads of 470 ohms and 560 ohms for 5 minutes. The analyzed parameters include voltage, current, power, and output energy. The results show that the aluminum electrode achieved a higher maximum charging power of up to 18 mW; however, its energy discharge efficiency was very low at only 0.87%. In contrast, the copper electrode demonstrated a more balanced charging and discharging performance with an energy discharge efficiency of 19.4%. Analysis also indicates that the copper substrate maintains better voltage stability after 6 hours of storage compared to aluminum, which experienced significant degradation. Thus, the copper electrode is superior in maintaining the power and stability of a simple N-GLC-based symmetric supercapacitor system.

Hilmala Nurmualimah; Nur Rohmat; Alvian Harris Gita Purnama

Jurnal Riset Rumpun Ilmu Teknik 2026 Pusat riset dan Inovasi Nasional

This research aims to analyze the influence of thermal conditions; specifically the temperature difference between the test object and the environment; on the characteristics of air flow and heat transfer around it. The object of this study is a test piece subjected to free air flow under various temperature conditions; focusing on the convection heat transfer phenomenon. The main problem addressed is how temperature variations affect the convection heat transfer coefficient; heat transfer rate; and heat flux; as well as changes in air velocity and pressure profiles. Therefore; the objective of this research is to quantitatively compare and assess these thermal and fluid parameters through an experimental study approach and Computational Fluid Dynamics (CFD) simulation. The methodology involves direct measurement of temperature and pressure parameters under low and high-temperature conditions; which are then processed to determine the convection coefficient (); heat transfer rate (); and heat flux (). The main findings indicate that at low-temperature conditions; the heat transfer coefficient () was found to be 53.26 ; the heat transfer rate () was 24.99 W; and the heat flux () was 537.87 ; with a pressure drop of 0.86 Pa. In conclusion; thermal conditions play a crucial role in determining the dynamics of air flow and the efficiency of heat transfer; the greater the temperature difference (); the higher the potential heat transfer rate; establishing a strong correlation between thermal conditions and the convection phenomenon.

Reni Isuntari

Jurnal Manajemen Riset Inovasi 2026 Pusat Riset dan Inovasi Nasional

This study aims to examine the level of regional financial independence and various financial ratios in assessing the performance of regency and city governments in the Special Region of Yogyakarta (DIY) for the 2019–2024 period. The method employed is a descriptive qualitative approach supported by quantitative data in the form of Budget Realization Reports (LRA). Performance measurement was conducted through several key indicators, including independence, effectiveness, efficiency, and growth ratios. The results indicate that the level of fiscal independence remains relatively low, characterized by a high dependency on transfer funds from the central government. On the other hand, the effectiveness ratio shows good achievement, as most regions were able to meet their revenue targets, particularly from Local Own-Source Revenue (PAD). However, the efficiency of expenditure management remains uneven across regions. Furthermore, the revenue growth ratio shows fluctuations influenced by economic conditions, including the impact of the pandemic. Overall, regional financial performance still needs to be improved, especially in strengthening fiscal independence and optimizing PAD potential.

Daurat Sinaga; Cahaya Jatmoko; Sindhu Rakasiwi; Feri Agustina; Heru Lestiawan +1 more

Bumi: Jurnal Hasil Kegiatan Sosialisasi Pengabdian kepada Masyarakat 2026 Asosiasi Riset Teknik Elektro dan Informatika Indonesia

The rapid development of information technology has had a significant impact on the world of education, particularly in the use of mobile applications as learning media. Developing Android-based applications using Flutter is one innovation that can increase efficiency and provide a more personalized and adaptive learning experience. In this context, educators are required to continue innovating to meet the increasingly diverse and dynamic needs of students in the digital era. The Multimedia and Information Technology Professional Association (PPMultindo), an organization that brings together technology professionals, is taking advantage of this opportunity by developing an Android-based learning platform. This platform is designed to provide easier, more flexible, and more interactive access to learning materials, as well as support the process of designing more engaging materials. Features such as learning data analysis, material recommendations, and automatic evaluation are expected to increase the effectiveness and efficiency of the teaching and learning process, while also providing a means for collaboration between members. However, the implementation of this technology still faces various challenges, such as limited technological competence of educators, inadequate infrastructure, and the need for curriculum adjustments. Therefore, collaborative efforts are needed to optimize the use of mobile technology to support educational transformation.

Rizqi Kartika Wardani; Rian Adi Pamungkas; Intan Silviana Mustikawati

International Journal of Economics, Commerce, and Management 2026 Asosiasi Riset Ekonomi dan Akuntansi Indonesia

Digitalization in the healthcare sector is a strategic step to enhance efficiency, accuracy, and service quality. One of the key innovations gaining significant attention is the use of Electronic Medical Records (EMR). Purpose: This study aims to analyze nurse competence, social influence, and usability on actual use electronic medical record with perceived ease of use as intervening variable at Satya Negara Hospital. Methods: The research method used a quantitative approach with a cross-sectional design, involving 108 nurses as respondents selected through a saturated sampling technique. Data were collected using a questionnaire and analyzed using a Structural Equation Model (SEM) based on Partial Least Squares (PLS). Findings: The results indicate that nurse competence, social influence, and usability significantly affect the actual use of EMR. Additionally, perceived ease of use mediates these relationships, enhancing the adoption and utilization of EMR systems. Implications: The managerial implications of this study include the need to enhance nurse competency training, strengthen social support in the workplace, and improve the usability of the Electronic Medical Records (EMR) system to encourage more optimal use. This study also contributes to the development of literature on health information technology implementation by integrating human, social, and technical factors into the analytical model.

Ni Komang Mira Canthika Kencana Wati Karang; Ni Kadek Dwi Anggi Maharani; Sindy Anggriana; Luh Oktavia Sulistiawati; Chosy Agatha Br Colia

Pajak dan Manajemen Keuangan 2026 Asosiasi Riset Ekonomi dan Akuntansi Indonesia

Taxpayer compliance is a crucial factor in optimizing state revenue to support national development financing independently. This study aims to analyze the dynamics of taxpayer compliance in Indonesia by examining two main aspects: individual awareness and the effectiveness of the tax system. The method used is a descriptive qualitative approach with a literature review of various national journals from the last five years. The findings indicate that taxpayer compliance is influenced not only by internal factors such as knowledge, awareness, and tax morale but also by external factors such as tax service quality, system digitalization, and regulatory complexity. Tax reforms and the implementation of digital systems such as e-filing and e-billing have been proven to significantly increase taxpayer compliance through ease of access and reporting efficiency. However, real challenges remain, such as low community tax literacy and perceptions of unfairness regarding the management of tax funds by the government. Therefore, a strong synergy is needed between increasing public awareness through continuous education and improving the taxation system to create sustainable and optimal compliance. Improving transparency and accountability in the management of tax funds is a strategic step to strengthen public trust in tax authorities in Indonesia.

Nabila Amalia Nurrohmah; Agus Supriatna

Pajak dan Manajemen Keuangan 2026 Asosiasi Riset Ekonomi dan Akuntansi Indonesia

This study aims to analyze the financial distress condition of PT Garuda Indonesia (Persero) Tbk during the period 2015–2024 using the Springate and Grover models. The research employs a quantitative descriptive approach with secondary data obtained from the company’s annual financial statements. Financial distress analysis is conducted by calculating financial ratios included in each model to describe the company’s financial condition over the observation period. The results indicate that PT Garuda Indonesia (Persero) Tbk experienced financial distress during several periods, particularly before and during the COVID-19 pandemic, which was reflected in weakened liquidity, declining profitability, and reduced efficiency in asset utilization. However, following the financial restructuring process after 2021, both the Springate and Grover models show an improvement in the company’s financial condition, indicating a transition toward a more stable non-distress status. Although the Springate and Grover models use different financial indicators and classification approaches, both are able to descriptively capture the dynamics of financial distress experienced by the company. The differences in classification results reflect the distinct focus of each model, where the Springate model is more sensitive to liquidity and operational performance, while the Grover model emphasizes asset profitability. Therefore, the combined use of both models provides a more comprehensive overview of the financial distress condition of PT Garuda Indonesia (Persero) Tbk during the research period.

Ilham Ahmadi; Erry Yudhya Mulyani; Anastina Tahjoo

International Journal of Economics, Commerce, and Management 2026 Asosiasi Riset Ekonomi dan Akuntansi Indonesia

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.