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Tele-Herbal Medicine is a technology-driven service designed to deliver herbal medicine consultations and therapies through wellness clinics, aiming to improve access to personalized and affordable care. This study systematically assesses its effectiveness, implementation, and challenges as part of integrated health services by reviewing relevant literature published in the past five years. Findings indicate that Tele-Herbal Medicine significantly enhances patient access, offering tailored and cost-efficient herbal treatments. Despite these promising outcomes, implementation faces key obstacles, including inadequate regulatory frameworks, the absence of standardized herbal product validation procedures, and concerns over patient data security. These limitations underscore the urgent need for comprehensive policies, quality assurance mechanisms, and strict data protection protocols, consistent with broader telemedicine guidelines. By addressing these issues, Tele-Herbal Medicine can evolve into a reliable and sustainable model, enabling wellness clinics to expand services without compromising safety or quality. Ultimately, its success depends on clear legal support, standardized validation systems, and robust monitoring tools to ensure effectiveness, safety, and full integration into the healthcare ecosystem, thus positioning it as an innovative solution that bridges traditional herbal practices with modern digital health services.

The licensing of clinics and hospitals is crucial for achieving quality and equitable healthcare in Indonesia. The legal framework, including the 2009 Health Law and the 2020 Omnibus Law, has introduced a risk-based approach via the Online Single Submission (OSS) system to streamline the process. However, significant challenges remain. These include bureaucratic complexity, inconsistent regional regulations due to autonomy, lack of data integration between institutions, and high accreditation costs. These barriers particularly hinder small investors and limit the distribution of healthcare facilities in remote areas. Recent reforms, such as the National Digital Public Service Mall (MPP Digital), aim to address these issues by reducing licensing time to under one hour, thereby boosting transparency and efficiency. Despite this progress, unresolved issues concerning patient data privacy, the uneven distribution of medical personnel, and conflicting environmental regulations still need harmonization. To foster inclusive investment and support the 2030 Universal Health Coverage (UHC) goals, this research proposes key solutions: implementing fiscal incentives, adopting AI technology for verification, and strengthening public-private partnerships. With these targeted reforms, the licensing system can become a powerful driver for better healthcare access and sectoral growth.

Drug stock-outs are an indicator of pharmaceutical management failure that directly affects patient safety and the quality of hospital services. Gatoel Hospital Mojokerto experienced an increase in the percentage of drug debt from 3.14% in January to 6.20% in July 2025, with 1,607 patients affected. This study aims to identify the factors causing drug stock-outs and formulate preventive strategies through the optimization of the Minimum-Maximum Stock Level (MMSL) system based on the Hospital Information System. A mixed-method approach was used, combining secondary data analysis (January–July 2025) and in-depth interviews. Fishbone analysis was applied to identify root causes, USG analysis to determine priorities, and SWOT analysis to formulate intervention strategies. Priority drug classification was carried out using the ABC-VEN method. The intervention involved implementing an MMSL pilot project for 150 drug items under Pareto category A. The analysis identified six dimensions of stock-out causes: man, materials, methods, machines, measurement, and environment. The highest priority issue was drug demand forecasting based on historical data (USG score: 125). SWOT analysis placed the organization in quadrant II, recommending a Weakness-Opportunities (WO) strategy. MMSL implementation was initiated through the development of SOPs and the entry of 150 priority drug items into the system. Drug stock-outs are caused by multifactorial issues that require systemic intervention. MMSL optimization has the potential to serve as a long-term solution, provided there is expanded coverage, strengthened human resource capacity, and comprehensive system integration.

The quality of outpatient services is an essential indicator of hospital performance and patient satisfaction. At Mega Buana Hospital Palopo, patient complaints remain regarding waiting times, limited facilities, and staff communication, highlighting the need for evaluation based on the Ministry of Health Regulation No. 129/Menkes/SK/II/2008. This study aimed to analyze the relationship between human resources, medical staff interactions, service processes, and patient satisfaction with outpatient service quality. This research employed a quantitative design with a cross-sectional approach. A total of 116 patients were selected through accidental sampling. Data were collected using a validated and reliable questionnaire and analyzed using the chi-square test. The results revealed significant associations between human resources (p=0.001), medical staff interactions (p=0.003), and patient satisfaction (p=0.002) with outpatient service quality. The service process, particularly waiting time and queue management, proved to be important factors influencing patients’ perceptions of service quality. Overall, the service quality was categorized as good but not yet fully aligned with the national standards, especially in administrative speed, queue system, and facility comfort. In conclusion, outpatient service quality at Mega Buana Hospital Palopo is influenced by human resources, medical staff interactions, service processes, and patient satisfaction. The findings emphasize the importance of strengthening human resource management, improving the quality of medical staff communication, enhancing queue management, and providing adequate supporting facilities to meet national service standards.

The purpose of this research is to analyze the innovation in emergency health services through the implementation of the Ambulans Hebat program in Semarang City, to analyze the challenges and obstacles faced in the implementation of the Ambulans Hebat service, and to analyze the quality of emergency health services provided by Ambulans Hebat. This research is descriptive qualitative in nature, using interview techniques with 9 informants and a questionnaire with 96 respondents. The results of this research show that the Ambulans Hebat program in Semarang City demonstrates innovation through digital technology (GPS, applications) that enhances response and coordination, an integrated command center for efficient information flow, and medical personnel training, although it requires better data integration, signal strengthening, and broader training; however, challenges such as limited fleet and medical personnel, weak inter-agency coordination, and traffic impacts necessitate additional units, integrated systems, and infrastructure innovations; quality evaluation indicates a 15-minute response time, high patient satisfaction, and successful initial handling, but requires route optimization, expanded satisfaction surveys, and additional technical training.

Electronic Medical Records (EMR) are a crucial component of hospital information systems that support the effectiveness, accuracy, and continuity of patient care. However, their implementation among nurses at Hospital X remains suboptimal due to barriers related to organizational culture, leadership, and individual motivation. This study aims to analyze the effect of organizational culture (X1) and transformational leadership (X2) on the implementation of EMR (Y) through work motivation (Z) as an intervening variable. The research applied an explanatory-causal design with a quantitative approach, using a cross-sectional survey method. Data were collected through questionnaires distributed to nurses and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The findings reveal that organizational culture and transformational leadership significantly influence EMR implementation both directly and indirectly through work motivation, with p-values less than 0.05. These results indicate that strong organizational values, collaborative culture, and transformational leadership that fosters motivation and innovation can improve nurses’ willingness and effectiveness in utilizing EMR. The study concludes that enhancing organizational and leadership factors, along with maintaining high work motivation, is essential to ensure successful EMR adoption and optimize healthcare service quality in hospitals.

Infertility is a reproductive health issue that not only affects biological aspects, but also causes significant psychological burdens, particularly anxiety in women. In the context of Saudi Arabian culture, which has strong pronatalist values, infertile women often face social and emotional pressures that can exacerbate their psychological condition. Social support is seen as a protective factor that plays an important role in helping individuals adapt to the stress of infertility. This study aims to analyze the relationship between the level of social support and the level of anxiety in Saudi women facing infertility at the Dr. Sulaiman Al-Habib Takhassusi Branch, Riyadh. This study uses a quantitative approach with a cross-sectional analytical observational design. The research sample consisted of 30 infertile women selected using consecutive sampling techniques. The levels of social support and anxiety were measured using a standardized questionnaire, then analyzed using Spearman's correlation test with a significance level of 0.05. The results showed that most respondents were aged 20–35 years and experienced primary infertility. The Spearman test showed a statistically significant relationship between the level of social support and the level of anxiety (p = 0.000) with a correlation coefficient of r = 0.625, indicating a moderate to strong positive relationship. This indicates that women with higher levels of anxiety tend to receive or seek more intense social support. In conclusion, social support plays an important role in the dynamics of anxiety in infertile women. The integration of structured psychosocial support into infertility services is essential to improve patients' psychological well-being and quality of life.

In the healthcare sector, patient revisit intention serves as an important measure of hospital success, influencing financial stability, operational effectiveness, and long-term patient retention. With increasing competition, hospitals must strengthen trust, improve service quality, and maintain a positive institutional image to retain patients. This study focuses on the declining number of non-BPJS (non-insured) patients at Cinta Kasih Tzu Chi Hospital, Cengkareng, which impacts revenue sustainability. The research aims to assess how trust and customer perceived value affect revisit intention, and whether hospital image moderates these relationships. A quantitative approach was applied using a structured questionnaire distributed to 95 non-BPJS outpatients who had previously sought treatment more than once. Data were analyzed through Structural Equation Modeling (SEM) using the Partial Least Squares (PLS) method via SmartPLS software. The findings reveal that both trust and perceived value significantly and positively influence revisit intention, implying that patients with strong trust and satisfaction tend to return. Although hospital image directly influences revisit intention, it does not significantly moderate the link between perceived value and revisit intention. Therefore, hospitals are advised to enhance patient trust and perceived value while sustaining a credible institutional image to strengthen loyalty among non-BPJS patients

Hypertension is a condition in which systolic blood pressure exceeds 140 mmHg and diastolic pressure exceeds 90 mmHg persistently. Uncontrolled high blood pressure can cause disorders in the circulatory system and vital organs such as the heart and brain. One non-pharmacological effort to lower blood pressure in hypertensive patients is through deep breathing relaxation exercises, performed twice a day for ten minutes. RSU Siaga Medika Purbalingga, located in Padamara District, has recorded the highest number of hypertension cases in the area, totaling 4,470 patients. Based on a preliminary survey, many hypertensive patients were unaware of the benefits of deep breathing relaxation therapy; therefore, a Community Service (PkM) activity was conducted in the hospital’s Internal Medicine Clinic. The method involved educational sessions using lectures and demonstrations, supported by leaflets and videos. Participants’ knowledge was evaluated using pretest and posttest questionnaires. The results showed that most respondents were female (60%) and aged between 46–55 years (40%). Knowledge levels significantly improved, from the “low” category (40%) before education to the “good” category (90%) after education. Thus, deep breathing relaxation therapy has the potential to be an effective alternative method to help reduce blood pressure in patients with hypertension.

The integration of Internet of Things (IoT) with cloud computing has revolutionized healthcare systems, offering scalable and real-time patient monitoring. However, optimizing response times and energy consumption remains crucial for efficient healthcare delivery. This research evaluates various algorithmic approaches for workload migration and resource management within IoT cloud-based healthcare systems. The performance of the implemented algorithm in this research, Hybrid Dynamic Programming and Long Short-Term Memory (Hybrid DP+LSTM), was analyzed against other six key algorithms, namely Gradient Optimization with Back Propagation to Input (GOBI), Deep Reinforcement Learning (DRL), improved GOBI (GOBI2), Predictive Offloading for Network Devices (POND), Mixed Integer Linear Programming (MILP), and Genetic Algorithm (GA) based on their average response time and energy consumption. Hybrid DP+LSTM achieves the lowest response time (82.91ms) with an energy consumption of 2,835,048 joules per container. The outcome of the analysis showed that Hybrid DP+LSTM have significant response times improvement, with percentage increases of 89.3%, 79.0%, 83.8%, 97.0%, 99.8%, and 99.94% against GOBI, GOBI2, DRL, POND, MILP, and GA, respectively. In terms of energy consumption, Hybrid DP+LSTM outperforms other approaches, with GOBI2 (3,664,337 joules) consuming 29.3% more energy, DRL (2,973,238 joules) consuming 4.9% more, GOBI (4,463,010 joules) consuming 57.4% more, POND (3,310,966 joules) consuming 16.8% more, MILP (3,005,498 joules) consuming 6.0% more, and the GA (3,959,935 joules) consuming 39.7% more. The result of ablation of the Hybrid DP+LSTM model achieves a 47.05% improvement over DP-only (156.57ms) and a 70.64% improvement over LSTM-only (282.41ms) in response time. On the energy efficiency side, Hybrid DP+LSTM shows 22.80% improvement over LSTM-only (3,671,51 joules), but 7.34% underperformance compared to DP-only (2,640,93). These research findings indicate that the Hybrid DP+LSTM technique provides the best trade-off between response time and energy efficiency. Future research should further explore hybrid approaches to optimize these metrics in IoT cloud-based healthcare systems.

The Emergency Severity Index (ESI) is a triage method that determines the escalation of treatment for patients based on the severity of their emergency condition. In order to improve the level of satisfaction of individuals receiving health services, it is necessary to provide quality services that are responsive to the expectations and needs of patients. This study aims to explore the relationship between the ESI (Emergency Severity Index) level and patient satisfaction in the Emergency Room of Pertamedika Ummi Rosnati Hospital. The research design applied is analytical with a cross-sectional method. From a total population of 500 patients in December, 51 respondents were selected using purposive sampling. The instruments used included the ESI (Emergency Severity Index) Questionnaire and CSQ-8 (Client Satisfaction Questionnaire), with univariate and bivariate data analysis using the Chi-Square test. The results showed that in the high ESI index category, most participants (37 people or 92.5%) expressed satisfaction with the services received, while 3 people (7.5%) were dissatisfied. In the moderate ESI group, 9 respondents (90.0%) reported satisfaction, while only 1 respondent (10.0%) reported dissatisfaction. Conversely, in the mild ESI level, there were no patients who were satisfied (0%), and one patient (20.0%) was dissatisfied. Through analysis using the Chi-Square statistical test, a ρ value of 0.009 (≤ 0.05) was obtained, indicating a significant relationship between ESI levels and patient satisfaction. Based on these findings, it can be concluded that there is a correlation between ESI classification and the level of satisfaction of service users in the Emergency Department. The researchers recommend that patients gain a better understanding of the ESI stages, and the Emergency Department is expected to provide education, such as putting up informative banners related to ESI (Emergency Severity Index) to increase patient understanding of the triage process in the Emergency Department.

This study examines the application of systems thinking in modern healthcare organizations, with a particular focus on Peter Senge’s Fifth Discipline. Using a systematic literature review of 20 selected articles, the study investigates the potential and challenges of applying systems thinking across key areas such as patient safety, service integration, resource management, and innovation. Findings indicate that systems thinking provides a holistic framework to better understand and address the inherent complexity of healthcare systems. By fostering interconnections among organizational components, it enhances the capacity to improve performance, ensure patient-centered care, and support sustainable change. Nevertheless, implementation is hindered by obstacles such as resistance to change, lack of shared understanding, and difficulties in measuring systemic outcomes. To address these barriers, the study highlights strategies including leadership development, staff training, and the establishment of appropriate evaluation tools. These measures strengthen organizational readiness and support a culture of continuous learning. The study concludes that systems thinking offers valuable insights for healthcare organizations to adapt to evolving challenges, but its success requires long-term commitment, supportive leadership, and systematic implementation. Future research should further explore the integration of systems thinking with emerging digital health technologies and assess its long-term impact on health outcomes and organizational resilience.

Homecare services are increasingly recognized as a preferred healthcare option because of their practicality, flexibility, and accessibility, especially for elderly patients and individuals with physical limitations who face difficulties in reaching health facilities. This study aims to examine the relationship between consumer, provider, sociocultural, and organizational factors with patients’ preferences in selecting homecare services. Employing a quantitative approach with a descriptive analytical design, data analysis was conducted using the chi-square test to determine the significance of each factor. The findings reveal that consumer-related aspects, such as personal needs, convenience, and trust (p = 0.005), along with sociocultural influences including social norms, cultural values, and family support (p < 0.001), have a significant relationship with patients’ choices of homecare services. In contrast, provider factors (p = 0.096) and organizational factors (p = 0.161) were found to have no significant impact on the decision-making process. These results suggest that patients’ decisions are primarily shaped by internal motivations and sociocultural environments rather than institutional or organizational elements. Thus, it is essential for healthcare providers to focus on understanding community needs, cultural practices, and patient expectations to ensure that the services offered are both relevant and acceptable. By integrating cultural sensitivity and consumer-oriented strategies, homecare services can become more effective, trusted, and widely utilized within the community.

This study aims to determine and analyze the influence of Servant Leadership, Work Motivation, and Work Environment on Employee Job Satisfaction at the Jimbun Medika Inpatient Primary Clinic. The background of this research is based on the phenomenon observed in the field, where employee job satisfaction levels show frequent fluctuations. These fluctuations have the potential to impact not only individual productivity but also the overall quality of healthcare services provided to patients. The research method used is a quantitative approach with a survey technique as the primary data collection method. The population in this study includes employees of the Jimbun Medika Inpatient Primary Clinic, with data collected using structured questionnaires. The data were analyzed using statistical tools, including multiple linear regression analysis, to determine the effect of the independent variables on the dependent variable. The research findings indicate that Servant Leadership (X1), when tested partially, does not have a significant effect on employee job satisfaction. In contrast, Work Motivation (X2) and Work Environment (X3) each show a positive and significant influence on employee job satisfaction. Furthermore, when analyzed simultaneously, all three independent variables—Servant Leadership, Work Motivation, and Work Environment—have a significant combined effect on job satisfaction levels among employees at the clinic. These findings suggest that to improve employee satisfaction and ultimately enhance service quality, the management of Jimbun Medika should prioritize improving motivation and providing a supportive work environment, while also re-evaluating leadership strategies to better align with employee needs and expectations.

Anxiety is an emotional response that is commonly experienced by patients before surgery, including in pre sectio caesarean patients. High levels of anxiety can affect the patient's physiological and psychological condition, so appropriate handling efforts are needed. Non-pharmacological interventions, such as prayer dhikr therapy, can be used as an alternative to help reduce anxiety because it provides relaxation, calmness, and increased spirituality. This study aims to analyze the effectiveness of dhikr sholawat therapy on anxiety levels in pre sectio caesarean patients. The research design used a quasi-experiment with a pre-test and post-test control group approach. The research sample consisted of pre-sectio caesarea patients who met the inclusion criteria, then divided into two groups, namely the intervention group that was given prayer dhikr therapy and the control group that only received standard treatment. The instrument used to measure anxiety levels is the Hamilton Anxiety Rating Scale (HARS). Data analysis was carried out by statistical tests according to the distribution of data to find out the difference in results between the two groups. The results showed a significant decrease in anxiety levels in the intervention group compared to the control group (p < 0.05). These findings prove that prayer dhikr therapy is effective in reducing anxiety in pre-sectio caesarean patients. Thus, this therapy can be recommended as one of the non-pharmacological nursing interventions that support the improvement of service quality and patient comfort.

Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by the dengue virus and transmitted through the bite of Aedes aegypti mosquitoes. In 2023, 48 cases of DHF were reported in the Kebun Lada Public Health Center area, reflecting a high incidence rate and limited medical resources in managing the cases. This situation emphasizes the need for an alternative solution that can support a fast and accurate diagnostic process. This study aims to develop an expert system for diagnosing DHF using the Case-Based Reasoning (CBR) method. CBR functions by comparing the symptoms experienced by patients with previous cases stored in the knowledge base, thereby producing relevant diagnostic recommendations. The proposed system is implemented as a web-based application using PHP as the programming language and MySQL as the database management system. The expected outcomes of this study are to assist medical personnel in reducing diagnostic time, improving the accuracy of decision-making, and increasing the effectiveness of health services in primary healthcare facilities. In addition, the system is designed to provide wider access for the community to recognize early symptoms of DHF, which can contribute to preventive actions and reduce the risk of severe complications. Thus, the developed expert system has the potential to become a practical solution to overcome the shortage of medical personnel and enhance public health awareness.

Background: There are still shortcomings in the implementation of a truly safe and optimal thoracic examination protocol for toddlers in certain hospital settings. Furthermore, data related to direct radiation dose measurements and evaluation of the effectiveness of thoracic examination techniques for toddlers specifically in the local context in Indonesia are very limited. Objective: To examine the thoracic examination procedure that can be performed with a high level of safety without compromising the quality of diagnostic results and to evaluate the radiation exposure dose and thoracic examination techniques in toddlers at Hospital. Methodology: This study used a mixed methods approach with a convergent parallel design. Quantitative data were obtained from radiation dose measurements and examination parameters, while qualitative data were collected through observation, interviews, and group discussions, then analyzed thematically to understand the factors that influence radiation dose in infant thoracic examinations. Results: Research on thoracic radiology examinations in toddlers at Heart and Vascular Hospital was conducted systematically and in accordance with established procedures. Some limitations emerged from limited radiation dose records and inconsistent use of protective shields. Efforts to reduce radiation exposure include optimizing examinations, proper collimation, selecting exposure parameters, and educating families and staff. Continuous training and strict implementation of standard operating procedures (SOP) are essential to raise awareness of the ALARA principle. Internal policies and routine oversight are also needed to improve radiation dose monitoring, with the hope of improving the quality of radiology services and optimizing protection for toddler patients.

Background: Nurses are the most dominant health workers in hospitals including inpatient installations. This dominance tends to have an impact on the main focus of the community including patients. When the nurse's performance is good, being able to cover all services in the hospital will be of good value in the eyes of the community and patients, making it a crucial point for nurses to work in accordance with the competencies, main tasks and functions and practice standards set by health care facilities. This study examines the relationship between nurse performance and patient satisfaction treated at the inpatient installation of Bhayangkara Hospital Jayapura. Method: This study is a type of non-experimental quantitative research with correlation studies. Data collection was carried out using questionnaires. The number of respondents was 98 people with the same number of nurses and patients, namely 49 people. The sampling technique used was incidental. Data were analyzed using spearmank rho. Result: Based on the results of the study, it was found that the age of 26-45 years, female, with a Diploma III education, and a length of work of more than 3 years. While the majority of patient respondents were aged 18-25 years, female, with the most education being high school, having a self-employed job, and a length of care of 1-3 days. The performance of nurses found to be categorized as good while the majority of patient satisfaction was very satisfied. The results of the spearman rho analysis obtained a correlation strength level of 0.924 with a p-value of 0.000. Conclusion: Nurse performance is related to patient satisfaction treated at the inpatient installation of Bhayangkara Hospital Jayapura. It is expected that the measurement of nurse performance with patient satisfaction will be carried out periodically, a maximum of once a year to evaluate nursing services.

This study aimed to evaluate the effect of murrotal therapy on pain and anxiety levels in patients after radiofrequency action. This study uses a quantitative approach with a pre-experimental design of one group pretest-posttest involving 50 post-radiofrequency patients at Sultan Agung Hospital Semarang. The research data were collected using the Numeric Rating Scale (NRS) instrument to assess pain levels and the Zung Self-Rating Anxiety Scale (SAS) to assess anxiety levels. Univariate analysis showed that most of the respondents were women with an average age of 44.04 years, included in the intermediate adult category. The results of bivariate analysis with the Wilcoxon Signed Rank Test showed a significant decrease in both pain and anxiety levels after being given murrative therapy, with a p-value of 0.000 for both variables. This shows that murrotal therapy is effective in providing psychological relaxation and spiritual distraction effects, so that it can reduce the intensity of pain while reducing anxiety in patients. Based on these findings, it can be concluded that murrotal therapy is a non-pharmacological intervention that is simple, safe, and easy to apply by health workers. It also has great potential as a complementary therapy that supports the management of pain and anxiety after medical procedures, especially invasive procedures such as radiofrequency. Thus, the application of murrotal therapy can be used as an additional alternative in improving the quality of nursing services in hospitals.

Introduction: Repurchase intention is one of the important indicators in the world of health services, especially in hospitals. XYZ General Hospital must evaluate the services provided to patients by understanding patient perceptions, particularly through patient experience, as 50% of respondents expressed unwillingness to recommend or reuse the hospital’s services. This highlights a potential gap between service delivery and patient expectations. Method The purpose of this study was to analyze the influence of patient experience, brand image, and trust on repurchase intention at XYZ Hospital, with attitude as an intervening variable. This study employed a quantitative explanatory research design, involving 182 patients from outpatient and inpatient units who had visited more than once. Data were collected through structured questionnaires and analyzed using the Structural Equation Model (SEM) with the Partial Least Square (PLS) method, supported by the SmartPLS software. Results: The results revealed that patient experience, brand image, and trust significantly affect patient attitudes, which in turn directly influence repurchase intention. Attitude serves as a mediating variable between patient experiences, brand image, trust, and repurchase intention. Simultaneous testing confirmed that all independent variables have a joint effect on repurchase intention. Among the variables tested, attitude showed the strongest direct influence on repurchase intention, while patient experience had the highest indirect effect through attitude. Conclusion: These findings underscore the critical role of patient experience in shaping positive perceptions of service quality, which contribute to strengthening brand image, increasing trust, and fostering patient attitudes that support future service utilization. Therefore, healthcare providers must prioritize improving communication, staff responsiveness, and patient-centered care to enhance overall experience, build loyalty, and ensure long-term sustainability of healthcare services.