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The completeness of nursing care documentation serves as a primary indicator of hospital service quality and remains a critical component of patient safety, clinical communication, and legal accountability. Despite its importance, empirical evidence from various healthcare facilities indicates that nursing records are frequently suboptimal, incomplete, or inconsistent. This study aims to analyze the complex interrelationships between burnout and coaching on the completeness of nursing care documentation, specifically examining the role of nursing competence as a mediating (intervening) variable at the Dr. Chasbullah Abdulmadjid General Hospital in Bekasi City. Utilizing a quantitative research framework with a cross-sectional design, this study sampled practicing nurses stationed across inpatient and intensive care units. Primary data were gathered through a validated, structured questionnaire designed to measure psychological burnout, the frequency of clinical coaching, perceived professional competence, and the objective completeness of documentation. The data were subjected to rigorous analysis using Structural Equation Modeling–Partial Least Squares (SEM-PLS) to test the hypothesized pathways within the conceptual model. The results demonstrated that burnout exerts a significant negative influence on both nursing competence and the quality of documentation, suggesting that emotional exhaustion hinders professional performance. Conversely, systematic coaching was found to have a significant positive impact, directly improving both competence levels and documentation adherence. Critically, the analysis confirmed that nursing competence acts as a vital intervening variable; it effectively mediates and strengthens the influence of both burnout reduction and coaching interventions on the overall completeness of nursing care records. This study concludes that proactive burnout management and the institutionalization of structured coaching programs are essential strategic priorities. By addressing these factors, hospital management can enhance individual nurse competence, thereby ensuring high-quality, comprehensive nursing documentation that supports patient safety and institutional integrity.

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

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.

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

This research aims to design an Information Systems and Information Technology (IS/IT) strategic plan for Wyndham OPI Hotel Palembang to support operational efficiency and enhance the quality of five-star hotel services. The study applies the Ward and Peppard framework, supported by analytical methods including Value Chain,PEST,SWOT,Critical Success Factors (CSF), MOST and McFarlan Strategic Grid. Through these approaches, the current IS/IT condition, challenges, and opportunities for digital system development within the hotel environment were mapped. The analysis reveals that although the hotel has implemented technologies such as SiteMinder and the Rhapsody management system, there is a need to improve self-service check-in capabilities, strengthen IT infrastructure, and maximize digital technology utilization. The proposed strategy recommends the development of an integrated self check-in system, enhancement of network infrastructure, and employee training through an LMS platform. This strategic plan is expected to support the hotel’s digital transformation to remain competitive in the modern hospitality industry.

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.

Medical personnel compliance in prescribing drugs according to the National Formulary (ForNas) is essential to ensure rational therapy, improve service quality, and enhance efficiency in health financing at government health facilities. However, compliance remains a challenge at Johar Baru Regional General Hospital, Central Jakarta. This study aimed to analyze factors influencing medical personnel compliance with ForNas-based prescribing, including drug availability, management policies, and the knowledge, attitudes, norms, and perceptions of medical staff.A qualitative approach was used through in-depth interviews with medical personnel, heads of supporting service sections, and pharmacy unit leaders. The study also involved observation and review of hospital formulary documents, minimum service standards reports for 2024, and monitoring and evaluation reports on prescribing compliance for 2024 and January June 2025. Data were analyzed using thematic analysis supported by NVivo software.The findings indicate that compliance is influenced by medical personnel’s understanding of ForNas policies, clinical experience, and professional attitudes toward prescribing standards. Management factors such as supervision, technological support, and procurement systems also play important roles. Limited drug stocks and suboptimal control systems were identified as major obstacles.The hospital is recommended to strengthen compliance by updating clinical practice guidelines, developing a ForNas-based hospital formulary, improving management support, optimizing information technology systems, ensuring drug availability, and proposing additional ForNas drugs to the Ministry of Health.

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.

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

Background: In the competitive healthcare landscape, where human resources are pivotal to organizational success, affective commitment defined as emotional attachment to the workplace is essential for nurse retention and service quality. Satya Negara Hospital in North Jakarta exemplifies the challenges faced by Indonesian healthcare institutions, with a notably high nurse turnover intention of 30% in 2024, signaling low affective commitment and underscoring the urgency to identify its drivers. While person-job fit and career development are established antecedents of commitment, their combined influence within Indonesia’s nursing context, along with the potential moderating role of meritocracy, remains underexplored.. Methods:  Using a quantitative, cross sectional design, data were collected via a validated questionnaire from all 108 nurses at the hospital and analyzed using multiple regression.. Results: The results revealed that person-job fit, career development, and meritocracy collectively explain 96.6% of the variance in affective commitment. Furthermore, when meritocracy was tested as a moderating variable, the explanatory power of the model increased significantly, with the adjusted R² value rising from 96.6% to 98.5%. This indicates that the presence of a meritocratic system substantially amplifies the positive effects of both person-job fit and career development on commitment.. Conclusion: The study concludes that a synergistic combination of job fit, growth opportunities, and a merit-based system is fundamental to fostering nurses’ emotional attachment. These findings contribute to organizational and psychological theory integration and offer practical human resource strategies for enhancing nurse commitment and reducing turnover in healthcare settings.

Rapid global environmental changes, especially due to advances in technology and information, have had a significant impact on various sectors of life, including the health sector. In the context of modern health services, hospitals are no longer just places of healing, but also institutions that are required to provide high-quality services, based on patient safety, and are able to adapt to the dynamics of community needs. This change requires a transformation in human resource management, especially related to the interpersonal and psychosocial competencies of nurses as the spearhead of medical services.Purposes:​ to analyze the effect of effective communication and Assertive Attitude on Nurses' Work Productivity in hospitals, with Work Fatigue as a mediating variable.Methods: This type of research is quantitative, using statistical figures to measure the influence of independent variables on dependent variables. The research design is a cross-sectional study.Results: The results of this study indicate that effective communication, assertiveness, and job fatigue collectively significantly influence nurses' work productivity. Communication and assertiveness positively contribute to job fatigue, which in turn affects productivity. Job fatigue is also shown to be a significant mediator in the relationship between communication and assertiveness on work productivity .Conclusion : The importance of strengthening effective communication as a strategy to increase productivity. Organizations need to design communication systems that support openness, transparency, and clarity of information and culture-based assertiveness training, so that employees can express their opinions appropriately without causing resistance in the team.

Digital transformation in the health sector requires hospitals to improve service effectiveness through the use of Hospital Management Information Systems (HMIS). Berkah Pandeglang Regional General Hospital, as a regional hospital, still faces challenges in utilizing HMIS, such as limitations in infrastructure and user competence. This study aims to analyze the effect of SIMRS implementation and evaluation on the effectiveness of healthcare services. The research method uses a quantitative approach with a descriptive-verificative design. The research population consists of 278 healthcare workers, and 74 respondents were selected using proportionate stratified random sampling. Data were collected through closed questionnaires and analyzed using multiple linear regression to test the influence of variables. The results of the analysis show that the implementation and evaluation of SIMRS have a positive and significant effect on the effectiveness of health worker services. The most dominant components in implementation are the availability of hardware and human resource competence, while in evaluation, the most decisive aspects are the perception of usefulness and ease of use of the system. The conclusion of this study confirms that the success of SIMRS depends on the synergy between optimal implementation and systematic evaluation. Improvements in technological facilities, user training, and periodic monitoring are recommended to strengthen the effectiveness of health worker services at Berkah Pandeglang Regional General Hospital.

The implementation of patient safety culture in hospitals remains a significant challenge, often leading to adverse events. Establishing a strong patient safety culture requires effective interprofessional collaboration among healthcare professionals to deliver patient-centered care. However, factors such as organizational distrust and job dissatisfaction continue to hinder collaborative efforts and negatively affect the quality of care and patient safety outcomes.This study aims to examine the influence of organizational trust and job satisfaction on patient safety culture, with interprofessional collaboration serving as an intervening variable at MP hospital.  This quantitative associative research used a causal approach involving 93 inpatient nurses as respondents. Primary data were obtained through questionnaires using an ordinal scale based on a 4–1 Likert scale. Data processing employed the three-box method, and data analysis was conducted using Structural Equation Modeling (SEM).The results revealed that organizational trust, job satisfaction, and interprofessional collaboration simultaneously and partially influence patient safety culture. Moreover, interprofessional collaboration was found to mediate the relationship between organizational trust, job satisfaction, and patient safety culture.The study concludes that enhancing patient safety culture can be achieved by strengthening organizational trust and job satisfaction through effective interprofessional collaboration. Hospitals should develop supportive systems that foster care and concern among staff, enhance conflict management, improve performance appraisal mechanisms, and promote open, effective communication across all professional groups involved in patient care. These strategies can create a safer, more collaborative, and high-quality healthcare environment

Hospitals in DKI Jakarta continue to face service quality challenges, including long waiting times, fragmented information systems, and limited patient access to digital health technologies. Although digital transformation and digital literacy are expected to enhance service quality, the mediating role of patient experience remains insufficiently explored. This study investigates the effects of digital transformation and digital literacy on service quality, with patient experience as a mediating variable. A quantitative explanatory design was applied using data from 200 outpatients. Measurements were based on validated indicators of digital transformation, digital literacy, patient experience, and service quality. Structural Equation Modeling (SEM) with AMOS was employed for analysis. The findings show that digital transformation significantly improves patient experience and service quality. Digital literacy positively affects patient experience but does not directly influence service quality. Patient experience fully mediates the relationship between digital literacy and service quality and partially mediates the effect of digital transformation. These results highlight the critical role of patient experience in translating digital capabilities into perceived service improvements. Hospitals are encouraged to strengthen digital transformation initiatives, enhance digital literacy support—especially for older adults—and design user-friendly digital services that facilitate communication and access. This study integrates the Technology Acceptance Model and Customer Experience Theory to provide empirical evidence on how digital-based interventions can advance hospital service quality.

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.

This study aims to analyze the performance of the Hospital Management Information System SIMRS in the pharmacy unit of RSU Fitri Candra Wonogiri using the HOTFIT model approach. The HOT-FIT model is an evaluation framework that includes four main aspects, namely Human (system users), Organization (organizational support and policies), Technology (system and information quality), and Net Benefit (benefits obtained from system use). This study uses a quantitative method with Structural Equation Modeling data analysis techniques based on Partial Least Square (SEM-PLS), which allows for simultaneous analysis of relationships between variables. Data were obtained from 61 respondents who are SIMRS users in the pharmacy department, through the distribution of Likert-based questionnaires. The results of the analysis show that the four independent variables Human, Organization, Technology, and Net Benefit have a positive and significant effect on SIMRS performance. The Adjusted R-Square value of 0.902 indicates that the model is able to explain 90.2 of the variability in system performance. Empirical findings in the field indicate that the implementation of SIMRS has had a tangible impact on improving work efficiency, accelerating the pharmaceutical service process, and supporting decision-making based on accurate and up-to-date data. Furthermore, active user involvement, managerial support, and the quality of the information technology system are crucial factors in supporting the system's successful implementation. This study confirms that the success of SIMRS depends not only on its technological sophistication but also on strong integration between human and organizational aspects and the resulting benefits. Therefore, a holistic approach to information system evaluation and development is crucial for improving the quality of healthcare services in hospitals.

In the healthcare system, hospitals have a legal responsibility to ensure the safety and rights of patients while receiving medical services. However, in certain emergency situations that are unpredictable—such as natural disasters, epidemics, social unrest, or technical disruptions beyond human control—hospitals face challenges in fulfilling their responsibilities optimally. These situations are often categorized as force majeure or circumstances of necessity. Issues arise when there is no clear and definite legal regulation regarding the extent to which hospitals can be exempted from legal responsibility in force majeure situations. This creates a legal gap that could harm both the hospital and the patients. This research aims to examine and analyze the legal gap regarding hospital responsibility in force majeure situations and provide a conceptual overview of the direction for forming ideal legal norms in the future. This research uses a normative juridical method, with a legislative and conceptual approach. The data sources consist of primary legal materials such as laws, government regulations, and technical regulations in the healthcare field; secondary legal materials such as literature, journals, and legal articles; and tertiary legal materials such as legal dictionaries. The analytical technique used is descriptive-analytical, focusing on the systematic interpretation of existing legal norms and theoretical approaches to the concepts of legal responsibility and force majeure in healthcare services. This research is expected to contribute academically and provide a foundation for the formulation of responsive and just legal policies in dealing with extraordinary situations in the healthcare sector. By addressing this legal gap, the study aims to provide a basis for future legal reforms that will protect both healthcare providers and patients in the face of unforeseen circumstances that may affect the provision of healthcare services.

Electronic Medical Record (EMR) systems have become a fundamental component of hospital information systems, aiming to improve the quality, efficiency, and continuity of patient care. However, the success of EMR implementation depends largely on user satisfaction. This study investigates user satisfaction with the EMR system implemented at Dr. Soetarto (DKT) Hospital, a mid-tier hospital in Yogyakarta, Indonesia. The research addresses issues related to usability, data accuracy, and system responsiveness that potentially hinder effective EMR usage. The objective is to evaluate user satisfaction using the End User Computing Satisfaction (EUCS) framework, which consists of five dimensions: content, accuracy, format, ease of use, and timeliness. A quantitative approach was applied through a structured questionnaire distributed to 40 healthcare workers, including medical records staff, nurses, pharmacists, and administrative personnel. Data analysis using Spearman correlation revealed significant positive relationships among all EUCS dimensions, with the strongest association found between format and ease of use. The findings indicate that while users are generally satisfied with the system’s performance, improvements are still needed in timely data retrieval and user interface consistency. This study highlights the critical need for continuous system evaluation and end-user involvement to optimize EMR functionality and healthcare service delivery.

Electronic Medical Records (EMR) are essential for improving the quality, efficiency, and continuity of healthcare services. Despite mandates requiring full implementation of EMRs in Indonesian healthcare facilities by the end of 2023, many hospitals continue to face challenges in achieving effective adoption. This study aims to analyze the implementation of EMRs in the outpatient services of Nur Hidayah Hospital, Yogyakarta, using the 5M framework: Man, Money, Machine, Materials, and Method. Employing a qualitative descriptive approach, data were collected through in-depth interviews, observations, and document analysis involving key informants from medical records staff, registration officers, and IT personnel. The findings revealed that while the availability of staff and supporting infrastructure such as computers and software was generally adequate, limitations persisted in human resource specialization, training access, and system integration. Financial planning for EMR-related needs was done through annual budgeting (RAB), but coordination between departments remained minimal. Key challenges included slow internet connectivity, limited IT staff, and lack of specific Standard Operating Procedures (SOPs) for EMR usage. Overall, the EMR system has been implemented in most outpatient units, yet not all units have fully transitioned due to technical and organizational barriers. This study concludes that optimizing EMR implementation requires not only technological readiness but also organizational alignment, continuous staff development, and robust inter-departmental coordination.

The National Health Insurance (JKN) program, administered by BPJS Kesehatan, has significantly expanded public access to healthcare services, particularly inpatient care. This study aims to analyze inpatient JKN reimbursement patterns at Surakarta General Government Hospital during the period of 2020 to 2024. The analysis focuses on five main variables: INA-CBGs grouping codes, class of care, severity level, INA-CBGs tariff, and actual hospital costs. A descriptive-analytic method with a quantitative approach was employed, utilizing secondary data extracted from the INA-CBGs system. The results indicate that inpatient reimbursements were predominantly concentrated in Class 3 services (64%–70%) and severity level 1 (45%–59%). From 2020 to 2022, respiratory-related cases dominated, likely due to the COVID-19 pandemic, while in 2023–2024 a shift occurred toward non-communicable diseases such as cardiovascular and metabolic conditions. A consistent negative tariff gap was identified, particularly in Class 3 and severity level 1, where INA-CBGs reimbursements were insufficient to cover actual service costs. These findings underscore the importance of periodic review of INA-CBGs tariff structures, reinforcement of Quality and Cost Control (KMKB), and optimization of reimbursement management information systems to enhance service efficiency and ensure the financial sustainability of JKN, especially in Type C hospitals that serve as the primary level of healthcare delivery.