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Breast cancer has a high global incidence and is the most prevalent cancer among women. Chemotherapy is a primary treatment option, but it may cause various physical and psychological side effects that can reduce patients’ quality of life. This study aimed to describe the characteristics of breast cancer patients undergoing chemotherapy and examine the relationship between chemotherapy side effects and quality of life at the outpatient unit of Ciremai Hospital. A cross-sectional analytical observational design was applied, with 30 patients receiving chemotherapy between May and July as the sample. Data were collected from medical records and the Indonesian version of the WHOQOL-BREF questionnaire, then analyzed using Spearman rank correlation. Most patients were aged 40–60 years, had a senior high school education, were housewives, and were in the 2nd or 5th chemotherapy cycle. Frequently reported side effects included nausea, vomiting, decreased appetite, early satiety, dizziness, sleep disturbances, body pain, and alopecia, mostly categorized as moderate. Most patients had a relatively poor quality of life. The analysis indicated a strong positive correlation between chemotherapy side effects and patients’ quality of life, with a Spearman correlation coefficient of 0.604 (p = 0.000 < 0.05), demonstrating a significant and strong relationship.

Breast cancer has a high global incidence and is the most prevalent cancer among women. Chemotherapy is a primary treatment option, but it may cause various physical and psychological side effects that can reduce patients’ quality of life. This study aimed to describe the characteristics of breast cancer patients undergoing chemotherapy and examine the relationship between chemotherapy side effects and quality of life at the outpatient unit of Ciremai Hospital. A cross-sectional analytical observational design was applied, with 30 patients receiving chemotherapy between May and July as the sample. Data were collected from medical records and the Indonesian version of the WHOQOL-BREF questionnaire, then analyzed using Spearman rank correlation. Most patients were aged 40–60 years, had a senior high school education, were housewives, and were in the 2nd or 5th chemotherapy cycle. Frequently reported side effects included nausea, vomiting, decreased appetite, early satiety, dizziness, sleep disturbances, body pain, and alopecia, mostly categorized as moderate. Most patients had a relatively poor quality of life. The analysis indicated a strong positive correlation between chemotherapy side effects and patients’ quality of life, with a Spearman correlation coefficient of 0.604 (p = 0.000 < 0.05), demonstrating a significant and strong relationship.

Nurse workload is the total number or volume of tasks that must be completed by nurses during their professional practice in hospitals, including both physical and mental responsibilities in providing nursing care to patients. Meanwhile, nurse burnout is a condition of emotional and mental fatigue experienced by nurses due to prolonged work pressure and the high intensity of emotional demands in the hospital environment. However, workload problems are still commonly found in hospitals, with one of the main contributing factors being work stress caused by excessive job demands and continuous pressure during work activities. The population in this study were outpatient, inpatient and emergency nurses at Ibnu Sina Islamic Hospital, Bukittinggi in 2025 This study used a quantitative method with a cross-sectional approach, analyzing the relationship between one variable and another. This study had 130 samples consisting of outpatient nurses, inpatient nurses, and emergency room nurses. Sampling was carried out using a total sampling technique. The results of this study indicate a significant relationship between workload and burnout at a significance level of 0.00 (≤ 0.05). There is a significant relationship between workload and nurse fatigue at Ibnu Sina Islamic Hospital Bukittinggi in 2025.

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.

Services in the health sector are a form of public service that must be implemented properly by the government. In the context of health services, the importance of effective and efficient implementation cannot be ignored because this has a direct impact on people's quality of life. In order for health services to achieve their goals, various requirements must be met, including the availability of adequate facilities and infrastructure, a harmonious relationship between patients and service providers, easy accessibility, and high quality. The aim of this research is to determine the description of the service quality of administrative staff. at the Kelapa Gading Community Health Center. The method used is descriptive with a quantitative approach which produces univariate results. This research was conducted at the Kelapa Gading Community Health Center with a total of 150 respondents. The variables in this research are Service Procedures, Completion Time, Service Costs, Service Products, Facilities and Infrastructure, Accreditation of Service Officers. The population in this study were all 1.216 outpatients with a sample of 150 respondents.

The quality of interaction between physicians and patients plays a crucial role in the healthcare system, as it directly affects patient satisfaction. Ineffective communication by physicians may reduce patient satisfaction and increase the risk of complaints and medical disputes. This study aims to analyze the relationship between doctor–patient communication patterns and patient satisfaction in outpatient services. This research employed a quantitative approach with an observational analytic design using a cross-sectional method. The study population included all outpatient patients, with a sample of 110 respondents selected through accidental sampling. The independent variable was doctor–patient communication, while the dependent variable was patient satisfaction. Data were collected using a questionnaire, and analysis was performed using the Chi-Square test with a 95% confidence level. The results showed that the majority of respondents rated doctor–patient communication as good (80.9%) and reported high levels of satisfaction (75.5%). The analysis revealed that among respondents who experienced good communication, 84.3% reported high satisfaction, whereas the proportion of high satisfaction decreased significantly in the groups with moderate and poor communication. In conclusion, there is a significant relationship between the quality of doctor–patient communication and patient satisfaction in outpatient services, where improvements in communication quality are consistently associated with increased patient satisfaction.

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.

The increasing competition in the healthcare industry requires hospitals to establish effective relationship strategies to enhance patient loyalty. This study aims to examine the effect of Customer Relationship Management (CRM) on patient loyalty, with brand salience and customer engagement behavior (CEB) as mediating variables. The research adopts a quantitative approach using Partial Least Squares Structural Equation Modeling (PLS-SEM). Data were collected from 155 outpatients at Cengkareng General Hospital (RSAR) who had experienced CRM-related services, using a structured questionnaire measured on a four-point Likert scale. The findings reveal that CRM has a significant positive effect on brand salience, customer engagement behavior, and patient loyalty. Among these relationships, CRM demonstrates the strongest influence on customer engagement behavior, indicating that relationship-based strategies effectively encourage active patient involvement. Furthermore, customer engagement behavior significantly affects patient loyalty, suggesting that patients who are more engaged—through feedback, recommendations, and participation—are more likely to develop stronger loyalty toward healthcare providers. In contrast, brand salience does not have a significant effect on patient loyalty, indicating that brand awareness alone is insufficient to drive loyalty in the healthcare context. Mediation analysis shows that customer engagement behavior partially mediates the relationship between CRM and patient loyalty, whereas brand salience does not act as a mediator. These results suggest that CRM enhances patient loyalty not only directly but also indirectly through strengthening engagement behavior. This study contributes to healthcare marketing literature by integrating relationship marketing and customer engagement perspectives, highlighting engagement as a more critical mechanism than brand salience in fostering sustainable patient loyalty.

In response to the evolving landscape of public healthcare services, hospitals are expected not only to maintain operational efficiency but also to adapt to the shifting needs and expectations of patients as healthcare consumers. The presence of non-BPJS patients in regional public hospitals plays a strategic role not only contributing to revenue diversification but also reflecting service quality, institutional competitiveness, and shaping public perception. The declining trend in outpatient visits by general patients at RSUD Balaraja over the past three years highlights the need to understand the factors influencing consumer behavior in determining revisit intentions. This study examines the effect of co-creation and hospital image on the revisit intention of outpatient general patients at RSUD Balaraja, with patient experience as a mediating variable. The research employed a quantitative explanatory design involving 278 outpatient general patients selected through purposive sampling. Data were collected via structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results indicate that patient experience plays a significant mediating role in shaping revisit intention among general outpatients at RSUD Balaraja. These findings confirm that patient experience serves as a central factor in post-service evaluation processes, which ultimately drive patients’ intention to return. Therefore, hospitals need to enhance patient involvement in service processes (co-creation), improve public perception of institutional image (hospital image), and develop patient-centered service systems as a key strategy to increase revisit intention among general outpatients.

The implementation of Patient Safety Goals remains a major challenge in hospital management, particularly in ensuring consistent compliance among nurses. This study aims to analyze the influence of nurses’ knowledge and motivation on the implementation of Patient Safety Goals, with clinical leadership positioned as a mediating variable. A quantitative cross-sectional design was employed in a general hospital in Jakarta, Indonesia. Data were collected from 119 nurses across inpatient, outpatient, emergency, and operating units using structured questionnaires. The data were analyzed using Structural Equation Modeling (SEM) with AMOS, supported by the Three-Box Method to assess the level of variable achievement. The results indicate that nurses’ knowledge and motivation have a significant direct effect on clinical leadership. Clinical leadership also demonstrates a significant positive effect on the implementation of Patient Safety Goals. Furthermore, clinical leadership plays a significant mediating role in the relationship between both nurses’ knowledge and motivation and the implementation of Patient Safety Goals. The model explains 76.67% of the variance in Patient Safety Goal implementation, highlighting the strategic role of clinical leadership in translating individual competencies into safe clinical practices. These findings contribute to healthcare management literature by reinforcing the importance of clinical leadership as an organizational mechanism that strengthens patient safety performance. From a managerial perspective, the study emphasizes that improving patient safety outcomes requires not only enhancing nurses’ knowledge and motivation, but also systematically developing clinical leadership competencies. Hospital management is encouraged to invest in leadership development programs, supportive supervision, and non-punitive incident reporting systems to ensure sustainable implementation of Patient Safety Goals.

The development of Digital Marketing and Electronic Word of Mouth (eWOM) has encouraged hospitals to adopt digital communication strategies to attract patients’ visit intentions. However, in public hospitals, the effectiveness of these strategies in influencing patient behavior still requires empirical validation. This study aims to analyze the influence of Digital Marketing and eWOM on patient visit intention, with Brand Awareness as an intervening variable at RSUD Cengkareng.This research employed a quantitative approach with an explanatory design. Data were collected from November to December 2025 from 100 general outpatient respondents selected using the Slovin formula and a simple random sampling technique. The data were gathered through structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS software.The results show that Digital Marketing and eWOM have a positive and significant effect on Brand Awareness. Both variables also significantly influence patient visit intention, with eWOM demonstrating the strongest effect. These findings indicate that information shared through digital platforms and patient recommendations plays an important role in shaping potential patients’ decisions to visit the hospital. However, Brand Awareness does not have a significant effect on patient visit intention and does not mediate the relationship between Digital Marketing, eWOM, and visit intention. This suggests that, in the context of RSUD Cengkareng as a public hospital, patients’ visit decisions are more directly influenced by digital information exposure and the credibility of online recommendations rather than by brand recognition alone.

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

Patient safety is one of the key elements in providing quality health services. Patient safety is a top priority because it has become a global issue in hospital health services. This study aims to determine the relationship between workload and the implementation of patient safety among nurses in the Outpatient Room of Grha Permata Ibu Hospital in 2025. This study is a quantitative, analytical study. This quantitative research uses a cross-sectional design. The population in this study consisted of 40 nurses in the Outpatient Room of Grha Permata Ibu Hospital. Therefore, the sample in this study consisted of 40 respondents using a total sample technique. The instrument used in this study was a questionnaire. Data analysis was performed using univariate and bivariate analysis with the chi-square test. Based on the statistical test results, the p-value was 0.023, meaning that p-value < α (0.05). Therefore, it can be concluded that there is a relationship between workload and the implementation of patient safety among nurses in the Outpatient Ward of Grha Permata Ibu Hospital in 2025. The hospital is advised to ensure fair task distribution, provide facilities, and offer training and psychological support to manage stress.

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

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

Developmental Dysplasia of the Hip (DDH) in children often results in joint stiffness, muscle weakness, limited range of motion, and gait impairment following surgical management and immobilization. Early physiotherapy intervention is essential to restore hip function and walking ability. This study aimed to evaluate the effectiveness of active exercise on functional walking in outpatient children aged 3–5 years after DDH surgery. A case study design was conducted on three female patients who completed a five-week rehabilitation program consisting of ten active exercise sessions, including hip strengthening, mobility training, and balance exercises, combined with a home program. Outcome measures included hip range of motion, Manual Muscle Testing, and Modified McKay and Harris Hip Score assessed at baseline, mid-intervention, and post-intervention. The results showed improvements in hip range of motion, particularly in flexion, extension, abduction, adduction, and external rotation, while internal rotation improved but did not reach normal values. Muscle strength increased from grade 1–2 to grade 3 in most hip muscle groups. Functional walking scores improved from poor to good and excellent, with patients achieving independent, symmetrical gait without pain. These findings indicate that active exercise is an effective rehabilitation approach to reduce impairments and enhance functional walking in children after DDH surgery. The study highlights the importance of structured physiotherapy and caregiver involvement to optimize recovery and participation in daily activities.

This study aims to determine the level of patient satisfaction with pharmaceutical services at the Bobotsari Community Health Center. Patient satisfaction is an important indicator that reflects the quality of healthcare services. This research employed a quantitative descriptive method using a SERVQUAL-based questionnaire, consisting of five dimensions: tangible, reliability, responsiveness, assurance, and empathy. A total of 100 outpatient respondents were selected through accidental sampling. Data were analyzed using descriptive statistics to determine satisfaction scores for each dimension. The results showed that the tangible dimension achieved 80.57% and the reliability dimension achieved 82%, both categorized as very satisfied. Meanwhile, responsiveness (79.02%), assurance (79.05%), and empathy (77.95%) were categorized as satisfied. The overall average satisfaction level was 79.72%, indicating that patients were generally satisfied with the pharmaceutical services. However, several aspects such as service speed, communication clarity, and personal attention from staff still require improvement. The findings emphasize the importance of maintaining service quality to achieve better patient experiences and public trust.

The Outpatient Unit is an important service unit that contributes to the hospital's revenue. However, at Adam Talib Cikunir Hospital, the number of patient visits has not yet reached the target, thus it is necessary to formulate a strategy to enhance competitiveness. This research aims to develop a strategic plan for the Outpatient Unit to improve service quality and increase its contribution to the hospital's revenue. The research uses a qualitative descriptive approach. Analysis is conducted through Internal Factor Evaluation (IFE), External Factor Evaluation (EFE), SWOT analysis, and Quantitative Strategic Planning Matrix (QSPM). The IFE score of 2.44 and the EFE score of 2.41 place RS DAT Cikunir in Quadrant V of the IE Matrix, which means RS DAT Cikunir is in a Hold and Maintain position. The SWOT analysis generates several alternative strategies, and the QSPM prioritizes three strategies: enhancing specialized services (score 5,84), expanding services and digital promotion (score 5,66), and optimizing cooperation with BPJS and private insurance (score 5,38). The research concludes that improving specialized services, expanding services and digital promotions, as well as optimizing cooperation between BPJS and private insurance are the right strategies to enhance service quality, attract more patients, and strengthen the competitiveness of RS Dokter Adam Talib Cikunir amid competition in the healthcare sector.  

Diabetes mellitus is a chronic disease with a steadily increasing prevalence in Indonesia. This condition not only affects physical health but also requires patients to make significant lifestyle changes to maintain stable blood glucose levels. Efforts to adopt a healthy lifestyle such as regulating diet, exercising regularly, and managing stress are often met with various challenges. In this context, family support plays a crucial role in helping patients adapt and remain consistent in self-management. This study aims to describe the experiences of type 2 diabetes patients in maintaining a healthy lifestyle and the forms of family support they receive. A qualitative phenomenological approach was used, involving three participants undergoing outpatient treatment at RSUD Sultan Iskandar Muda Nagan Raya. Data were collected through in-depth interviews, observations, and documentation, then analyzed thematically. The findings show that patients face challenges in maintaining dietary control, consistent exercise, and emotional balance. However, family support such as reminding patients to take medication, providing healthy meals, and offering emotional motivation serves as a key factor that strengthens patients’ commitment to a healthy lifestyle. The study concludes that the success of diabetes management is highly influenced by active family involvement. Therefore, educational and health intervention programs should integrate families as essential partners in supporting patients with diabetes.