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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.

The highly competitive healthcare industry in Cirebon poses a significant challenge for Klinik Utama X, especially as a non-BPJS facility. This condition requires a paradigm shift from a provider-centric marketing mix to a patient-centric approach to retain patient loyalty. This study aims to evaluate and formulate the marketing strategy of Klinik Utama X using a comparative 4P (Product, Price, Place, Promotion) and 4C (Customer Solution, Customer Cost, Convenience, Communication) approach based on SWOT analysis. This research used a qualitative descriptive design with purposive sampling, gathering primary and secondary data through in-depth interviews, observations, and document studies. The data were systematically evaluated using Internal Factor Evaluation (IFE) and External Factor Evaluation (EFE) matrices. The findings reveal that the clinic is strategically positioned in Quadrant I, with an IFAS score of 2.53 and an EFAS score of 2.60, indicating strong internal capabilities to seize external opportunities. The recommended aggressive growth strategy involves integrating psychiatric and aesthetic services, penetrating the Business-to-Business (B2B) market through corporate medical check-ups, accelerating digitalization via telemedicine and online queuing, and preparing for BPJS accreditation. The managerial implications suggest that the clinic must prioritize resolving internal human resources and strengthening financial record-keeping systems before investing heavily in medical assets, while actively expanding digital convenience and corporate partnerships to secure short-term financial stability.

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.

Healthcare institutions worldwide are undergoing digital transformation to improve efficiency and patient experiences. While many studies focus on clinical applications of information technology (IT), its impact on administrative service quality remains limited, even though administrative services are patients’ primary point of contact. This study examines how IT adoption influences administrative service quality in Indonesian healthcare institutions, focusing on relationships between IT implementation levels and service quality dimensions, as well as mediating and moderating factors. Using a mixed-methods sequential explanatory design, quantitative data were collected from 385 patients and 127 administrative staff across 24 hospitals, supported by 32 in-depth interviews. Service quality was measured using SERVQUAL dimensions: tangibles, reliability, responsiveness, assurance, and empathy. The findings show significant positive relationships between IT adoption and all service quality dimensions, with the strongest effects on reliability and responsiveness. Staff digital competency and system usability partially mediate these relationships, while implementation quality acts as a key moderating factor. Well-implemented systems yield substantially higher service improvements than poorly implemented ones. Most patients prefer digital services when functioning properly, although many report frustration when systems fail or staff lack competency. This study highlights the importance of effective IT implementation to enhance administrative service quality and offers practical insights for healthcare management.

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.

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

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.

Patient safety culture is an essential component in improving the quality of healthcare services and preventing medical errors in hospitals. However, the implementation of patient safety culture is often influenced by several organizational and individual factors, including situational awareness, availability of hospital infrastructure, and the balance between effort and rewards experienced by healthcare workers. This study aims to analyze the influence of situational awareness and hospital infrastructure on patient safety culture, with effort–reward imbalance acting as a mediating variable. The research was conducted at RSIA Tiara and involved healthcare workers as respondents. A quantitative approach with a cross-sectional design was applied in this study. Data were collected through structured questionnaires distributed to healthcare professionals and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The results show that situational awareness has a significant positive effect on effort–reward imbalance and patient safety culture. Hospital infrastructure also significantly influences effort–reward imbalance and patient safety culture. Furthermore, effort–reward imbalance significantly affects patient safety culture and mediates the relationship between situational awareness, hospital infrastructure, and patient safety culture. These findings indicate that improving healthcare workers’ situational awareness and ensuring adequate hospital infrastructure can help reduce work imbalance and strengthen patient safety culture. In conclusion, hospital management should prioritize training programs to enhance situational awareness, improve supporting facilities, and implement fair reward systems to promote a sustainable and positive patient safety culture in healthcare organizations.

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.

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.

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.

Nursing care documentation is crucial for service quality and patient safety, but incomplete and inconsistent documentation remains a challenge in hospitals. This study focuses on nurses at Medika Lestari Hospital, where documentation compliance is below expectations. The aim is to analyze how organizational commitment and supervision affect nursing care documentation, with work motivation as an intervening variable. A quantitative cross-sectional design with a structural model approach was used, and data were collected via structured questionnaires and analyzed using SEM-PLS. The results show that organizational commitment positively impacts documentation compliance (β = 0.268; p = 0.013), highlighting the importance of nurses’ attachment to organizational goals. Supervision, however, has no significant direct effect on documentation (β = 0.220; p = 0.109). Both organizational commitment (β = 0.285; p = 0.018) and supervision (β = 0.382; p = 0.000) significantly influence work motivation, indicating that managerial control and organizational attachment contribute to motivation. However, work motivation does not significantly affect documentation (β = 0.231; p = 0.053) and does not mediate the effects of commitment or supervision on compliance. In conclusion, improvements in documentation are primarily driven by organizational commitment rather than motivational or supervisory factors. Hospital management should focus on enhancing nurses’ organizational commitment and aligning supervisory practices with institutional values to improve documentation compliance sustainably.

This study investigates the effects of safety leadership and work environment on patient safety culture, with work motivation as an intervening variable among nurses at Hospital X in Jakarta. A quantitative approach using a cross-sectional design was employed, with data collected from 111 nurses through structured questionnaires. The data were analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results show that safety leadership and work environment have significant positive impacts on nurses’ work motivation. Additionally, work motivation directly influences patient safety culture. The study also finds that work motivation partially mediates the relationship between safety leadership and patient safety culture, as well as between work environment and patient safety culture. These findings suggest that both leadership practices and environmental conditions affect patient safety culture directly and indirectly by enhancing nurses’ motivation. The study highlights the importance of safety leadership and supportive work environments in promoting a sustainable patient safety culture through improved nurse motivation. From a practical perspective, hospital management should focus on fostering effective safety leadership practices and creating conducive work environments to enhance patient safety culture. This research contributes to the literature on patient safety and management by providing empirical evidence on the role of work motivation in strengthening safety culture in hospitals.

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

The implementation of the Standard Inpatient Class (KRIS) policy presents challenges for hospitals in ensuring equitable service delivery. Organizational readiness depends not only on adequate physical infrastructure but also on an adaptive organizational culture and strong clinical leadership to guide change. As a referral hospital, RS BM must ensure alignment across organizational components to meet KRIS standards sustainably. This study analyzes the influence of infrastructure quality and clinical leadership on organizational readiness for KRIS implementation, with organizational culture as an intervening variable. A quantitative cross-sectional design was used, involving 136 healthcare and medical personnel working in the inpatient units of RS Bhakti Mulia. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling–Partial Least Square (SEM-PLS) to examine relationships among variables. Infrastructure quality and organizational culture significantly and positively affect organizational readiness. Clinical leadership, while not directly influencing readiness, has a significant positive effect on organizational culture. KRIS readiness at RS BM is shaped by infrastructure quality, clinical leadership, and organizational culture, with culture acting as the main mediator. The hospital shows strong readiness but still faces gaps in progress monitoring, inpatient room layout and privacy, leadership direction, and team participation. Strengthening monitoring mechanisms, improving room design according to KRIS standards, enhancing clinical leadership capacity, and fostering a collaborative organizational culture are essential to support comprehensive and sustainable KRIS implementation

This study investigates the clinical handover process as a critical component of patient safety and healthcare service quality in hospital settings. Inconsistent communication, incomplete documentation, and the absence of standardized procedures were identified as major problems contributing to communication failures and potential adverse events. The objective of this research was to develop and test a structured and effective handover model that could improve communication accuracy and documentation reliability among healthcare professionals. A mixed methods design was employed, consisting of a qualitative phase (in-depth interviews, observations, and document analysis) to explore real-world handover practices, followed by a quantitative phase using a pretest–posttest design to evaluate the effectiveness of the proposed model. The study proposes an integrated handover model based on SBAR-IM (Situation, Background, Assessment, Recommendation, Intervention, Monitoring) strengthened by Quality Control (QC) and Mutual Confirmation (MC) mechanisms. The findings demonstrate a significant improvement in handover quality after implementation, with communication scores increasing from 74 to 84.5 and documentation scores improving from 48.3 to 63.0 (p < 0.05). Qualitative results further revealed reduced communication errors, improved clarity of clinical information, and enhanced interprofessional collaboration. This study concludes that the proposed SBAR-IM–based QC–MC model is effective, practical, and suitable for improving patient safety and healthcare service quality in hospital environments.

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

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.

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