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In this paper, we study the use of linear programming for the performance enhancement of fortified queues systems in which resources are unreliable in terms of variation and a case study on Marjan Hospital is considered. The quality management maturity level in the hospital was measured by an integrated inspection tool; senior management was found to be concerned for quality of service improvement and implementation of modern technology systems. Strengths and weaknesses in that activity are shown, and it is evidenced the need of boosting the quality of service activities and promoting the coordination between the different areas. From the findings, the study recommends the use of linear programming technique,Orgers should as well enhance proper training and development and Acquisition of modern day technology for effective performance improvement and quality of service. The study demonstrates that the adoption of linear programming techniques could be a viable solution to optimize resource allocation and enhance performance in the hospital's queue systems. Additionally, the research underscores the importance of investing in staff training and development programs, as well as the acquisition of state-of-the-art technology, to further improve service delivery and ensure sustainable quality improvement in the long term.

This study aims to explore the communication styles and experiences of healthcare workers in enhancing public service communication skills at Petir Community Health Center (Puskesmas Petir) in Tangerang City. Effective communication is a crucial factor in the quality of healthcare services for patients; however, various challenges such as time constraints, differences in patients’ backgrounds, and work pressure often hinder optimal interactions. This research employs a qualitative approach with a case study method, involving in-depth interviews, participatory observations, and document analysis to uncover the experiences, perceptions, and practices of healthcare workers in communicating with patients and the community. The findings indicate that communication skills are improved through internal training, peer mentoring, and the adaptation of communication strategies to match patient characteristics. Additionally, personal motivation, managerial support, and a conducive work environment play significant roles in the successful implementation of communication strategies. The results of this study provide an in-depth understanding of public service communication practices within the community health center context and serve as a basis for recommendations in developing training programs and policies to enhance the quality of interactions between healthcare workers and the community.

Depression is one of the mental health problems that often arise in patients with chronic diseases, such as diabetes mellitus, hypertension, and chronic kidney failure. This condition not only impacts the patient's quality of life, but also affects the treatment process and the burden on the family. However, mental health literacy in the community is still low, so targeted preventive and curative efforts are needed. The Community Service Program (PKM) aims to improve people's mental health through educational interventions with scientific booklet media that are easy to understand and apply. The activity method is carried out in a participatory manner, including the preparation stage, socialization, educational implementation, and evaluation. Education is provided to the community with a focus on preventing depression through a healthy lifestyle, stress management skills, and early intervention efforts by seeking professional support. Evaluation is carried out through pre-post tests, observations, and group discussions. The results of the activity showed an increase in public knowledge about depression, a change in attitudes to be more open in expressing feelings, as well as practical skills in relaxation, maintaining sleep patterns, and building social support. Participants also better understand the importance of seeking professional help when depressive symptoms are getting worse. The conclusion of this PKM is that the scientific booklet has proven to be effective as a preventive and curative educational intervention medium, and can be an innovative strategy in improving the mental health of people affected by chronic diseases.

Tuberculosis (TB) remains one of the leading infectious diseases causing morbidity and mortality in Indonesia. Limited public health literacy regarding TB symptoms, prevention, and treatment adherence contributes to delayed diagnosis and poor treatment outcomes. This community service program aimed to improve public understanding and awareness of TB through interactive educational activities conducted at the Outpatient Unit and TB Clinic of UPT Puskesmas DTP Saketi, Pandeglang Regency. The activities involved 30 participants, including TB patients and their families. Interactive counseling sessions, audiovisual media presentations, and group discussions were used to engage participants actively. Evaluation results showed a 35% increase in participants’ knowledge scores, greater awareness of the importance of completing treatment, and improved communication between patients and healthcare workers. The implementation of interactive education proved effective in enhancing TB health literacy and supporting national TB elimination efforts at the primary healthcare level.

The JKN Mobile application is an electronic-based service innovation introduced by BPJS Health to facilitate JKN participants in accessing healthcare services and managing their membership information. This study aims to explore the experiences and perspectives of outpatient patients regarding the effectiveness of the JKN Mobile online registration system at Baubau City Regional General Hospital. A qualitative phenomenological approach was employed, with informants selected through purposive sampling. Data were collected to capture the meanings of patients’ experiences in using the application. The findings show that most patients are satisfied with the practicality, speed, and flexibility of the online registration system. However, technical problems, particularly unstable internet connectivity, remain a major challenge. Furthermore, the online registration system has contributed to improved service efficiency and patient satisfaction. These findings indicate the importance of continuous evaluation and improvement of the JKN Mobile online registration system to enhance service quality and health information system development at Baubau City Regional General Hospital.

Managing Regional Public Service Agency (Badan Layanan Umum Daerah/BLUD) hospitals requires planning and budgeting processes that are accountable, measurable, and aligned with service performance. In practice, BLUD planning is still constrained by fragmented applications (hospital information system/SIMRS, finance, human resources, e-office, and procurement), duplicate data entry, approval delays, and limited monitoring of process compliance. This study aims to analyze requirements and design a web-based BLUD planning information system using an Enterprise Application Integration (EAI) approach through middleware to improve cross-system interoperability, data consistency, and the timeliness of executive reporting. The study adopts the Design Science Research (DSR) framework, comprising problem identification, definition of solution objectives, artifact design and development, demonstration, evaluation, and communication/report writing. The proposed system includes a unit-based budget proposal module and item management, a role-based approval workflow (RBAC) with SLA tracking, a budget ceiling (pagu) master to benchmark proposals, audit trails and report exports, and an executive dashboard integrating budget perspectives, service indicators (e.g., bed occupancy rate/BOR and patient visits), and process compliance. It also provides an integration design via middleware (ESB/message broker) supported by a canonical data model (CDM) and traceable logging (trace_id/correlation_id). Evaluation using black-box testing and API contract testing indicates that the main planning workflow operates as intended and the integration interfaces are consistently defined, providing a foundation for staged implementation and further performance evaluation.

The work behavior of health workers is a key factor in determining the quality of service and patient safety in hospitals. In healthcare organizations with high work demands, feedback and rewards are important instruments of human resource management to form positive work behaviors. However, empirical evidence on the role of rewards as a mediating variable in the relationship between feedback and work behavior of health workers, particularly in Indonesian regional hospitals, is limited. This study aims to analyze the influence of feedback on work behavior through the role of reward mediation in health workers at Konawe Hospital, Southeast Sulawesi Province, Indonesia. This study used a quantitative approach with a cross-sectional design. Data was collected through a survey using a structured questionnaire based on the Likert scale of 170 health workers with ASN status at Konawe Hospital. The sampling technique used a combination of purposive and accidental sampling. Data analysis was carried out with Partial Least Squares–Structural Equation Modeling (PLS-SEM) using SmartPLS software version 4.0. The results showed that rewards had a positive and significant effect on work behavior (β = 0.579; t = 10.308; p = 0.000), and feedback had a positive and significant effect on rewards (β = 0.805; t = 25.851; p = 0.000). In addition, feedback also had a positive and significant effect on work behavior through rewards (β = 0.466; t = 8.362; p = 0.000), which confirms the mediating role of rewards. There is an influence of appraisal on work behavior and feedback on awards and awards has been shown to significantly mediate the influence of feedback on the work behavior of health workers. These findings emphasize the importance of effective feedback management and an integrated reward system as a managerial strategy to encourage positive work behavior and improve the quality of health services in regional hospitals.

Informed consent constitutes a fundamental legal and ethical requirement in healthcare services, ensuring that every medical action is performed with the patient’s full awareness and voluntary approval. In Indonesia, the obligation to obtain informed consent is firmly regulated under the Health Law No. 17 of 2023, the Minister of Health Regulation on Medical Consent, and provisions on medical records. This paper examines the essential role of informed consent as a protective instrument for both patients and healthcare providers within the clinical and legal framework. Informed consent guarantees patients’ rights to information, autonomy, and decision-making, while providing legal safeguards for medical practitioners by documenting the process of explanation, acceptance, or refusal of medical treatment. Proper documentation within medical records ensures accountability, continuity of care, and serves as crucial evidence when medical disputes arise. Medical disputes often stem from dissatisfaction, communication gaps, or misunderstandings about risks inherent in medical procedures. Therefore, informed consent functions not merely as an administrative requirement but as a mechanism for preventing conflict, clarifying responsibilities, and distinguishing unavoidable medical risks from professional negligence. By strengthening the implementation of informed consent, healthcare providers can enhance transparency, improve service quality, and reduce the likelihood of medical litigation.  

The National Health Insurance Program (Jaminan Kesehatan Nasional or JKN) is a government initiative aimed at ensuring equitable, accessible, and affordable healthcare services for all Indonesian citizens. Since its implementation in 2014, the program has covered more than 90% of the population; however, several challenges remain, particularly concerning the quality of services at primary healthcare facilities such as community health centers (puskesmas). This study aims to analyze the quality of JKN services at the Cengkareng Public Health Center, West Jakarta, using the five dimensions of service quality proposed by Parasuraman: tangibles, reliability, responsiveness, assurance, and empathy. The research employed a descriptive qualitative method through in-depth interviews, direct observations, and document analysis involving healthcare workers and JKN patients. The findings indicate that the overall service quality at Puskesmas Cengkareng remains suboptimal. The tangibles and assurance dimensions are relatively good, while reliability, responsiveness, and empathy are still lacking. Major complaints include long waiting times, poor doctor–patient communication, and unfriendly staff attitudes. These findings highlight the need for improving human resource professionalism, strengthening service management systems, and conducting periodic evaluations to enhance the overall quality and patient satisfaction among JKN participants.  

This study examines the implementation of digital health services via the Mobile JKN application at the Payung Sekaki Community Health Center in Pekanbaru City and explores factors affecting service effectiveness, especially complaints about long waiting times. Using a descriptive qualitative approach based on the Mobile Health Acceptance Model by Handayani et al. (2021), the study focuses on five constructs: ease of use, system availability, system responsiveness, health workers’ digital skills, and user trust. The results show that Mobile JKN has significantly simplified administrative processes, accelerated registration, and improved service efficiency at the health center. Effectiveness is supported by factors such as the application’s general ease of use, faster queue data processing, and adequate digital skills among staff. Users also show a high level of trust, though queue time estimation still needs improvement. Despite these benefits, complaints about long waits persist due to patients who register online but still queue manually and misunderstandings between Mobile JKN and e-Puskesmas queue numbers. Late patient arrivals also contribute to delays. Overall, Mobile JKN proves effective in enhancing digital health services, but further optimization is needed through better socialization of service procedures, accurate queue information, and improved system integration to maximize the advantages of digitalization.

This study analyses the challenges of digitalising registration services at Primary Healthcare Facilities (Fasilitas Kesehatan Tingkat Pertama, FKTP) in East Java, including limitations in human resources, technological infrastructure, and public digital literacy, all of which affect the satisfaction of National Health Insurance (Jaminan Kesehatan Nasional, JKN) patients. Utilising the Systematic Literature Review (SLR) methodology with the PRISMA approach, the study reviews literature from 2024–2025 sourced from databases such as Google Scholar, using keywords related to digitalisation, FKTP, and patient satisfaction. The analysis is based on the ADO (Antecedent, Decision, Outcome) framework. The findings identify three key factors: (1) Antecedents (human resource competence, infrastructure, digital literacy); (2) Decisions (human resource training, facility modernisation, public outreach); and (3) Outcomes (increased patient satisfaction through time efficiency and ease of access). The study emphasises the need to strengthen human resources, provide adequate infrastructure, and educate the public to ensure the sustainability of digital healthcare services at FKTPs in East Java.

The advancement of information technology has had a significant impact across various sectors, including healthcare. The digitalization of healthcare services has become a solution to improve efficiency, effectiveness, and accessibility for the public. Puskesmas Selindung still uses a manual patient registration system, which leads to several issues such as long queues, extended waiting times, and the risk of lost or damaged patient records. Based on visit data, the number of patients coming to Puskesmas Selindung has increased each year. Therefore, a digital queue system is needed to optimize the patient registration process. This research aims to analyze and design an Android-based patient registration queue application to improve service efficiency at Puskesmas Selindung. The research methods include system requirements analysis, user interface design, and the development of core features to support the online patient registration process. The implementation of this application is expected to reduce long queues, speed up administrative processes, and make it easier for patients to access healthcare services more effectively and accurately. With this Android-based system, the quality of healthcare services at Puskesmas Selindung is expected to improve significantly.

Diabetes mellitus (DM) is one of the global health challenges that continues to rise, including in Indonesia. However, the lack of education and counseling from pharmacists regarding the use of natural ingredients medicines has the potential to affect the effectiveness of treatment and the management of DM. This study aims to measure the level of knowledge, attitudes, and behaviour of DM patients, related to the use of natural ingredient drugs in DM management. This study uses a cross-sectional method design, starting with the collection of quantitative data. Sampling was conducted using purposive sampling technique over a period of four months. The research involved 101 DM patients from 15 pharmacies in Kendal Regency. The level of knowledge (44.6%), attitude (66.3%), and behaviour (39.6%) of patients in the moderate category. However, the limited knowledge of pharmacists remains a barrier to optimizing pharmaceutical services related to educating patients about natural ingredient medications.

This study aims to analyze the spatial patterns of ambulance transport demand in Semarang City based on patients’ origin subdistricts, origin villages, and destination healthcare facilities. The analysis employed the K-Means Clustering algorithm as a data mining method to group areas according to similarities in the volume of ambulance requests. The dataset consisted of ambulance transport service records from January 2024 to September 2025, obtained from the Semarang City Health Office. The analytical procedures included data cleaning, normalization, determination of the optimal number of clusters using the Elbow Method, and cluster formation using K-Means. The results show two main clusters for subdistricts and destination healthcare facilities. High-demand subdistricts were generally densely populated areas such as Banyumanik and Pedurungan, with an average of 1,256 requests, while RSUP Dr. Kariadi emerged as the dominant referral facility with 3,893 requests. Meanwhile, village-level origins formed three clusters, with average demands of 549 (high), 190 (medium), and 36 (low). These findings are expected to support strategic planning for equitable ambulance fleet distribution and improved efficiency of patient transportation services in Semarang City.

Doctors play a crucial role in determining the quality of healthcare services and in upholding the right to health as guaranteed by the constitution and international human rights frameworks. Despite this essential role, medical practice continues to encounter significant challenges, including disparities in medical education quality, inadequate competency assessment mechanisms, and limited integration of professional ethics, discipline, and scientific standards within the health legal system. These issues create risks to patient safety and undermine public trust in medical services. This research analyzes the urgency of health law reform to ensure physician competence and proposes an integration model that unites ethics, discipline, and scientific foundations as the core pillars for equitable and welfare-oriented medical professional governance. Using a normative legal research method, this study adopts legislative, conceptual, and comparative approaches. Primary and secondary legal materials are examined qualitatively through doctrinal studies, normative analysis, and comparisons with governance practices of the medical profession in other countries. The study finds that health law reform should prioritize strengthening regulations on competency standards, transparent certification and periodic recertification systems, as well as integrated professional oversight that aligns ethics, discipline, and legal accountability. The proposed integration model serves as a framework to ensure that every physician maintains measurable competence, adheres to professional ethics, and upholds clear legal responsibilities in clinical practice. Reforming health law through such integration is a strategic step to enhance medical service quality, reinforce patient protection, and advance global justice and welfare.

Human Immunodeficiency Virus (HIV) infection leading to Acquired Immune Deficiency Syndrome (AIDS) remains a global public health issue, with 39 million people living with HIV worldwide in 2022. Although X Hospital in Malang City provides a comprehensive care program, internal data shows a significant level of non-adherence to antiretroviral (ARV) therapy, often in the form of irregular consumption or discontinuation of medication without medical recommendation. This observational study with a cross-sectional approach aims to identify the determinants of ARV non-adherence, involving 81 non-adherent AIDS patients at Hospital X through total sampling techniques. The characteristics of the respondents were dominated by males, highly educated, and working in the non-government sector, with the majority using the ARV regimen TLD, COTRIMOXAZOLE. The results of statistical analysis indicate that all eight determining variables tested show a highly significant positive correlation (p < 0.001) with non-compliance, meaning that the more severe the problems with these factors, the lower the patient compliance. Furthermore, the top five factors showed a very strong positive correlation (r > 0.80) with non-adherence, namely motivation/depression, social support, communication with service providers, treatment costs, and age or routine. These findings underscore that these five key determinants must be a crucial focus in designing and implementing targeted intervention strategies to effectively improve patient adherence to ARV therapy.

Response time refers to the speed of nurses in providing initial responses to patients, measured from the moment patients arrive at the hospital entrance until they receive medical attention from emergency room staff. Patient satisfaction is an important indicator of healthcare quality, reflecting the comparison between patient expectations and the services received. This study passed the ethical review process with approval number 66/EC-LPPM/UWHS/IV-2025 and used a quantitative correlational design with a cross-sectional approach. The sampling technique applied purposive sampling involving 197 respondents. Data were collected using a nurse response time observation sheet and a patient satisfaction questionnaire that had undergone validity and reliability testing. The validity test using the Pearson Product Moment method showed that the calculated r value was greater than the r table value of 0.361, indicating that all questionnaire items were valid. The reliability test using Cronbach’s alpha produced a coefficient value of 0.855, confirming that the instrument was reliable. Data analysis used univariate and bivariate analysis with the Spearman’s rho test. The results showed that nurse response time was categorized as fast (≤ 5 minutes) for 177 respondents (89.8%). Patient satisfaction levels showed that 177 respondents (89.8%) were very satisfied, 10 respondents (5.1%) were satisfied, and 10 respondents (5.1%) were moderately satisfied. The Spearman Rank test produced a p-value of 0.000 (<0.05) with a correlation coefficient of 0.893, indicating a strong and positive relationship between nurse response time and patient satisfaction in the Emergency Room of Charlie Hospital Kendal.

Electronic Medical Record (EMR) is an essential component of hospital digital transformation aimed at improving administrative efficiency and service quality. This study aims to analyze the factors influencing the implementation of EMR in outpatient registration at a private hospital in North Jakarta. A mixed-methods design was employed, combining quantitative data collected from questionnaires completed by 30 registration staff with qualitative data obtained through structured interviews and direct observation. The logistic regression analysis revealed that Training and Staff Competence (X2) had a significant positive effect on outpatient registration (OR 30.663; p=0.040), while System Integration and Data Security (X4) also showed a significant effect (OR 15.121; p=0.047). In contrast, Technological Infrastructure Readiness (X1) was positive but not significant (p=0.112), and Organizational Culture and Managerial Support (X3) was negative and not significant (p=0.954). Simultaneously, the model explained 72.1% of the variation in registration effectiveness (Nagelkerke R²=0.721) with a classification accuracy of 93.3%. Qualitative findings supported the quantitative results, highlighting insufficient staff training, persistent technical issues in BPJS system bridging, and difficulties faced by elderly patients in adapting to digital registration. Elderly patients still required staff assistance and simple educational media such as tutorial videos displayed in hospital waiting areas. This study concludes that staff competence and system integration are the key determinants of successful EMR implementation in outpatient registration. It is recommended that hospitals strengthen continuous training programs, improve network and server stability, and expand patient education initiatives to ensure effective, efficient, and patient-friendly digital services.

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.

This study aims to analyze the effect of the use of Health Information Media in the form of leaflets on the level of patient knowledge about influenza in pharmacies Ngudi Waluyo, Ungaran. Leaflet Media is used as an educational tool to improve patient understanding related to influenza, including aspects of causes, symptoms, complications, and management and treatment. The type of research used is quasi experiment with pre-test and post-test design, involving 94 respondents who meet the inclusion criteria. Data analysis was conducted using the Wilcoxon statistical test to determine the difference in the level of knowledge of patients before and after education. The results showed a significant increase in the level of knowledge of patients after obtaining education using leaflets. Before being given education, respondents with a good knowledge level category were 56.7%, and increased to 96.8% after providing education, with a value of p = 0.001 (p < 0.05) which showed a significant difference between the two measurements. Thus, the Health Information media in the form of leaflets proved effective in increasing patient knowledge about influenza and can be used as an alternative educational media that is simple, practical, and efficient in supporting pharmaceutical services in pharmaceutical service facilities.