Inctroduction

SPM on pharmacy services includes waiting time for finished drug services 30 minutes and waiting time for concoction drug services ≤ 60 minutes, the absence of 100% drug delivery errors, customer satisfaction 80%, prescription writing according to the formulary 100%. The performance of the RSKD IFRS until June 2019 is seen from the indicator that the non-concoction waiting time takes 9.2 minutes, and the 12.1-minute blend has met the target, namely the non-concoction waiting time < 30 minutes and the compound < 60 minutes. 99.96% customer satisfaction indicator has met the target > 80%. Meanwhile, indicators of compliance with prescription writing according to the formulary have not yet been carried out. The indicator of no incidence of medication errors in June has been reached 100%. Based on Permenkes no 72 of 2018 the indicator value in the RSKD IFRS of 90% is in accordance with the standard. Pharmaceutical service standards in hospitals, policies for the management of pharmaceutical preparations, medical devices and medical consumables must be implemented in a multi-disciplinary, coordinated manner and use an effective process to ensure quality and cost control. IFRS as the only provider of pharmaceutical services including formulary manufacture, procurement and distribution of pharmaceutical preparations, medical devices and medical consumables.

The success of implementing pharmaceutical service standards in hospitals must be supported by the availability of pharmaceutical resources, one of which is human resources (HR). The availability of pharmaceutical human resources in addition to following existing regulations must also adjust to the needs of the hospital. Furthermore, in carrying out pharmaceutical activities various factors affect the performance of an employee, basically the level of employee performance is influenced by factors from within the employee himself and factors outside the employee. Factors from within the officer include knowledge and skills, competencies in accordance with their work, work motivation, and job satisfaction. Factors from outside of the employee, namely the workload and leadership style in the organization that play a very important role in influencing employee

performance. However, if the employee burden is managed properly, it will have a positive effect on work performance, especially the productivity and quality of employee work. Some researchers consider that there is an influence between workload on employee performance. In addition, an important factor in achieving quality indicators of hospital management, especially in the pharmaceutical sector, must also look at employee job satisfaction because it can affect the work behavior of employees in an organization. do not like employees to work. So it can be said that if an employee feels job satisfaction, it will also have a positive effect on improving the quality of the employee's work. Therefore, the behavior of employees in the organization must be directed towards achieving the goals that have been set. Motivation is a driving force that also affects the behavior of employees in the organization. Employee behavior at work is basically aimed at achieving satisfaction so it is necessary to pay attention to the things that can motivate the employee. If an employee is satisfied with his work, he will have more motivation and have more performance. Some people who conduct research on job satisfaction and performance include (Maryani & Supomo, 2001)both studies found that there was a significant relationship between job satisfaction and performance. Incompleteness, inaccuracy, in the implementation of pharmaceutical services has a bad impact on the health service process to patients, because the time for the medical service process becomes long. The high percentage of inappropriate pharmaceutical services is an indicator of the low performance of pharmacy employees in hospitals which is thought to be the result of low employee motivation in carrying out their work, both internal motivation (intrinsic) and motivation from outside employees (extrinsic). Dharmais Cancer Hospital is a National Cancer Center Hospital located in Jakarta. In May 2018 Dharmais Cancer Hospital Jakarta received a Hospital Accreditation Certificate from the Hospital Accreditation Commission (KARS) with the predicate of passing the Plenary Level Accreditation. This is one of the efforts Dharmais Cancer Hospital Jakarta to maintain service quality by running services in accordance with hospital accreditation standards. At the Dharmais Cancer Hospital in Jakarta, the goal of improving the quality of service is to improve health services through efforts to improve the quality of services at the Dharmais Cancer Hospital Jakarta effectively and efficiently in order to achieve optimal health status. Dharmais Cancer Hospital Jakarta has established several Hospital Quality Indicators as benchmarks in efforts to improve service quality. Dharmais Jakarta Cancer Hospital in an effort to realize the hospital's vision is "To become a comprehensive cancer hospital and develop a national cancer center that is equivalent to Asia level". The management and all staff of the Jakarta Dharmais Cancer Hospital will always ensure the satisfaction of hospital customers by providing Pro CARE CS medical services which means Professional means carrying out and completing a certain job completely, satisfactorily, and on time. Care or Peduli means communicating politely to all parties C Continuous Improvement or continuous improvement means appreciating feedback, coaching and mentoring and Synergy means communicating with each other clearly and openly. In realizing the goal of Dharmais Cancer Hospital Jakarta to become a leading hospital and role models in the treatment and prevention of cancer. Based on an initial survey of 10 pharmacists, there are still many employees (10%) who complain of being tired when the office, especially the morning service, sometimes doesn't have time to rest, eat, plus pharmacists who don't come because of illness, causing the workload to be more. The survey results also showed 50% of employees expressed job dissatisfaction this was related to salary provision, relationships with superiors and job placements were not in accordance with their skills and abilities (Muindi, 2011). In addition, 20% of employees show low work motivation, this is because the work environment is not conducive and the workload is high. In addition to the results of observations based on the RSKD suggestion box, the phenomenon of complaints felt by 3 patients / families, including "long pharmacy service, employees do not smile and behave rudely". Long waiting time is one of the components that have the potential to cause patient dissatisfaction.

Previous research on the analysis of the need for personnel in the Pharmacy Installation of the RSKD conducted by (Ramadhia, 2014), the results of the calculation of the need for personnel, obtained that the Pharmacy Installation still experienced a shortage of 2 pharmacists and 1 pharmacist assistant. The number of patients and the lack of pharmacists in their services are the main factors in the high workload. The results of the preliminary study using a questionnaire, they perceived that the workload of the RSKD pharmacy staff was in the high category (81.06%) Based on the above background, the researchers examined "The Effect of Workload and Job Satisfaction of Pharmacy Workers on Achieving Quality Indicators with Motivation as Intervening Variables at Dharmais Cancer Hospital Jakarta"

Method

The research design that will be used in this research is a quantitative approach research model. Quantitative model is a decision model that uses numbers.

A. Literature review

1. Workload

Workload is something that arises from the interaction between the demands of tasks, the work environment where it is used as a workplace, skills, behavior and perceptions of workers. Work motivation

According to (Asyï¿½ari, 2018) motivation is the desire to do something and determine the ability to act to satisfy individual needs, a need, in our terminology, means a physical or psychological deficiency that makes certain outcomes look attractive.

2. Job satisfaction

3. Quality Indicator

B. Hypothesis Development

ï¿½ H1: There is a significant effect between workload and job satisfaction together on the achievement of quality indicators with motivation as an intervening variable in the Pharmacy Installation of Dharmais Cancer Hospital

ï¿½ H2 : There is a significant effect between workload on the motivation of pharmacists at Dharmais Cancer Hospital

ï¿½ H3 : There is a significant effect between job satisfaction and motivation of pharmacists at Dharmais Cancer Hospital

ï¿½ H4 : There is a significant influence between workload on the achievement of quality indicators in the Pharmacy Installation of Dharmais Cancer Hospital

ï¿½ H5: There is a significant influence between job satisfaction on the achievement of quality indicators in the Pharmacy Installation of Dharmais Cancer Hospital

Results and Discussion

A. Characteristics of Respondents

The characteristics of the respondents are, most of the respondents are aged 31-35 years with a total of 16 people from 54 people with a percentage of 29.63%, the characteristics of respondents according to gender are mostly women with a total of 42 people from 54 people with a percentage of 77.78%, the characteristics of respondents according to education most of the respondents have a DIII education level with a total of 36 people from 54 people and a percentage of 66.67%.

B. Hypothesis Testing

Based on Table 1, the determination of the hypothesis to be accepted or rejected is explained as follows: The workload construct has a significant effect on work motivation (t = 3.782; p < 0.05), job satisfaction has a significant effect on work motivation (t = 2.558; p < 0.05) , workload has a significant effect on indicators of pharmaceutical quality (t = 2,593 ; p < 0.05), job satisfaction has a significant effect on indicators of pharmaceutical quality (t = 2,042 ; p < 0.05), and work motivation has a significant effect on indicators of pharmaceutical quality ( t = 3,870 ; p > 0.05)

Discussion

1. The Effect of Workload and Job Satisfaction Together on the Achievement of Pharmaceutical Quality Indicators with Work Motivation as an Intervening Variable

From the previous PLS in table 4. the workload variable has a positive influence on the achievement of pharmaceutical quality indicators (O= 0.547, p-value: 0.000 <0.05 and t statistic 2.593 1.96 and the job satisfaction variable has a positive effect on the achievement of pharmaceutical quality indicators (O= 0.432, p-value). : 0.000 < 0.05 and t statistic 2.042 1.96. Furthermore, in table 4.22 after being intervened by work motivation, it is known that the workload variable has a positive influence on the achievement of pharmaceutical quality indicators (O= 0.607, p-value : 0.000 < 0.05 and t statistic 6.117 1.96 and Job satisfaction variable has a positive effect on the achievement of pharmaceutical quality indicators (O= 0.227 p value : 0.000 < 0.05 and t statistic 2.117 1.96) and workload and job satisfaction variables together have a positive and significant effect on the achievement of hospital quality indicators with motivation work as an intervening variable O= 0.508 , p value : 0.000 < 0.05 and t statistic 7.231 1.96. Workload is something that arises from the interaction between the demands of tasks, the work environment where it is used as a workplace, skills, behavior and perceptions of workers. According to suggests that job satisfaction is as a general attitude of an individual towards his work. Work requires interaction with co-workers and superiors, following organizational rules and policies, meeting performance standards, living in good conditions. work that is often less than ideal, and other similar things.According toï¿½ motivation is the desire to do something and determine the ability to act to satisfy individual needs, a need, in our terminology, means a physical or psychological deficiency that To make certain outputs look attractive, quality according to is very subjective, depending on perceptions, value systems, background, social, educational, economic, cultural and many other factors in society or individuals related to services. These results indicate that work motivation mediates the effect of workload and job satisfaction on the achievement of pharmaceutical quality indicators. And this variable acts as a partial control in the relationship between workload and job satisfaction on the achievement of pharmaceutical quality indicators with the magnitude of the coefficient of influence between the hypothesized constructs indicated by the value of the path coefficient. The biggest effect is workload of 0.607, and the smallest effect is job satisfaction of 0.227. Therefore, the fifth hypothesis which states that workload and job satisfaction has a positive influence on the achievement of pharmaceutical quality indicators of work motivation as an intervening variable is proven true. Motivation is a person's strength (energy) that can lead to a level of persistence and enthusiasm in carrying out an activity, both originating from within the individual itself (intrinsic motivation) and from outside the individual (extrinsic motivation).The results of this study are in accordance with previous studies, namely by (Yurasti, 2016), ,(Munawirsyah, 2016), (Darojati, 2018), that workload has a positive and significant effect on performance and job satisfaction has a positive and significant effect on service quality. The results showed that motivation mediating the effect of workload and job satisfaction had a positive influence on the achievement of pharmaceutical quality indicators (Srimarut & Mekhum, 2020), this is because employees are required to work according to SOPs that make employees enthusiastic or motivated because employees who have high motivation will feel challenged and carry out their duties and responsibilities. it fits the role applicable rules.

2. The Effect of Workload on Work Motivation

Workload has a significant positive effect on the motivation of pharmacists (O = 0.518) with the t-statistical value is 3.782 1.96 and the p-value is 0.000 <0.05. Therefore, the first hypothesis which states that workload has a positive effect on work motivation is proven true.

Based on the results of the descriptive analysis of table 4.1 above, it can be seen that the average value of the workload is 35,975 in the medium workload category. The highest indicator is the working time indicator, namely the question item "I often finish work on time" which is 39.6. while the lowest indicator on the item ï¿½I feel confused, tired and depressed during workï¿½ is 31.6. Based on table 4.3 above, it can be seen that the average value of work motivation is 32.44 which is included in the medium category. The highest indicator is the indicator of the need for security, namely the question item "The hospital provides a good safety belt or K3 to employees during their work. carry out the taskï¿½, which is 34.8. while the lowest indicator is the indicator of the need for security, namely the item "The hospital guarantees the children of employees who excel in education for employees who have passed away and the hospital provides educational scholarships to the children of employees who excel" which is 30. A set of task demands, as an effort, and as an activity or achievement. The workload is in the form of tasks that can have a positive or variable impact. The workload can be either physical or psychological. Workload is something that arises from the interaction between the demands of tasks, the work environment where it is used as a workplace, skills, behavior and perceptions of workers. According to motivation is the desire to do something and determine the ability to act to satisfy individual needs, a need, in our terms, means a physical or psychological deficiency that makes certain outcomes look attractive. The theory defines the characteristics of these dimensions. The connection with this research is that the workload is a task carried out by each employee, whether high or low. This study shows that the workload is in the medium category, which means it is neither high nor low but has a very significant influence on motivation at work. The research has similarities with the research conducted by (Yurasti, 2016), namely they both examine workload variables, then the data collection method is a questionnaire as a data collection tool but also has a difference, namely there is a performance variable, analyzed by multiple linear regression analysis. Based on the results of the study, hospitals should be able to reduce the burden on employees so they don't feel tired, confused and work on time and motivate employees by ensuring that the children of employees who excel in education for employees who have died and hospitals provide educational scholarships to employees' children who excel.

3. The Effect of Job Satisfaction on Work Motivation

Job satisfaction has a significant positive effect on the work motivation of pharmacists (O = 0.443) with a statistical t value of 2.558 1.96 and a p-value of 0.000 <0.05. Therefore, the second hypothesis which states that job satisfaction has a positive effect on work motivation is proven true. Based on the descriptive analysis of table 4.2 above, it can be seen that the average value of job satisfaction is 31.46 which is included in the Quite Satisfied category. The highest indicator is in the co-worker indicator, namely the question item "My close relationship with co-workers so far has made my work run very well" namely of 44.6 while the lowest indicator on the job promotion indicator is the item "My place of work provides complete information and data regarding the requirements to occupy a certain position for each employee" which is 8.4.

Based on table 4.3 above, it can be seen that the average value of work motivation is 32.44 which is included in the medium category. The highest indicator is the indicator of the need for security, namely the question item "The hospital provides a good safety belt or K3 to employees during their work. carry out the taskï¿½, which is 34.8. while the lowest indicator on the indicator of the need for security is the item "The hospital guarantees the children of employees who excel in education for employees who have passed away and the hospital provides educational scholarships for the children of employees who excel" which is 30.4. Based on these results, it can be stated that work motivation has a high influence on employees so that employees are motivated by their work. According to , job satisfaction is a general attitude of an individual towards his work. The job demands interaction with coworkers and superiors, following organizational rules and policies, meeting performance standards, living in work conditions that are often less than ideal, and the like. According to motivation is the desire to do something and determine the ability to act to satisfy individual needs, a need, in our terminology, means a physical or psychological deficiency that makes certain outcomes look attractive (Sheldon & Gunz, 2009).ï¿½

The results of this study are in accordance with previous studies which state that the higher the job satisfaction of employees, the higher the work motivation (Niati, Siregar, & Prayoga, 2021). stated that job satisfaction will increase work motivation or in other words job satisfaction has a positive correlation with employee work motivation. The theory explains in general the description of each dimension, where in this study it is seen that job satisfaction has a very significant influence on motivation. The results of the three boxes are also in the category of being quite satisfied and having moderate motivation. This means that in this case the employees at the hospital feel that they are not so satisfied with their working conditions so that they have mediocre work motivation. In addition, this research is also in line with research conducted by (Munawirsyah, 2016) which has similarities, namely both researching job satisfaction variables, then the data collection method is a questionnaire as a data collection tool and the difference is that there are employee performance variables, partial linear regression analysis

Based on the results of the study, the implications that should be carried out by hospitals so that employee work motivation increases, one of them is by providing complete information and data regarding the requirements to occupy a certain position for each employee.

4. The Effect of Workload on the Achievement of Pharmaceutical Quality Indicators

Workload has a significant positive effect on the achievement of pharmaceutical quality indicators (O = 0.547) with a statistical t value of 2.5932 1.96 and a p-value of 0.010 <0.05. Therefore, the third hypothesis which states that workload has a positive effect on work motivation is proven true. Based on the results of descriptive analysis. Based on table 4.1 above, it can be seen that the average value of the workload is 35,975 which is included in the medium workload category. The highest indicator is the working time indicator, namely the question item "I often finish my work not on time" which is 39.6. while the lowest indicator on the item ï¿½I feel confused, tired and depressed during workï¿½ is 31.6.

Based on table 4.4 above, it can be seen that the average value of the Achievement of Pharmaceutical Quality Indicators is 32.23 in the medium category. The highest indicator is the service quality indicator, namely the question item "The hospital always provides quality medicine to patients" which is 34.4. while the lowest indicator on the indicator of the absence of drug administration events according to the formulary is the item "I always write generic names or drug trade names" which is 30. Pharmaceutical quality indicators are a set of tools used as a reference or standard for achieving hospital pharmacy services that have been established. According to the Minister of Health No. 129 of 2008 in this case includes four things, namely waiting time for service, the absence of errors in drug administration, customer satisfaction, and writing prescriptions after formulary. Workload is something that arises from the interaction between the demands of tasks, the work environment where it is used as a workplace, skills, behavior and perceptions of workers.

Quality according to is very subjective, depending on perceptions, value systems, background, social, educational, economic, cultural and many other factors in society or individuals associated with services. Based on the theory presented and the results obtained, this study means that the workload has a significant influence on the quality of service, the results of the threebox itself are also in the medium category, where the workload is between high and low so that the services provided are in accordance with what can be expected. given by employees.

The results of this study are in accordance with previous studies which state that the lighter the workload of employees, the higher the achievement of pharmaceutical quality indicators. Research conducted by (Yurasti, 2016) obtained the results that there was a positive and significant effect between workload on the performance of the Koperindag and SME employees of 91%. Other research by (Adityawarman, Sanim, & Sinaga, 2015) workload has a positive and significant direct effect on the performance of BRI employees in the Krekot Branch at the significance level. Furthermore, research by (Anita, Aziz, & Yunus, 2013) stated that the workload partially had a significant effect on work performance. On the contrary, stated that there was no relationship between workload and nurse performance in implementing patient safety. If the workload for employees exceeds the employee's own work capacity, it will make the employee less productive which in turn will reduce performance, especially the achievement of predetermined quality indicators. The existence of a workload that is in accordance with professionalism and adequate health service facilities can ultimately improve employee performance so that they can provide the best service according to the minimum service standards that have been set (Panggabean, 2012).In addition, this study has similarities and differences with research conducted by (Saputra, 2016) where Similarities: examines the workload with service quality, and Differences: this study relates the characteristics of respondents.

Based on the results of the study, the implications that should be carried out by hospitals so that the achievement of pharmaceutical quality indicators increase, one of them is by increasing the number of employees so that the division of labor and work time to complete work becomes more optimal.

5. The Effect of Job Satisfaction on the Achievement of Pharmaceutical Quality Indicators

Job satisfaction has a significant positive effect on the achievement of pharmaceutical quality indicators (O = 0.693) with a statistical t value of 3.870 1.96 and a p-value of 0.000 <0.05. Therefore, the fourth hypothesis which states that job satisfaction has a positive influence on the achievement of pharmaceutical quality indicators is proven true. Based on table 4.2 above, it can be seen that the average value of job satisfaction is 31.46 which is included in the Quite Satisfied category. The highest indicator is in the co-worker indicator, namely the question item "My close relationship with my co-workers has made my work run very well" which is 44.6 while the lowest indicator on the job promotion indicator is the item "My place of work provides complete information and data regarding the requirements to occupy a certain position for each employee" which is 8.4. Based on table 4.4 above, it can be seen that the average value of the Achievement of Pharmaceutical Quality Indicators is 32.23 in the medium category. The highest indicator is the service quality indicator, namely the question item "The hospital always provides quality medicine to patients" which is 34.4. while the lowest indicator on the indicator of the absence of occurrence of drug administration according to the formulary is the item "I always write generic names or drug trade names" which is 30. Based on these results it can be stated that pharmaceutical quality indicators have a high influence on employees so that employees are able to provide pharmaceutical services effectively. optimal.

According to, job satisfaction is a general attitude of an individual towards his work. The job demands interaction with coworkers and superiors, following organizational rules and policies, meeting performance standards, living in work conditions that are often less than ideal, and the like (Dewi, Yulianto, & Ruswanti, 2022). Quality according to is very subjective, depending on perceptions, value systems, background, social, educational, economic, cultural and many other factors in society or individuals associated with services. Based on the results of the study, the implications that should be carried out by hospitals for achieving pharmaceutical quality indicators are increasing, one of which is by way of every employee having the same opportunity to get a promotion. The definition explains what each dimension means, and describes the meaning of each dimension. In this study, it was found that job satisfaction has a significant influence on service quality, where the results of the three boxes also illustrate that employees are quite satisfied with their work, which means that the work done is not optimal. This study has similarities and differences that are in line with Susanto's research, where Equation: Both research on employee job satisfaction variables. Furthermore, the data collection method is a questionnaire as a data collection tool. Differences: Analyzed by multiple linear regression analysis.

ï¿½In relation to the quality of service, if the work has not been carried out optimally, the services provided are also the same, this is also evident from the results of the three boxes that the quality of service is in the medium category, which means that it has not achieved what the patient expects.

6. Finding

Based on the results of the study found the following research findings:

a. Health workers are still working not in accordance with the working hours that have been set.

b. Health workers feel that they do not fully get the right to career development.

c. Relationships with colleagues and superiors are also a major factor in carrying out their duties. So that the average satisfaction of health workers is in the medium category

Conclusion

From the results of hypothesis testing and discussion in this study, several conclusions can be drawn, including the following:

1. There is a significant effect of workload on the motivation of pharmacists at Dharmais Cancer Hospital. Which means that the workload can affect one's work motivation if the workload is high in the task, the motivation of the employees themselves becomes low and vice versa so that the work is carried out in accordance with expectations.

2. There is a significant effect of job satisfaction on the motivation of pharmacists at Dharmais Cancer Hospital. Which means that job satisfaction can affect work motivation, if employees feel satisfied with their work, the motivation to work is also high so that employees feel better in carrying out their duties.

3. There is a significant effect between workload on the achievement of quality indicators in the Pharmacy Installation of Dharmais Cancer Hospital. This means that the workload will greatly affect the quality of services provided, if the burden is high, employees will provide services with inappropriate work pressure so that the services provided are also not in accordance with patient expectations.

4. There is a significant influence between job satisfaction on the achievement of quality indicators in the Pharmacy Installation of Dharmais Cancer Hospital. This means that job satisfaction is a factor that can affect the services provided, where if the employee is satisfied with the job, it means he has provided services in accordance with the expected service quality.

5. There is a significant influence between workload and job satisfaction on the achievement of quality indicators with motivation as an influential factor in the Pharmacy Installation of Dharmais Cancer Hospital. Which means that if the workload is high it can affect job satisfaction and also work motivation is low so that together it can affect the achievement of quality indicators that are not good and not optimal. Therefore, it is very important for the hospital to improve it so that the quality of service is satisfactory.

7. Managerial Implications

Based on the results of the study, the researchers determined the managerial implications as follows:

a) So that the workload of officers can be recalculated and evaluated, especially the working time and rest time of officers because this can affect the performance of officers in providing services.

b) In order to create good job satisfaction, it is necessary to pay attention to the attitude of superiors towards subordinates and to be evaluated immediately, as well as information that needs to be given properly to each employee with the data needed by employees, as well as providing opportunities for employees to be able to develop their careers.

c) In order for officers to have high motivation in their work, attention must be paid to the guarantees that can be provided by the hospital for the officers themselves and for their families, including children who excel in the form of scholarships or educational allowances.

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Item	Original Sample (O)	Sample Mean (M)	Standard Deviation (STDEV	T Statistics (\|O/STDEV\|)	P Values
Workload => work motivation	0.518	0.509	0.137	3.782	0.000
Job satisfaction => work motivation	0.443	0.462	0.234	2.558	0.000
Workload => pharmaceutical quality indicator	0.547	0.561	0.211	2.593	0.010
Job satisfaction => pharmaceutical quality indicator	0.432	0.430	0.223	2.042	000
Work motivation=> pharmaceutical quality indicator	0.693	0.610	0.256	3.870	0.000