EFFECT OF PATIENT SAFETY IMPLEMENTATION AND MARKETING MIX ON OUTPATIENT RE-VISITING INTEREST OF PATIENTS WITH PATIENT TRUST AS AN INTERVENING VARIABLE

The number of hospitals that stand is a necessity of a form of competition in the field of the health industry. this also affects patients in determining the choice of a place for health services. the interest in patient re-visits can be determined by the factors of implementing patient safety and marketing mix. research objectives: this study aims to analyze the effect of the implementation of patient safety and marketing mix on the interest in re-visiting patients in outpatient hospital 'x' with variables intervening patient confidence. research method: quantitative explanatory because it is to know the relationship between variables that are based on the research hypothesis. the samples in this study used the hair formula, namely (5-10) x n. the number of samples is (5) x 36, so 180sampel will be taken. the analysis technique uses structural equation modelling (sem). results of the study: the implementation of patient safety and marketing mix had a significant effect on patient confidence and interest in re-visiting. trust also significantly affects the patient's re-visiting interest. in addition, this study found that patient confidence mediated the effect of applying patient safety and marketing mix on patient re-visiting interest at "x" hospital bekasi.


Introduction
The hospital is experiencing rapid development from year to year. In 2020, there were 2,985 hospitals in Indonesia, consisting of 2,449 general hospitals and 536 special (Siddiqua, 1994). Sustainable business is critical to the success of a competitive hospital (Han & Hyun, 2015). The number of hospitals that stand is an inevitable form of rivalry in the health industry. This also affects patients in determining the choice of place of health care.
Behavior or health efforts are any activity carried out by individuals who want themselves to be healthy, in an effort to prevent diseaseor when detected suffering from a disease. Primary care services provide an entry point into the health system that directly impacts people's well-being and the use of other health care resources. Patient safety has been recognized as a global issue of importance for the past 10 years. Unsafe primary and outpatient care results in greater morbidity, higher use of health services, and economic costs.
Unsafe treatment practices and inaccurate and delayed diagnosis are the most common causes of patient harm affecting millions of patients worldwide. However, most of the work has been focused on hospitalization and very little understanding of what can be done to improve patient safety in primary care (Daker-White et al., 2015). The Effect of Patient Safety Implementation and Marketing Mix On Outpatient Re-Visiting Interest of Patients with Patient Trust as An Intervening Variable provision of safe primary care is a priority because every day millions of people use primary care services around the world, thus providing several potential solutions to reduce patient losses as much as possible (Faujdar et al., 2020). According to, patient safety is an important part of health services in the prevention and reduction of risks, errors and injuries that may occur during service. According to (Kubasiak et al., 2017), patient safety is a system in which hospitals make patient care safer. The system includes risk assessment, identification, and management of matters related to patient risk, incident reporting and analysis, the ability to learn from incidents and their follow-up, and the implementation of solutions to minimize risk. This system is expected to be able to prevent injuries due to mistakes due to taking an action or not doing the action that should be done. One of the goals of patient safety is to reduce the number of patient safety incidents, that is, any accidental cases and conditions that result in preventable injuries to patients, consisting of adverse cases, near-injury cases, noninjured cases, and potential injury cases.
In fact, the safety incidents that occur in the world according to the WHO report occur at the time of surgical procedures (27%), drug administration errors (18.3%) and infection events (HAIS) by 12.2%, In Indonesia, data related to fall patient incidents based on a report from the XII PERSI congress in 2012 showed that the incidence of falling patients was included in the top three hospital medical incidents and ranked second after medicine error. Data from the report shows that as many as 34 cases or equivalent to 14% of falling incidents in hospitals in Indonesia, whereas to realize patient safety, the incidence rate of falling patients should be 0%. This proves that the incidence of falling patients is still high and is still far from the accreditation standard which states that incidents of falling patients are not expected to occur in hospitals or 0% of events (Simamora & Siregar, 2019).
This fact shows that the application of low patient safety will have an impact on the interest in re-visiting patients. The results of studies on the implementation of patient safety to the interest in re-visiting patients have not been found, but several studies have shown that there is a strong correlation between the credibility of services affecting the intention of patient return visits (Sia et al., 2018). The credibility of the service is important because it reflects the quality of health services. For patients, credible services can guarantee their health and safety problems (Tang et al., 2018). To reduce the patient's sense of uncertainty, patients need to have confidence in the performance of the hospital. For management, credible services can show that their marketing efforts have become more cost-effective. This is because it is most likely the reception of messages from the general public. The credibility of the service serves as an important driver for influencing consumer behavior and decision making (Sia et al., 2018). Patients have a preference for such services when conducting the selection process. When the patient trusts the service, it will engage and continue the health service. The credibility of a good service can help a business to stand out from the competition and have a higher income. Therefore, this study focuses on the implementation of patient safety as a predictor in increasing patient return visits, in order to imply that the implementation of patient safety is important in increasing the number of patient return visits in hospitals (Rennke et al., 2013).
Another factor that is considered to be able to influence consumers' interest in returning to use health services is the marketing mix). The role of the marketing mix made by the company is very important for customers. Good and satisfactory quality can make customers interested in making a purchase and eventually generate loyalty and not switch to other products (Havidz & Mahaputra, 2020). The use of the Marketing Mix Model in a sale of goods or services can be useful because marketing managers can be facilitated in assessing the strengths and weaknesses of the products sold so that it has an impact on increasing customer satisfaction and high sales (Londhe, 2014). The results of research by (Luo et al., 2015) found that marketing mixes are biased towards repurchase intentions.
Patient trust as the patient's belief that the doctor will act in the best interest of the patient and will provide appropriate care (Thom & Campbell, 1997). The positive relationship between consumer confidence and repurchase interest has gone through various studies. The studies concluded that in companies engaged in services, consumer confidence is closely related to behavioral decisions. The results of research by (Upamannyu et al., 2015) show that customer trust has a positive effect on repurchase intention. (Şahin et al., 2013) also shows customer trust has a stronger influence on customer intentions/interest in making repurchases, triggering customer loyalty.
Hospital X where to conduct research is a class C hospital surrounded by many companies / factories that use large machines, so it is very prone to accidents due to work, Hospital X which is located on Jalan Raya Narogong 202 Kemang Pratama Bekasi, which is handled by specialist doctors, coupled with emergency room services and supporting services such as pharmacies, Laboratory, Radiology and One Day Care.
Over time, various facilities and supporting equipment continue to be added and equipped. There are demands to provide wider services from the community, currently, the market share of Hospital X is divided by 90% for BPJS and 10% for general patients. Along with the demands of business development, hospitals can no longer only rely on BPJS patient services, because BPJS's profit margins are relatively small, which often harms the hospital.
Hospitals must try to increase the number of patients, especially general patients and also their patients, because it takes an increase in hospital income to survive and develop. Hospital X actually has the potential to benefit because it is strategically located and close to elite housing and is located in front of the highway which is an arterial road access that connects Bekasi City and Bogor as well as Bekasi regency areas such as Cibitung, Cilengsi, Cikarang and Karawang

Research Methods
Research Method is a design of how a study will be carried out. The design is used to obtain answers to the research questions formulated. This research belongs to the type of explanatory that aims to explain the relationship of causality (influence) and test hypotheses, using a quantitative approach and based on the degree of explanatory it is classified in associative research (van Nes & Yamu, 2020). Hypothesis proof is carried out by a survey method that takes samples for research and uses questionnaire-shaped instruments to collect the main data.
This study is to find out the relationship between variables based on previous hypotheses that have been put forward by previous researchers. The relationship between the variables referred to in this study is to determine the effect of the implementation of patient safety and marketing mix on the interest in re-visiting patients with trust as a mediation variable at "X" Hospital Bekasi.

A. Sample and sample retrieval techniques
The measurement scale used in this study is an ordinal scale. The ordinaly ang scale used in this study is the likert scale. The likert scale is an ordinal scale that measures how much the subject agrees or This statistical analysis is used to estimate several regressions that are separate but interconnected simultaneously.

A. Data description
This study is a quantifiable study with data collection using questionnaires that are distributed directly to respondents of general patients (non-BPJS), BPJS patients, JAMKESDA patients and patients Insurance in the on-road unit (Specialist poly and IGD) of 'X' Hospital in Bekasi that meets the sample criteria, namely general patients who have previously been treated at 'X' Hospital in Bekasi are minimized 1x in the last 2 years and make visits in the period January -June 2021. The questionnaire data distributed during the study to as many as 180 copies and returned in a complete state and met the criteria of 180 copies. This meets the minimum requirements of sample calculation. Based on Table 1, it is known the characteristics of respondents from 180 respondents, the majority of respondents are more women than men as many as 105 people (58, 3%). The majority of respondents in the age range of 41-50 years were 94 people (52.2%), with the last education being the high school equivalent of 82 people (45.6%)%). B. Validity Test Results. The validity test was carried out in the early stages of the study for the purposes of pre-test which was carried out in the third week of March by distributing questionnaires to 30 respondents who visited 'X' Hospital in Bekasi, who met the criteria to be able to be used as respondents. In this study, the testing of validity instruments used the SPSS program with the KMO method. A variable that is declared valid and can be further analyzed if it meets the criteria stating that KMO Measure Sampling of Adequacy in the KMO column while greater or equal to 0.5 probability levels (sig) must be less or equal to 5% (0.05). Then to find out whether an item is valid can be seen from the MSA value in the Anti Image Correlation's column. An MSA value above 0.5 indicates that the item is valid and can be further analyzed. C.

D. Reliability Test Results
Reliability test in this study with the alpha cronbach technique. A variable is said to be reliably the alpha value of cronbach>0.60. The results of the validity test with the help of SPSS software are as follows.

E. Hypothesis Test Results
The hypothesis test criteria state that if the t-value is greater than 1.96 or the probability value <level of significant (alpha=5% or 0.05) then it is stated that there is an influence of the independent variable on the dependent variable.
Hypothesis testing can be known through causality tests in the following table.

Conclusion
Results based on research and trust can be said regarding the implementation of patient safety and marketing mix in the face of the interest of patients visiting in the Outpatient Hospital 'X' with patient intervention. 1. The can have a significant effect on patient confidence. This shows that the implementation of high patient safety can have a significant impact on changes in patient confidence 2. The marketing mix has a significant effect on patient confidence. This shows that the low marketing mix carried out by hospitals can have a significant impact on changing patient confidence. 3. The implementation of safety has a significant effect on the interest in returning to the hospital X.This shows that the low application of safety can have a significant impact on changes in the interest in patient return visits.
4. The marketing mix has a significant effect on the interest in returning to patients. This suggests that the low marketing mix by hospitals can have a significant impact on changing patient return visits. 5. Trust has a significant effect on the interest in returning to the patient. This suggests that low patient confidence can have a significant impact on changes in patient return visits 6. Client trust mediates the effect of implementing patient safety on revisits. 7. Patient trust mediates the influence of the marketing mix on interest in revisits BIBLIOGRAFI Daker-White, G., Hays, R., McSharry, J., Giles, S., Cheraghi-Sohi, S., Rhodes, P., & Sanders, C. (2015). Blame the patient, blame the doctor or blame the system? A meta-synthesis of qualitative studies of patient safety in primary care. PloS One, 10 (8)