How to cite:
Simanjuntak, J, P, B., Andry, Wahidi, K, R., (2022 Effect of Patient Safety Implementation and
Marketing Mix On Outpatient Re-Visiting Interest of Patients with Patient Trust as An Intervening
Variable. Jurnal Health Sains 3 (10) http//10.46799/jhs.v3i7.530
E-ISSN:
2723-6927
Published by:
Ridwan Institute
Jurnal Health Sains: p–ISSN: 2723-4339 e-ISSN: 2548-1398
Vol. 3, No. 10, Oktober 2022
EFFECT OF PATIENT SAFETY IMPLEMENTATION AND MARKETING MIX ON
OUTPATIENT RE-VISITING INTEREST OF PATIENTS WITH PATIENT TRUST AS
AN INTERVENING VARIABLE
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi
Universitas Esa Unggul, Jakarta, Indonesia
Email: [email protected], [email protected]om, kemalarita410@gmail.com
ARTIKEL INFO
ABSTRACT
Tanggal Diterima:
02 Oktober 2022
Tanggal Direvisi:
10 Oktober 2022
Tanggal Dipublish:
25 Oktober 2022
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.
Keywords: Marketing Mix;
Trust; Interest in Revisiting;
Implementation of Patient
Safety Goals
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
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1529
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, non-
injured 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
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi
1530 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
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
Effect of Patient Safety Implementation and Marketing Mix On Outpatient Re-Visiting Interest
of Patients with Patient Trust as An Intervening Variable
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1531
disagrees with the questions given by the
researcher. The likert scale has 5 answer
choices, namely: Strongly Disagree,
Disagree, Doubt - Doubt, Agree, and
Strongly Agree (Sugiyono, 2016).
Research instruments
1. Variable Dependen (Y = Interest Of
The Return)
2.Variable Independen (X1 =
Implementation of Patient Safety,
X2 = Mix of marketing)
3. Intervening Variable Instruments (Z
= ConfidencePasien)
B. Data analysis techniques
• Data analysis carried out is a data
quality test and a hypothesis test.
• Test data quality
• Validity test
• Reability test
• Hypothesis test
Testing of the research model was
carried out using Structural Equation
Modelling (SEM) besides that it was
known as analysis of moment structures.
This statistical analysis is used to
estimate several regressions that are
separate but interconnected
simultaneously.
Results and Discussion
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.
Table 1
Distribution of Respondent Characteristics
No.
Characteristic
Category
Percentage (%)
1
Types of
gender
Man
41,7
Woman
58,3
2
Age
21-30 years
9,4
31-40 years
13,9
41-50 years
52,2
> 50 years
24,4
3
Education
Primery School
7,2
Junior High
School
12,8
Senior High
School
45,6
College
23,3
No School
11,1
Source: Primary Data, 2022.
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi
1532 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
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.
Table 2
Reliability Test Results
Variable
The Value of
Cronbach's
Alpha
N of
item
Critical
Value
Information
Implementation of Patient
Safety
0.874
15
0,60
Reliable
Marketing Mix
0.895
12
0,60
Reliable
Patient Trust
0.897
6
0,60
Reliable
Re-Visit Interest
0,754
3
0,60
Reliable
Source: Primary Data, 2022
Based on Table 22, it is known that the value
of Cronbach's Alpha variable for The
Implementation of Patient Safety Targets is
0.874, variable Marketing Mix was 0.895, and
the Patient Trust variable was 0.897, and
the Re-Visit Interest variable was 0.754. By
demkikian it can be concluded thatall the
statements items of all variables are declared
reliable because the value of Cronbach's
Alpha> 0.60, so the data is obtained later can
be continued as viable research data.
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.
Effect of Patient Safety Implementation and Marketing Mix On Outpatient Re-Visiting Interest
of Patients with Patient Trust as An Intervening Variable
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1533
Hypothesis testing can be known through
causality tests in the following table.
Table 3
Direct and Indirect Relationship Test Results
Hypothesis
Relationship
Standardization
coefficient
Error
standards
t-
Value
t-
table
Decision
H
1
PKP → KP
0,24
0,070
3,51
>1.96
H
1
Accepted
H
2
BP → KP
0,62
0,081
7,63
>1.96
H
2
Accepted
H
3
PKP →
MKU
0,07
0,037
2,09
>1.96
H
3
Accepted
H
4
BP → MKU
0,17
0,049
3,42
>1.96
H
4
Accepted
H
5
KP → MKU
0,80
0,072
11,11
>1.96
H
5
Accepted
H
6
PKP →
KP→ MKU
0,20
0,058
3,27
>1.96
H
6
Accepted
H
7
BP → KP→
MKU
0,49
0,07
6,30
>1.96
H
7
Accepted
Source: Primary Data, 2022.
Information:
PKP : Implementation of Patient Safety
BP : Marketing Mix
KP : Patient Trust
MKU : Interest in Revisiting
F. Respondent Answer Index Analysis
This analysis of the answer index per
variable aims to find out a descriptive
picture of the answers to the question items
posed to the respondents. The scoring
technique used in this study was to follow
the scale range of each variable. Data
Analysis
Data analysis in this study used
Structural Equation Modeling (SEM) with
the help of Lisrel 8.80 software. There are
several stages of analysis, namely:
Confirmatory Factor Analysis (CFA) Test,
Overall Model Match Test, Structural
Model Match Test, Hypothesis Test.
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.
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi
1534 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
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 re-
visits.
7. Patient trust mediates the influence of
the marketing mix on interest in re-
visits
Effect of Patient Safety Implementation and Marketing Mix On Outpatient Re-Visiting Interest
of Patients with Patient Trust as An Intervening Variable
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1535
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),
e0128329.Google Scholar
Faujdar, S. S., Kumar, S., Mehrishi, P.,
Solanki, S., Sharma, A., & Verma, S.
(2020). Hand hygiene knowledge,
attitude, practice and hand microflora
analysis of staff nurses in a rural
tertiary care hospital. Journal of
Family Medicine and Primary Care,
9(9), 4969. Google Scholar
Han, H., & Hyun, S. S. (2015). Customer
retention in the medical tourism
industry: Impact of quality,
satisfaction, trust, and price
reasonableness. Tourism
Management, 46, 20–29. Google
Scholar
Havidz, H. B. H., & Mahaputra, M. R.
(2020). Brand image and purchasing
decision: Analysis of price perception
and promotion (literature review of
marketing management). Dinasti
International Journal of Economics,
Finance & Accounting, 1(4), 727–
741. Google Scholar
Kubasiak, J. C., Francescatti, A. B., Behal,
R., & Myers, J. A. (2017). Patient
Safety Indicators for judging hospital
performance: Still not ready for prime
time. American Journal of Medical
Quality, 32(2), 129–133. Google
Scholar
Londhe, B. R. (2014). Marketing mix for
next generation marketing. Procedia
Economics and Finance, 11, 335–
340. Google Scholar
Luo, A., Roach, S., & Jiratchot, C. (2015).
The effect of the 7Ps of the marketing
mix on air freight customer
satisfaction and repurchase intention.
Google Scholar
Rennke, S., Nguyen, O. K., Shoeb, M. H.,
Magan, Y., Wachter, R. M., & Ranji,
S. R. (2013). Hospital-initiated
transitional care interventions as a
patient safety strategy: a systematic
review. Annals of Internal Medicine,
158(5_Part_2), 433–440. Google
Scholar
Şahin, İ. E., Yılmaz, B., & Akgün, A.
(2013). Measurement of efficiency in
the Turkish banking sector in the
2009-2011 period: A DEA approach.
Mediterranean Journal of Social
Sciences, 4(10), 744. Google Scholar
Sia, C. Y., Lai, K. P., Noor, M. N. M.,
Ismail, H. Bin, Tong, D. Y. K., &
Yuen, Y. Y. (2018). The Influence Of
Hospital Service Credibility On
Patients’revisit Intention. Turk
Online J Des Art Commun-TOJDAC,
1315–1321. Google Scholar
Siddiqua, B. A. (1994). Development of
the Law of Evidence in Pakistan and
Bangladesh With Special Reference
to Witness Testimony. University of
London, School of Oriental and
African Studies (United Kingdom).
Google Scholar
Simamora, R. H., & Siregar, C. T. (2019).
Knowledge of Nurses about
Prevention of Patient Fall Risk in
Inpatient Room of Private Hospital in
Medan. Indian Journal of Public
Health Research & Development,
10(10). Google Scholar
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi
1536 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
Tang, W., Ren, J., & Zhang, Y. (2018).
Enabling trusted and privacy-
preserving healthcare services in
social media health networks. IEEE
Transactions on Multimedia, 21(3),
579–590. Google Scholar
Thom, D. H., & Campbell, B. (1997).
Fotlg INALRESEARCH patient-
physician trust: an exploratory study.
J Fam Pract, 44(2), 169. Google
Scholar
Upamannyu, N. K., Gulati, C., Chack, A.,
& Kaur, G. (2015). The effect of
customer trust on customer loyalty
and repurchase intention: The
moderating influence of perceived
CSR. International Journal of
Research in IT, Management and
Engineering, 5(4), 1–31. Google
Scholar
van Nes, A., & Yamu, C. (2020).
Exploring challenges in space syntax
theory building: The use of positivist
and hermeneutic explanatory models.
Sustainability, 12(17), 7133. Google
Scholar
.
Copyright holder:
Jhon Perry B Simanjuntak, Andry, Kemala Rita Wahidi (2022)
First publication right:
Jurnal Health Sains
This article is licensed under: