Introduction

Employee performance has an important role in the quality (quality) of the hospital. Research �shows that good service performance will affect the quality of service in hospitals.

This is influenced by many factors, including leadership, communication and control systems. If the influencing factors have a good value, it will be able to provide a good value also on improving employee performance, which in turn will be able to improve the quality of service, and vice versa. This applies to any institution, both privately owned and owned by the government, thus encouraging the hospital to conduct a review of various aspects of existing services, in order to determine strategic steps to improve the performance of hospital employees/employees.

Human resources are assets owned by an organization including hospitals that need to be managed effectively in order to provide added value. To manage human resources into organizational assets such as hospitals, effective leadership is needed as well as to improve quality, one of which needs to increase 'leadership' or leadership (Dewi et al., 2022).

Leadership as an indicator of the quality of human resources is a factor that will determine the success of an organization such as a hospital. Likewise, in providing services to the community so that services provided to people in need are obtained quickly and satisfactorily without neglecting the accuracy, thoroughness and assurance of government policy security, the quality of leadership plays a very decisive role (Siagian, 2005). Effective leadership requires the right combination of taskoriented behavior and relationship-oriented behavior, and considers the maturity level of subordinates (Hersey & Blanchard, 1982). Leadership is described as individual behavior when leading a group activity towards a common goal (Al-Sawai, 2013).

The communication system is a very important component for the sustainability and success of an organization. In order to achieve organizational goals, all members of the organization must cooperate with each other (Neves, 2012). Of course, this collaboration can work well, if in the interaction, every member of the organization can be directly involved in the implementation of the communication system (Bass, 1998). An organization consists of communication units in hierarchical relationships between one another and function in an environment (Pace, 2006).

The organizational control system is a series of management activities in the form of supervision, direction and performance appraisal based on employee behavior, meaning that employees are supervised, directed and assessed for their activities, not the output they produce (Baldauf et al., 2001). The organizational control system also plays an important role in improving employee performance. Shows that performance is strongly influenced by the organization's management control system. This control system aims to align employee behavior with organizational goals to be achieved(Widaryanto, 2005), (Noorein Inamdar, 2007).� From the research conducted, there are several problems that need to be solved related to the low performance of hospital employees (Lestari et al., 2020).

An initial interview with the director of RS X stated that there were several problems facing RS X. In several service units, General Hospital X still carries out leadership with an old style and less democratic. This is due to the low educational background of the head of the room in leading his work unit. The attitude and behavior of the hospital leadership also affects the performance of its employees. Leaders are not good at sharing the goals or mission of Hospital X. From the board of directors of Hospital X, there is also a lack of firm action in disciplining its employees. Problems with poor communication and weak control systems are also a source of problems at General Hospital X.

Because of this, in this study the researchers wanted to know and analyze the influence of leadership and communication on the performance of nurses and the control system as an intervening variable at General Hospital X, Tangerang, Banten (Wijaya & Suwandana, 2022). More specifically, the researcher wants to know whether the leadership of the head of the room, communication from the head of the room to nurses, as well as the control system on the performance of nurses at General Hospital X (Mugiono et al., 2020).

Method��

This study uses a cross sectional causality method which aims to determine the effect of variables by analyzing the factors that influence the leadership style by the object of research. The research was conducted with an analytical survey with a comparative quantitative approach using a causality research design with a time dimension of one short study, which is a study to study the dynamics of the correlation between variables including risk and effect by using a data collection approach at the same time.� In this study using a path analysis model because between the independent variable and the dependent variable there is a mediation that affects. In this study, there are 4 variables, namely the independent variable (independent) leadership and communication, control system (mediation) while the dependent (dependent) nurse performance.

Results and Discussion

Univariate Test�

�

Table 1. Matrix Analysis Three Box Method

No	Variable	Average Indeks
1	Leadership	64,0
2	Communication	64,7
3	Control System	63,6
4	Nurse Performance	66,6

Source: Matrix Analysis Three Box Method (2023)

The table 1 above presents respondents' responses to the influence of variables on leadership style, communication, control systems, and nurse performance. The application of leadership style is considered very good by employees. Furthermore, communication is also running optimally applied based on the results of respondents. The control system that runs in the hospital is also very good. The nurse's performance is assessed as quality and has the highest average value compared to the other three variables.

Normality test

Normality test shows that the results of the data provide a skew value between the range of 0.503 to -0.407, it can be concluded that the data is normal.

Covarians Test

The determinant value of the covariance matrix is 6.164 and is far from zero, meaning that there is no multicollinearity and singularity.

Simultaneous Test

The measurement model test is to test the relationship between indicators and variables. The combination of structural and measurement model testing allows researchers to test measurement error as an integral part of AMOS-path analysis and perform factor analysis along with hypothesis testing. In the measurement model test, the Chi-square result is 0.261, this indicates that the first hypothesis (H1) is rejected.

The Coefficient Of Determination Test

Table 2. Test the coefficient of determination

	Estimate
Control System	,427
Nurse Performance	,714

�Source: Test the coefficient of determination (2023)

�The estimate value for the control system variable is 42.7% and the nurse performance variable estimate is 71.4%. In this study, the control system variable was not significantly influenced by leadership and communication styles. From the results of the analysis of determination, it is concluded that the influence of leadership style, communication, and control systems on nurse performance is 71.4%, while the remaining 29.6% is influenced by other factors outside of this study.

Partial Test

Table 3. Partial Test

			Estimate	S.E.	C.R.	P	Label
Leadership	�	Control System	,011	,150	,072	,942	Par_1
Communication	�	Control System	,687	,091	7,517	***	Par_2
Control System	�	Nurse Performance	,784	,078	10,090	***	Par_3
Communication	�	Nurse Performance	,042	,082	,508	,611	Par_4
Leadership	�	Nurse Performance	-,030	,101	-,292	,770	Par_5

Source: Partial Test (2023)

Hypothesis 1 estimates the effect of leadership style on nurse performance 0.030 & has a CR of 0.101 and p-value 0.770> 0.05 then the hypothesis is rejected, meaning that there is no positive and significant influence between leadership style on nurse performance. Hypothesis 2 estimates the influence of leadership style on the control system 0.011 & has a CR of 0.072 and p-value 0.942> 0.05 then the hypothesis is rejected, meaning that there is no positive and significant effect between leadership style on the control system. Hypothesis 3 estimates the effect of communication on nurse performance 0.042 & has a CR of 0.082 and p-value 0.611> 0.05 then the hypothesis is rejected, meaning that there is no positive and significant effect between communication on nurse performance. Hypothesis 4 estimates the effect of communication on the control system 0.687 & has a CR of 7.517 and p-value 0.00 <0.05 then the hypothesis is accepted, meaning that there is a positive and significant effect between communication on the control system. Hypothesis 5 estimates the effect of the control system on the nurse's performance 0.784 & has a CR of 0.078 and a p-value of 0.00 <0.05 then the hypothesis is accepted, meaning that there is a positive and significant effect between the control system on the nurse's performance.

Direct Mediation Test

Table 4. Direct Mediation Test

	Communication	Leadership	Control System
Control System	,654	,006	,000
Nurse Performance	,041	-,018	,818

Source: Direct Mediation Test (2023)

Based on the table above, it is known that the direct effect of the communication variable on the control system is 0.654, the direct effect of the leadership style variable on the control system is 0.006, the direct effect of communication on the nurse's performance is 0.041, the direct influence of the leadership style on the nurse's performance is -0.018, the effect of the control system on the nurse's performance is 0.818 (Pangaribuan & Supriyanto, 2021). The measurement results show that the biggest direct effect is the effect of communication on the control system.

Indirect Mediation Test

Table 5. Indirect Mediation Test

	Communication	Leadership	Control System
Control System	,000	,000	,000
Nurse Performance	,534	,005	,000

�Source: Indirect Mediation Test (2023)

Based on the table above, it is known that the indirect effect of communication on the performance of nurses with the control system as a mediation is 0.534, the indirect effect of leadership style on the performance of nurses with the control system as a mediation is 0.005. The measurement results show that the biggest indirect effect is the effect of communication on the nurse's performance. The structural model of the direct and indirect influence path analysis in this study is presented as follows:

Figure 2. Constelation Research

Based on the path analysis presented, it can be calculated the indirect effect of leadership style on nurse performance with the control system as a mediation, namely 0.01 x 0.78 = 0.0078. So it was concluded that the comparison of the direct influence of the leadership style variable on the nurse's performance and the indirect effect of the leadership style variable on the nurse's performance with the control system as a mediation was 0.0078 > -0.03. This means that there is mediation/intervening, where the control system is able to make the leadership style meaningful to the nurse's performance. The nurse's performance cannot be directly influenced by the leadership style.

Furthermore, the indirect effect of communication on the performance of nurses with the control system as a mediation is 0.69 x 0.78 = 0.5382. The comparison of the direct effect of communication variables on nurse performance and the indirect effect given by communication on nurse performance with the control system as a mediation is 0.5382 > 0.04. This means that there is mediation/intervening, where the control system is able to make communication meaningful to the nurse's performance. The nurse's performance cannot be directly affected by communication (Khairani et al., 2018).

Conclusion

From this research, several conclusions can be drawn including: There is no influence between leadership and nurse performance at General Hospital X, Tangerang, Banten. There is no influence between leadership and control system at General Hospital X, Tangerang, Banten. There is no influence between communication and nurse performance at General Hospital X, Tangerang, Banten. There is a positive and significant influence between communication and control systems at General Hospital X, Tangerang, Banten. There is a positive and significant influence between the control system on the performance of nurses at General Hospital X, Tangerang, Banten. There is no influence between leadership style and communication on the performance of nurses with a control system as a mediation at General Hospital X, Tangerang, Banten.

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Copyright holder:

Yunita Fitri Widiyawati, Hosizah Markam, Rina Mutiara (2023)

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Jurnal Health Sains

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