The Effect of Quality Service Towards Outpatients Satisfaction at Poasia Community Health Centre

The quality of outpatient services can be measured by the SERVQUAL model that considers five dimensions: tangibles, reliability, responsiveness, assurance, and empathy. This study aimed to look at the effect of service quality on outpatient satisfaction at the Poasia community health center's pharmacy. The subjects in this study were 33 outpatients. The analysis technique used is gap analysis to compare patients' expectations and reality, normality test data based on questionnaire patient satisfaction tested for validation. This study's results indicate the average value of the gap in the Poasia community health center's pharmacy, amounting to -0.44. From the value of the gap, the lowest gap value in the pharmacy center of Poasia is the place of service and the provision of inadequate drug information of -0.88. Based on the paired t-test where a significant value >0.05, Ho is rejected, and Ha accepted, which means a significant difference between the quality of service and patients' satisfaction in the Pharmacy of Puskesmas Poasia Kendari City. This study concludes that there is a significant gap between expectations and reality at the Poasia community health center's pharmacy.


INTRODUCTION
Nowadays, health problems have become a basic need for the community. As the standard of living of the community increases, so does the community demand health quality (Kumar & Preetha, 2012;Krieger & Higgins, 2002). They require health service providers such as community health centers or Puskesmas to improve the quality of services better, not only services that are healing diseases but also include services that are preventive (preventive) to improve quality of life and provide satisfaction for consumers as users of health services (Wendimagegn & Bezuidenhout, 2019;Kuntoro & Istiono, 2017;Mayberry et al., 2006). Pharmaceutical service standards are the criteria used as a guide for pharmaceutical personnel in carrying out pharmaceutical services (Bobbins et al., 2020). It must support the community health center's three main functions, namely as a center for promoting health-oriented development, a center for community empowerment, and a first-level health service center that includes individual health services and community health services (Anderson & Sharma, 2020;Martínez-Mardones et al., 2020;Herman & Susyanty, 2012).
Pharmaceutical services are integrated activities to identify, prevent, and resolve drug problems and health (Ministry of Health of the Republic of Indonesia, 2016).
Providing the highest quality service is not easy for the community health center because it involves patients' quality of life so that if an error occurs in medical treatment can harm patients (Mitchell, 2008). Lewis and Booms (1983) define quality or service quality as a measure of how well the level of service provided is consumer expectations. Based on this definition, service quality can be realized by meeting patients' needs and desires and their delivery accuracy to offset patients' expectations. Thus, two main factors affect the quality of service, namely expected services and perceived/perceived services (Widayati et al., 2017;Nadi et al., 2016).
Several dimensions are used to see patient satisfaction at the pharmacy: responsiveness, reliability, empathy, tangible, and assurance (Chusna et al., 2018). The dimension of responsiveness or responsiveness is the staff's ability to help customers and provide services responsively. Reliability is the ability to provide the promised service with immediate, accurate, and satisfactory; empathy or concern is the ease of conducting relationships, good communication, personal attention, and understanding of its customers' needs. The assurance is secured covering ability, courtesy, and trustworthiness owned by staff, is free of risk or doubt; tangibles or physical evidence is a direct manifestation which includes physical facilities, which include the expertise of the equipment used, the condition of the facilities, the condition of human resources (human resources) including the appearance of health teams and the community health center's staffs (Mohebifar et al., 2016). Previous studies showed that dimensions affect the service quality toward patient satisfaction (Mulia, 2017;Hidayah et al., 2019;Lely & Suryati, 2018).
Poasia community health center is one of the community health centers in Kendari City, located in the Poasia District. Services factor provided by the Poasia community health center is considered necessary by patients; thereby, it provides the best service to patients and finds out whether the quality of services provided has met patient expectations. Previous research has been conducted at another community health center in Kendari City but in a different sub-district . Therefore, this study aims to determine the satisfaction of outpatient for pharmacy services at the Poasia community health center. To measure the patient's expectation toward the Poasia community health center's services, the SERVQUAL model was used. The SERVQUAL is a multi-dimensional research instrument used to measure the patient's expectations of services and five dimensions used (Ko & Chou, 2020).
This research was conducted at the Poasia community health center, Kendari, to obtain the dimension that can be improved for further quality of patients' pharmaceutical service, specifically outpatients.

MATERIALS AND METHODS
In this study, the researcher's problem is quality service towards outpatient satisfaction patients at the Poasia community health center, Kendari. The research uses quantitative methods with outpatients as the subject. It was conducted for three months (November 2019 to January 2020). The population of the population is 1,300 patients. Due to the relatively large population, taking a sample to the patient, a total of 33 patients conducted Consecutive Sampling, is random sampling qualified inclusion until the required number of samples is met (Sastroasmoro & Ismael, 2011

Gap analysis
The level of patient satisfaction is explained by using gap analysis. This analysis compares the mean between expectation and reality received by the patient from the service dimension, particularly reliability, responsiveness, assurance, empathy, and tangibles. The highest satisfaction occurs if the reality exceeds expectations (Zun et al., 2018), when the service provided is maximum (4) while the expectation is minimal (1) so that a score of 4 -1 = 3. Conversely, the lowest satisfaction occurs when the service provided is far below expectations, namely when the service provided is minimal (1) while the expectation is maximum (4), so a score of 1-4 = -3 is obtained. The satisfaction range is -3 to 3 so that an interval can be obtained using the formula (Mulyono, 1991): From the interval calculation, the gap classification is obtained as shown in Table I. Meanwhile, if the significance value <0.05, the data is not normally distributed (non-parametric data) and analyzed using the Wilcoxon test (Ghasemi & Zahediasl, 2012).

Paired t-test
This test is conducted to determine whether there are significant differences between the reality and expectations studied to determine whether H0 is rejected or accepted. If the results obtained are significant differences, then H0 is rejected, but if the differences occur are not significant, then H0 is accepted. A paired t-test is carried out if the two data compared are normally distributed or the Wilcoxon test, if at least one of the data compared, is not normally distributed as seen from the value of reality and expectations.

RESULTS AND DISCUSSION
Poasia community health center is located in the Poasia district of Kendari, about 9 km from the Capital of the Province, as shown in Figure 1. The borders of the community health center, as follows: 1. Kendari bay borders the north side 2. Abeli sub-district borders the east side.
3. Moramo sub-district borders the south side.

Tangible
Tangible is the patient's response to physical evidence provided by the health center pharmacy. In Table II, the smallest gap value is about the place of service, and the provision of adequate drug information is -0.88, and the biggest regarding the neat appearance of the pharmacy staff is -0.39 (n = 5). It means that patients are less satisfied with the services provided from the tangible dimension.

Reliability
Reliability shows the ability of pharmacies to carry out services that are reliable and trustworthy. In Table II, the smallest gap value of prescription services that are easy and straightforward is -0.69, and the biggest one regarding the quality of drug packaging received in good condition is -0.39 (n = 4). It means that patients are not satisfied with the services provided by the reliability dimension.

Responsiveness
Responsiveness is the patient's response to the pharmacy staff's willingness to help patients and provide services responsively.

Assurance
Assurance is the patient's response to the pharmacist's knowledge and courtesy to feel confident and trusts when buying drugs. In Table II, the value gap is the smallest of the drug delivered to the patient is in good condition is -0.84, and the greatest of the staff's pharmacies to prepare medications correctly and accurately is -0.39 (n = 4). It means that patients are less satisfied with the services provided by the assurance dimension.

Empathy
Empathy is the patient's response to the personal attention given by the pharmacy staff.   Table II  The quadrant I items are assessments from questionnaires number 5, 6, 8, 9, 10, 14, 17, 20, and 22, where the most assessment is obtained from the dimension of reliability (three out of four). If seen from II I

III IV
the patient's interests, the service is at a high level in this position. However, if seen from the reality, the patient feels a low level, the pharmacist is responsive to the patient's problem, the pharmacist provides the drug immediately with drug information, the pharmacist prepares the medicine correctly and thoroughly, the pharmacy staff listens to the patient complaints and questions, the medicine submitted is in good condition and demands improvement.

Paired t-test
A paired t-test is an analysis involving two measurements on the subject of an influence. Based on the results contained in the t-test, the mean value at the pharmacy is -0.225, as presented in Table IV. It means the satisfaction expected by the patient is less than the desired expectations so that the satisfaction received by the patient is still lacking; the reliability of the pharmacy staff

CONCLUSION
There are differences in respondents' average ratings in assessing the quality of servants with a significant value of 0.000 from the statistical calculation of paired t-test results. Based on these results, there is a gap between the expected service and the services provided for outpatients by the Poasia community health center's pharmacy, Kendari.