CC BY
1
UDC 331; DOI 10.18551/rjoas.2023-11.04
THE ROLE OF HOSPITAL IMAGE MEDIATES EFFECT OF THE BENEFITS OF CORPORATE SOCIAL RESPONSIBILITY ACTIVITIES AND SERVICE QUALITY
ON PATIENT SATISFACTION
Sari Ketut Dewi Kurnia*, Piartrini Putu Saroyini, Suasana I G.A.K.G.,
Sukaatmadja I Putu Gde
Faculty of Economics and Business, University of Udayana, Bali, Indonesia *E-mail: dewikurniaaaaaa11@gmail.com
ABSTRACT
The development of health in the service sector has penetrated various fields, one of which is medical or health services. Services are patient-oriented because the measure of perceived quality does not lie in the size of the health service provider but lies in the patient's self-satisfaction. Measuring the level of customer satisfaction is an important element in providing better, more efficient, and more effective services. This research uses a quantitative approach by collecting primary data through questionnaires distributed to 240 respondents who are patients who provide services at the RSUD Bali Mandara. The sampling method uses nonprobability sampling with the Purposive Sampling method. This research uses the Structural Equation Model (SEM) with a Partial Least Squares (PLS) approach to test the relationship between the variables studied. The results of the analysis show that the variables of corporate social responsibility and service quality have a positive and significant effect on patient satisfaction. The corporate social responsibility variable has a positive and significant effect on the hospital image. The service quality variable has a positive and significant effect on the hospital image. The hospital image has a positive and significant effect on patient satisfaction. Hospital image is able to mediate the influence between corporate social responsibility and service quality on patient satisfaction.
KEY WORDS
Patient satisfaction, corporate social responsibility, service quality, hospital image.
Hossain et al., (2020) said that the development of health in the service sector has penetrated various fields, one of which is medical or health services. The hospital industry as a form of medical service provider is one form of health facilities and infrastructure organized by the government and society that functions to carry out health efforts (Carlin, 2016).
According to Al Damen (2017), patient satisfaction is the level of conformity between patient expectations of ideal care and their perceptions of the actual care they receive. Librianty (2018) said that measuring the level of customer satisfaction is an important element in providing better, more efficient and more effective services. National standards for patient satisfaction with health services are set by the Ministry of Health. Regulation of the Ministry of Health of the Republic of Indonesia in 2016 on minimum service standards for patient satisfaction is above 95 percent (Ministry of Health of the Republic of Indonesia, 2016). If the level of patient satisfaction with health services is below the 95 percent standard, then the service is considered not of high quality and the services provided to patients do not meet the minimum standards (Istiana et al., 2019).
The Bali Mandara regional general hospital (RSUD) is one of the Bali provincial government hospitals with class B type. Modernization of communications technology is a means of assessing the quality of hospital services. Bali Mandara Hospital has a Google review site written directly by patients about their satisfaction after visiting. of these reviews, there were 660 reviewers with 1-star reviews (the lowest rating) being the second highest. Several negative reviews stated that they were not satisfied with the hospital services provided. Regarding the infrastructure provided, they complained about long queues, lack of professionalism of nurses and doctors. Oliver (2022) said Google reviews can be a way to show customer responses regarding details of the services offered. Negative reviews show
that several service elements have not met the expectations of service users. When their expectations have not been achieved, it can be said that service user satisfaction has not been achieved.
Bali Mandara Hospital is required to always maintain service quality so that patient satisfaction increases. There is a program to improve health services at the Bali Mandara Regional Hospital. The following are the achievements of Bali Mandara Hospital service performance indicators in 2021:
Table 1 - Performance of Health Services at Bali Mandara Hospital in 2021
Program Unit Achievements Target Realization — Information
BOR (Bed Occupancy Ratio) percent 60-85 44,74 Not yet ideal
LOS (Average Length of Stay) days 6-9 7,17 Ideal
TOI (Turn Over Interval) days 1-3 7,68 Not yet ideal
BTO (Bed Turn Over) times 40-50 26,26 Not yet ideal
NDR (Net Death Rate) permil Less than 25 permil 49 Not yet ideal
GDR (Gross Death Rate) permil Less than 45 permil 57 Not yet ideal
Source: RSUD Bali Mandara, 2022.
Based on Table 1, the achievement of service performance indicators at Bali Mandara Hospital in 2021 shows that there are five health service performances that are classified as not yet ideal. Health service outcomes that are not yet ideal can cause patient satisfaction to decrease. It is said that when the BOR is not ideal, then facility utilization is low and this can result in low patient satisfaction.
CSR (Corporate Social Responsibility) is one of the programs implemented by Bali Mandara Regional Hospital in addition to optimizing service quality to increase patient satisfaction. The CSR program is one of the obligations that must be carried out by companies and government agencies and must be carried out in accordance with CSR principles themselves (Fitriani and Astuti, 2021). CSR activities at Bali Mandara Hospital have been carried out since 2017, when this program was previously called the healthy community movement. Apart from collecting funds from voluntary assistance, Bali Mandara Hospital employees provide opportunities by inviting private donors, communities and foundations to raise funds. Apart from that, the CSR activities carried out are providing education about health information for patients who are visiting the Bali Mandara Regional Hospital, donating hand sanitizers to all communities around Sanur, providing free swabs, providing counseling and carrying out blood donation activities for hospital employees and these activities can shape perceptions in the minds of the public.
Table 2 - Pre-survey of people who have visited Bali Mandara Regional Hospital
Statement Yes (people) No (people)
Bali Mandara Regional Hospital provides informative health service counseling 28 2
Bali Mandara Regional Hospital carries out social activities 13 17
Bali Mandara Hospital has good service facilities 23 7
I would recommend RSUD Bali Mandara to close relatives 13 17
Source: Data processed, 2023.
Based on Table 2, the pre-survey results show that as many as 28 people felt that the Bali Mandara Regional Hospital provided informative health service outreach to patients and the surrounding community. This activity was aimed at increasing health information to the community. A total of 13 people felt the benefits of the Bali Mandara Regional Hospital's activities from free examinations and carrying out social activities such as providing health facilities such as masks and hand sanitizer, but 17 people felt the opposite. The activity of providing masks and visiting orphanages is a form of the hospital's concern and responsibility for the health and environment of the community around the hospital. Furthermore, 23 out of 30 people felt that the service facilities at Bali Mandara Regional Hospital were good, such as fast registration, BPJS services, 24 hour emergency services,
availability of ambulances. 25 people said that they would come to RSBM again as one of their hospitals of choice to meet their health needs. The results of this pre-survey show that the community feels the benefits of CSR activities such as counseling and social activities because they receive health information to improve the health standard of people's lives.
As a result of interviews with 10 patients who were waiting and undergoing outpatient treatment at the Bali Mandara Regional Hospital polyclinic, there were several patient statements that described their perceptions about the Bali Mandara Regional Hospital. 10 patients who were in the waiting room of the polyclinic said that the public felt that the counseling and sharing of health information was very informative because it could provide health knowledge that the public had not previously known. An overview of the five most popular patient opinions about RSUD Bali Mandara, namely government hospitals, hospitals that have clean, well-maintained buildings, hospitals that are strategically located, new hospitals, hospitals that have fairly complete equipment. Patients also feel that Bali Mandara Regional Hospital is one of the clean government hospitals and has superior medical checkup services with fast results.
Kotler (2017) said that service quality is the expected level of excellence and control over this level of excellence to fulfill customer desires. When the service received exceeds expectations, the service quality is perceived as ideal quality. Conversely, if the service received is lower than expected, then the perceived service quality is poor. Several researchers were found to show inconsistent results, and this is also one of the research gaps. Researchers Alrubaiee et al., (2017), Sanjaya and Yasa (2018), Lubis (2018), and Yulita and Hidajat (2020) show that service quality influences patient satisfaction.
The presence of CSR in health services is seen as an instrument capable of providing competitive advantage (Fyall et al., 2019). According to Hur and Kim (2017), this has been done to support the argument of the influence of CSR on customer satisfaction and shows the opposite results. According to Perez and Bosque (2017), CSR activity initiatives strengthen and positively influence customer citizenship behavior, customer satisfaction, employee involvement and trust, word of mouth intentions and customer loyalty, only when CSR initiatives are communicated to the general public, however, this differs from Kim's research. et al., (2017) said that CSR does not directly affect customer satisfaction (Kim et al., 2017).
LITERATURE REVIEW AND HYPOTHESES DEVELOPMENT
Corporate social responsibility (CSR) covers every social and environmental activity in ensuring the progress of services (Visser, 2014). According to Perez and Bosque (2017) CSR activity initiatives strengthen and positively influence customer citizenship behavior, customer satisfaction, employee engagement and trust, word of mouth intentions and customer loyalty. According to Hossain et al., (2020) growing patient satisfaction in corporate social responsibility practices is not only about looking after patients over time, but also building relationships with patients for sustainable corporate social responsibility health care practices in the future. Therefore, if an organization engages in ethical activities such as corporate social responsibility initiatives, its customers will feel more satisfied and more loyal (Reza et al., 2020)
There are different results in research conducted by Kim et al., (2017) which states that CSR does not directly influence customer satisfaction. Similarly, research by Robinson and Wood (2018) found that company involvement in corporate social responsibility activities reduces consumer perceptions which have a negative impact on consumer responses to the organization, which can lead to consumer dissatisfaction.
H1: The benefits of corporate social responsibility activities have a positive and significant effect on patient satisfaction.
Jandavath and Byram's (2016) research shows that service quality influences patient satisfaction. Lee and Kim (2017), Abrar et al., (2020), Lai et al., (2020) show that service quality influences patient satisfaction. Ahmed et al., (2017) argue that the services provided by hospital staff affect patients, family and friends. Any misjudgment or mistake can have
fatal consequences. The quality of the organization's services always meets external and internal needs, desires and expectations of clients/consumers in order to fulfill personal desires. Good service quality always leads to high customer satisfaction. Batra and Taneja (2021) argue perceived service quality and satisfaction are somewhat related concepts because they both reflect the possible outcomes of a customer's exposure to stimuli in a particular environment. However, this is different from the research results of Safavi (2021), which states that service quality has no partial effect on consumer satisfaction.
H2: Service quality has a positive and significant effect on patient satisfaction.
Lubis' research (2017) states that corporate social responsibility has also helped shape the company's image. The social environment is sensitive to corporate social responsibility practices, so corporate social responsibility actions, no matter how small, can improve the company's image. Thus, companies must realize that corporate social responsibility will not do anything unless society perceives it well while improving the company's image in the minds of the public.
According to research by Siripipatthanakul (2021), corporate social responsibility felt by patients has a more critical influence on the brand image of private dental clinics.
H3: The benefits of corporate social responsibility activities have a positive and significant effect on the hospital's image.
Sektiyaningsih's research (2019) states that service quality has a positive and significant effect on the hospital's image. Based on the results of this research, it proves that the quality of service has an impact on the good image of the hospital. If the quality of service increases, the image of the hospital will also improve. Akob et al., (2021) said that the relationship between service quality and hospital image has the strongest demonstration relationship. Service quality is also a reason that shapes consumer perceptions of increased rationalization and strong customer (patient) decision making.
H4: Service quality influences hospital image.
Sukawati (2021) shows that hospital image has a positive and significant effect on patient satisfaction. The results of this study recommend that hospital management continue to improve its image by providing good service, so that patient satisfaction is maintained. The results of the same assessment conducted by Espinosa et al., (2018) are said to suggest that repeat customers' brand image positively influences overall satisfaction. According to research by Citra et al., (2021), hospital image has a significant influence on increasing patient satisfaction, where the higher the hospital image, especially within the scope of hospitals in the area, it will be able to increase patient satisfaction.
H5: Hospital image has a positive and significant effect on patient satisfaction.
As research conducted by Lubis et al., (2017) states that CSR has a high influence on a hospital's image. It was found that there would be a greater chance of improving the hospital's image as long as it carried out CSR actions. Good CSR practices will increase the value of hospitals in the long term because they will practically increase effectiveness and efficiency in service delivery. Basalamah et al., (2021) said a good image will increase customer satisfaction, service quality, return intention and loyalty.
According to Hossain et al., (2020) growing patient satisfaction in corporate social responsibility practices is not only about looking after patients over time, but also building relationships with patients for sustainable corporate social responsibility health care practices in the future. The social environment is sensitive to corporate social responsibility practices, so corporate social responsibility actions, no matter how small, can improve the image.
H6: Hospital image is able to significantly mediate the influence of the benefits of corporate social responsibility activities on patient satisfaction.
The importance of providing health services in a timely manner, so that it can increase customer satisfaction, which ultimately creates a positive image. Afwan and Santosa (2019) stated that service quality has a positive effect on brand image, so a company that wants to improve its brand image must focus on improving good service quality.
Sektiyaningsih's research (2019) states that service quality has a positive and significant effect on the hospital's image. According to Batra and Taneja (2021) perceived
service quality and satisfaction are somewhat related concepts because they both reflect the possible outcomes of a customer's exposure to stimuli in a particular environment.
H7: Hospital image is able to significantly mediate the influence of service quality on patient satisfaction.
METHODS OF RESEARCH
This research was carried out at the Bali Mandara Hospital, Bali Province, which is located on Jalan Bypass Ngurah Rai Number 548 Denpasar, precisely in Sanur Kauh Village, South Denpasar District. This location was chosen as the research location because it is one of the Bali provincial government hospitals which is 6 years old. The population of this study were domestic patients who received services/had experience of treatment at Bali Mandara Regional Hospital. The sampling technique used in this research is non-probability sampling, namely the purposive sampling method. Purposive sampling is a technique for determining samples with certain considerations. The criteria used in selecting respondents:
• Have received medical services at least once in the last 3 months;
• The minimum age of the respondent is 18 years with the assumption that the respondent is in the early adulthood category. According to Septiantari (2020), 18 years old is considered an adult so he can understand information and understand the consequences of decisions taken.
The sample size that is considered representative is 5-10 times the number of indicators (Hair et al., 2014). The number of indicators in this study was 24 items, so the sample size ranged from 120-240 respondents. Based on these considerations, the sample size for the study was set at 240 respondents.
The research data collection method was carried out using a survey method using a questionnaire. The questionnaire is in the form of a Google form which is distributed directly to domestic patients or those accompanying these patients who are providing services at the Bali Mandara Regional Hospital. Data is measured using a Likert Scale, Sugiyono (2018) explains that the Likert scale uses a scale of 1-5 with the information on scale 1 being strongly disagree and scale 5 being strongly agree. Before distributing the questionnaire, the questionnaire is first evaluated by validity and reliability test. In this research, the inferential statistics used are PLS-based SEM analysis.
RESULTS AND DISCUSSION
The respondents used in this study were 240 domestic patients who visited and received services at Bali Mandara Hospital.
Table 3 shows data on respondents' characteristics which include gender, age, highest level of education and type of job, so it can be described as follows:
a) Based on gender, 52.9 percent of respondents were female and 47.1 percent of respondents were male. This shows that the majority of domestic patients at Bali Mandara Regional Hospital are female;
b) Based on age, 10 percent of respondents aged 20-25 years, 14.6 percent aged 2631 years, 30.4 percent aged 32-37 years, 25 percent aged 38-43 years and aged > 44 year by 20 percent. This shows that as a person ages, the need for health services will increase due to a decrease in organ function;
c) Based on the latest education, 15.4 percent of respondents had a high school education, 38.7 percent had a diploma, 43.7 percent had a bachelor's degree, and 2.2 percent had a master degree. This shows that the majority of Bali Mandara Regional Hospital patients have a bachelor's degree (S1), so they pay more attention to the need for health services;
d) Based on type of job, 10.5 percent of respondents worked as students, 32.9 percent as private employees, 40.8 percent as civil servants, 10.4 percent as entrepreneurs, and 5.5 percent as others. This shows that the majority of patients at Bali Mandara Hospital are civil
servants, which means that many people are referred to Bali Mandara Hospital because of the health insurance they already have.
Table 3 - Respondent Characteristics
No Characteristics Number of Respondents Percentage
1 Based on Gender Female Male Total 127 113 240 52,9% 47,1% 100%
2. Based on Age 20-25 years old 26-31 years old 32-37 years old 38-43 years old >44 years old Total 24 35 73 60 48 240 10% 14,6% 30,4% 25% 20% 100%
3. Based on Latest Education Senior High School Diploma Bachelor Degree Master Degree Total 37 93 105 5 240 15,4 38,7 43,7 2,2 100%
4. Based on Job Students Private employees Civil servants Entrepreneurs Others Total 25 79 98 25 13 240 10,5 32,9 40,8 10,4 5,5 100%
Source: Data processed, 2023.
Table 4 - Results of Convergent Validity
Variable Indicator Outer Loading
X1.1 0.864
Corporate Social Responsibility (X1) X1.2 0.898
X1.3 0.880
X2..1.1 0.780
X2.1.2 0.716
X2.1.3 0.821
X2.2.1 0.846
X2.2.2 0.881
X2.2.3 0.847
Service Quality (X2) X2.3.1 0.838
X2.3.2 0.799
X2.3.3 0.867
X2.4.1 0.838
X2.4.2 0.833
X2.4.3 0.805
X2.5.1 0.799
X2.5.2 0.774
X2.5.3 0.734
M1.1 0.883
Hospital Image (M) M1.2 0.939
M1.3 0.890
Y1 0.895
Patient Satisfaction (Y) Y.2 0.918
Y.3 0.877
Source: Data processed, 2023.
The inferential statistical analysis used in this research is Structural Equation Modeling based on Partial Least Square (SEM-PLS) or SEM with PLS. This evaluation aims to validate
the model and test the reliability of each construct in accordance with empirical studies and theory. There are three criteria for evaluating the outer model using smart PLS, namely: convergent validity, discriminant validity and composite reliability. The following are the results of inferential statistical analysis in this research:
Outer model evaluation is also called measurement model evaluation which is used to assess the validity and reliability of the model. Indicator criteria are measured by convergent validity, discriminant validity and average variance extracted (AVE), while reliability is measured by composite reliability.
The Covergent validity test is used to describe the correlation of constructs with their indicators. Individual indicators are considered reliable if they have a correlation above 0.70. The results of the Covergent validity test are presented in the model as seen in Table 4.
Outer loading describes how much the dimensions and indicators are related to the variables. Based on Table 4, the outer loading value shows that all indicators have a value above 0.70, thus it can be concluded that all dimensions and indicators used in this research are valid.
Discriminant Validity of the reflective measurement model, indicators are assessed based on the cross loading of the measurement with the construct. If the cross loading value of each indicator of the variable in question is greater than the cross loading of other variables, then the indicator is said to be valid. The following are the results of the discriminant validity test:
Table 5 - Results of Cross Loading
Indicator M1 X1 X2 Y1
M1.1 0.883 0.620 0.667 0.632
M1.2 0.939 0.645 0.716 0.686
M1.3 0.890 0.634 0.697 0.652
X1.1 0.570 0.864 0.698 0.597
X1.2 0.615 0.898 0.647 0.630
X1.3 0.658 0.880 0.699 0.700
X2.1.1 0.624 0.645 0.780 0.635
X2.1.2 0.500 0.604 0.716 0.529
X2.1.3 0.620 0.668 0.821 0.625
X2.2.1 0.660 0.656 0.846 0.631
X2.2.2 0.672 0.682 0.881 0.623
X2.2.3 0.662 0.629 0.847 0.662
X2.3.1 0.684 0.609 0.838 0.687
X2.3.2 0.591 0.583 0.799 0.588
X2.3.3 0.651 0.654 0.867 0.616
X2.4.1 0.684 0.633 0.838 0.618
X2.4.2 0.635 0.662 0.833 0.631
X2.4.3 0.616 0.658 0.805 0.597
X2.5.1 0.595 0.613 0.799 0.565
X2.5.2 0.586 0.598 0.774 0.594
X2.5.3 0.541 0.535 0.734 0.606
Y1.1 0.662 0.660 0.686 0.895
Y1.2 0.711 0.706 0.716 0.918
Y1.3 0.573 0.597 0.627 0.877
Source: Data processed, 2023.
Based on Table 5 above, it explains that there is very good discriminant validity. It can be seen that the cross loading value of each indicator of the variable is greater than the cross loading of other variables, so it can be stated that the discriminant validity data using cross loading in this research is valid.
Another method for assessing discriminant validity is by using the Fornell-Larcker criterion approach. The Fornell-Larcker Criterion approach compares the average variance extracted (AVE) with the correlation between latent variables or constructs. Specifically, the AVE of each construct should be higher than the correlation with other constructs.
Table 6 shows that in the Fornell-Larcker criterion approach the root of the AVE value is higher compared to other constructs. This can be stated that the discriminant validity data using the Fornell-Larcker criterion approach in this research is declared valid.
Table 6 - Results of Fornell-Larcker Criterion
Variable Mi Xi X2 Yi
Mi 0.904
X! 0.700 0.881
X2 0.767 0.773 0.8i3
Yi 0.727 0.732 0.756 0.897
Source: Data processed, 2023.
Composite reliability is a reliability test on the outer model. The criteria measured in this test are composite reliability and Cronbach's alpha value of the indicators that measure the variables. A reliable variable is a variable that has a composite reliability value > 0.7 with a Cronbach's alpha value > 0.60. The composite reliability test results are presented in Table 7.
Table 7 - Results of Composite Reliability
Variable Cronbach's Alpha Composite Reliability Information
Mi 0.882 0.93i Reliable
Xi 0.757 0.9i2 Reliable
X2 0.963 0.967 Reliable
Yi 0.844 0.925 Reliable
Source: Data processed, 2023.
Based on Table 7, it shows that the value of Cronbach's alpha and composite reliability for all constructs has a value of more than 0.7, thus the research construct is reliable.
The R-square value is used to find out how big (percent) the influence of the exogenous variable is on the endogenous variable, the range of R-square values is 0-1, if the R-square value is close to zero, the weaker the influence of the exogenous variable is on the endogenous variable, conversely, if it is close to one then, the stronger the influence of exogenous variables on endogenous variables. The variable R-square value can be seen in Table 8.
Table 8 - Results of R-square
Variable R Square
Hospital Image 0.6i3
Patient Satisfaction 0.652
Source: Data processed, 2023.
Table 8 shows that the R-square value for the hospital image variable is 0.613, which means that this research model is moderate or 61.3 percent of the hospital image variable is influenced by corporate social responsibility activities and service quality and the remaining 38.7 percent is influenced by constructs outside the model. The R-square value of the Patient Satisfaction variable is 0.652, which means this model is strong or 65.2 percent of the patient satisfaction variable is influenced by corporate social responsibility activities and service quality and the remaining 34.8 percent is influenced by other constructs that are not included in the model.
Inner model testing is carried out by looking at the Q-square value which is a goodness of fit model test. If the Q-square value is greater than zero (0), it shows that the model has a predictive relevance value, while the Q-square is less than zero, then it shows that the model lacks predictive relevance. If the calculation results show a Q-square value of more than zero, then the model can be said to have relevant predictive value.
The calculation of the Q-square value can be seen as follows:
Q2 = 1 - (1-R2) (1-R2) = 0.867
The Q2 value obtained in this study was 0.867 or 86.7 percent, thus it can be concluded that the model in this study has a relevant predictive value because it can explain the information in this study. The value results from Q2 show that 86.7 percent of the variation in patient satisfaction is influenced by the variables corporate social responsibility, service quality and hospital image, while 13.3 percent is influenced by other variables outside the research model.
Testing the direct influence hypothesis in this research is using Partial Least Square (PLS). Hypothesis testing aims to find out how much influence the independent variable has on the dependent variable. Significance values can be obtained using bootstrapping techniques. The statistical test used to test the hypothesis is the t test on each path of influence between variables.
Table 9 - Results of Direct Effect (Path Coefficients)
Original Sample T Statistics
Variable (O) (|O/STDEV|) P Values
Hospital Image -> Patient Satisfaction 0.280 3.070 0.003
Corporate Social Responsibility -> Hospital Image 0.265 3.200 0.003
Corporate Social Responsibility -> Patient
Satisfaction 0.292 3.169 0.000
Service Quality -> Hospital Image 0.562 6.813 0.000
Service Quality -> Patient Satisfaction 0.316 3.970 0.000
Source: Data processed, 2023.
Based on testing the direct influence in table 9 above, it can be seen that:
1) Hypothesis 1 on the Corporate Social Responsibility variable on patient satisfaction has a t-statistic value of 3.169 (3.169 > 1.96) and a p-value of 0.000 (0.000 < 0.05), so the hypothesis is accepted. These results indicate that there is a direct influence between Corporate Social Responsibility on patient satisfaction. This shows that the more benefits the corporate social responsibility activities carried out by Bali Mandara Hospital are felt, the higher the patient satisfaction will be;
2) Hypothesis 2 on the service quality variable on patient satisfaction has a t-statistic value of 3,970 (3,970 > 1.96) and a p-value of 0.000 (0.000 < 0.05), so the hypothesis is accepted. These results indicate that there is a direct influence between service quality and patient satisfaction. This shows that the better the quality of service provided by Bali Mandara Hospital, the higher the patient satisfaction;
3) Hypothesis 3 on the Corporate Social Responsibility variable for hospital image has a t-statistic value of 3,200 (3,200 > 1.96) and a p-value of 0.003 (0.003 < 0.05), so the hypothesis is accepted. These results indicate that there is a direct influence between Corporate Social Responsibility on the hospital's image. This shows that the more benefits the corporate social responsibility activities carried out by Bali Mandara Hospital are felt, the better the hospital's image will be;
4) Hypothesis 4 on the service quality variable on hospital image has a t-statistic value of 6,813 (6,813 > 1.96) and a p-value of 0.000 (0.000 < 0.05), so the hypothesis is accepted. These results indicate that there is a direct influence between service quality and hospital image. This shows that the better the quality of service provided by Bali Mandara Hospital, the better the image of the hospital;
5) Hypothesis 5 on the hospital image variable on patient satisfaction has a t-statistic value of 3,070 (3,070 > 1.96) and a p-value of 0.003 (0.003 < 0.05), so the hypothesis is accepted. These results indicate that there is a direct influence between hospital image and patient satisfaction. This shows that the image of RSUD Bali is getting better.
Table 10 - Results of Indirect Effect (Specific Indirect Effect)
Variable
Original Sample Standard
Sample (O) Mean (M) Deviation (STDEV)
T Statistics
(\O/STDEV\) P Values
Corporate social responsibility -> hospital image -> Patient satisfaction Service quality -> hospital image -> patient satisfaction_
0.074 0.079 0.038
0.157
0.160
0.059
2.667
1.994 0.049
0.008
Source: Data processed, 2023.
Apart from the direct influence, this research also examines the indirect influence of corporate social responsibility and service quality on patient satisfaction which is mediated by the hospital's image. The results of the indirect effect test are presented in Table 10.
Based on Table 10, the results of the indirect influence between variables are as follows:
1) Corporate Social Responsibility towards patient satisfaction through hospital image obtained a correlation value of 0.074 with t-statistic 1.994 > 1.96 and P-value 0.049 < 0.005, thus there is an indirect influence between Corporate Social Responsibility on patient satisfaction through hospital image declared significant;
2) Service quality on patient satisfaction through hospital image obtained a correlation value of 0.157 with t-statistic 2.667 > 1.96 and P-value 0.008 < 0.005, thus the indirect influence between service quality on patient satisfaction through hospital image was declared significant.
The effect of the benefits of corporate social responsibility activities on patient satisfaction. Based on the hypothesis test, it shows that H1 is accepted. The results of testing the first hypothesis show that the benefits of corporate social responsibility activities have a positive and significant effect on patient satisfaction. Based on the results of hypothesis testing, it can be interpreted that the higher the perceived benefits of corporate social responsibility activities, the higher the patient satisfaction at Bali Mandara Hospital. The results of this research confirm Expectancy Disconfirmation Theory (satisfaction theory) or can be shortened to EDT, which is a theory commonly used to explain how satisfaction or dissatisfaction is formed. The World Business Council for Sustainable Development made a statement that Corporate Social Responsibility (CSR) or corporate social responsibility is defined as a business committee of a company to implement behavioral ethics and contribute to sustainable economic development.
The summary results of the respondents' assessments show that the respondents' assessments agree with the statement which states that these results are in accordance with previous research conducted by Hossain et al., (2020), Ma et al., (2021), Limbu et al., (2020), Ahmad et al., (2016), and Younis et al., (2021) show that corporate social responsibility influences patient satisfaction. Hossain et al., (2020) fostering patient satisfaction in corporate social responsibility practices is not only about looking after patients over time, but also building relationships with patients for care practices and caring about sustainable health in the future. Therefore, if an organization engages in ethical activities such as corporate social responsibility initiatives, its customers will feel more satisfied and more loyal (Reza et al., 2020).
The effect of service quality on patient satisfaction. The results of testing the second hypothesis show that service quality has a positive and significant effect on patient satisfaction. Based on the results of hypothesis testing, it can be interpreted that the better the service quality, the higher the patient satisfaction at Bali Mandara Hospital. The results of this research confirm the EDT Theory, which is a theoretical model which explains that a feeling of satisfaction or dissatisfaction is obtained after purchasing a product and then comparing expectations with the actual product performance. In satisfying customers, apart from products that are safe and comfortable to use, the services provided by the company must be of high quality. Service quality is defined as how far the comparison between reality and customer expectations for the service they receive. Another definition of quality is a
dynamic condition related to products, services, people, processes and the environment that meets or exceeds expectations.
These results are in accordance with previous research conducted by Ahmed et al., (2017), Hossain et al., (2020), Limbu et al., (2020), Ma et al., (2021), and Younis et al., (2021) shows that service quality influences patient satisfaction. According to Ahmed et al., (2017) the services provided by hospital staff affect patients, family and friends. Any misjudgment or mistake can have fatal consequences. The quality of the organization's services always meets external and internal needs, desires and expectations of clients/consumers in order to fulfill personal desires. Good service quality always leads to high customer satisfaction. According to Batra & Taneja (2021) perceived service quality and satisfaction are somewhat related concepts because they both reflect the possible outcomes of a customer's exposure to stimuli in a particular environment.
The effect of the benefits of corporate social responsibility activities on the image of Bali Mandara Hospital. The results of testing the third hypothesis show that the benefits of corporate social responsibility activities have a positive and significant effect on the image of Bali Mandara Hospital. Based on the results of hypothesis testing, it can be interpreted that the more the benefits of corporate social responsibility activities are felt, the better the image of Bali Mandara Hospital will be created. According to Lubis (2017) corporate social responsibility has also helped shape the company's image. The social environment is sensitive to corporate social responsibility practices, so corporate social responsibility actions, no matter how small, can improve the company's image. Thus, companies must realize that Corporate Social Responsibility will not do anything unless society perceives it well while improving the company's image in the minds of the public. The benefits of corporate social responsibility activities are realized in the form of joint performance with employees, the environment and society which will later aim to improve the quality of life in a way that is beneficial for both business and development. This sustainable development focuses on balancing economic aspects, social aspects and environmental aspects.
The effect of service quality on the image of Bali Mandara Hospital. The results of testing the fourth hypothesis show that service quality has a positive and significant effect on the image of Bali Mandara Hospital. The better the quality of hospital services, the better the image of Bali Mandara Hospital. According to Sektiyaningsih (2019) service quality has a positive and significant effect on the hospital's image. Based on the results of this research, it proves that the quality of service has an impact on the good image of the hospital. If the quality of service increases, the image of the hospital will also improve.
Service quality is applied to every business that has customer service aspects and directly deals with customers. If the service received or perceived is as expected, then the quality of the service is perceived as good and satisfactory. If the service received or perceived exceeds customer expectations, then the service quality is perceived as ideal quality. Conversely, if the service received is lower than expected then the quality of the service is perceived as poor quality. In line with research conducted by Hossain et al., (2020), Ma et al., (2021), Limbu et al., (2020), Ahmad et al., (2016), and Younis et al., (2021) show that service quality influences hospital image.
The effect of the image of Bali Mandara Hospital on patient satisfaction. The results of testing the fifth hypothesis show that the Image of Bali Mandara Hospital has a positive and significant effect on patient satisfaction. Based on the results of hypothesis testing, it can be interpreted that the better the image of Bali Mandara Hospital, the higher the patient satisfaction. Citra et al., (2021) the image of a hospital has a significant influence in increasing patient satisfaction, where the higher the image of a hospital, especially within the scope of hospitals in that area, it will be able to increase patient satisfaction.
The results of this research confirm Expectancy Disconfirmation Theory (satisfaction theory) or can be shortened to EDT, which is a theory commonly used to explain how satisfaction or dissatisfaction is formed. Corporate image is defined as the general impression created in the minds of the public about a company. Image is an experience that is embedded in people's minds regarding everything that has been done by the company. A good corporate image is an asset for most companies, because image can have an impact
on perceptions of value, quality and satisfaction (Basalamah et al., 2021). The hospital brand becomes a promise to consumers and implies that service staff will provide the healthcare that consumers need (Khodadad Hosseini, 2017). Research by Hossain et al., (2020), Ma et al., (2021), Limbu et al., (2020), Ahmad et al., (2016), and Younis et al., (2021) shows that Hospital Image affects patient satisfaction.
The role of hospital image at RSUD Bali Mandara is able to significantly mediate the influence of the benefits of corporate social responsibility activities on patient satisfaction. The results of testing the sixth hypothesis can be seen from the indirect influence value. This shows that the image of the RSUD Bali Mandara Hospital is able to mediate the influence of the benefits of corporate social responsibility activities on patient satisfaction, which can be interpreted as the better the Hospital Image of RSUD Bali Mandara, the greater the influence of the benefits of corporate social responsibility activities on patient satisfaction at RSUD Bali Mandara.
According to Hossain et al., (2020) growing patient satisfaction in corporate social responsibility practices is not only about looking after patients over time, but also building relationships with patients for sustainable corporate social responsibility health care practices in the future. The social environment is sensitive to corporate social responsibility practices, so corporate social responsibility actions, no matter how small, can improve the company's image.
The influence of the image of Bali Mandara Hospital is able to significantly mediate the influence of service quality on patient satisfaction. The results of testing the sixth hypothesis can be seen from the indirect influence value. This shows that the Hospital Image of RSUD Bali Mandara is able to mediate the influence of service quality on patient satisfaction, which can be interpreted as the better the Hospital Image of RSUD Bali Mandara, the greater the influence of service quality on patient satisfaction at RSUD Bali Mandara.
Sektiyaningsih's research (2019) states that service quality has a positive and significant effect on the hospital's image. According to Batra & Taneja (2021) perceived service quality and satisfaction are somewhat related concepts because they both reflect the possible outcomes of a customer's exposure to stimuli in a particular environment.
CONCLUSION
The findings of this research enrich the application of Expectancy Disconfirmation Theory to the hospital service environment. This research is expected to provide an empirical contribution and strengthen the relationship between the benefits of corporate social responsibility, service quality, hospital image and patient satisfaction for the development of marketing science.
The quality of service at Bali Mandara Regional Hospital needs to be improved regarding the punctuality of service hours based on the results of the low service quality variable for the indicator "Bali Mandara Regional Hospital staff provides services on time" in order to improve the quality of hospital services according to standards and patients feel comfortable providing services at Bali Regional Hospital. Mandara. In the corporate social responsibility benefit variable, it is known that the indicator "Corporate social responsibility activities in the form of accurate health education provide a positive contribution in improving the health of the hospital environment" has the highest average so that the Bali Mandara Hospital can be maintained to maintain sustainable relationships with patients and improve health standards. Patients have felt the impact of health education because it provides new insight into health information that patients did not previously know and they feel that the hospital cares about patients. The accuracy of the information provided is also important because patients will apply it in their daily lives and can improve the health standard of life for patients and the community. The image of the regional hospital has been created from the perceptions of patients and the public. The sense of comfort in the service experience provided by the hospital to patients and the facilities provided has been ingrained in the minds of patients.
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