INTERNATIONAL JOURNAL OF SOCIAL SERVICE AND RESEARCH

INTERVENTIONS TO INCREASE IN-PATIENT VISITS AT GAMBIRAN HOSPITAL, KEDIRI CITY, DURING THE COVID-19 PANDEMIC

Trianike Nor Aini*, Mas Roro Dyah Ayu, Iman Gautama, Galih Duta Prihadi, Jumita Dos Santos G

STRADA Indonesia Institute of Health Sciences, Kediri, East Java, Indonesia

Email: [email protected]*, [email protected], [email protected], [email protected], [email protected]

Abstract

Currently, hospitals must contend with global competition in various health sectors. The public's demand for health services increases annually. The community requires prompt, accurate, and high-quality services. With the increasing number of patients and the limitations of government hospitals, there are frequently public complaints about hospital services. In addition, a patient's interest in receiving services at a hospital is influenced by his or her satisfaction with those services, so if hospital services are subpar, this will have an effect on the number of hospital visits in the era of the COVID-19 pandemic. The purpose of this study is to provide an overview of efforts to increase inpatient visits at Gambiran Hospital. The method employed is qualitative surveying. The results of the study indicate that several appropriate strategies are required to address the various problems that have been identified, particularly during the current pandemic, including the need to increase the capacity of officers to be able to provide education to patients, along with superior human resources to market through media, which is required by society today in order to instill community confidence in the safety of care at the Gambiran Hospital.

Keywords: health services; hospital management; patients

Received 24 May 2022, Revised 04 June 2022, Accepted 23 June 2022

INTRODUCTION

Gambiran hospitals are faced with the development of the times with the era of global competition in various health sectors. The high competition in the hospital sector makes them try to stay afloat to continue operating. To anticipate this, it is important to maintain service quality. With the increasing number of patients and the limitations of government hospitals, public complaints about the services provided by hospitals often arise. An imbalance between patient coverage causes this dissatisfaction, facilities owned, quality, and competence of human resources in government hospitals, so government hospitals are often described with low quality or service quality (Fauziah, 2021).

Interest in patient visits in receiving services at the hospital is influenced by the experience of satisfaction with the services provided, so if hospital services are low, it will affect the number of hospital visits. The decrease in the number of old and new visits shows that the interest in patient visits to return to hospital services will also decrease, especially if patients suffer from chronic diseases. The service quality of health workers, hospital facilities and infrastructure will also improve the quality of service for the number of patient visits (Attas, 2014).

Since mid-2020, the whole world has been declared to be in a period of the Corona Virus Disease-19 (COVID-19) pandemic, including Indonesia. As a result, almost all community activities are disrupted, one of which is hospital services. During the pandemic, several regulations were enforced, namely limiting the number of hospital visits to patients being treated. Then several hospitals were temporarily focused on being referral hospitals for COVID-19 patients. This affects the interest and courage of people who want to check themselves in hospitals, especially those that require incentive treatment.

Hospital service indicators that can be used to determine the level of utilization, quality and efficiency of hospital services are Bed Occupation Rate (BOR), Average Length of Stay (AvLOS), Turn Over Interval (TOI) and Bed Turn Over (BTO). Monitor activities in the in-patient unit. In-patient services are services for patients who perform observation, diagnosis, therapy or rehabilitation and who need to stay overnight, use a bed, and receive food and nurse services on an ongoing basis (Riza Fahmi, Arifah Devi Fitriani, 2020). Determine the level of utilization, efficiency and frequency of bed use in hospitals can be seen from the BTO indicator. In-patient indicators related to BTO are important to consider to improve service quality. High BTO has the potential to disrupt the balance of clinical aspects. Marketing is a social process involving important activities that enable individuals and companies to get what they need and want through exchanges with other parties and develop exchange relationships (Handajani & Furi, 2019).

With the changes that occur, the hospital needs to develop a strategy. The strategy can be obtained from the hospital's performance evaluation results. This is important to do to get information about service changes during the pandemic and find out what makes patients satisfied or dissatisfied with hospital services, especially outpatients. This strategy will be effective if it can increase customer satisfaction, supported by techniques to capture market opportunities so that hospitals can provide health services that follow customer needs (Utami, Purwaningsih, & Ni’mah, 2020).

Based on the visit data from the Gambiran Hospital, it can be seen that patient visits both in-patient, outpatient and support since 2019-2021 have decreased. The average BOR in 2019 is 54.77%, in 2020 is 47.39%, and until October 2021 by 45.45%. In 2019 inpatient visits, 15,877 patients (8,265 males, 7612 women) were admitted, in 2020 it decreased to 10,470 visits (5,331 males, 5139 females) and in 2021 in semester 1 there were only 5,030 visits (2,550 males, 2480 female). It can be seen that during this pandemic, there was almost a 50% decrease in patient visits at the Gambiran Hospital. Meanwhile, in 2021, especially in semester 1, the average monthly visitor is 298-300.

Based on the results of Inpatient Services activities in 2020 with 332 beds, the bed usage rate (BOR) was 73.58% (Standard 75-80%), several patients who died (NDR) was 30.55% (Standard < 25%), GDR 62.93% (Standard < 49%), the number of patients who died in the ER was 81 people and DOA 122 people. Beds in Gambiran Hospital have increased with most patients due to COVID-19 infection. This is allegedly affecting the public's interest in seeking treatment because they feel afraid and unsafe in hospitals that treat COVID-19 patients. From the data obtained from the profile of the Gambiran Hospital in 2020, efforts to improve the quality of services carried out by the Gambiran Hospital have carried out various activities, including relocation to a new building expected to support better health service process. In November 2017, a verification survey was carried out to follow up on findings of deficiencies in the accreditation survey conducted annually. In 2020 also obtained results from the Kediri City Community Satisfaction Index for Gambiran Hospital, namely the Interval Value (NI) of 3.4146 or the Conversion Interval Value (NIK) of 85.37 and can be declared good. This shows that Gambiran Hospital already has a place in the people's hearts, so it is hoped that this can be used to attract more customers. For this reason, the Gambiran Hospital promotion team has also made several efforts, including using social media such as Facebook, website, YouTube and WhatsApp. Besides social media, the promotion team utilizes several electronic media, namely through local TV channels such as Dhoho TV and JTV.

In connection with the above description, this study aims to explore further efforts to increase in-patient visits at Gambiran Hospital in the COVID-19 pandemic era to carry out marketing and service strategies to restore or even increase the number of patients visits, especially in outpatient installations.

METHOD

This research uses a qualitative approach with a case report study method (Moleong, 2021). Using case study research, researchers will gain specific expertise or insight into the problem they have chosen to explore, which is usually contemporary. Case study research allows researchers to examine phenomena in their context. Case studies are empirical investigations in the sense that they are based on knowledge and experience, or in a more practical sense, they require data collection and analysis (Creswell, 2017). In addition, a SWOT analysis is also included in this study. SWOT Analysis is a technique used to evaluate the "strengths," "weaknesses," "opportunities," and "threats" of an organization, a strategy, a project, a person, or a commercial activity's "strengths," "weaknesses," "opportunities," and "threats" (Gurl, 2017). To determine Efforts to increase Inpatient Visits at Gambiran Hospital in the Pandemic Era

RESULTS AND DISCUSSION

A. Assessment

In order to increase patient visits, especially in in-patient services at Gambiran Hospital, several appropriate strategies are needed, especially during the current pandemic.

The assessment or identification of problems in this residency report uses a Fishbone (fishbone diagram). The Diagram fishbone illustrates the relationship between the problem and all the causal factors that affect the problem. Diagrams Fishbone helps determine the root cause of problems with a structured approach and get ideas that can provide solutions for solving a problem.

1. Fishbone Diagram

Problem assessment to analyze efforts to increase in-patient visits at Gambiran Hospital using the Fishbone, categorized using 5M, namely Man, Method, Material, Machine, and Measurement. Improving the 5 M's of management (Men, Money, Materials, Machines, and Method) has a significant impact on the quality of hospital services, therefore hospital performance indicators will have a good and ideal value (Eniraisa & Hidayat, 2018). With the following description:

a) Man: Officers have difficulty providing education to patients

b) Methods: Marketing is not optimal through various electronic media

c) Material: Insufficient materials/ materials to be promoted through electronic media

d) Machine: Infrastructure for providing information about service flow and safety of treatment during the Covid-19 pandemic 19 is still lacking

e) Measurement: People are still afraid to go to the Covid-19 referral

2. Problem Formulation

Based on Fishbone that has been made to increase in-patient visits at Gambiran Hospital, the following problems can be formulated:

a) It is necessary to increase the capacity of officers to be able to provide education to the public. and patients

b) Not yet optimal marketing through various electronic media

c) Insufficient materials/materials to be promoted through electronic media

d) Infrastructure for providing information about service flow and safety of treatment during the Covid-19 pandemic is still lacking.

e) People are still afraid to go to the Covid-19 referral hospital

3. Priority Problems

Based on the formulation of problems related to efforts to increase in-patient visits at the Gambiran Hospital, Kediri City, in the COVID-19 pandemic era to determine priority problems, the USG method (Urgency, Seriousness, Growth) was. The following is the determination of the priority of problems using the USG method:

Table 1

Determining the Priority of Problems with the USG Method

No	Indicators	U	S	G	UxSxG	Rank
1	Officers have difficulty providing education to patients	4	4	4	64	2
2	Not optimal marketing through various electronic media	5	5	5	125	1
3	Insufficient materials/materials to be promoted through electronic media	3	4	4	48	3
4	Infrastructure providing information about the flow of services and safety of treatment during the Covid-19 pandemic is still lacking	3	4	4	48	4
5	People are still afraid to go to referral hospitals Covid-19	3	3	3	27	5

Table 2

Calculation of the Internal Matrix Evaluation Factor (IFE)

No	Factors Analysis	Weight	Rating	Score
A. Strengths (S)
1	The presence of competent human resources	0.3	3	0.9
2	Hospital commitment and human resources in realizing the hospital's vision and mission	0.3	4	1.2
3	Availability of in-patient rooms in various classes with complete facilities	0.3	3	0.9
4	Strategically located urban areas	0.4	4	1.6
	Total Strengths	1.3		4.6
B. Weaknesses (W)
1	Served as a COVID-19 referral hospital so that people are afraid when seeking treatment during a pandemic	0.3	3	0.6
2	Marketing is not optimal which ensuring the safety of patients seeking treatment even at a covid-19 referral hospital during the pandemic	0.2	5	1
	Total Weakness	0.5		1.6
Total IFE: S - W (4.6-1.6)				3

Table 3

Matrix Calculation External Factor Evaluation (EFE)

No	Factors Analysis	Weight	Rating	Score
Opportunities (O)
1	Ba the number of collaborations between hospitals that collaborate, especially health facilities that use BPJS	0.4	4	1.6
2	There is cooperation with other institutions for self-evaluation	0.3	4	1.2
3	There is support from the Regional Government and the Ministry of Health	0.4	5	2
	Total Opportunities	1.1		4.8
Threats (T)
1	Competition between hospitals that have a quality service system with relatively cheaper financing	0.3	3	0.6
2	The existence of a pandemic period so that people are afraid to seek treatment	0.3	2	0.6
3	The influence of globalization and modernization demands the development of training and modalities used in services	0.3	1	0.3
4	Increasing demands of patients who want optimal quality	0.3	2	0.6
	Total Threats	1,2		2.1
Total EFE: O - T (4.8-2.1)				2.7

Table 4

SWOT Analysis Efforts to Increase Inpatient Visits at Gambiran Hospital in the Era of Pandemic

Strengths (S)

a. The existence of competent human resources, seen from their education, such as a Master's degree

b. Commitment to hospitals and human resources in realizing the hospital's vision and mission

c. Availability of in-patient rooms for various classes with complete facilities

d. Strategic locations in urban areas

Weaknesses (W)

a. Served as a COVID-19 referral hospital so that people are afraid when taking treatment during the period of pandemic

b. Not yet optimal marketing ensures the safety of patients seeking treatment even at a covid-19 referral hospital during the pandemic.

Opportunities (O)

a. Much collaboration between hospitals that collaborate, especially health facilities that use BPJS

b. There is cooperation with other institutions for self-evaluation

c. There is support from the Regional Government and the Ministry of Health

SO Strategy

a. Recruiting human resources by utilizing cooperative partners

b. Optimizing socialization and marketing in health facilities under Gambiran Hospital

c. Making hospital profiles in the form of images and videos to show the shape of the buildings and facilities needed have

WO Strategy

a. Marketing/promotion through various electronic media, especially radio

b. Installation of service lines during the pandemic, starting from the emergency room to the in-patient room

Threats (T)

a. Competition between hospitals that have a quality service system with relatively cheaper financing

b. The existence of a pandemic period, so people are afraid to seek treatment

c. The influence of globalization and modernization demands the development of training and modalities used in services

d. Increased demands

of patients who want optimal quality

ST Strategy

a. Optimizing health perceptions for every officer during a pandemic

b. Optimizing services to patients to increase patient satisfaction

c. Scheduling services during a pandemic so that they are easily accessible

Strategy WT

a. Optimizing marketing and educating the public about the safety of treatment in the pandemic era

b. Presenting visually attractive information as a medium of information on social media and local television

Based on the assessment, this was done using a SWOT flyover to prioritize strategies to address existing problems, so this residency intervention plan is marketing optimization to increase in-patient visits at Gambiran Hospital in the Pandemic Era.

B. implementation

Marketing is a series of activities used to get potential buyers' attention, motivate them to buy, get them to buy, and try to get them to buy and buy again. The increasing public demand for quality and affordable health facilities inevitably makes this institution try to survive amid increasingly fierce competition while meeting these demands through marketing (Yuwono, Suhariadi, Handoyo, Fajrianti, & Septarini, 2005). This marketing optimization strategy has 3 elements: Internal Marketing, External Marketing, and Interactive Marketing.

1. Internal Marketing: intended for internal hospitals

a) Product Knowledge for officers at Gambiran Hospital Socialization/dissemination of services to officers at Gambiran Hospital

b) An attractive hospital interior design display that shows comfort and practices even though it is also a referral for Covid-19 patients

c) Communication of officers in providing services

d) Behavior employees in serving without discriminating against patients

e) Technical competence of employees in providing

f) Performance Appearance from employees who show aspects of professionalism and personal care to visitors

g) Creating a clean, comfortable, and safe environment.

2. External Marketing: aimed at the wider community

a) Promotion using electronic media, especially radio to target customers starting from the lower class to the upper class

b) Creating an audiovisual hospital profile to be continuously shown on Youtube, Instagram, Facebook, and Television.

c) Maintaining promotions that have been carried out optimally by always updating social media.

d) Socialization and promotion to first-level health facilities or to hospitals with types under RSUD Gambiran to establish cooperation regarding BPJS patient referrals.

3. Interactive Marketing: intended so hospital staff or internals can achieve customer satisfaction by applying what is invested in internal marketing to convey it well to customers.

CONCLUSION

The study of the problems that have been carried out at the Gambiran Hospital states that. The marketing method implemented has not been optimal in using electronic media, especially radio, because radio is listened to by many people. Meanwhile, the flow of services to patients, either in the information or the existing facilities, has not been socialized to the public, so there are still many people who are afraid to seek treatment at the Gambiran Hospital for fear of being infected, especially considering that Gambiran Hospital is a Covid-19 referral hospital. Efforts to educate the wider community so they can access more hospital social media.

In order to increase patient visits, especially in in-patient services at Gambiran Hospital, several appropriate strategies are needed for various problems that have been found, especially during the current pandemic, including the need to increase the capacity of officers to can provide education to patients, of course, with superior human resources to market through media which is very much needed by the community today so that it confidence.

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