The relationship of the quality of health services emphaty dimension with patient satisfaction in the health services of the Lepo-Lepo health center, Kendari city, Indonesia

Public Health Center as public service institutions in providing health services are required to prioritize quality services and increase customer satisfaction. The Public Health Center is the spearhead of health services at the lower level in which services are organized so that they are easily accessible and easily accessible by the whole community. The purpose of the study was to determine the relationship between the quality of health services in the dimension of empathy with patient satisfaction at the Lepo-Lepo Health Center in Kendari City in 2021. The type of research used was an analytical survey with a Cross Sectional Study approach. The population in this study were 448 patients. The sample size of this study was 211 patients. Collecting data by using a questionnaire. Data analysis was performed by Univariate and Bivariate. The results showed that there was no relationship between empathy and patient satisfaction in health services at the Lepo-Lepo Public Health Center, Kendari City, with a p value of 0.522 (p>0.05). Conclusion; there is no relationship between empathy and patient satisfaction in health services at the Lepo-Lepo Public Health Center. Recommendation; The Public Health Center should continue to strive to improve health services, through the fulfillment of the availability of infrastructure, service facilities and improving the attitude of officers in providing services


Introduction
Satisfaction is an expression of people's feelings that arise after comparing perceptions of the performance of a product.According to [1] states that the quality of health services is the degree to which the needs of the community or individuals are met for health care in accordance with good professional standards by using resources fairly, efficiently, effectively within limitations safely and satisfying customers in accordance with good norms and ethics Article 5 of Law Number 36 of 2009 concerning Health mandates that safe, quality and affordable health services are the responsibility of the Government and the right of every person.Likewise, Article 42 paragraph 1 of Presidential Regulation Number 12 of 2013 concerning Health Insurance states that health services to Health Insurance participants must pay attention to service quality, be oriented to patient safety aspects, effectiveness of actions, suitability to patient needs, and cost efficiency.In the current era of the National Social Security System, especially in the health sector, the Public Health Center as the Technical Implementation Unit of the District/City Health Service is the front line in the implementation of basic health efforts, has the responsibility to provide health services for the community through the implementation of public health efforts and individual health efforts.These health efforts must be carried out in a comprehensive, tiered, integrated, quality, fair and equitable manner, as well as satisfying the entire community in the work area for which they are responsible [2].
Health service is one of the efforts held jointly in a health organization to maintain and improve health, prevent, cure disease and restore the health of individuals, families, groups or communities.The quality of health services needs to be improved because of the community's or individual's needs for health that are in accordance with standards with reasonable, efficient, effective use of resources within the limited capacity of the Government and the community, and are carried out safely and satisfactorily in accordance with good norms and ethics so that people feel satisfied.with the services provided.The creation of service quality will certainly create satisfaction for service users.The quality of this service can ultimately provide several benefits, including the establishment of a harmonious relationship between providers of goods and services and customers, providing a good basis for creating customer loyalty and forming a word of mouth recommendation that is profitable for service providers [3].
Users of health services at the Public Health Center demand quality services not only regarding healing from physical illness but also regarding satisfaction with the attitudes, knowledge and skills of officers in providing services and the availability of adequate facilities and infrastructure that can provide comfort.With the increasing quality of service, the function of services at the Public Health Center needs to be improved to be more effective and efficient and provide satisfaction to patients and the community.The function of the Public Health Center which is very heavy in providing services to the community is faced with several challenges in terms of human resources and increasingly sophisticated health equipment, but must continue to provide the best service [4].
Patient satisfaction is a manifestation of the patient's feelings and the level of feelings that arise as a feedback response from the health services they receive.Satisfaction will be achieved if the patient's expectations are met by the reality of the services they receive.There are 5 dimensions that represent the patient's perception of the quality of health services, namely; (1) reliability which measures the ability to provide services as promised accurately and reliably, (2) responsiveness, namely the ability to provide services as quickly as possible, (3) assurance associated with providing a sense of security and trust to patients, (4) empathy, namely the ability to give sincere personal attention to patients and (5) tangible where service providers are required to be able to display maximum resources in their services both in terms of equipment and service providers [5].
Good service quality can improve service quality and patient satisfaction.So that satisfied customers will share satisfaction with producers or service providers.Even satisfied customers will share their taste and experience with other customers [6].Patients feel dissatisfied due to failure to communicate, time crisis, product or service quality, service quality or quality, price, and cost.One of the causes of patient dissatisfaction in health services is the quality of health services.Good service quality can improve service quality and patient satisfaction.So that satisfied customers will share satisfaction with producers or service providers [7].
The Public Health Center encourages all stakeholders to participate in efforts to prevent and reduce health risks faced by individuals, families, groups, and communities through the Healthy Living Community Movement.The Public Health Center mobilizes and is responsible for health development in its working area.Public Health Center encourages independent healthy living for individuals, families, groups, and communities.Public Health Centers provide health services that are accessible and affordable by all communities in their working areas, regardless of social, economic, religious, cultural and belief status.Public Health Center organize Health Services by utilizing technology that is in accordance with service needs, easy to use, and does not have a negative impact on the environment.The Public Health Center integrates and coordinates the implementation of public health efforts and individual health efforts across programs and across sectors and implements a Referral System which is supported by the management of the Public Health Center [8].
From the initial survey conducted by researchers at the Lepo-Lepo Health Center in Kendari City, it was found that several patients who used health services experienced complaints in services that questioned the length of service waiting time, limited service facilities, slow service officers, and limited parking area.Based on this information, researchers are interested in conducting research on health service satisfaction by patients at the Lepo-Lepo Public Health Center, Kendari City.The purpose of this study was to analyze the relationship between the quality of health care dimensions of empathy with patient satisfaction at the Lepo-Lepo Health Center, Kendari City in 2021.

Material and methods
The type of research used is an analytical survey research with a Cross Sectional Study approach.The size of the population of this study was 448 patients.The size of the research sample used was 211 patients.Respondents' inclusion criteria were patients who visited at least 2 visits, resided in the working area of the Lepo-Lepo Health Center, and were willing to be respondents.Collecting data by using a questionnaire.Data analysis was carried out using Uni Variate and Bivariate.

Empathy
Empathy is the willingness of employees to care, give special personal attention, ease in making relationships, good communication and understanding customer needs [9].The distribution of respondents according to empathy is presented in table 1; Table 1 shows that of the 211 respondents (100%), most of the respondents have sufficient empathy, namely 167 respondents (79.1%) compared to respondents who have less empathy, which are 44 respondents (20.9%).

Service Quality
According to [10] suggests that the concept of service quality related to patient satisfaction is determined by five elements commonly known as service quality "SERVQUAL" (reliability, responsiveness, assurance, empathy and tangible).The quality of health services shows the level of perfection of health services in creating a sense of satisfaction in each patient.The more perfect the satisfaction, the better the quality of health services.The distribution of respondents according to Service Quality is presented in table 2; Table 2 shows that of the 211 respondents (100%), most of the respondents have satisfied Service Quality, namely 152 respondents (72%) compared to respondents who have dissatisfied Service Quality, which is 58 respondents (28%).

Dimension of Empathy
The Relationship between Empathy and Patient Satisfaction In the health services of the Lepo-Lepo Public Health Center, Kendari City, it can be presented in table 3; Table 3 shows that of the 167 respondents (100%) who have sufficient empathy, there are more patients who say they are satisfied with the Service Quality, as many as 122 respondents (73.1%) than patients who say they are not satisfied with the Service Quality, which is 45 respondents (26.9 %).Meanwhile, from 44 respondents (100%) who had less empathy, there were more patients who expressed satisfaction with Service Quality, namely 30 respondents (68.2%) compared to patients who expressed dissatisfaction with Service Quality, namely 14 respondents (31.8%).%) The results of the chi square test obtained a value of p = 0.522 (p> 0.05) which means that Ho is accepted.This shows that there is no relationship between Empathy and Patient Satisfaction in health services at the Lepo-Lepo Health Center, Kendari City in 2021.

The Relationship between Empathy and Patient Satisfaction in Lepo-Lepo Health Center Health Services in 2021
Health is the desire and desire of all human beings.Not only by individuals, but also by families, groups and even community groups.To support optimal health in every community, various efforts are made and must be implemented, such as the implementation of public health services.The implementation of health services for the general public at the village level has a Village Polyclinic and a Sub-Public Health Center then at the sub-district level in Indonesia is through the Community Health Center which is a functional organizational unit of the District/Municipal Health Service and is given the responsibility as a health manager for the community in each sub-district of the district/municipality.the municipality concerned.At the regional level there is a regional general hospital.Every level of health services in villages to districts/cities must pay attention to patient satisfaction through service quality [11].
The Empathy is the willingness of employees to care, give special personal attention, ease in making relationships, good communication and understanding customer needs.This dimension is a combination of dimensions: Access, which is the ease of utilizing the services offered, Communication, is the ability to convey information to customers or receive input from customers, Understanding customers, including the company's efforts to find out the needs and desires of customers, Giving special attention to each customer.patients, attention to patient and family complaints and services to all patients regardless of social status [9], Based on the research findings in table 1, it shows that, in general, patients who stated sufficient empathy were more numerous than patients who stated less empathy.This shows that the higher the empathy, the higher the level of patient satisfaction in health services.Conversely, the lower the empathy, the lower the level of patient satisfaction with health services at the Lepo-Lepo Health Center.This happens because patients are increasingly aware of their needs and desires in services, in the form of a willingness from health workers to be more concerned and quickly understand the patient's needs and desires, emotional encouragement, understanding and giving special personal attention to patient complaints, the convenience and good response in service relationships, ease and friendliness in communication, listens to patient needs and complaints well, and helps patients find what their wants and needs are.
Patient satisfaction is a person's feeling of pleasure that comes from a comparison between the pleasure of an activity and a product service with the expectation of satisfaction.This patient satisfaction can be created through good service by medical personnel in health institutions.Thus, if the service is not good, the patient who is dissatisfied will file a complaint with the hospital.Complaints that are not handled immediately will result in a decrease in patient satisfaction with the capability of health services at the hospital.Consumer satisfaction has become a central concept in business and management discourse [11] The quality of health services needs to be improved because of the community's or individual's needs for health that are in accordance with standards with reasonable, efficient, effective use of resources within the limited capacity of the government and the community, and are carried out safely and satisfactorily in accordance with good norms and ethics.Health services, whether at Polindes, Pustu, Public Health Center, hospitals, or other health care institutions, are a system consisting of various interrelated, interdependent, and mutually influencing components.The quality of health services in Public Health Center and hospitals is the end product of the interaction and dependence of service aspects [12].
Another finding obtained during the study was in terms of access that patients wanted in the form of ease in utilizing health services offered or provided by the Public Health Center.In terms of communication the patient wants in the form of ease of communication and the ability of officers to convey information to patients or receive input from patients.In terms of understanding the customer that the patient wants in the form of an officer's effort to find out the needs and desires of the patient.Other findings in the form of officers paying special attention to each patient, the officer's attention to patient and family complaints and officer services to all patients regardless of social status.
Patient satisfaction depends on the quality of health services.Measuring the level of patient satisfaction is closely related to the quality of service.Satisfaction occurs when the needs, desires, expectations of customers can be fulfilled.Patient satisfaction is a feeling of pleasure or satisfaction that the product or service received has met or exceeded his expectations.Patient satisfaction is one indicator of the quality of services we provide and patient satisfaction is a capital to get more patients and to get loyal patients.Loyal patients will reuse the same health services if they need more [13].
The results of the chi square test obtained a value of p = 0.522 (p> 0.05) which means that Ho is accepted.This shows that there is no relationship between Empathy and Patient Satisfaction in health services at the Lepo-Lepo Health Center, Kendari City in 2021.The results of this study are not in line with the results of research [15] which says that there is a significant relationship between service quality and patient satisfaction.Research [16] found that there is a significant relationship between Service Quality (Responsiveness, Assurance, Tangible, Empathy, and Reliability) with Patient Satisfaction in the medical records section of Muhammadiyah Hospital Bandung.Research [17] obtained the results of the simultaneous analysis of the five variables both from physical evidence, reliability, responsiveness, assurance, and empathy affect patient satisfaction.Research [11] shows the results of the variables of physical evidence, reliability, responsiveness, assurance and empathy have a positive influence on patient satisfaction using National Health Insurance at the Medical Rehabilitation Hospital.Research [18] showed that the quality of health services (Responsiveness, Assurance, Tangible, Empathy, and Reliability) with the level of patient satisfaction had a relationship.
Research [19] found that there is an effect of Facilities and Quality of Service (Responsiveness, Assurance, Tangible, Empathy, and Reliability) on patient satisfaction.Research [20] found that service quality (X) which consists of reliability, certainty, reality, empathy, and responsiveness, has a significant effect on customer satisfaction.
From the results of the statistical test, it was found that there was no relationship between Empathy and Patient Satisfaction.In health services at the Lepo-Lepo Health Center, Kendari City in 2021, this happened because there were several factors that influenced it, for example there was no willingness from health workers to be more concerned and quickly understand the needs.and patient desires, lack of emotional encouragement, lack of understanding and lack of attention from officers in service, lack of ease of service, lack of friendliness in communication, and have not helped patients find what their wants and needs are.
This study is also not in line with the results of research [21], it was found that the results of the average calculation of the five dimensions of service quality gave a b value of 184 (80.79%) and indicated that the research respondents were satisfied with the overall health services obtained at the UPTD Mutiara Health Center.The results of the study the form of patient assessment scores were analyzed and grouped according to their level in order to obtain a level of satisfaction in the aspect of reliability 81.75%, responsiveness 81.92%, assurance 82.01%, empathy 80.52% and tangible 77.77% with a level of satisfaction overall.Overall 80.79% are included in the satisfied category.Research [18] showed that the quality of health services (Responsiveness, Assurance, Tangible, Empathy, and Reliability) with the level of patient satisfaction had a relationship.
Good service quality is not only measured by the luxury of facilities, completeness of technology and physical appearance, but also from the attitude and behavior of employees who must reflect professionalism and have a high commitment.In practice, a patient satisfaction survey was conducted to improve the hospital environment, patient facilities, and facilities in the context of consumerism [22].
A health service is said to be of high quality if it is able to create satisfaction for the patients it serves.Patient satisfaction is not only seen from how the facilities and infrastructure are available in health services but also how nurses serve patients well according to their competencies, then how to communicate and be friendly to all patients regardless of patient status.If the patient feels satisfied after being hospitalized, it is necessary to try to maintain that the patient does not switch to another hospital.Satisfaction is one indicator of the quality of services provided which is the capital to get more and more loyal patients.Loyal patients will reuse the same health service if they need it again and will even invite others to use the same facility.Patient satisfaction occurs when what the needs, desires, or expectations can be fulfilled.These expectations can be fulfilled through the health services received by him.Therefore, patient satisfaction is the gap between the service received by the patient and the patient's expectations of the service [23].

Conclusion
There is no relationship between empathy and patient satisfaction in health services at the Lepo-Lepo Health Center, Kendari City with a p value of 0.522 (p>0.05).Recommendation; The Public Health Center should continue to strive to improve health services, through the fulfillment of the availability of infrastructure, service facilities and improving the attitude of officers in providing services.

Table 1
Distribution of respondents according to empathy in health services at the Lepo-Lepo Health Center, Kendari City in 2021 Source: Primary Data, year 2021

Table 2
Distribution of respondents according to Service Quality in health services at the Lepo-Lepo Health Center, Kendari City in 2021

Table 3
Relationship between Empathy and Patient Satisfaction in health services at the Lepo-Lepo Health Center, Kendari City in 2021 [8]lic Health Center encourages all stakeholders to participate in efforts to prevent and reduce health risks faced by individuals, families, groups, and communities through the Healthy Living Community Movement.The Public Health Center mobilizes and is responsible for health development in its working area.Public Health Center encourages independent healthy living for individuals, families, groups, and communities.Public Health Centers provide health services that are accessible and affordable by all communities in their working areas, regardless of social, economic, religious, cultural and belief status.Public Health Center organize Health Services by utilizing technology that is in accordance with service needs, easy to use, and does not have a negative impact on the environment.The Public Health Center integrates and coordinates the implementation of public health efforts and individual health efforts across programs and across sectors and implements a Referral System which is supported by the management of the Public Health Center[8].