Aspects that Influence Patient Satisfaction at the Elderly Clinic at Puskesmas X Surabaya

: In 2021 figures pain elderly reached 21.61%, while 41.42% of the population elderly experience complaint health and 36.97% of the population elderly No experience disturbance health. Treatment efforts undertaken to Public health center recorded 14.25% figure the low compared to effort treatment carried out in practice doctor amounting to 47.50%. Obstacle in increase health and well-being elderly influenced by quality services provided Public health center for all over patients in the elderly clinic. Measurement level satisfaction patients in the study This using five aspects of service quality (SERVQUAL), namely aspect evaluation including aspects reliability, aspect responsiveness, aspect guarantee, aspect empathy and aspect proof physique. Research purposes This for know description level satisfaction patient based on SERVQUAL aspects in patients at the Elderly Clinic X Surabaya Community Health Center. Study manifold observational analytic Cross-Sectional design. Amount respondents used as many as 62 patients using Simple Random Sampling Technique. Data collection using questionnaire with scale likert. Data analysis used the Spearmen Rank correlation test. Research result obtained quality service aspect reliability of 49 patients satisfied (79%), aspect responsiveness of 53 patients satisfied (85.5%), aspect guaranteed 44 patients satisfied (71%), aspect empathy 47 patients satisfied (75.8%), and aspects proof physical of 50 patients satisfied (80.6%) but 2 patients not enough satisfied (3.2%). Analysis results there is significant relationship between quality elderly poly services to satisfaction patients at Puskesmas X Surabaya with mark significance 0.000 (<0.05).


I. INTRODUCTION
According to BPS data, in 2021 the morbidity rate for the elderly reached 21.61%, while 41.42% of the elderly population experienced health complaints and 36.97% of the elderly population did not experience health problems.Treatment efforts carried out at community health centers were recorded at 14.25%, this figure is very low compared to treatment efforts carried out at doctors' practices of 47.50% (BPS East Java, 2021).Patient satisfaction is the final result of a health service, therefore patient satisfaction is very important in health center health services (Wartiningsih, 2020).The importance of patient satisfaction with service quality is the main concept in controlling quality and improving quality improvement programs.A patient group that is very important in making health service policies is elderly patients, because they are also users of health services.(Ambariani, 2014).The results of patient satisfaction evaluations can be the basis for policy and management of resource allocation for health services.Apart from that, patient satisfaction can be used as material for evaluating patient treatment results (Wartiningsih, 2023).The service process for elderly people must be prioritized because it is the most important domain for an elderly person.The decrease in the level of people seeking treatment at the community health center has an impact on poor health services, which can also affect the decline in the level of health in the community, because many diseases will not be treated (Bayu, 2017).The Iconesia survey institute recorded data on the satisfaction of the people of Surabaya city with health services from community health centers in 2016 that there was a difference between the hope index (79.2%)and the satisfaction index (75.9%).In 2017, Puskesmas X in West Surabaya had a gap in expectations (87.50%) and satisfaction (69.74%) (Wartiningsih, 2022).Based on the explanation and information provided, this research is important because since the elderly polite community health center program was introduced in 2003, there are still very few community health centers that have implemented it.Quality and satisfying health services are an effort to utilize health services in accordance with the expectations of puskesmas patients.One of the keys to the success of health services is the level of patient satisfaction.Patient satisfaction assessments can be measured from various factors, such as the quality of clinical services, availability of medicines, professional behavior of health workers in providing services, service location infrastructure, physical comfort, emotional support, and respect for patient opinions and preferences.To improve the quality of health services for patients, there are many factors that must be considered, such as the overall health condition of the elderly, including the quality of treatment, health facilities, and other variables related to the elderly.Therefore, the increase in the number of visits by elderly patients at community health centers can be considered as an impact of increasing elderly patient satisfaction (Bayu, 2017).

II. METHOD
The research carried out was quantitative research which aimed to examine the relationship between the quality of elderly clinic services and patient satisfaction at Puskesmas X Surabaya.This research has received an ethical clearance certificate from the Health Research Ethics Commission, Faculty of Medicine, Ciputra University No. 073/EC/KEPK-FKUC/VIII/2023 to be a requirement for carrying out research.The research was conducted at the Elderly Clinic at Puskesmas X Surabaya.The research design used is analytical observational, where the researcher only observes and measures to obtain data without intervening with the patient as the research object.The research design used is a cross-sectional study, where the dependent variable and independent variables are observed simultaneously over a certain period of time.The research was carried out using a questionnaire which would be distributed to patients at the elderly clinic at Puskesmas X.The population used was elderly patients at the elderly clinic at Puskesmas the sampling technique in this research is the Simple Random Sampling technique, which is a simple random sampling technique carried out by randomly selecting sample elements from the population to be studied.Data analysis for this research used the Spearmen Rank test with the Statistical Product and Service Solution (SPSS) version 26.0 program.

III. RESULT
Under This is results study about characteristics patient elderly as well as results analysis Rank Spearmen.Analysis related influencing aspects satisfaction patients at Puskesmas X Surabaya.

Characteristics Patient
Respondents in research This dominated by patients aged 60-74 years that is amounted to 82.3%, whereas aged 75-90 years amounting to 17.7%.In terms of characteristics type gender, respondent dominated by female patients at 66.1%, whereas respondents man as much as 33.9%.Last level of education respondents the most is elementary school is amounting to 35.5%.On characteristics work respondents, dominated with Already No Work by 79%.From the research results, a significance value (Sig.(2-tailed)) of 0.000 (<0.05) was obtained, which means that there is a significant relationship between the reliability aspect of the service variable and the patient satisfaction variable.The SPSS output also shows a correlation coefficient of 0.594, which means that the correlation or strength of the relationship between the reliability aspect variable and the patient satisfaction variable is 0.594 or a strong correlation.Apart from that, the correlation coefficient number in table 5.11 is positive, namely 0.594, so that the reliability aspect variable and the patient satisfaction variable have a unidirectional nature, which means that if the reliability aspect of service is maintained, patient satisfaction will increase.From the research results, a significance value (Sig.(2-tailed)) of 0.000 (<0.05) was obtained, which means that there is a significant relationship between the responsiveness aspect of the service variable and the patient satisfaction variable.The spss output also shows a correlation coefficient of 0.861, which means the correlation or strength of the relationship between the responsiveness aspect variable and the patient satisfaction variable is 0.861 or a very strong correlation.Apart from that, the correlation coefficient number in table 5.12 is positive, namely 0.861, so that the responsiveness aspect variable and the patient satisfaction variable have a unidirectional nature, which means that if the responsiveness aspect of service is maintained, patient satisfaction will increase.From the research results, a significance value (Sig.(2-tailed)) of 0.000 (<0.05) was obtained, which means that there is a significant relationship between the guarantee aspect service variable and the patient satisfaction variable.The spss output also shows a correlation coefficient of 0.670, which means the correlation or strength of the relationship between the guarantee aspect variable and the patient satisfaction variable is 0.670 or a strong correlation.Apart from that, the correlation coefficient number in table 5.13 is positive, namely 0.670, so that the guarantee aspect variable and the patient satisfaction variable have a unidirectional nature, which means that if the guarantee aspect service is maintained, patient satisfaction will increase.From the research results, a significance value (Sig.(2-tailed)) of 0.000 (<0.05) was obtained, which means that there is a significant relationship between the empathy aspect service variable and the patient satisfaction variable.The SPSS output also shows a correlation coefficient of 0.562, which means that the correlation or strength of the relationship between the empathy aspect variable and the patient satisfaction variable is 0.562 or a strong correlation.Apart from that, the correlation coefficient number in table 5.14 is positive, namely 0.562, so that the empathy aspect variable and the patient satisfaction variable have a unidirectional nature, which means that if the empathy aspect of service is maintained, patient satisfaction will increase.From the research results, a significance value (Sig.(2-tailed)) of 0.000 (<0.05) was obtained, which means that there is a significant relationship between the physical evidence aspect service variable and the patient satisfaction variable.In the SPSS output, a correlation coefficient figure of 0.655 was also obtained.which means the correlation or strength of the relationship between the physical evidence aspect variable and the patient satisfaction variable is 0.655 or a strong correlation.Apart from that, the correlation coefficient number in table 5.15 is positive, namely 0.655, so that the physical evidence aspect variable and the patient satisfaction variable have a unidirectional nature, which means that if the physical evidence aspect of service is maintained, patient satisfaction will increase.So from the results of this research it can be concluded that from the five aspects of the quality of elderly clinic services, the aspect that has a significant relationship value and the highest correlation or strength of relationship is the responsiveness aspect, namely 0.861, which means the relationship is very strong.So if the responsiveness aspect is maintained, patient satisfaction will increase.Likewise with other aspects, if all aspects of elderly poly services are maintained, patient satisfaction will increase.

IV. DISCUSSION
The characteristics of the patients who were respondents in this study were dominated by those aged 60-74 years with a percentage of 82.3%.Research conducted by De Salins et al. (2016) said patient age was significantly associated with overall satisfaction with greater satisfaction in patients aged 50 years and older.Another study conducted by Sulistyo et al., (2019) Patient satisfaction is directly and positively influenced by age >18 years.However, this study did not examine the relationship between age and patient satisfaction.The gender of the respondents was mostly women compared to men, namely 66.1% or 41 patients.In Rusnoto's (2019) research, it was explained that there is a relationship between gender and level of satisfaction.This relationship explains that male patients are more easily satisfied than women (Rusnoto et al., 2019).However, in this study the researchers did not examine the relationship between gender and patient satisfaction.In terms of educational characteristics, this study was dominated by patients with elementary school education.A high level of education can influence a person's rational and irrational thinking patterns in making decisions, using or exploiting health services.A low level of education tends to have thoughts that are not fixed or change frequently compared to someone who has a higher level of education (Arifin et al., 2019).Meanwhile, work is dominated by patients who do not work.A person's job will greatly influence understanding of health (Rizal, 2018).Health service quality indicators are the most influential determinants of patient satisfaction in all studies (Batbaatar et al., 2017).In the results of previous research, it was explained that service quality can be defined as the level of service provided whether it meets or exceeds patient expectations or not (Fandy Tjiptono, 2017).There are five aspects in measuring service quality (SERVQUAL), namely: reliability, responsiveness, guarantee, empathy and physical evidence (Bayu Yustisia, 2017).According to research by Wartiningsih (2022), the reliability aspect is the ability of health facilities to provide promised services satisfactorily and accurately.study conducted by Meesala & Paul (2018) found that reliability and responsiveness (not empathy, realness, and reassurance) impact patient satisfaction.Patient satisfaction is directly related to patient loyalty to the hospital.In this study, regarding the reliability aspect, the dominant respondents were satisfied with the services provided according to the promised schedule and diseases and medicines delivered well.Research conducted by Waters et al.(2016 ) that there are seven themes that influence patient satisfaction with clinical assessments.These themes are clinic waiting time, clinical contact time, trust, empathy, communication, hope and connectedness.In the aspect of responsiveness, the dominant respondents were very satisfied with the service provided quickly and responsively.Another study conducted by Materla et al. (2019) also stated that students consider the availability of qualified medical staff within 10 minutes of check-in and the provision of after-hours care as attractive attributes that create greater satisfaction.In line with research conducted by Fang et al. (2019) it was found that "Medical Staff Service Attitude" is the most important factor influencing patient satisfaction.In the aspects of assurance and empathy, the dominant respondents were satisfied with the staff's friendly and polite attitude, paying attention and caring for all patients.Research conducted by Ko et al. (2009) says factors that were positively related to satisfaction were as follows: the doctor's personal attitude, the doctor's technical skills, the nurse's personal attitude, the physical environment, and more time with the doctor to discuss procedures.The top three items that dissatisfy ecdemic patients are long waiting times for treatment, complicated formalities, and overall poor service attitudes, so patients choose other health services (Liu et al., 2018).This shows that the attitude and friendliness of health workers is very important to make patients feel satisfied (Otani et al., 2011).The Services provided by officers are also influenced by psychological factors such as research conducted by Leggat et al., (2017) found that officers provide services that will result in higher patient satisfaction if they feel empowered in a psychologically safe environment.Rather, their views about the patient experience are related to their commitment to the hospital (Tsai et al., 2015).Meanwhile, regarding the aspect of physical evidence, several respondents were dissatisfied with the facilities at the health center and the incomplete examination equipment.Physical aspects such as the facilities provided by health services are one of the determining factors for patient satisfaction when they are undergoing treatment (Xesfingi & Vozikis, 2016).Providing services in the form of physical evidence aspects such as facilities, completeness of medical equipment needs to be given more attention.(Al-Neyadiet al., 2018)

V. CONCLUSIONS
The satisfaction you get in a way whole Already fine, where aspect proof physique is one of aspects that have mark dissatisfaction In aspect responsiveness obtained very satisfying results ,followed with 3 aspects others who have results sufficient satisfaction good.So that required minor improvements to aspects proof physical order level satisfaction patient the more either at health center X.