The Effect Of The Mediation Role Of Value Co-Creation On Loyalty At Hospital

Abstrak 

This research analyzed the mediation of value co-creation on patient participation and customer relationship management toward patients' loyalty at the Obstetrics and Gynaecology Polyclinic of Islamic Hospital of Hj. Siti Muniroh Tasikmalaya. This quantitative methodology used a cross-sectional survey and primary data from the questionnaire. The sample size was 271 patients. The sampling technique used purposive sampling, a sampling technique with the criteria. The analysis technique was Partial Least Square (PLS). The result indicated that the patients participation and customer relationship management toward loyalty had a mediation effect from the value co-creation variable. Patient participation and CRM affect value co-creation in outpatients at the Obstetrics and Gynaecology Polyclinic of the Islamic Hospital of Tasikmalaya, both partially and simultaneously.

 

INTRODUCTION

The COVID-19 pandemic that hit Indonesia, especially areas in Java and Bali, caused several vital industrial sectors to experience paralysis due to the hampering of company operational activities and weakening people's purchasing power, thus causing the Consumer Price Index (CPI) to experience deflation for 3 (three) consecutive months throughout the third quarter of 2020 (BPS, 2020). Currently, various policies are being implemented by the government to suppress the spread of the virus and reduce the worst risks due to the virus, from organizing vaccinations and restricting community activities to enforcing health protocols. However, the opposite is true for the pharmaceutical and health services sectors.

As one of the places of health services, hospitals are one of the referrals in handling patients, especially patients with positive COVID-19 status. However, hospitals must maintain service standards because they relate to many people's lives. In the midst of the booming condition of COVID-19-positive patients, several hospitals are still overwhelmed due to patient overload, causing the level of medical services to decline and resulting in a decrease in patient loyalty. 

Recent developments have emerged from negative public stigma regarding the COVID-19 pandemic; people who want to visit/seek treatment experience fear of being exposed to the virus, and there is fear of negligence of health workers, especially those who handle COVID-19 patients so they can spread the virus. Thus, the stigma given will worsen the situation and the spread of the disease itself. COVID-19 patients admitted that they felt depressed by the negative stigma that is developing today due to the photos being disseminated by certain parties. Medical officers who handle COVID-19 patients also experience discriminatory actions from the public because they are afraid of carrying the virus, and so on. This is also because people often get negative news (hoaxes) about COVID-19, even the effects of COVID-19 vaccination (Bali et al. Department, 2020).

The World Health Organization (WHO) has recorded 10 (ten) variants of the COVID-19 virus, of which 4 (four) are under strict surveillance. One of them is the Delta variant, which now reaches 76% of the variants circulating in 22 provinces in Indonesia with a faster transmission rate than other variants (CNBC Indonesia, 2021). Therefore, the negative stigma that occurs significantly impacts public trust, especially in hospitals as providers of health facilities that handle patients exposed to COVID-19. In addition, there is a negative stigma in patients during the COVID-19 pandemic or even after the positive rate decreases. Patients are often ignored, and the medical treatment process is sometimes treated differently; this is because health workers may consider patients exposed to COVID-19, even though lab results have not been obtained, or even the pain suffered is not a symptom of COVID-19. So that this makes patients uncomfortable with the services they receive. In addition, patients who test positive for exposure to the virus experience fear, anxiety, and guilt or even get discrimination even though they have recovered and recovered from COVID-19 (klikdokter.com). Therefore, the Tasikmalaya Islamic Hospital should conduct socialization with the public, straighten out incorrect information, and continue to improve its medical services. This creates community satisfaction, especially for patients who have used medical services at the hospital.

Loyalty is a reference that patients feel their medical needs are met. Especially in health services, patient participation is essential. The patient's participation refers to the level of effort and involvement of the patient, both physically and mentally, in experiencing the medical services he receives. Vivek et al. (2012) consider the active participation of customers as an antecedent to influence a person's involvement in shaping the creation of an innovation of a product or service. Therefore, if the services received are by or felt as expected, medical services are perceived as ideal, and desires and expectations are fulfilled, resulting in strong patient loyalty. As Mursid & Wu (2021), Ubud et al. (2017), and Hossain et al. (2019) have researched, they state that patient participation can affect loyalty. In this case, patients will recommend hospitals, create a positive image, and maintain the hospital's credibility.

The hospital should maintain patient participation while maintaining a good relationship with the patient. However, based on the initial observations made on patients of the Tasikmalaya Islamic Hospital, information was obtained that patient participation in seeking information related to hospital services and the communication process between patients and health workers was not optimal, making patients feel less satisfied with the existing medical services. 

Based on the results of initial observations on 30 patients of the Tasikmalaya Islamic Hospital, the patients did not play an active role in seeking information related to the medical services owned by the Tasikmalaya Islamic Hospital, with a percentage of 83% and the remaining 17% seeking information. The high number of patients who do not seek information is due to the limited information shared by the hospital. However, as many as 60% of patients share information they know with others. In terms of relationships with the hospital, patients still have limitations in interacting with the hospital; for example, as many as 80% do not interact intensely with the hospital in medical services.