Volume 3,
No. 10 October 2024 - (1947-1955)
p-ISSN 2980-4868 | e-ISSN 2980-4841
https://ajesh.ph/index.php/gp
The
Influence of Organizational Climate, Doctor Motivation, and Transformational
Leadership Style on Completing Medical Records
Prama
Sesari Saraswati1*,
Andry2,
Rokiah Kusumapradja3
1,2,3
Universitas Esa Unggul,
Indonesia
Email:
pramasesari1404@gmail.com, andry@esaunggul.ac.id, rokiah.kusumapradja@esaunggul.ac.id
ABSTRACT:
Complete medical record filling is
an indicator of the quality of hospital services. Therefore, it is important to
improve the quality of services, including medical record documentation. This
study aims to examine the relationship between organizational climate,
physician motivation, and transformational leadership style on medical record
completion. This study used a cross-sectional design with a total sampling
approach, involving 49 doctors involved in filling medical records. The
relationship between organizational climate, physician motivation, and
transformational leadership style was evaluated to understand their influence
on medical record filling. The results showed that organizational climate, physician
motivation, and transformational leadership style significantly and positively
influenced medical record filling at North Serpong Regional General Hospital.
This study has implications for hospitals should develop standard operating
procedures (SOPs) related to medical record filling, conduct socialization and
training for health workers, and provide sanctions or reprimands for those who
do not comply with the established standards.
Keywords:
Organizational Climate, Doctor
Motivation, Transformational Leadership Style, Medical Records.
INTRODUCTION
Organizational
climate, doctor motivation, and transformational leadership style are
interrelated factors that can influence the completion of medical records in
healthcare settings. Organizational climate refers to the shared perceptions of
the values, attitudes, and practices that shape behaviour in an organization (Mutonyi
et al., 2022).
A positive
organizational climate can increase job satisfaction, employee motivation, and
overall performance (Chu et
al., 2021). A positive organizational
climate in healthcare can also lead to better patient outcomes (Chu et
al., 2021), (Berberoglu,
2018).
Organizational
climate is a relatively long-lasting perception regarding the quality of the
internal environment that is felt by its members and will then influence work
behavior. The climate is based on shared perceptions of “the way” things are
done (the intangibles of the internal environment).
Doctor
motivation is critical to ensuring high-quality patient care (Chu et
al., 2021). Motivated doctors are
more likely to provide better care, be more productive, and have better patient
satisfaction (Chmielewska
et al., 2020); (Wang
et al., 2023). Ideal motivation that can
stimulate effort and opportunities to develop abilities.
Transformational
leadership focuses on inspiring and motivating individuals to achieve a shared vision
(Khan
et al., 2020). Transformational leaders
often create a positive organizational climate by fostering open communication,
encouraging employee development, and promoting a sense of shared purpose (Chu et
al., 2021). This leadership style has
been shown to be effective in improving employee motivation, job satisfaction,
and overall performance (Chu et
al., 2021), (Khan
et al., 2020), (Qalati
et al., 2022).
Filling out
medical records is crucial in healthcare, as accurate and timely documentation
is essential for effective patient care (Belrhiti
et al., 2020); (Adane
et al., 2019). Filling outpatient
medical records is an obligation that must be carried out by every professional
care provider (PPA) and other health workers.
However, this
task can be time-consuming and may not be perceived as a priority by some
healthcare professionals (Belrhiti
et al., 2020). Therefore, understanding
the factors that influence the completion of medical records is essential for
improving patient care and overall organizational performance in healthcare.
The study could
identify the specific aspects of organizational climate, doctor motivation, and
transformational leadership style most strongly associated with filling out
medical records. This information could then be used to develop targeted
interventions to improve the completion of medical records, such as training
programs for healthcare professionals or changes to the organizational
structure
A preliminary
study found that 60% stated that the organizational climate was not running
well. The organizational structure and leaders in the office are in accordance
with government regulations. Still, the responsibilities and duties in
supervision, control, and direction imposed by the organization are less felt.
As many as 80%
said there was no work motivation, and many people felt that many policies
taken by the leadership were unfair, causing working conditions to become
uncomfortable and interpersonal relationships were often created. About 70%
said that the leadership style of current leaders shows a lack of communication
between leaders and subordinates, leaders have not become role models or role
models in solving problems, leaders do not listen to employees' aspirations,
and leaders never give individual attention.
Based on these
problems and research gaps, this study aims to determine and analyze the effect
of organizational climate, doctor motivation, and transformational leadership
style on the completeness of medical records at North Serpong Regional General
Hospital. The benefit of this study is to provide insight into the relationship
between organizational climate, doctor motivation, and transformational
leadership style in filling medical records. Practically, the results of the
study can help hospital management in developing training programs, policies,
and creating a more positive work environment. This aims to improve the
completeness of medical record filling, the quality of patient care, and
hospital operational efficiency. In addition, this study also provides guidance
for leaders in the health sector to implement a more supportive and fair
leadership style.
RESEARCH METHODS
This
study employs a quantitative approach with a cross-sectional design to assess
the influence of the independent variables—organizational climate (X1), doctor
motivation (X2), and transformational leadership style (X3)—on the dependent
variable, which is the completion of medical records (Y). The research is
conducted at the North Serpong Regional General Hospital between December 2023
and January 2024. The study sample consists of 49 doctors who are responsible
for providing services and completing medical records. Given the limited number
of participants, total sampling was applied as the sampling technique. Inclusion
criteria, include: 1) specialist and general practitioners involved in filling
out medical records; 2) willingness to participate in the study; and 3) a
minimum of one year of service at the hospital. Doctors who were unavailable
during data collection were excluded from the study.
The
data collection method involves administering questionnaires. The measure for
completing medical records evaluates the accuracy and comprehensiveness of
patients' medical histories, provided by healthcare professionals. This
instrument consists of three dimensions: 1) adequacy of medical record content,
2) timeliness, and 3) proper documentation of results. Responses are recorded
on a Likert scale with options ranging from 4 (strongly agree) to 1 (strongly
disagree), with a total of 20 items. A higher total score reflects a more
positive patient experience.
An
organizational climate questionnaire was utilized to gauge participants'
perceptions of the quality of the internal environment and its impact on work
behavior. This instrument consists of five dimensions: 1) structure, 2)
responsibility, 3) reward, 4) warmth, and 5) support. Like the medical record
instrument, responses are measured using a Likert scale from 4 (strongly agree)
to 1 (strongly disagree), with a total of 20 items. A higher score indicates a
more positive organizational climate.
All
research instruments underwent validity and reliability testing with a sample
of 30 participants. The results of the reliability tests indicated that the
instruments had acceptable reliability: the organizational climate
questionnaire (Cronbach's alpha = 0.745), the motivation questionnaire
(Cronbach's alpha = 0.749), and the leadership style questionnaire (Cronbach's
alpha = 0.74).
Descriptive
statistics are employed to present the characteristics of respondents. The
three-box method analysis is applied to determine the tendency of respondents’
answers to each variable, utilizing index analysis. Regression analysis is used
to explore the relationship between the dependent variable and one or more
independent variables. The t-test (partial) is conducted to determine the
individual effect of each independent variable on the dependent variable, while
the F-test (simultaneous) assesses the collective influence of all independent
variables on the completion of medical records.
Almost
half of the respondents in this study were aged 26-35 (44.9%) and were male
(51.0%) and female (49.0%). Based on employment status, there were 33 ASN
respondents, or 67.3%, and 16 non-ASN respondents, or 32.7%.
Regarding
respondents' education, less than half (46.9%) were general practitioners, and
more than half (53.1%) were specialist doctors. They worked as doctors for less
than 1 year (20.4%) and more than 1 year (79%). Regarding income and status,
respondents with income less than Rp. 10,000,000 IDR (20.4%) and more than
20,000,000 IDR almost half (40.9%).
Testing
the first hypothesis states that organizational climate, doctor motivation, and
leadership style jointly influence the filling out medical records. The formula
for the multiple linear regression equation is: Y= a +bx1 + bx2 +bx3
This equation concludes
that the organizational climate, doctor's motivation, and transformational
leadership style influence the filling out medical records at the North Serpong
Regional General Hospital. If the organizational climate, doctor's motivation,
and transformational leadership style are 0, the medical record filling will be
32.834%. Every improvement in the organizational climate will increase the
number of medical records filled by 11.7%. Every increase in doctor motivation
will increase medical record filling by 4%. Each increase in transformational
leadership style will increase medical record filling by 5.2%.
Table
1. Regression table
|
ANOVAa |
|||||||
|
Model |
Sum of Squares |
df |
Mean Square |
F |
Sig. |
|
|
|
1 |
Regression |
21.202 |
3 |
7.067 |
4.544 |
.004b |
|
|
Residual |
584.145 |
45 |
12.981 |
|
|
|
|
|
Total |
605.347 |
48 |
|
|
|
|
|
|
a. Dependent Variable: medical record filling |
|||||||
|
b. Predictors: (Constant),
leadership style, motivation, organizational climate |
|||||||
Association between the
independent variables and the dependent variable
Table
2 describes the association between the independent variables and the dependent
variable. The results found that there is an association between organization and
medical record filling (p-value<.05); motivation was positively association
with medical record filling (p-value<.05); and leadership style also has an association
with medical record filling (p-value<.05);
Table
2. Association between variables
|
|
B |
Std. Error |
t |
p-value |
|
|
1 |
(Constant) Organizational climate Motivation Leadership style |
32.834 .117 .040 .052 |
9.150 .110 .053 .079 |
3.588 2.835 1.730 1.751 |
.001 .007 .010 .028 |
The
study results showed that the F-score was 4.544, greater than the F table score
of 2.81, with a p-value of 0.004<0.050. Thereby, organizational climate,
doctor motivation, and transformational leadership style have a significant
effect on the variable of filling in medical records simultaneously
The
results of this study explain that filling out medical records includes the
adequacy of medical record content data, timeliness, and correct documentation
of results as a whole, which respondents consider as important factors for
hospitals.
The
results of the three-box method also show the highest index score of data
adequacy dimension in the contents of medical records. Therefore, the data
adequacy in the contents of medical records must be maintained as indicators of
the adequacy of the data, namely the contents of the medical record at least
consist of the patient's identity, History results, Results of physical and
supporting examinations, Diagnosis; Treatment and health service follow-up
plans; and Name and signature of the Health Personnel providing health services
The
previous research showed that leadership style and organizational climate
influence the simultaneous filling of medical records (YUNINDA,
2024). Another researcher, (Ahmad,
2020), in the Analysis of
Factors that Influence the Filling of Medical Records in Dental and Oral
Hospitals, showed quantitative research results to show knowledge, motivation,
and attitudes toward filling out medical records.
The
influence of organizational climate on filling out medical records
The
research results show that organizational climate influences filling out
medical records. The results of this research also explain that to improve
filling in medical records, the organizational climate must be improved by
improving Structure, Responsibility, Respect, Warmth, Support, Loyalty,
organizational identity, and Risk.
Apart
from that, the results of the three-box method analysis show that loyalty and organizational
identity are related to feelings of pride in one's existence in the
organization and loyalty shown during work. The level of loyalty to achieving
organizational goals will be associated with strong commitment. High commitment
to employees shows a need to increase loyalty so that the organization's
identity is created well.
This
is in accordance with (Maslow,
2007) theory regarding the
motivation of human needs arranged in a hierarchy. One of these needs is
esteem, which includes self-esteem and respect from others. These needs include
internal respect, such as self-esteem, autonomy, and achievement, as well as
external factors, such as status, recognition, and attention.
With
respect for employees, it is hoped that understanding of the principles of
organizational climate or employees' views on the environment will be felt by
all parts of the organization because this will last a long time and will
influence behavior (Lussier,
2017) in filling out medical
records so that it will improve employee performance. Organizational climate
focuses on perceptions that are reasonable or can be assessed, especially those
that give rise to motivation so that they have a direct influence on employee
performance (Parker
et al., 2003).
This
research supports the organizational climate theory from (Lussier,
2017), which states that
organizational climate is a relatively long-lasting perception regarding the
quality of the internal environment that is relatively felt by its members and
will then influence work behavior.
This
research also supports (Luthans,
2011) theory that organizational
climate is an overall feeling conveyed by physical rules, ways of interacting,
and how organizational members behave towards themselves and customers or
outsiders. Under positive control, people work to be recognized for contributing
to the company. Positive control through reinforcement intervention strategies
is much more effective and long-lasting than negative control. This creates a
much healthier and more productive organizational climate
The
influence of doctor's motivation on filling out medical records
The
research results show that the doctor's motivation influences filling in the
medical record. Thus, to increase the filling of medical records, it is
necessary to increase doctor motivation.
The
results of the three-box method show that salary is one of the reasons someone
has high motivation. A salary is a form of payment or a right given by a
company or agency to employees. In this study, respondents with the highest
income, namely >Rp. 20,000,000, showed that income influenced the filling
out of medical records.
Apart
from that, competence is important in increasing doctors' motivation to fill
out medical records. The competencies possessed by human resources need to be
continuously developed so that productivity and performance, both personally
and organizationally, continue to increase. It is necessary to carry out human
resource development activities as a form of the hospital's commitment to
supporting all employees so that they have the latest knowledge and
competencies to create a conducive work environment and optimize the
performance of all existing employees.
The
results of this research also support the motivation theory of (Herzberg,
1966), who proposed the Two
Factor Theory. Based on what Herzberg stated, satisfaction is caused by a
series of factors called motivator factors/ intrinsic motivators/ with the job
motivator. Factor, while not dissatisfied, is caused by the absence of a
different series of motivators, which are referred to as maintenance factors/
extrinsic motivators/ with the maintenance factors.
The
results of this research support previous research by Jaufan (2019) regarding
the relationship between hygiene factors and motivation factors in filling out
medical records. The results of research conducted quantitatively show that
hygiene factors and motivation factors influence filling out medical records.
Another
research is (Boris
et al., 2023) regarding Motivational
Analysis of Inpatient Medical Records at Ganesha Hospital in Gianyar City with
the results of research carried out quantitatively, which showed a significant
relationship between knowledge and inpatient medical records at Ganesha
Hospital in City. Gianyar.
The
influence of leadership style and filling in medical records
The
research results show that leadership style influences the filling out of
medical records. The results of this research also explain that to improve the
filling of medical records, it is necessary to improve the transformational
leadership style by increasing Charisma, Idealism, Inspirational Motivation,
Intellectual stimulation, and Individual Attention.
Transformational
and charismatic leaders have the ability to develop great symbolic power, which
they then use to influence their employees. Employees idealize such leaders and
often develop a strong emotional attachment to their vision. Charismatic and
transformational leaders engage in behavior that instills a strong sense of
idealism in their employees, as stated by (Lussier,
2017).
This
research supports the Transformational Leadership theory according to (Bass
et al., 1987), where the leadership
style of a leader who influences followers in an organization to achieve the
goals set by the company makes followers more aware of the importance and value
of work and persuades followers not to put their own interests first. For the
sake of the organization
This
research supports the Transformational Leadership theory, according to (McShane,
S. and Glinow, 2018), which is a leadership
perspective that explains how leaders change teams or organizations by
creating, communicating, and modeling a vision for an organization or work unit
and inspiring employees to fight for that vision. In addition to supporting the
transformational leadership theory, according to (Kinicki,
2008), it is the transformation
of employees to pursue organizational goals above organizational leadership
above personal interests.
The
results of this research support previous research by (Ridwan,
2021) on the Influence of Work
Motivation and Leadership Style and Their Contribution to Filling in Medical
Records. The research results show that work motivation and leadership style
have a positive effect on filling in medical records. The results of research
by (Ernawati
et al., 2020) regarding the relationship
between workload and leadership style on filling in the EMR method in inpatient
rooms, with the results of research conducted quantitatively showing that
workload and leadership style influence filling in the EMR.
In
the Inspirational Motivation dimension, the respondents responded that hospital
leaders could understand the vision and mission and increase their employees'
enthusiasm and ability to communicate with others in the hospital. In the
Intellectual Simulation dimension, the respondent responds that hospital
leaders can stimulate the creation of new ideas and innovations in their work
but are still not optimal in completing their tasks.
CONCLUSION
The
conclusion that can be stated in this study is that the organizational climate,
doctor motivation, and leadership style simultaneously affect the filling of
medical records. This means that the better the organizational climate, doctor
motivation, and leadership style, the better the filling of medical records.
Hospitals need to make standard operating procedures (SOPs) for filling medical
records properly and correctly. Regular monitoring and evaluation of medical
record filling with socialization of medical record filling also needs to be
done. This study contributes to improving the quality of health services
through improving the completeness of medical record filling, which in turn
will improve patient safety and hospital operational efficiency. In addition,
the results of this study can serve as a reference for other hospitals in
developing policies and training programs aimed at improving organizational
climate, motivating medical personnel, and implementing more effective
leadership styles. In the future, this study can serve as a foundation for
further research examining other factors that influence medical record
completion, as well as expanding the analysis to other aspects of hospital
services, such as patient satisfaction and the efficiency of digital medical
record management.
REFERENCES
Adane, K., Gizachew,
M., & Kendie, S. (2019). The role of medical data in efficient patient care
delivery: a review. Risk Management and Healthcare Policy, 67–73.
Ahmad, M.
H. (2020). Pengaruh Pengetahuan, Sikap dan Motivasi Terhadap Kepatuhan Dokter
dalam Penulisan Diagnosis pada Resume Medis di RS Zahirah 2018. Jurnal
Administrasi Rumah Sakit Indonesia, 4(3).
Bass, B.
M., Avolio, B. J., & Goodheim, L. (1987). Biography and the assessment of
transformational leadership at the world-class level. Journal of Management,
13(1), 7–19.
Belrhiti,
Z., Van Damme, W., Belalia, A., & Marchal, B. (2020). Unravelling the role
of leadership in motivation of health workers in a Moroccan public hospital: a
realist evaluation. BMJ Open, 10(1), e031160.
Berberoglu,
A. (2018). Impact of organizational climate on organizational commitment and
perceived organizational performance: empirical evidence from public hospitals.
BMC Health Services Research, 18, 1–9.
Boris, J.,
Ginting, N., & Gulo, N. O. (2023). Analisis Kelengkapan Berkas Rekam Medis
Pasien Covid-19 Di Rumah Sakit Santa Elisabeth Medan Tahun 2021. Jurnal
Kesehatan Saelmakers PERDANA (JKSP), 6(2), 350–356.
Chmielewska,
M., Stokwiszewski, J., Filip, J., & Hermanowski, T. (2020). Motivation
factors affecting the job attitude of medical doctors and the organizational
performance of public hospitals in Warsaw, Poland. BMC Health Services
Research, 20, 1–12.
Chu, H.,
Qiang, B., Zhou, J., Qiu, X., Yang, X., Qiao, Z., Song, X., Zhao, E., Cao, D.,
& Yang, Y. (2021). The impact of transformational leadership on physicians’
performance in China: A cross-level mediation model. Frontiers in Psychology,
12, 586475.
Ernawati,
D., Huda, N., Arini, D., & Elysabeth, O. P. (2020). Hubungan Beban Kerja
Perawat Dan Pelaksanaan Dokumentasi Asuhan Keperawatan Metode Emr (Electronic
Medical Record) Di Ruang Rawat Inap Rs Premier Surabaya: Relationships on
Nurses Work and Implementation Of Nursing Documentation Method EMR (Electronic
Medical Record) In Premier Hospital Surabaya. Jurnal Ilmiah Keperawatan
(Scientific Journal of Nursing), 6(2), 199–204.
Herzberg,
F. (1966). Work and the nature of man. World.
Khan, H.,
Rehmat, M., Butt, T. H., Farooqi, S., & Asim, J. (2020). Impact of
transformational leadership on work performance, burnout and social loafing: a
mediation model. Future Business Journal, 6(1), 40.
Kinicki,
A. (2008). Organizational behavior: Core concepts. McGraw-Hill.
Lussier,
R. N. (2017). Human relations in organizations: Applications and skill
building. McGraw-Hill.
Luthans,
F. (2011). Organızatıonal behavıor: An evidence-based approach. The
McGrow-Hill Companies.
Maslow, A.
H. (2007). A theory of human motivation. Psychological Review Google Schola,
2, 21–28.
McShane,
S. and Glinow, M. Von. (2018). Organizational behavior: emerging knowledge,
global reality. McGraw-Hill Education.
Mutonyi,
B. R., Slåtten, T., Lien, G., & González-Piñero, M. (2022). The impact of
organizational culture and leadership climate on organizational attractiveness
and innovative behavior: a study of Norwegian hospital employees. BMC Health
Services Research, 22(1), 637.
Parker, C.
P., Baltes, B. B., Young, S. A., Huff, J. W., Altmann, R. A., Lacost, H. A.,
& Roberts, J. E. (2003). Relationships between psychological climate
perceptions and work outcomes: a meta‐analytic review. Journal of
Organizational Behavior: The International Journal of Industrial, Occupational
and Organizational Psychology and Behavior, 24(4), 389–416.
Qalati, S.
A., Zafar, Z., Fan, M., Limón, M. L. S., & Khaskheli, M. B. (2022).
Employee performance under transformational leadership and organizational
citizenship behavior: A mediated model. Heliyon, 8(11).
Ridwan, Y.
S. (2021). Pengaruh Motivasi Kerja Dan Gaya Kepemimpinan Serta Kontribusinya
Terhadap Kinerja Pegawai Rekam Medis Di Rsud Kabupaten Karawang (Penelitian
Pada Pegawai Instalasi Rekam Medis RSUD KAB. Karawang).
Wang, H.
H. X., Li, Y. T., Duan, H., & Wong, M. C. S. (2023). Physician motivation
and satisfaction matter in healthcare. Hong Kong Med J, 29(1),
8–10.
YUNINDA,
E. (2024). Pengaruh Kepemimpinan Melayani, Keadilan Distributif Dan
Kebijakan Kompensasi Terhadap Kepuasan Kerja Serta Implikasinya Terhadap
Kinerja Dokter Umum Non Pns (Suryei Pada Rumah Sakit Pemerintah Area
Ciayumajakuning). UNIVERSITAS PASUNDAN.
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Prama Sesari Saraswati,
Andry, Rokiah Kusumapradja (2024) |
|
First publication right: Asian Journal of Engineering, Social and Health
(AJESH) |
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