THE INFLUENCE OF IMAGE AND SERVICE QUALITY ON PATIENT SATISFACTION THAT HAS AN IMPACT ON PATIENT LOYALTY

: Along with the growth of the population in Indonesia, the need for health services is increasing as well. with the phenomenon of competition between Hospitals which are increasingly becoming a challenge because it causes very fierce competition. Hospital managers must work hard to face the competitive climate with fast and precise business strategies. At a high level of competition, only hospitals with quality services and a good image can survive and excel compared to others. Hospitals must be able to provide quality services at competitive prices with the aim of achieving customer satisfaction and will have an impact on the emergence of customer loyalty. This research is categorized as survey research, where this research instrument is in the form of a questionnaire. The population in the study were patients who had more than once used the facility at the Family Hope Hospital Outpatient Installation. The sample was 118 respondents. The analysis of this study uses a structural SEM equation model based on components or variants, namely by using Partial Least Squares. This study resulted in a t-statistical value of image positively affecting patient satisfaction at Harapan Keluarga Hospital with a sample value of 0.435, image positively affecting patient loyalty at Harapan Keluarga Hospital with a sample value of 0.41, patient satisfaction with positive value for patient loyalty at Harapan Keluarga Hospital with a sample value of 0.245, service quality with positive value to patient satisfaction at Harapan Keluarga Hospital with a sample value of 0.407, the quality of service is positively valued to patient loyalty at The Family Hope Hospital with a sample value of 0.315.


INTRODUCTION
In the era of globalization that occurred moment this, bring impact positive and negative on all sector including sector health.According to (Magnus, 2012) magnuat the Global Health Security Agenda meeting, it was stated that globalization cause happening trend service health in Indonesia will characteristic international, so user service service health will have Lots very choice.For face it, ministry health in Indonesia must quick organize self for can give quality and satisfactory service.According to WHO, definition or Hospital meaning is something part comprehensive (integration) of organizational and medical, functioning give service health complete to public Good curative nor rehabilitative, where is the service output reach service family and environment, Hospital is also center training power health as well as For biosocial research (Meyer et al., 2014) (Beattie et al., 2005).
Currently in Indonesia the increase degrees health public Keep going continuously endeavored maximum maybe, various policies were rolled out by the government.Regulation government about Hospital policy was also directed For increase access, affordability and quality service safe health.Hospital is institution service organizing health service health individual in a manner plenary that provides service take care stay, treat way, and bad emergency (Ministry of Health, 2020) (Dumonda et al., 2022).
As growth amount population in Indonesia, needs service health the more also increased.Existence Hospital considered very important For give service health For Indonesian society.Popping up its a private hospital a number of year lately This give very positive impact for Indonesian people in need service medical quality, easy, fast and cheap.
However for Hospital administrator, with exists phenomenon the become challenge Because raises very tight competition.Hospital Managers must Work hard face climate competition with a fast and precise business strategy.on the rate enough competition high, then only Hospital with service quality and possession image good can survive and excel compared to with others (Widiyawati, 2011).
Based on data from the Ministry of Health, the number of hospitals throughout Indonesia is up to 2,813 units end of 2018.Family Hope Hospital is a class D hospital that has a number of facility good health service take care road nor take carestay.Currently Harapan Keluarga Hospital has 9 services polyclinic and polyclinic content is Polyclinic which is owned by Harapan Keluarga Hospital moment This there is four doctor obstetrician practicing in the polyclinic obstetrical partner at Mitra Keluarga Hospital, one of them is dr.H. Ali Rustaman TA, SpOG which is founding father from Mitra Keluarga Hospital.Experience practice and flying hours that have long made dr.H. Ali Rustaman TA, SpOG is highly sought after by patients (Fadli et al., 2020).With Hospital age is still say young, Harapan Keluarga Hospital Already own enough image Good in the eyes society.Family Hope Hospital focus For always maintain quality service for customers still feel satisfied with services provided.However if judging return comparison the average number of patients general from year to year tend fluctuating.this worried impact from less image Good or less service satisfying so that happen decline patient at Harapan Keluarga Hospital.Ca n't denied that patient general is one source income House important pain.So that if lost loyalty patient general For come return get treatment is something enough to lose large (Mulyani & Rafiqa, 2018).

Figure 1 Graph of Average Visits General Patient in the Polyclinic of Harapan Keluarga General Hospital
Chart on showing dynamics average patient visit common come more from once at the Harapan Keluarga Hospital polyclinic.From the data obtained, it happened significant decline in 2019 to 2020.Many factors can influence decline amount patient in the polyclinic of Harapan Keluarga Hospital that, one of them is image and service health.Besides that, the pandemic is very influential Lots to decline amount visit.
In terms services, Harapan Keluarga Hospital Still face various critics to ever time waiting and service slow by some patient in a number of time last.As mentioned by section management Hope Family Hospital services, p This because soared his visit patients and treatment system registration only during a pandemic However amount source Power man Not yet There is addition, so feel overwhelmed For serve patients (Sumarni & Sumiati, n.d.).
The image built by Harapan Keluarga Hospital in accordance with vision and mission of the Hospital which is highly respected high.Vision of Harapan Keluarga Hospital is to be an Islamic Hospital with service plenary and affordable, choice main public Sumedang, East Bandung and its surroundings.Whereas mission from Harapan Keluarga Hospital are (Mulyani, 2018): 1. Give service quality health in a manner efficient in accordance desire customer.

Enforce deep Islamic values
service health in accordance standard sharia certification.

Increase loyalty and quality source
Power professional human.4. Organize activity social, promotive and educative for public around.
Hospital must Can provide service quality with price compete with objective For achievement satisfaction customers and will impact on emergence faithfulness customer.
Besides maintaining customers, Hospitals also have to capable get customer loyal new.one his efforts related increase faithfulness customer is with build strong image where the Hospital is sued For always notice the image it has For get position top in choice customer.one efforts made by the Hospital in form customer loyalty is with build a very strong image, where the Hospital is sued must Keep going notice image he has in order to get position highest in choice customers (Bayhaqi, 2006).
Hospital that has good image in the eyes customers, products and services his relatively more Can accepted by society.Employees working at the Hospital with good image will have a sense of pride so that can trigger motivation they For Work more productive compared to with the Hospital with image bad in society.Good image in the eyes society will too profitable in a manner business, that is own opportunity For can increase sales, market share and rates growth his.In times of crisis like Now Currently, there are many hospitals in Indonesia, especially in cities big experience crisis trust, then need For build Hospital image be very important For built since early (Wu, 2011).In addition to a good image in the eyes community, quality service is also one factor important for the Hospital for Can give patient satisfaction so that Can creation loyalty to customers.Hospital must Can evaluate is services provided Already in accordance with hope customer or no.because that, the Hospital must always can guard trust patient with increase quality service.Service quality health is service possible health satisfying every user service service health in accordance with level the average satisfaction of the population as well as the maintenance in accordance with standards and codes ethics profession that has set.With fulfillment hope patient, with so they will feel satisfied and will arise loyalty to the Hospital (C.Aryani, 2021).
one indicator success of the Hospital is ability in build image and always maintain quality from service, then should every hospital needs know How Hospital image will be formed in the middle community and quality order strategy service No decrease even can always improved.However, still A little once the Hospital evaluates image as well as minimal allocating funds for activity (D. Aryani & Rosinta, 2011).
Loyalty customer Alone No can separated from satisfaction customer.circles practitioner nor academics agreed that satisfaction and loyalty related in a manner tight and not inseparable.But pattern connection between both of them characteristic asymmetry remember most loyal customers satisfied consumers, however No all satisfaction consumer meaning loyalty (Oliver, 1999).Loyalty customer This appear Because exists influence from perceived satisfaction customers (Wijayanti, 2008).
creation loyalty customer possible company develop connection period long with customer.Besides that costs required For interesting customer new too far more big compared to cost For maintain loyal customers to the company (Amalia et al., 2021).
Based on background behind above and consider Not yet Once his done study similar to that carried out at Harapan Keluarga Hospital, then the writer is very interested do research entitled " The Influence of Image and Quality Service to Satisfaction Patient Impact on Loyalty Patient " at Harapan Keluarga Hospital.

RESEARCH METHODS
object study This is patient general public at the Harapan Keluarga Hospital Outpatient Installation who came more from one time visit.Study This use cross sectional survey method for analyze closeness connection between variable One with variables other.Obtained data is the primary data collected from results questionnaire.Obtained data Then analyzed with approach quantitative (against results questionnaire patient).
Study in a cross-sectional manner ie something type research that does collection information / questionnaire only once in One time certain to sample (Yani et al., 1995).Cross sectional data were collected at once on one moment certain and only very just with method spread questionnaire to the respondents.Survey method is collection information based on a questionnaire respondents (Yusuf et al., 2022).With thereby study This belong in method survey in which the researcher use instrument questionnaire For get data to subject researcher in period relative time short.

A. Description Answer Respondents
Description answer respondent is results answer originating respondents from questions for each variable research.Description answer will explained based on scale likert Following is results answer whole respondents, which are summarized into each of the existing variables.Table 4.

E. Results of answers Respondents
Answer from respondent processed using the Smart PLS 3.0 program.Answer received of 118 respondents.
Respondents fill in questionnaire that has been shared using the Google Forms link.Testing hypothesis use technique analysis Partial Least Square (PLS) with the Smart PLS 3.0 program.Inner models or normal called by effect test or hypothesis testing aim For predict connection between latent variable.Following This is the inner model test with the Smart PLS 3.0 program tested in study this.Equality This is fruit thought from framework thinking study this.There is symbol C represents symbol.Based on the data in the table obtained outer loading all indicators above 0.7, so convergent validity is increasing high.

b. Cronbach alpha, Composite reliability, and Average Variance Extracted (AVE)
Test results reliability and mean variations extracted in each variable ie can described in the table following.

Table 8 Reliability Test Results
Reliability test results use cronbach alpha, according Ghozali (2011) a instrument said reliable if own mark cronbach alpha > 0.7.The results of the analysis in the table with results that each variable own mark cronbach`s alpha > 0.7 So concluded that all variable own mark cronbach alpha > 0.7 and reliable.
Test results composite reliability where each variable mark more composite reliability big from 0.6 can concluded that all variable fulfil condition composite reliability.
Test results Average Variance Extracted (AVE) obtained for each variable own AVE value > 0.5 then fulfil Average Variance Extracted.

c. Inner Model Test
Test the inner model ie For determine whether or not the structural model fits in the study, as follows results testing inner model.

a. Coefficient Determination (R 2)
Table 9 Inner Structural Model Testing R 2 shows variable patient satisfaction of 0.651, which means that the patient satisfaction variable can be explained by the variables that influence it in the study of 0.651 or 65.1 %, the remaining 34.9% is influenced by other variables.
R 2 shows variable patient loyalty of 0.820, which means that the patient loyalty variable can be explained by the variables that influence it in the study of 0.820 or 82.0%, the remaining 18% is influenced by other variables.b.Q-Square Predictive Relevance

Hypothesis Test Results
Estimated parameter significance give very useful information For know connection between variable in study this.Testing hypothesis done with see mark probability its and t-statistics his.For mark probability, the p-value with an α of 5% is <0.05.t-table values for α 5% is 1.960.So that criteria reception hypothesis is when t-statistic value > ttable .Testing hypothesis with method Smart PLS 3.0 done with method perform the bootstrapping process.On research This bootstrapping is done directly and bootstrapping is not direct, so obtained connection influence variable exogenous to endogenous variable as following :

Bootstrapping Direct Effects
Assessment bootstrapping direct effect or influence bootstrapping direct, aimed For evaluate probability or significance between variable.Calculation This processed with data between two related variables direct.Following This is results from calculation of bootstrapping effect directly :

The
Influence of Image and Service Quality on Patient Satisfaction That Has an Impact on Patient Loyalty Page 796 Asian Journal of Engineering, Social and Health Volume 2, No. August 8, 2023 Figure 1 Equation Models Partial Structure Figure 2 Outer Loading Model Phase II G Figure 3 Bootstrap Model SpOG Still serve good on installation take care stay or take care the road at the Family Hope Hospital, he is one figure who has quality five-star doctor, proven he can change something Clinic Maternity to be a good Hospital and can make patient satisfied with service so that Lots arriving patients back, p That is something form from loyalty.

Table 4 Description Answer Respondents Regarding Image
Page 798Asian Journal of Engineering, Social and Health Volume 2, No. August 8, 2023

Table 7 Description Answer Respondents About Loyalty
Table above is gathering answer from respondent to point representative question loyalty to existing patients get service At home family Hope pain.From that table obtained good average value, value the Can interpreted all respondent who filled in feel satisfied with the service you get so that they feel want to get back service if need.

Table 11 Boostrapping results Influence Direct
influence positive and significant.5. Quality service to loyalty patient statistical value For quality service to loyalty patient the original sample value is 0.315 positive and t count of 3.068 > t-table (1.960) and p-value 0.003 <0.05 and the original sample value is positive.With thereby hypothesis on research This accepted.That is, quality service to loyalty patient own influence positive significant.Bootstrapping Indirect Effects Assessment of bootstrapping indirect effect or bootstrapping effect no direct, aimed For evaluate probability or significance between variables bridged by variables other.Calculation This processed with data between two related variables in a manner No direct because exists variable link.Following This is results from calculation of bootstrapping effect No directly : Page 804 Asian Journal of Engineering, Social and Health Volume 2, No. August 8, 2023 own