ORGANIZATIONAL CLIMATE ANALYSIS AND PERFORMANCE ON JOB SATISFACTION OF MEDICAL AND MEDICAL PERSONNEL AT THE REGIONAL GENERAL HOSPITAL OF CIAMIS DISTRICT

This study aims to examine how the influence of organizational climate and performance on the job satisfaction of medical workers and medics at the Ciamis District General Hospital. The research uses quantitative research methods and refers to the theory of organizational climate and performance, which has six aspects: structure, standards, responsibility, rewards, support, commitment, and other items ranging from work accuracy, job reviews, etc. The population of this study were employees at the Tasikmalaya and Banjar City General Hospitals. A sample of 98 respondents was taken using proportional random sampling. They were collecting data using a questionnaire designed by the needs of research and observation. The results of this study indicate that the organizational climate and performance have a significant influence on the job satisfaction of medical workers and medics at the Ciamis District General Hospital. On the other hand, the dimensions of the structure, the dimensions of standards and the dimensions of commitment have no significant effect on the job satisfaction of medical workers and medics at the Ciamis District General Hospital. The organizational climate, especially human resources, is still limited at the Ciamis District General Hospital, showing the strength displayed by medical personnel and medical staff, where medical personnel can display ways and strategies in building structure, responsibility, support, commitment with all their subordinates, especially helping provide more effective care for all patients.

staff. The Regional General Hospital is a regional technical institution that seeks to increase the job satisfaction of medical personnel as a leading institution owned by the region that functions to serve the community's needs for complete inpatient services directly. The Ciamis Regency general hospital, as the spearhead and implementer of various activities related to patient care, can be said to be an institution that must play a better role because it is the only option to obtain effective patient care.
The Regional General Hospital of Ciamis Regency, as the spearhead in health services to the community in practice, uses a structure, standard, responsibility, appreciation, support, commitment approach and the results it achieves at the Ciamis Regency General Hospital. The Ciamis General Hospital tries to focus on structure, which means reflecting the feeling of being organized, maximizing roles, showing responsibility, and having clarity of duties so that the job satisfaction of medical staff and medical staff is built to provide services to the community. The standard approach taken by the General Hospital The blood of Ciamis Regency focuses more on the standard of results, work pressure, and the degree of pride in completing the work.
The object of this research is the Regional General Hospital of Ciamis Regency to be the job satisfaction of medical staff and medical staff for the following reasons: services to patients and roads are increasingly complex, even relatively longer. The impression felt by the patient is essential to be assessed more objectively in terms of service. In addition, to serve patients, various efforts are needed to increase the job satisfaction of medical staff and medical personnel according to the patient's condition. Services for patients can create independence and be more professional in their services, so the job satisfaction of medical staff and medical staff is needed.
Various phenomena were found from various incidents, documents, and reports regarding the job satisfaction of medical workers and medics at the Ciamis Regency general hospital, as follows.
In dealing with prospective patients, the staff or medical personnel and medical staff have not responded quickly and carefully, so they do not support improving and maintaining the quality of hospital services; this condition occurs and is experienced by many hospital organizations.
In the minimum service standards listed, the slowness of the officers or medical staff in treating typhoid fever sufferers through a low-fibre diet, chloramphenicol, antipyretics, but in fact, the patient still has intestinal bleeding, this incident is often experienced in public health services.
From a brief description of the low job satisfaction of employees at the Ciamis District General Hospital, the question arises that there is still the need to build responsibility, appreciation, support, and commitment as well as structures and standards at the General Hospital continuously so that health services can be carried out according to the targets set.
Based on the results obtained from the initial research, various symptoms are suspected to be the cause of the weak organizational climate and performance in General Hospitals that are not managed carefully at the Ciamis District General Hospital as follows: the structure, standards and responsibilities are not yet maximal. Ciamis District General Hospital. Other problems relate to the lack of appreciation given to its employees, the conditions of work support for its employees, various forms of commitment needed in handling patients in an emergency, and the results achieved by employees while carrying out their duties and work. This condition shows the support and commitment that has not been applied by the leadership, such as doctors and midwives, the rules are violated and have not carefully reviewed the work rules, even though these factors determine the organizational climate and the work of its work at the Ciamis District Blood General Hospital. The Regional General Hospital of Ciamis Regency has not been maximal in building an organizational climate and continuous performance by its dimensions so that it contributes to increasing the job satisfaction of medical staff.
To further investigate the factual conditions of the organizational climate and performance in the Ciamis District General Hospital, and to increase the job satisfaction of medical and medical staff, the question was asked how the analysis of organizational climate and performance on employee job satisfaction (medical and paramedical staff) at the Ciamis District General Hospital.
Organizational climate and performance are increasingly urgent to manage and maintain the continuity of organizational life, including in increasing employee job satisfaction. Each organization has its way of running its business, including building its organizational climate, which is shown in various forms, such as suppressive, neutral, supportive, and depending on the setting, even the organization has a unique work climate. Organizations tend to attract and retain people suited to their climate so that, to some extent, the pattern is sustainable and coherent.
Organizations have different climates that affect the quality of their members, such as increasing employee job satisfaction, while performance focuses on what the organization, managers and workers need to succeed. Therefore, the centre of attention rather than the organizational climate, namely the structure of standards, rewards, support, and commitment. It strengthens several organizational desires to increase employee job satisfaction in achieving its goals. Tagiuri and Litwin (Wirawan, 2008) assert: "a relatively enduring quality of the internal environment of an organization that (a) is experienced by members, (b) influence their behavioural, and can be described in terms of the values of a particular set of characteristics (or attributes) of the organization". The statement implies that organizational climate is a relatively lasting quality of the organization's internal environment, experienced by members of the organization, influencing their behaviour and can be described in terms of a set of characteristics or characteristics of the organization. So, the organizational climate is the dominant value supported by the organization, which can describe the ways of doing a job in a particular place and the basic trust assumptions that exist among organizational members. Stringer (2008) asserts: " a concept desiring the subjective nature or quality of the organizational environment, its properties can be perceived or experienced by members of the organization and reported by them in an appropriate questionnaire". The statement shows that organizational climate is a concept that describes the subjective nature or quality of the organization's internal environment. Its elements can be perceived and practiced by organization members and reported through the appropriate questionnaire. So organizational climate can be studied by members of the organization how the organization relates to the environment so that it can increase organizational commitment and the consistency of the behaviour of its members. Therefore, organizational climate is perceived as the view of members of the organization, both individually and in groups, staying in touch with the organization. Each organization will have a different climate, where a diversity of organizational climates is designed, and all organizations have strategies for managing human resources. An open organizational climate encourages employees or employees to express interests and dissatisfaction without fear of reprisal and attention. Therefore, the organizational climate has the following dimensions: structure, standards, responsibilities, rewards, support, and commitment (Wirawan, 2008). The structural dimension reflects being well organized and having clear roles and responsibilities in the organizational environment. The standard dimensions measure feelings of pressure to improve performance and the degree of P-ISSN 2442-5958 E-ISSN 2540-8674 Vol.7, No.2, 2021 http://jurnal.unpad.ac.id/cosmogov/index 114 pride for organizational members. The dimension of responsibility emphasizes organizational members feeling compelled to solve their problems. The reward dimension is directed at members feeling valued if they complete a task well. The support dimension focuses on feelings of trust and mutual support. The commitment dimension focuses on members' feelings of pride in their organization. Steve Kelneer (1998) focuses more on: (a) flexibility conformity, (b) responsibility, (c) standards, (d) reward, (e) clarity, (f) theme commitment. From this statement, it is more revealing than the dimensions of organizational climate put forward the determining side where a person is carrying out tasks and work. It is evidenced by indicators such as organizational conditions to provide freedom of action for employees' employee feelings regarding the implementation of organizational tasks carried out with a sense of responsibility for the results achieved. Organizational conditions in which management pays attention to carrying out tasks well, employee feelings about appreciation and recognition for good work, and feelings they are what is expected of them with the job, the role, the sense of pride they have on the organization and a willingness to put in more effort when needed. David, Irwin, and James (2002) mention seven organizational climate measurements: conformity, responsibility, reward, team spirits, clarity, standard, and leadership. The organizational climate must also be seen from the nature of the organizational climate as stated by , which includes a good organizational climate; all climates are abstract, abstract and perceptual, the climate itself.
The performance study emphasizes the role played by individuals, groups, and organizations. Performance emphasizes the outcome aspect rather than a successful process. It is even confirmed by Wibowo (2010) that performance is the result of someone's activities that are carried out continuously in the organization. The statement shows the results obtained by clear expectations and an understanding of the work that has been completed. Performance is essentially related to the process of a person's ongoing activities carried out with all the abilities and skills possessed to fulfil and create expectations.
Performance management is directly related to humans in the organization, and this is because humans are the most crucial resource in an organization. In operating the organization, every human being or human resource who has different behaviour and thoughts will also result in differences in their performance. Therefore, we need planning, organizing, directing, and reviewing employee performance. Performance Management or Performance Management can be considered a systematic process in which an organization involves its employees in achieving the organization's mission and goals. Many studies show a close correlation between effective performance management and the achievement of organizational goals. Therefore, Armstrong (2004) asserts that performance management is a means to get good results from organizations, teams, and individuals by understanding and managing performance within common goals. P-ISSN 2442-5958 E-ISSN 2540-8674 Vol.7, No.2, 2021 Performance is an activity that a person does by producing something that benefits the organization. Performance can focus on the performance of an organization, department, employee, or even the process for creating a product or service and other areas. Armstrong (1999) asserts that performance is the result obtained by a person for the achievement or work he has completed. The performance is more focused on the aspect of open cooperation between managers and employees concerning the achievement of goals, providing feedback from managers to employees and vice versa from employees to managers, and performance appraisal. Armstrong (2004) focuses more on a strategic and integrated approach to deliver sustainable success to organizations by improving the performance of the employees who work within them and developing the capabilities of teams and individual contributors.
In contrast to his opinion, Bacal (1999) states that performance management is continuous communication and is carried out in partnership between an employee and his direct supervisor. This process includes activities to build clear expectations and understanding of the work. Meanwhile, Castello (1994) emphasizes the driving forces behind all organizational decisions, work effort and resource allocation.
Employee job satisfaction is an evaluation that describes a person's attitude, being or not happy, satisfied or dissatisfied at work. Job satisfaction is individual. The higher the assessment of the activity felt by the individual's wishes, the higher the satisfaction with the activity. Asad (2002) states that job satisfaction is an individual thing, meaning that everyone will have a different level of satisfaction, tending to have individual personal judgments on its aspects; promotion, working conditions, work record and supervision. Byar & Rue (2004) assert that job satisfaction is the general attitude of employees towards their work, while Grenbert & Baron (2007) state that job satisfaction is a cognitive, affective, and evaluative reaction from individuals that creates a pleasant experience with their work. Therefore, in fulfilling job satisfaction, employees need to emphasize emotional attitude, love for work, work morals, discipline, and work performance. Employee job satisfaction in the organization uses a theoretical approach, including incompatibility theory, equity theory, two-factor theory, while job satisfaction aspects include: job content, rewards, promotions, working conditions. Aspects of job satisfaction in the organization are determined by the pattern of the field; the work itself, the work environment, individual needs, rewards, job promotions, job promotions, working conditions, co-workers' supervision. Standards are included in one of its fields, namely the implementation of hospital services, medical services, support services and nursing services both as well as outpatients, which at least must be carried out by hospitals. Minimum service standards for Regional General Hospitals in the service of minimal activities that must be carried out in medical services include indicators, namely the availability of services for poor patients, class III, and supporting services consisting of  Soeroso (2005). He stated that; The principles of how a hospital should behave in terms of medical services, economic activities, and responsibilities to society and the environment, health service institutions always behave ethically are community-oriented. Public Responsibility for general hospitals is fundamental if the hospital aims to assist patients or the customer community who need it; this has been proven by prioritizing the public Responsibility of general hospitals in various ways, including consideration of providing quality services and outpatient services. Even Queen Elizabeth Hospital Hong Kong in Soeroso (2005) has Civic responsibilities in the Code of Professional Ethics. It is explained that the community's Responsibility is to provide hospital services to the public under any circumstances support and participate in activities related to improving the degree of health. Public health and welfare, maintaining political neutrality, are prohibited from providing misleading explanations or misleading the public and are prohibited from publishing about a person.
The public responsibilities of public hospitals in Indonesia have been stated in the Code of Ethics for Indonesian public hospitals, which in essence, is the hospital's obligation to the community and the environment. Hospitals must be honest and open, sensitive to public suggestions and criticism and strive for services to reach outside the hospital. Moreover, hospitals in carrying out their operations are responsible for the environment so that pollution does not occur that is detrimental to the community. Therefore, the code of ethics for patient care must be translated into noble values that are stated and dedicated to the community in the form of a statement of hospital public Responsibility that is clear for the implementation of services and is easily understood by the wider community.
The concept of patient care in public hospitals is also described by the National Health Service in Adhitama (2006), which states: Clinical governance is a framework through which NHS organizations are accountable for continuously improving the quality of their services and saving high standards of care by creating an environment in which clinical care will flourish". Clinical governance is a relatively new concept in public hospital organizations that focus on eliminating weaknesses related to the quality of clinical care, which includes medical care, nursing, and care by other health workers. Clinical governance is part of corporate governance in hospitals which is the primary basis for policies in providing health services to patients and outpatients. Even The British Association of Medical Managers in Adhitama (2006) added: The implementation of clinical governance in P-ISSN 2442-5958 E-ISSN 2540-8674 Vol.7, No.2, 2021 http://jurnal.unpad.ac.id/cosmogov/index 117 hospitals is aimed at ensuring to establish a system capable of monitoring the quality of clinical practice and ensuring that it remains on track and functions perfectly. An assessment of clinical practice is carried out to improve it so that clinical practitioners meet the standards of the national professional body.
In implementing clinical governance in public hospitals, three main areas of hospital management must be considered, namely the area of non-clinical management, financial management, and unique management in the clinical field. The National Health Service in Adhitama (2006) adds that the concept of Clinical governance in public hospitals, especially in the field of clinical management, includes: providing direct clinical care to patients consisting of; medical care (primary, secondary, and tertiary), nursing care, midwifery care, medical rehabilitation care, and other medical care. Hospital leadership and professionals who provide clinical care ensure clinical governance.
Performance that affects the improvement of health services will be more focused on aspects of approaches in the organizational climate, and there are at least six dimensions of the organizational climate approach, namely structure, structure or process, and results. All three are interrelated and cannot be separated in organizational climate and performance. Therefore, the organizational climate approach focuses on structure, standards, rewards, actors, commitment, and the performance focuses on behaviour and performance management focuses on results.

METHOD
The research method used in this study is the explanatory method because the explanatory research method is a study that aims to determine the effect of one variable on another and has the aim of explaining, predicting, and controlling a symptom.
To answer the problems in the formulation of the problem, path analysis techniques or t-tests are used, then an indepth study is carried out based on the analysis of organizational climate and performance on employee job satisfaction. After the data processing results have been generated, it is continued by using collaborative analysis by interpreting the variables and dimensions analyzed.
Data analysis technique used path coefficients through statistical tests, with the formula t = Pyx / (1-R2yx)Ci.X2 th) / n-k-1 and the test formula t = r.n-2 / 1-r2. This path analysis is used to test the hypothesis with the following steps: determine path diagrams, determine structural equations, calculate path coefficients, test path coefficients.
Data collection techniques used in the field include Observations by recording various incidents or events related to aspects of the organizational climate approach, performance and effectiveness of patient services, in-depth interviews related to the management approach to aspects of behaviour and employees and distributing questionnaires to respondents in the two public hospitals.
The population in this study were employees (medical staff and medical staff) at the Ciamis District General Hospital. There are 456 people in the Ciamis District General Hospital. The researcher considers P-ISSN 2442-5958 E-ISSN 2540-8674 Vol.7, No.2, 2021 http://jurnal.unpad.ac.id/cosmogov/index the error rate of 10% so that the number of samples can be calculated using the Slovin formula, then the number of samples taken is 98 people. As for the sample size, the formula n = N/1+Ne2 is used. Where N = 456, e = 10 %. Then n = 456/1+456 (0.01) = 97.8 = 98.

RESULT AND DISCUSSION
The Regional General Hospital of Ciamis Regency strives to achieve its goals through various steps to improve and equalize services, both medical services and medical support services and other supporting services. These are sub-systems of the hospital service system whose existence is inseparable from one another. Likewise, the hospital service system is an integral part that cannot be separated from the overall service system and is influenced by various factors, including the rate of increase in population, geographical location, socio-economic community as well as the development of science and technology, including technological advances in the health sector. All health services provided by the Ciamis District General Hospital can achieve good results if supported by increased job satisfaction of employees or medical staff and medical staff.
To support the smooth running of these efforts in the 2020 fiscal year, the Ciamis District General Hospital has carried out various activities, including improving the quality of human resources through various efforts to build structures, setting standards, awards, discipline, commitment, and another coaching. Construction of treatment rooms for obstetrics and gynecological diseases of advanced stage I and rehabilitation of the Obstetrics Room Building and old obstetric diseases, physical maintenance of service room buildings. Furthermore, in line with the standardization of the Ciamis District General Hospital referring to the community's demands for health services which tend to increase regarding specialist services and customer satisfaction, the Ciamis District General Hospital strives to continue to equip skilled doctors who do not yet exist, among others; pulmonary surgeons and specialist doctors who are lacking.
In education, the Regional General Hospital of Ciamis Regency is also active by providing practice areas for students in health care, dental care, midwives, arrangement in various fields of expertise, workshops, seminars and other activities, joint research and use of laboratories and other facilities. In carrying out its organizational wheels, the Ciamis District General Hospital has a work program, goals, and targets to provide health services to the community. Therefore, the Ciamis District General Hospital tries to bring employees or medical personnel and medics with quality and extensive experience. One of the efforts to increase employee job satisfaction is by improving the structure, setting standards, more appropriate safeguards, high discipline in providing services, and uniting understanding in providing good service.
The Ciamis District General Hospital has 32 building units that are used for treatment units, and other rooms are used for outpatient units, medical emergency services, medical support, and other supports as well as administrative services standing on an area of 32,700 m2 with a total area of the building there is an addition of the ranged from 20% -100%, consist of; 1 unit condition 20%, 2 units condition 45%, 2 unit condition 50%, 1 unit condition 55%, 2 unit condition 60%, 1 unit condition 62%, 3 units condition 65%, 8 units condition 70%, 4 units the situation is 75%, and 4 units are 78%, 6 units are 80%, 1 unit is 85%, 1 unit is 90%, 1 unit is 95%, 1 unit is 98%, and 2 units are 100%.
The entire physical building of the Ciamis District General Hospital, which is still in reasonably good condition, consists of; main classroom building, emergency room building, ICU building, Hemodialysis R building, surgical building, main hospital building, polyclinic building, old radiology building, new radiology building, clinical pathology lab building, old major surgery building, polyclinic building, R building VIP 3 Lt, R 1 and R 7 buildings, VIP and main class R buildings, R 3 buildings, R 4 buildings, old R 5 buildings, R 6 buildings, CM room buildings, RAA and RAB buildings 2 Lt, R MB buildings, water storage building, Jami mosque building, wasray building, healthy cooperative building, nutrition installation building, vehicle garage building, multi-purpose building, canteen building, surgical building, and midwifery room building. The building has an area of 17,734.99 M2 in the General Hospital complex, 86 M2 of building area outside the General Hospital, 32,700 M2 of land area for General Hospital and 388.50 M2 of land outside as a doctor's office. All of these buildings can meet the needs of general hospital organizational activities and health services, especially patient care, and increase the security, health and welfare needs of all medical personnel and medical personnel at the Ciamis District General Hospital.
Then the analysis of organizational climate variables (X1) on the legal aspect of employee job satisfaction (Y) at the Ciamis District General Hospital is based on several stages. After analyzing with statistical calculations, the percentage value of the organizational climate variable (X1) on employee job satisfaction at the Regional General Hospital was obtained. The table shows the path coefficient value that the direct influence of organizational climate variables on employee job satisfaction or medical personnel and medical staff at the Ciamis District General Hospital is 16.00%, meaning that efforts to manage organizational climate variables focus on the place where the institution operates. Regional General Hospitals have been accompanied by channelling every structure, standard, discipline award, commitment and understanding in providing exemplary patient care. All employees can receive every message or information clearly and objectively, and every employee action is relatively consistent easy to understand. Run it.
The analysis of organizational climate variables (X1) on the structural aspect of employee job satisfaction at the Ciamis District General Hospital is 4.96%, meaning that the percentage value indicates that the effort to apply organizational climate suppressors to employee job satisfaction at the Regional General Hospital is quite reasonable, and all messages are received clearly. Every order is tailored to the interests of patient care. To meet the demands of channelling a reasonable, transparent, and appropriate approach requires the ability of individual health workers to work carefully, skillfully, and quickly, especially in serving patients. Health workers as staff try to serve patients at the Ciamis District General Hospital according to the authority in their duties and responsibilities, the facilities used in serving patients, and can manage information or messages related to patient care.
The analysis of organizational climate variables (X1) on responsibility for employee job satisfaction at Regional General Hospitals is 1.66%. The percentage value indicates that efforts to display natural behaviour in inpatient care have not been accompanied by mutual understanding. All health workers do not accept every message or information on patient services and have not been accompanied by clear and consistent leadership orders for implementing patient services at the Ciamis District General Hospital. Good behaviour or behaviour and mutual understanding between health workers as implementing health policy officials are less successful because it has not been supported by the attitude of the implementing leaders at the Ciamis General Hospital as civil servants. They are ready and trying to implement health policies incredibly patient care.
Analysis of organizational climate variables (X1) on the commitment to job satisfaction of medical employees and paramedical staff through its relationship with work outcomes at the Ciamis District General Hospital is 4.59%. The percentage value indicates efforts to implement commitment aspects, primarily services. Patients implementing staff can accept it and be consistent and clear on orders carried out according to health policies inpatient care. It turns out to be good because it has been accompanied by a structure or chart of relationships and cooperation between work units as implementers at Regional General Hospitals. In addition, it is also emphasized on the application of standard operating procedures for patient care and trying to spread the responsibilities of health workers inpatient care to be ready to complete tasks and activities and work as a whole at Regional General Hospitals.
Analysis of organizational climate variables on support for employee job satisfaction at the Regional General Hospital of Ciamis Regency is 27.21%. The percentage value indicates that the analysis of organizational climate dimensions on the aspect of support affects employees' job satisfaction at the Regional General Hospital through job content, rewards, promotions, working conditions, co-workers, and supervision.
Then in the analysis of performance variables (X2) on the process aspect of employee job satisfaction.
(Y) at the Ciamis District General Hospital based on several stages. After analyzing statistical calculations, the percentage value of the performance variable (X2) on employee job satisfaction at the Regional General Hospital was obtained. The table shows the path coefficient value that the direct influence of the performance variable on the process aspect on employee job satisfaction or medical staff at the Ciamis District General Hospital is 26.00%, meaning that efforts to manage performance variables in the process aspect focus on the location. Where the institution operates in the Regional General Hospital, it has been accompanied by the ability to implement the rules, determine the size, provide written awards, understanding in providing exemplary patient care, every message or information can be received by all employees clearly and objectively, and every employee action is relatively consistent. Moreover, easy to run.
The analysis of the performance variable on the outcome aspect on employee job satisfaction at the Ciamis District General Hospital is 21.96%, meaning that the percentage value indicates that the effort to apply performance suppressors to the outcome aspect on employee job satisfaction at the Regional General Hospital is quite reasonable, and all messages are received clearly. Every order is tailored to the interests of patient care. To meet the demands of channelling a reasonable, transparent and appropriate approach requires the ability of individual health workers to work carefully, skillfully and quickly, especially in serving patients. Health workers as staff try to serve patients at the Ciamis District General Hospital according to the authority in their duties and responsibilities, the facilities used in serving patients, and can manage information or messages related to patient care.
Empirically there are activities of health implementing personnel such as the Director, Deputy Director of Services, Deputy Director of General Affairs and Finance, Medical Committees, Functional Medical Staff, Nursing Committees and Internal Supervisory Units, and Heads of Sections and Heads of Sub-Sections at Regional General Hospitals. Channel and build a hospital organizational climate where every behaviour with mutual understanding, work results as part of an organizational climate and performance approach model such as health services, planning, formulating health policies, health service efforts, supervising and controlling all hospital activities and the like, and always consistent and clear on the contents of the leadership's orders to carry out the effectiveness of patient services at the Regional General Hospital.
To find out whether there are significant or insignificant differences between the two variables, namely the Ciamis District General Hospital, the variables that cover various dimensions, which include various indicators for each, can be seen from the respondents' answers. The calculation results show that the organizational climate (X1), which includes the dimensions; The structure, standards, awards, commitments, support, and responsibility, are different, meaningless, or some differences are not accurate or are no different or considered the same because the chi-squared value is smaller than the chisquared value. Table (2 = 0.28 < 2 = 4.30), meaning that H is accepted, and H is rejected, meaning that there is no significant difference.
Overall, the organizational climate variable (X1), which consists of subvariables of structure, employee standards, awards, shows a significant difference for the two hospitals, namely the Ciamis District General Hospital. This is because the results of the calculation of the chisquared value are more significant than the table chi-square value (2 = 40.33 > 2 = 7.81), meaning that H is accepted and H is rejected, meaning there is no significant difference (calculation attached). Thus, the overall difference in organizational climate is due to a significant difference in the conditions of responsibility or behaviour of the Ciamis District General Hospital, compared to individual employees and their work in each of these hospitals.

Development
of Thoughts on Modification of Organizational Climate Models and Performance in Regional General Hospitals.
Based on the analysis results of organizational climate variables (through the dimensions of structure, standards, responsibility, appreciation, support, and commitment) and performance (through the dimensions of processes and outcomes), employees' job satisfaction at the Ciamis District General Hospital is only 88.10%. This means that other factors are not examined, such as leadership factors and factors outside the hospital such as the economic environment, social environment, and others, but affect employee job satisfaction at the Regional General Hospital by 11.90%.
Similarly, the analysis of performance variables (through the process and results) on employee job satisfaction at the Regional General Hospital Ciamis Regency amounted to 72.00%. This means that other factors have not been studied, such as agreement factors and factors outside the hospital such as the economic environment, social environment, and others, but affect employees' job satisfaction at the Regional General Hospital by 28.00%. From the analysis of the percentage in the hospital, it shows that for the conditions at the Ciamis District General Hospital, it turns out that the agreement factor from the executive leadership, in this case, the director and deputy directors who implement performance has a significant influence.
The agreement or commitment of the implementing leaders who implement the organizational climate and performance at the Ciamis District General Hospital, both from the leadership and implementing officials who apply the organizational climate and performance, is influenced by at least three aspects, among others; a strong belief in the organization's goals and values, a willingness to give energy on behalf of the organization, and a strong desire to remain a member. Even Trisnantoro (2005) argues that organizational commitment is a state of the strong desire of organizational members to improve themselves voluntarily and strive for the organization's benefit. Organizational commitment includes its components, according to Trisnantoro (2005) that must be considered carefully, namely affective commitment which involves feelings of belonging and involvement in the organization, continuance commitment which means the dimension of commitment based on the costs that employees will bear if they leave the organization, and normative commitment which involves employee feelings to stay in an organization. This statement became the basis for researchers to develop proposed modifications to the modern theory of organizational climate and performance, especially behaviour and work results at the operational level, where various obstacles were found that required immediate thought and resolution by conditions in the field Ciamis District General Hospital.
Leadership ability (as a determinant of strengthening the performance of organizational leaders) as well as leaders and implementers who carry out efforts to build an organizational climate and performance at the Ciamis District General Hospital is crucial and needed to balance the effects of environmental change and various stakeholders, including specialist doctors. Nurses, general practitioners, and others. In this situation, the leadership and implementing officials who carry out efforts to build an organizational climate and performance in the regional hospital must create the identity of the regional general hospital and build values for all interested parties (stakeholders). Then Trisnantoro (2005) states that: "the leader who gives direction pays attention to three things, namely understanding and interpreting events outside the hospital, focusing on the future and being able to translate vision into action. activities that create value for hospitals, and leaders must have a character that means they can be trusted and able to communicate well".
Then the organization of the Ciamis Regency Regional General Hospital is one of the devices in the region, and this means that the Regional General Hospital organization has the responsibility to carry out bureaucratic tasks properly. The statement shows that for this purpose, the role of leadership is crucial in maintaining the organizational climate and performance of the Regional General Hospital bureaucracy as a regional apparatus, and this leadership will maintain so that the principles of organizational climate and performance that have been placed in the organization are firmly held by bureaucratic actors. Or executive officers. With good leadership, the principles in carrying out activities are held firmly, which will lead to confidence in the achievement of goals that are visible in front of the implementing officials (bureaucratic actors) at the Regional General Hospital. Because it is this principle that shows them to carry out these activities. This leadership forms an attitude so that it aligns the values of each implementing official (bureaucratic actor) or personal values with the principles of the Regional General Hospital organization so that there is an alignment between values individual and the principles he must adhere to the will creates a strong impetus for all implementing officials who implement health policies, including activities related to health services that will be more effective.
The existence of this sense of kinship will easily overcome the emergence of disturbances due to not completing one chain of activities from the overall activities of implementing officials who carry out health policies at Regional General Hospitals. In the bureaucracy of the Regional General Hospital with good leadership, this will be a synergistic system that is strong in its entirety which is an effort to build the organizational climate and performance that is coveted. Even more specifically, the leadership abilities to implement officials who carry out health policies in the bureaucracy of the Regional General Hospital are suitable for a form of leadership that is goal-oriented leadership, namely that which influences and shapes policy actors (implementing officials) at Regional General Hospitals in Ciamis Regency. to behave and behave consistently towards the fulfilment of the public interest.
Thus, the importance of efforts to build an organizational climate and performance that implements structures, standards, responsibilities, awards, commitments, processes, and results at the Ciamis District General Hospital. At this stage, it is indispensable to have the existence and role of implementing officials who carry out and prioritize commitment and abilities. "Goal-oriented leadership" supports more effective patient care at the Ciamis District General Hospital.

CONCLUSION
In the analysis of organizational climate and performance, it turns out that the dimensions of the structure, standard dimensions, and dimensions of responsibility, appreciation, support, commitment, process, results together have a significant effect on employee job satisfaction in General Hospitals. It means that simultaneously the dimensions of the structure, standards, and dimensions of responsibility, appreciation, support, commitment, process, results contribute to employee job satisfaction in General Hospitals.
The dimensions of the structure have a significant effect on employees' job satisfaction at the District General Hospital, meaning that the dimensions of the structure make a significant contribution to the job satisfaction of employees at the General Hospital.
The standard dimension significantly affects employee job satisfaction in General Hospitals, meaning that the behavioural dimension contributes significantly to employee job satisfaction in General Hospitals.
The dimension of responsibility significantly affects employee job satisfaction in General Hospitals, meaning that the award dimension makes a significant contribution to the workforce of employees in General Hospitals.
This condition is also confirmed by the results of the behavioural difference test, which includes agreement and understanding, which shows that there are significant differences in General Hospitals. Thus, the overall difference in organizational climate and performance is due to significant differences in behavioural conditions compared to employees and the results of each hospital.
The theory of organizational climate and performance turns out to be so urgent to add a leadership approach carried out by the implementing officials, in this case, the directors and deputy directors at the General Hospital. This leadership approach which is goal-oriented leadership means that the form of leadership that is goal-oriented leadership crucially influences and forms the implementing officials, in this case, the directors and deputy directors at Regional General Hospitals. They carry out various organizational climates and consistently perform performance to fulfil interestspatient care and general health to the community.