The Quality of Inpatient Child Health Services at RSUD

This study aims to identify the quality of child health services in the inpatient room, identifying and analyzing inhibiting and supporting factors for the quality of child health services at dr. Doris Sylvanus Hospital Palangka Raya. It is a qualitative descriptive study conducted by applying observation, interviews, and documentation to collect data. It involved 3 nurses at dr. Doris Sylvanus Hospital Palangka Raya and 11 families of child patients as research subjects. The research showed that the quality of inpatient child health services dr. Doris Sylvanus Palangka Raya Hospital, especially those in the flamboyant room can be said to be good and able to meet the satisfaction of patients reviewed from 3 elements of service quality refers to Haywood-farmer, namely: Physical Facilities and Processes, People's Behaviour, Professional Judgment. However, there are some patient complaints caused by several factors inhibiting the quality of service at dr. Doris Sylvanus Hospital reviewed the quality of service elements referring to Haywood-farmer, namely: Physical Facilities and Processes, and Professional Judgment. ARTICLE HISTORY Submited: 21/10/20 Accepted: 15/01/21 Published: 27/02/21 KATA KUNCI Kualitas Pelayanan Kesehatan, Faktor Pendukung dan Penghambat


INTRODUCTION
Service is a factor that has a vital role in managing institutions or government institutions (Mulyadi et al., 2016). Service could be defined as service delivery or help for public interest by looking at the determined rules and regulations. Hospital is a public service provider in the health sector. The term service referred to fulfilling public needs to improve health status. The services could form as finance and administration services, medical services, nurse/paramedic services, pharmacy services, the physical environment of the treatment room, and medical support services.
Generally, public health service management in a hospital setting to patient admission, where the patient could come on their own accord or a reference from another party. The patient would be lead to the reception. Afterward, the reception would proceed to the ward and examined in detail and specifically to diagnosed the patient. After the diagnosis appears from the doctor, a follow-up decision will emerge that will determine whether the patient needs to be hospitalized or simply outpatient care. The services given by the hospital started from the arrival of the patient until the patient was allowed to go home.
According to the possession, there are several kinds of the hospital, one of them is Regional public hospitals which belongs to the local government. Rumah Sakit Umum Daerah (RSUD) dr. Doris Sylvanus is one of the public hospitals that belong to the local government placed in Palangka Raya. This hospital is a Hospital classroom education and referral hospital in Central Kalimantan.
RSUD dr. Doris Sylvanus Palangka Raya administers several health services, including medical and nonmedical support with superior emergency services, emergency room services, and inpatient services. In 2017 there are 24.339 inpatients visits.
The age range of patients who visits RSUD Dr. Doris Sylvanus Palangka Raya is varied, from the elders, adults, and kids. A separation for inpatient services between adults and kids interests the researcher in the quality of inpatient health services provided to pediatric patients.
The flamboyant room is an inpatient room specifically for children that established in 1987. This room is approximately 525 M2 equipped with various kinds of supporting facilities for the provision of inpatient health services, like patient's bed and dining table. The complaints about pediatric inpatient health services from the patient's family in RSUD Dr. Doris Sylvanus Palangka Raya make the hospital do innovation to overcome various kinds of patient complaints. It was done to improve patients' satisfaction with the services and increase public health level. To reach the goal, the implementation of health services must meet various conditions as seen from the characteristics of service quality.
There are various theories regarding service quality, one of them is a theory by Haywood-Farmer. By using the Haywood-Farmer analysis, it is expected could improve the quality of pediatric inpatient health services by RSUD Dr.Doris Sylvanus Palangka Raya, from the facility and process aspect, behavior aspect, and professional judgment aspect towards service providers performed by internal and external parties.
This analysis was done to identify every inhibiting and supporting factors in each aspect. Utilizing supporting factors and improving inhibiting factors expected to improve the quality of pediatric inpatient health service in RSUD Dr.Doris Sylvanus Palangka Raya.

LITERATURE REVIEW
Several previous studies used as reference view in this research because it has research topics related to the quality of service in a hospital. Surahmawati (2015) about The Quality of Health Service in Baru Regional Public Hospital (RSUD Baru) (Outpatient Services for Health Insurance Users). The result of this research by Surahmawati showed that the quality of outpatient health services in RSUD Baru in administrative procedures, it is known that the results are quite good by getting an average value of 2.72, while seen from the results of service quality in terms of time, the results are not good with an average acquisition of 2.26, from the level of service quality in terms of The attitudes of health workers were quite good, indicated by an average value of 2.94, while the quality level at health service facilities was quite good, indicated by an average value of 2.43. According to those four indicator variables, the average value is 2.58. It could be concluded that RSUD Baru has a pretty good outpatient service quality. Rosita (2017) about The Relation of Hospital's Health Service Quality with Inpatients Satisfaction Level. The result of this research showed that there is an impactful relation between health service quality is given with patients satisfaction level as customers. There is 94.5% influence level from inpatients satisfaction to health service given to people in PKU Aisyiyah Boyolali hospital, and the rest 5.5% was affected by various aspects that didn't analyzed by the researcher. Supartiningsih (2017) about Hospital Patients Satisfaction Service Quality (Inpatients Case). The analysis of this research found out that there is a low impact form independent variable to customers satisfaction (the service recipient is the display or physical evidence of the guarantee). If the customer's satisfaction wants to improve, waiting rooms has to increase and add more space, so does the outpatient rooms. All of it has to be arranged neatly to make patients comfortable when they visit or do the periodical treatment. Hadijah (2016) about Analysis Inpatient Service Quality at RSUD Undata Palu, Sulawesi Tengah. The researcher proves that the inpatient service quality in RSUD Undata Palu is deficient, cause there are still many complaints from the public as patients/customers. The result of this research is expected to improve nursing service quality in Undata hospital to suit the desired expectations.
In addition to several previous studies that become reference review in this research cause have similar research topic about service quality in hospital, this research also referred to several theories that fit the related topic, including: 1. Public Service Sedarmayanti (2020) stated that service has meaning to serve in a service sector needed by society in all aspects. The service activity is a duty and function from the state administration.

Publik Service Quality
Quality health services are services that can foster a sense of satisfaction to service users in accordance with the level of satisfaction desired by the community and its implementation is in accordance with established service norms and standards (Krismanto & Irianto, 2020). Service quality theory according to Haywood-Farmer (Seth et al., 2005) divide service quality into three characteristics, there are: a. Physical Facilities and Processes Physical facilities and processes stand for the basic characteristic of service. The physical facilities and processes include location, layout, decoration, size, facility, facility reliability process flow, balanced capacity, flexibility process control flow, punctuality, offered communication services pace range. Standardized service procedures for service providers and recipients, including procurement (Khozin & Mutmainah, 2019). b. People's Behavior People's behavior means in a service process there is a provider that provides service to the related person either directly or indirectly. People's behavior aspect includes proficiency in communication (verbal/non-verbal), appropriate timing, politeness, attitude, friendliness, dress, intonation, and problem-solving.
c. Professional Judgement Professional judgment has a meaning that service quality has professional judgment internally or externally. Professional judgment consists of diagnosing, suggestion giving, competence, innovation, guidance, honesty, confidentiality, flexibility, wiseness, and knowledge.

Inpatient Service
According to Depkes RI 1997 in (Suryanti, 2002) inpatient service is a service when patients were in a hospital using a nursing bed as a form of process to observation, therapy, diagnosis, medical rehabilitation and/or another medical service.  (2015) Quality, service.

Inpatient. Hospital
This research show inpatient health service quality in RSUD Baru, in administration procedures the result is pretty good with 2,72 average value, whereas the result from the timing sector has not good result with 2,26 average value, while service quality in health workers aspect shows a good result with 2,9 average value, and service quality in health service facility has also a good result with 2,43 average value. According to those four indicator variables, the overall average value is 2,58 which could be concluded that RSUD Baru has a good inpatient service quality. 2 Rosita (2017) Service quality. Health service. Patient satisfaction.
The result of the research shows that there is an impactful relation between given health service quality to the satisfaction level of the patients as customers. There is a 94.5% impact level from inpatient satisfaction to health service given to the public in PKU Aisyiyah Boyolali hospital, while another 5.5% is affected by various aspects that did not analyze by the researcher. 3 Supartiningsi h (2017) Tangible. Reability. Responds. Asurance.
The research analysis by the researcher finds out that there is a low impact from independent variable to the customer's satisfaction (the service recipient is the display or physical evidence of the guarantee). If customer satisfaction wants to increase, it has to be able to improve or add waiting rooms and inpatient rooms which organized neatly. This is primarily to make patients feel comfortable when visiting or doing a periodical treatment. 4 Hadijah (2016) Tangible.
The researcher proves that inpatient service quality in RSUD Undata does not have a good standard, cause generally there are still many complaints from the public as patients/customers. Source: Processed by the author (2020)

RESEARCH METHODS
This research applies a qualitative approach. The approach is used to conceive and explore the symptoms to produce an analysis obtained from a more detailed research process regards circumstances that happened in dr. Doris Sylvanus regional public hospital. This research collects data through observation, interviews, documentation, or visual material with constructing various views to the case that become a research focus (Moleong, 2019).
According to (Imam Gunawan, 2013) qualitative method aims to concoct the problems obtained and described scientifically. Developed by the researcher who incidentally is both an object and a subject in social research conducted. Therefore the research method is seen suitably by the researcher to explain comprehensively regarding service in dr. Doris Sylvanus regional public hospital.
The type of research used is descriptive, which tries to describe phenomena that occur in the actual field.
(Imam Gunawan, 2013) state "qualitative descriptive research to be able to explore various variations of data, perceptual understanding that could cause the emergence of the research phenomenon". The qualitative descriptive method is a method or way of research that does not aim to test against provisional presumptions, but only describes an actual and factual condition including situation, indication, or social phenomenon that happens in the society. (Soendari, 2012) opine descriptive research is research that aims to measure a social phenomenon through expanding the concept and collecting the data obtained.
The qualitative analysis method towards research data was done by the researcher through interactive way and carried out continuously to the finished, as far as until the data obtained in the research activities are saturated or get the appropriate results (Imam Gunawan, 2013). Research activity that was done Palangka Raya at dr.Doris Sylvanus regional public hospital is:

Data Reduction
Conducted by the researcher will only be directed at matters regarding service and infrastructure facilities, supporting service facility, and also human resources capabilities of dr. Doris Sylvanus regional public hospital in child health services provided. The reduction is an activity to summarize data obtained from the field, selecting information that fits the research title needs, focus on the core issue, focus on research and patterns (Gunawan, 2013). In this activity, the researcher directed to research goal that expected.

Data Display
From the data obtained regarding child health service at dr.Doris Sylvanus regional public hospital either primary data or secondary data which next organized in such a way as a narrative text so the result obtained could make the researcher easier to understand the phenomenon based on what has been understood previously.

Conclusion Drawing/Verification
Drawing conclusion or verification to research that has been organized. Because the primary or secondary data obtained by the researcher could have not sufficient to explain the detail regarding child health service at dr. Doris Sylvanus regional public hospital. Through drawing conclusion and verification method it could be identified which data has data gaps that have not been filled when the previous data collection is carried out, this allows researchers to find out and improve data.

Physical facilities and process
In the physical facilities and process dimension, the researcher discusses facility, room layout, and service process to the child inpatient at dr. Doris Sylvanus regional public hospital Palangka Raya. Flamboyant room is an inpatient room specifically for children and separated from adults inpatient room, in every room, there are 1 unit, 2 units, 4 units, and 10 units patient beds depending on the room sizes, other than that there is a dining table for patient and medicines provided by the doctor. Room layout in flamboyant roo, when we come in we would see a door like a house entrance and then there are every rooms of the patients. Inpatient room is completed with front and back door, also a window. Flamboyant room is nearby the mushola, mawar room, nusa indah room, bougenville room, nutritional installation, laundry, the corpse review room, etc. Place decoration viewed from the nurse point of view in flamboyant room dr. Doris Sylvanus regional public hospital is simple and suitable for kids. In the room there only half of the wall coated by colored ceramics, there are also enough chairs and a waiting room for the patient's family. The room only has a curtain to cover the window. As a whole, viewed by the nurse point of view, room layout and places n flamboyant room at dr. Doris Sylvanus regional public hospital has already neat. Reliability of physical facilities and processes at dr. Doris Sylvanus regional public hospital in the flamboyant room from the nurse point of view has not meet hospital standards as appropriate n supporting pediatric inpatient service. From the facility sector, there are still many adequate and suitable facilities like new several patient's beds, a lot of toilets because every room has a clean toilet. Other than that, it provides a wide, comfortable, and safe parking lot specifically for the employees. Viewed from the process flow, child health service provided by the nurses to the patients in dr. Doris Sylvanus regional public hospital in the flamboyant room if seen from the nurse point of view, already provided the existing operational standard. But from the patient's family point of view, there are still many patient's families that found difficulties, in fact, this happens because the patient's own family sometimes does not want to ask the nurse. Moreover, there is another problem where the patient's family has not realized which must be fulfilled by the patient to carry out child hospitalization at dr. Doris Sylvanus regional public hospital Palangka Raya.

People's Behavior
In this people's behavior dimension, the researcher discusses doctor's and nurse's behavior who provide child inpatient health service in dr. Doris Sylvanus regional public hospital Palangka Raya. Doctors and nurses in the flamboyant room try to always come on time and match the work schedule, not often they come early and if they are late they are willing to come home late. If the patient's guardians need a doctor's or nurse's help, they immediately come and examined the patient and also change the infusion if the fluids have already run out and also give injection, etc.
In the ability to communicate with patients, nurses in flamboyant room use gracious language and do not raise their voice to explain to the patients. From the patient's family point of view, nurses and doctors at dr. Doris Sylvanus regional public hospital in the flamboyant room has a friendly attitude to the patients, either when the doctors examine in the room or only passing by the patient's family outside the room. Nurse's and doctor's behavior in the flamboyant room are also really open to the patient's family, especially when delivering complaints and nurses or doctors do not subtract or add diagnoses of the patients and it delivered transparently. While interacting, patient's family feels there is kinship and unawkward, so the patients feel comfortable and not scared. Nurse's and doctor's uniforms in the flamboyant room are also suited with the rules and schedule that has been arranged by dr. Dori Sylvanus regional public hospital Palangka Raya. Nurses and doctors in the flamboyant room are also upheld neatness in clothing.

Professional judgment
In the professional judgment dimension, the researcher discusses a professional judgment to the nurses and doctors in dr. Doris Sylvanus regional public hospital Palangka Raya that help inpatient child health service. Diagnosis by nurses and doctors at dr. Doris Sylvanus regional public hospital has passed a research stage by gathering information in form taking blood samples and then be examined in a special laboratory. After the diagnosis result appears, doctors and nurses then tell the result to the patient and his family. Nurses and doctors at dr. Doris Sylvanus regional public hospitals Palangka Raya could say as an expert in their each special aspects. That could be seen from the capability and knowledge to handle the patient's complaints. Even so, nurse human resources at dr. Doris Sylvanus regional public hospitals Palangka Raya are still limited. Nurses at dr. Doris Sylvanus regional public hospital often give mental support like giving the advice to live healthily, suggest to eat healthy foods, keep the dietary habit, and keep clean. Commonly the advice is related to the treatment. Nurses at dr. Doris Sylvanus regional public hospital Palangka Raya also often helps people in the hospital, whether the patient's family to know where to go and explaining rules in the hospital so the visitors would understand the rules at dr. Doris Sylvanus regional public hospital Palangka Raya. Nurses and doctors in dr. Doris Sylvanus regional public hospital Palangka Raya often finds the patient's family who has a high sense of curiosity about his family who acts as patients, for that the nurses and doctors at dr. Doris Sylvanus regional public hospital Palangka Raya act wise, solutive, and calm in response to the patient;'s family, answer while being questioned, give solution when they need suggestions, and be a good listener while the patient's family lamented. Nurses and doctors are also required to be careful with their actions. For example while giving a shot or injection to the patients, put up the infusion, etc. This has been reflected in the nurses and doctors at the Regional General Hospital Dr. Doris Sylvanus Palangka Raya.

Supporting and Inhibiting Factors of Inpatient Pediatric Service Quality at dr. Doris Sylvanus Regional Public Hospital Palangka Raya.
Supporting and inhibiting factors according to the patient's guardian in providing service at dr. Doris Sylvanus Palangka Raya in the flamboyant room what patients see at this time is that the inhibiting factor is less than the supporting factors.
This proves that the quality of inpatient child health services at the dr. Doris Sylvanus Regional Public Hospital Palangka Raya is said to be good and able to meet patient satisfaction, although there are still some complaints from patients of dr. Doris Sylvanus Regional Public Hospital Palangka Raya that makes the hospital has to understand and correct the inhibiting factors to make patients more comfortable with the providing services.

Supporting Factors
The supporting factor has two point of views, as a ptient and as a nurse. a. Supporting factors according to patient's point of view at dr. Doris Sylvanus regional public hospital Palangka Raya is the strategic location that eases the transportation to the hospital, trusted doctor specialist, the availability of on-duty doctor, the doctors and nurses that always keep coming on time and friendly to the patients that create a warm sense of kinship. Furthermore, the service requirements are quite easy and the costs that must be paid by the patients are quite affordable. b. Supporting factors according to the nurse's point of view from dr. Doris Sylvanus regional public hospital Palangka Raya is nurses got more knowledge with special training.

Inhibiting Factors
The scope of the inhibiting factors is divided into two, the inhibiting factor based on the patient and the inhibiting factor based on the nurse. a. Inhibiting factors according to the patient's point of view is a lack of a more detailed explanation of the diagnosis of the patient. Also, the diagnosis of the disease is only delivered orally and the written results are kept by the nurse and doctor, and the patient admission process in the waiting room is quite long. b. Inhibiting factors according to the nurses of dr. Doris Sylvanus regional public hospital Palangka Raya's point of view is lack of examining equipment for the nurse to support or do their job, like the limited of thermometer and monitor. Moreover, the minimum quantity of human resources working at the dr. Doris Sylvanus regional public hospital Palangka Raya services are less than optimal.

CONCLUSION
Based on the analysis result of Inpatient Pediatric Service Quality at dr. Doris Sylvanus Regional Public Hospital Palangka Raya using Haywood-Farmer, obtain a result that the service quality is good and could meet the customer's satisfaction. This is affected by several supporting factors of service quality that could be seen from physical facilities And processes, patient handling process at dr. Doris Sylvanus Regional Public Hospital Palangka Raya takes place quickly, the facility at the hospital supports the implementation of health services, the terms of service are easy and the costs incurred by the patient are affordable. Other than that, from the people's behavior, the services provided by the nurses or the doctors are very disciplined and on time, also maintain courtesy to the patient. And from the professional judgment, the diagnosis of the patient's disease is informed as it is without adding and subtracting information about the patient's condition, the diagnosis is quite accurate because of the nurses and doctors at dr. Doris Sylvanus Regional Public Hospital Palangka Raya are health workers that have the expertise and experience.
Nevertheless, dr. Doris Sylvanus Regional Public Hospital Palangka Raya still needs to evaluate the services provided cause there are still several complaints from the patients regarding the services in dr. Doris Sylvanus Regional Public Hospital Palangka Raya. That is affected by several factors that inhibit service quality that could be seen from physical facilities And processes, although facilities owned by dr. Doris Sylvanus Regional Public Hospital Palangka Raya is supportive enough to the implementation of health services but there is a lack of several examines equipment like a thermometer, furthermore, the minimum quantity of human resources worked in dr. Doris Sylvanus Regional Public Hospital Palangka Raya makes the services less optimal. From the professional judgment, the patients of dr. Doris Sylvanus Regional Public Hospital Palangka Raya was unable to understand the explanation of the diagnosis conveyed by the doctor, because the results of the diagnosis were conveyed orally without any props.
With the identification of supporting and inhibiting factors of inpatient child health service quality at dr. Doris Sylvanus Regional Public Hospital Palangka Raya it is expected could make the hospita; knows which aspects that has to be repaired and which one should be improved to make patients more satisfied with the services that has been provided.