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1. ANALYSIS OF PATIENT SATISFACTION AT KOLAKA REGENCY HEALTH CENTER USING THE AMERICAN CUSTOMER SATISFACTION INDEX (ACSI) MODEL SYAMSIAH NUR M202201017 THESIS

2. 2 Background............. Patient satisfaction is a central element in assessing the quality of health services, as emphasized by WHO. Indicators of patient satisfaction include the responsiveness of healthcare workers, accessibility of services, available facilities, quality of medical care, and friendliness of staff. Evaluation of patient satisfaction indices is important to improve the quality of health care, provide important insights into patient assessments, and drive necessary improvements. One of the analytical models used is the American Customer Satisfaction Index (ACSI) Model, which was first applied in the health sector in the early 1990s in the United States and has become the basis for initiatives to improve the quality of health services around the world.

3. 3 The adoption of the ACSI Model by the Ministry of Health also has positive consequences in increasing transparency and accountability in Indonesia's health sector. Information related to patient satisfaction is the basis for providing constructive feedback to healthcare providers, while providing a better understanding to the public about the quality of services they receive. This step is in line with recommendations from the World Health Organization (WHO), which underscores the importance of promoting patient satisfaction as a key indicator in efforts to improve the quality of health services. With the adoption of the ACSI Model, Indonesia is entering an era of more systematic monitoring and quality improvement, aiming to provide better health services and meet patient expectations more effectively

4. Patients are a central indicator in the assessment of health service quality, which can be measured using the American Customer Satisfaction Index (ACSI) Model. ACSI has proven effective in analyzing patient satisfaction, improving transparency and accountability in the healthcare sector, as well as helping healthcare facilities understand critical factors that affect the patient experience, such as responsiveness, accessibility, and quality of care. In Indonesia, the adoption of ACSI by the Ministry of Health since 2013 has become an important foundation in efforts to improve the quality of health services. Despite challenges such as long wait times and uneven distribution of resources, the use of ACSI allows for more structured and data-driven evaluations for continuous improvement in health services, including in health centers. 4

5. 5 The patient satisfaction index in health services in Indonesia in the last three years shows significant dynamics. Despite real efforts to improve accessibility and quality of care, the patient satisfaction index still reflects a number of challenges. Factors such as waiting time, resource availability and understanding of health information remain the focus of improvement.

6. Table 1.3 Recapitulation of the results of the Quality Performance Indicator survey at Kolaka Regency health centers based on the type of service in 2023

7. 7 The data of Puskesmas in Kolaka Regency, which includes the type of service, accreditation, population, health workers, and patient visits, provides a comprehensive picture of the potential level of patient satisfaction in various regions. Highly accredited health centers such as Pomalaa show better standards of service, while challenges such as limited numbers of health workers and long waiting times can reduce patient satisfaction. The use of the American Customer Satisfaction Index (ACSI) Model is expected to help identify areas of improvement and improve the quality of services at the Kolaka Health Center.

8. The specific objectives of this study are: To find out how the Responsiveness of Services at the Kolaka Regency Health Center to patient satisfaction
To find out how Medical Services at the Kolaka Regency Health Center affect patient satisfaction.
To find out how the communication of the officers at the Kolaka Regency Health Center to patient satisfaction
To find out how the Accessibility of Services at the Kolaka Regency Health Center affects patient satisfaction
To find out how the facilities and service environment at the Kolaka Regency Health Center affect patient satisfaction
To find out how the responsibility and ethics of health workers at the Kolaka Regency Health Center are towards patient satisfaction
To find out how the Cost and Efficiency of Services at the Kolaka Regency Health Center affect patient satisfaction.

9. Novelty of research The novelty of this study as a differentiator from previous research is the addition of service responsiveness variables, which will provide a deeper understanding of the ability of health centers to respond to patient needs and complaints quickly and efficiently. In addition, this study will focus more on evaluating the quality of medical services provided at health centers, as well as paying attention to important aspects such as communication between health workers and patients, accessibility of services, quality of facilities and the environment, as well as the responsibilities and ethics of health workers. In addition, future research will also consider aspects of cost and service efficiency, including affordability of treatment costs and efficiency in the use of resources, which will provide a complete picture of the factors that affect patient satisfaction in health centers.

10. CONCEPT Framework Independent variables that lose dependent variables. The independent variables in this study are Service Responsiveness, Medical Services, Officer Communication, Service Accessibility, Service Facilities and Environment, Health Worker Responsibility and Ethics and Service Cost and Efficiency.
Bound variables are variables that are influenced by independent variables, so bound variables are bound variables and are influenced by other variables. In this study, the dependent variable is Patient Satisfaction.

11. RESEARCH METHODS This type of research is qualitative research that aims to describe and analyze phenomena, events, activities, attitudes, beliefs and perceptions of individuals or groups. The research approach uses a case study design, where researchers make in-depth observations on a specific group of people who experience a specific case or situation (Jackson & Bazeley, 2019).
Our research subjects consist of two types of informants: key informants and ordinary informants. There are 15 informants with 14 informants representing the health center, where the key informant is 1 person, namely the head of the health service division of the Kolaka Regency Health Office.
The informant collection technique we used was the Snowball Sampling method. This research will be carried out in all Kolaka Regency Health Centers totaling 14 Health Centers. This research will be carried out from April to May 2024.

12. Research Results Table 5.1. Distribution of Characteristics of Ordinary Informants and Key Informants The educational distribution data and demographics of the informants in this study reflect an important diversity of perspectives, with 14 ordinary informants and 1 key informant, aged 28-45 years. The majority of informants are women (9 people) and the rest are men (6 people), with varying levels of education, ranging from high school to S2. This diversity enriches the analysis of patient satisfaction using the ACSI model, allowing for a deeper and more representative understanding of patient perceptions and experiences at the Kolaka Regency Health Center.

13. 1. Responsiveness Waiting times at the Kolaka Regency Health Center, which is often long, especially on busy days and harvest seasons, are a key factor in the analysis of patient satisfaction using the ACSI model. Data shows that wait times of more than 1 hour occur most frequently, while wait times during peak hours are more efficient. This phenomenon shows that although there is efficiency during peak hours, long waiting times outside of peak hours can decrease patient satisfaction, affecting their perception of service quality and loyalty to the health center. The ease of access to information at the Kolaka Regency Health Center greatly affects patient satisfaction according to the ACSI model. Many patients have difficulty getting information online, especially regarding doctors' schedules, because information is not always updated, forcing them to come directly to the health center. Signal problems in rural areas are also an obstacle. Although physical information boards have been updated, increasing the dissemination of digital information, including the development of mobile applications, is urgently needed to increase transparency and patient trust in health center services. An analysis of patient satisfaction at the Kolaka Regency Health Center with the ACSI model highlights the importance of effective communication between health workers and patients. The majority of informants rated communication as "Very Good," but there was still room for improvement, especially during peak hours. Some patients have difficulty accessing information, and some rate communication only as "Pretty Good" or "Not Good." While generally good, improvements in information delivery and accessibility are needed to improve overall patient satisfaction.

14. In the analysis of patient satisfaction at the Kolaka Regency Health Center using the ACSI model, response to patient complaints and feedback is very important to improve service quality. The results showed that waiting time and waiting room cleanliness were the two main issues that were complained about the most, with four and three complaints received, respectively. Although other issues such as inpatient room facilities and queuing systems are also raised, a focus on improving wait times and hygiene can significantly improve patient satisfaction and strengthen their trust in the health center's services. 2. MEDICAL SERVICES An analysis of patient satisfaction at the Kolaka District Health Center shows that although access to health services is generally considered easy, challenges such as long waiting times and response to complaints are still a major concern. Inpatient and street facilities are appreciated, but special services often require referrals. While communication is considered varied, with some patients satisfied and others experiencing difficulties. Although the health center is planning improvements, especially through door-to-door programs and the addition of Mobile Health Centers, a focus on improving service efficiency and complaint response will be crucial to improve overall patient satisfaction.

15. The majority of informants considered health workers at the Kolaka Regency Health Center to be competent, professional, and experienced, which created a sense of security and confidence in patients. However, challenges such as medical personnel fatigue and suboptimal communication still exist, and there is a need to increase the number of health workers and develop competencies in several specialties. Although the competence of health workers is assessed as good overall, improvements in the communication and specialization areas are needed to further improve the quality of services. Most patients at the Kolaka Regency Health Center feel that the medical information provided is very clear and easy to understand, with adequate explanations of health conditions and treatments. However, some patients have difficulties with medical terms, so health workers need to provide additional explanations. This suggests that while medical communication is generally good, there is a need to simplify medical terminology and improve patient understanding through more comprehensive educational materials.

16. The results of the study at the Kolaka Health Center showed that the majority of patients were satisfied with the doctor's interaction, which was considered positive in terms of information clarity and empathy. Although doctors generally show patience and attention, there are some patients who report experiencing rushed or less empathetic interactions. The Puskesmas plans to improve the quality of interaction through workshops on patient-centered care. Overall, although there are some areas that need improvement, the majority of patients are satisfied with the doctor's services. The results of the study at the Kolaka Health Center showed that the majority of informants felt that the use of technology, especially electronic medical record systems, greatly accelerated services. However, there are acknowledged technical constraints, and some Informants expect technological improvements in disease diagnosis and monitoring, especially in remote areas. In response to this, the Health Center plans to expand the implementation of technology to all facilities in the next six months to overcome obstacles and ensure that the benefits of technology are felt equally.

17. 3. OFFICER COMMUNICATION The results of the study show that health workers in the Health Center are generally considered open and provide clear information, especially regarding referrals and procedures, although there is a variation in responsiveness when the Health Center is busy. Basic medical facilities are available, but some Informants suggest upgrading diagnostic facilities. Technology is considered helpful in ministry. Overall, while there are areas that need improvement, the majority of patients are satisfied with the availability and openness of healthcare workers. This study shows that health workers in the Kolaka Regency Health Center generally succeed in explaining medical information in an easy-to-understand way, using simple language and avoiding technical terms. The majority of informants (12) felt that the explanations given were clear and easy to understand, reflecting effective communication as a positive aspect of the service. However, there are some Informants (3) who feel that explanations are sometimes too short, and a small number (4) want more detailed but still simple explanations (1). This indicates the need for a balance between detail and simplicity in communication to ensure optimal understanding for all patients.

18. Health staff at the Kolaka Regency Health Center generally show a high level of empathy and personal attention to patients, with the majority of patients feeling cared for both medically and emotionally. Most of the informants (7) highlighted the medical and emotional attention provided by the staff, as well as 6 informants who felt concern for their overall well-being. However, some informants (4) noted that staff sometimes seem rushed due to the large number of patients, which can affect the quality of interaction. Overall, the response to the patient's needs was quite good, with 5 positive responses. To improve the patient experience, better workload management is needed to maintain the quality of service. Health workers at health centers are generally very responsive to patient questions and complaints, with the majority of respondents (14) appreciating quick responses and satisfactory solutions (7). However, there are deficiencies in handling complaints related to waiting times (2) and general attention to patients (5). Although the overall responsiveness level is rated good, significant improvements are still needed in managing wait times and increasing patient attention. The Health Office needs to strengthen the complaint handling system and provide additional training to improve service quality and patient satisfaction.

19. 4. ACCESSIBILITY SERVICES The location and facilities of health centers in Kolaka Regency vary, with some being in easily accessible city centers, while others are in more difficult to reach rural and inland areas. Facilities are generally adequate for basic services, but waiting rooms are often full and parking problems require more attention, especially in urban and industrial health centers. In suburban and rural areas, although access is easier, cleanliness and facilities need to be improved, especially during peak hours. Overall, despite challenges related to access and facilities, the majority of patients are satisfied with the location and facilities of the Health Center. Increasing the cleanliness and capacity of waiting rooms, especially in areas with difficult access, is recommended to improve comfort and quality of service. The service schedule of the Puskesmas in Kolaka Regency is considered quite flexible, but the high number of patients often leads to long queues and long waiting times. Additional service hours and medical personnel are needed to improve efficiency and reduce queues. The majority of informants felt the need to come early and proposed an increase in service hours and an increase in the number of medical personnel during peak hours. The follow-up plan includes schedule adjustments and resource upgrades to improve service efficiency and patient satisfaction.

20. The registration process at the Puskesmas is generally considered efficient thanks to the computerized system and queue numbers, but long queues during peak hours often slow down the process. The addition of registration counters and system improvements to handle technical issues are necessary to improve efficiency. The majority of informants stated that the registration system was efficient, but there were notes of the need for improvements during peak hours, with some complaints regarding wait times. The results of the study show that information about health services and facilities in Puskesmas is generally easily accessible through bulletin boards and information officers. However, access to online information still needs improvement, especially related to doctors' schedules, specialties, costs, and public health programs. Some informants indicated that while information is available, additional effort is required to access it. Improving online platforms and providing brochures or applications can improve information quality and patient satisfaction, as well as service efficiency.

21. The results showed that friendly staff support significantly improved comfort and reduced patient anxiety during visits to the Health Center. Most of the staff showed a friendly and helpful attitude, but there was a need to improve service consistency, especially during busy situations. The data shows that the positive experience and staff service are highly appreciated, with 12 and 8 responses respectively. However, consistency of service and handling during busy times received less attention. The implication of these findings is the need for additional training to improve service consistency and workload management to ensure service quality is maintained. 5. FACILITIES AND SERVICE ENVIRONMENT The results of the study showed that cleanliness in the Health Center was generally good, giving a positive impression and comfort to patients. While the waiting room and toilets are generally clean, some areas require more attention, especially during peak hours. The data recorded 8 positive assessments of cleanliness, but 5 assessments indicated the need for special attention during busy periods, and there was a need for improvements in toilets (3 assessments) as well as waiting rooms (2 assessments). One assessment suggested minor renovations. The implication of this data is the need for increased monitoring of hygiene during busy hours and renovation of facilities to ensure hygiene standards remain high and the patient experience remains comfortable.

22. The results of the study show that medical facilities and equipment in Puskesmas are generally adequate, modern, and well-maintained. However, some diagnostic tools sometimes do not function optimally and need to be updated, which leads to some follow-up examinations having to be referred to hospitals. Data from the interviews showed that although the equipment was mostly rated well, six units needed an update, and the occasional technical issue could affect patient satisfaction. To improve service quality, the follow-up plan includes a thorough audit of the equipment and a phased procurement to ensure all equipment is in good working order, speeding up diagnosis and reducing the need for referrals. The results of the study show that the waiting room at the Health Center is generally considered comfortable and equipped with adequate chairs. However, during peak hours, the waiting room is often full, causing discomfort as patients have to wait to stand up. Some patients also suggest an expansion of the waiting room to improve comfort. The informant's statement revealed that although the waiting room is considered comfortable, the problem of crowding during busy times indicates the need to expand capacity. The renovation plan to expand the waiting room is expected to improve patient comfort and satisfaction, with a focus on improving service quality and efficiency during waiting times.

23. Security at the Health Center is generally considered good, thanks to the presence of security officers who provide a sense of security. However, parking areas are often full and require more supervision, and there are concerns about lighting and remote locations. To improve security, the follow-up plan includes installing CCTV at strategic points, improving lighting systems, and more regular parking arrangements. These efforts are expected to increase patient satisfaction and ensure a safer environment. Access to the information center and registration at the Puskesmas is generally considered easy, with friendly staff assisting visitors. However, long queues during peak hours are often a problem, signaling the need for increased efficiency. The follow-up plan includes the development of an online registration system and the installation of digital information kiosks to reduce congestion and speed up the service process. The data shows that while access and service from officers are good, improved queue management and technology adoption will further improve patient satisfaction.

24. 6. RESPONSIBILITIES AND ETHICS OF HEALTH WORKERS The results of the study show that the quality of professional services at the Kolaka Health Center is generally considered very good by the informants. Health workers at this health center are considered professional, friendly, and competent, which increases patient confidence. However, there are records of inconsistencies in the approach to patients. To ensure consistency and quality of services remain high, the follow-up plan includes periodic evaluations and refresher training for healthcare workers. The visualization diagram shows that most of the informants praised the professional service, although there were some comments regarding the need for consistency and further training. The results of the study show that in the Kolaka Regency Health Center, health workers are generally open and ready to collaborate with patients, as well as provide detailed information. However, during busy periods, there are indications that communication could be disrupted, affecting the quality of interaction. Most patients feel heard and involved in their treatment, although sometimes healthcare workers seem rushed due to the workload. The visualization diagram confirms that most informants rated healthcare workers' communication and collaboration as excellent, although some identified constraints related to time and workload.

25. The results of the study show that the principles of ethics and privacy in the Kolaka Regency Health Center are applied very well. Patients feel safe and comfortable because their medical information is kept confidential, with examination and treatment procedures that ensure privacy, such as separating examination rooms and requesting permission before medical procedures. The visualization diagram confirms that most informants rated the application of ethical and privacy principles very well, with many comments highlighting the feeling of security and the practice of maintaining the confidentiality of information. The agency plans to hold follow-up training to continue to improve ethical standards and data confidentiality. The results of the study show that in the Kolaka Regency Health Center, health workers are generally very responsive to the needs and complaints of patients, providing quick and effective solutions, so that patients feel heard and valued. However, responsiveness can decrease when many patients are present, especially for complex complaints. The visualization diagram confirmed that most informants rated the responsiveness of healthcare workers as good or excellent, with some comments noting that response times sometimes needed improvement. To increase effectiveness, plans to establish a dedicated team and regular patient satisfaction surveys are being considered.

26. At the Kolaka Regency Health Center, patient satisfaction with education and empowerment is very high. Patients feel that the information and health education provided helps them understand their health conditions and make better decisions regarding self-care. While generally positive, there is room for improvement through regular counseling sessions and online educational materials. The data showed that most informants found health education services to be very beneficial and empowering for them, with few responses indicating the need for improvement. 7. COST AND EFFICIENCY OF SERVICE At the Pomalaa Health Center, the cost ratio per patient is considered very satisfactory by the majority of informants. They felt the cost of treatment was affordable and proportional to the quality of service received, with many citing good value for money. Although some suggestions to continue to pay attention to affordability emerged, generally patients were satisfied with the balance of cost and quality of service. The health center is committed to optimizing costs without compromising quality, demonstrating continuous efforts in maintaining a good cost-quality ratio.

27. The results showed that waiting times at the Pomalaa Health Center varied, with most patients reporting sometimes long waiting times. Nonetheless, many felt that the quality of service after entering the examination room was quite good, which offset the inconvenience caused by waiting times. Some patients report short wait times and efficient processes, while others feel there needs to be an improvement. The health center is trying to improve the queue system and patient flow. Overall, while wait times are challenging, the quality of service afterwards tends to be positive, with the majority of patients feeling satisfied. Efforts to improve wait time management can further improve the patient experience. The use of information technology in the Pomalaa Health Center has accelerated the administrative and medical processes, as well as improved information accuracy through electronic medical record systems and online registration. Despite technical constraints and limitations such as electronic queuing systems that have not been fully implemented, the technology overall helps to improve efficiency and maintain patient privacy. To further improve the service, there needs to be system improvements, further investment in technology, staff training, and the development of new features.

28. The results of the study show that health workers in health centers are generally effective in providing medical services in an organized and efficient manner. However, during peak hours or when there are many patients, staff shortages can degrade the quality of service. The addition of medical personnel, better shift arrangements, and multi-skill training to increase staff flexibility are proposed to reduce workload and improve coordination between departments. The results of the study show that the management of stock and inventory in Puskesmas is generally quite good, but there are still shortcomings, especially in the availability of drugs and medical equipment. Although stocks are often maintained, there are times when some medications are not available, affecting the smooth running of treatment. To improve availability and efficiency, the inventory management system will be updated with the implementation of an integrated system in the next 3 months. Patient and staff responses indicate the need for improvements in inventory management to ensure consistent availability and address shortages quickly.

29. Conclusion Patient satisfaction is greatly affected by often long and varied wait times, especially during busy days and harvest seasons. Although a digital queuing system has been implemented, further expansion and development of this technology is needed to reduce waiting times and improve service responsiveness.
The quality of medical services in Puskesmas is generally adequate with competent health workers, but there are shortcomings in the clarity of medical information and doctor-patient interaction. Improving information clarity and managing technology such as electronic medical records needs to be done to improve patient satisfaction.
Communication between officers and patients is quite good with the availability of the necessary information. However, sometimes brief explanations and overly hasty interactions reduce satisfaction. Intensive training for more efficient communication and complaint management is expected to increase satisfaction.
Service accessibility is generally good with strategic locations, but there are still challenges such as long queues during peak hours and difficulty in accessing in rural areas. Adjusting service schedules and adding counters can help address this issue.
The facilities and environment in the Puskesmas are generally good with adequate hygiene, but the often full waiting room and some areas that need to be improved can affect satisfaction. Expansion of the waiting area and improvement of the parking area are recommended.
The services provided by health workers are good and professional, with ethical and privacy principles maintained. However, handling complaints that sometimes require repetition shows the need for a special team for more effective complaint management.
Affordable service costs and good service efficiency affect patient satisfaction, although long wait times are still an issue. The use of information technology is good, but improvements in online registration and drug stock management are needed to improve efficiency and satisfaction..

30. Suggestion Implement an integrated digital queue system and develop a mobile application for health information to improve service responsiveness.
Conduct intensive communication training for healthcare workers and increase the use of information technology to improve doctor-patient interaction.
Form a dedicated team for handling complaints and implement a more effective patient feedback system.
Improve accessibility in rural areas through dor to dor health service programs and Mobile Health Centers, as well as optimize the queue system to reduce waiting times.
Renovate and expand facilities, especially waiting rooms, and increase hygiene and safety supervision.
Provide regular training on medical ethics and patient privacy, and develop a more comprehensive health education program for patients.
Implement an integrated inventory system to improve the management of drug stocks and equipment, as well as standardize IT systems throughout health centers to improve efficiency .

31. THANK YOU