The Effect of Service Quality on Patient Loyalty evidence from Privat Hospitality

: This study aims to investigate the effect of service quality on patient loyalty in private hospitals. The population in this study were all patients at Krakatau Medika Hospital. The samples used were outpatient and inpatient patients with purposive sampling as a data collection technique. the test results show that all dimensions of service quality affect patient loyalty.


Introduction
quality from the categories of places, people, equipment, communication tools, symbols and prices that they see.
b. Can not be separated ( inseparability ) In general, services are produced and consumed simultaneously. If someone performs a service, the service provider is part of the service. The special feature of services is that there is interaction between the service provider and the client so that both the service provider and the client affect the outcome of the service.
c. Various variety ( variability ) Services vary greatly depending on who provides them , when and where the service is carried out . Buyer service realize high variability _ from services and often discuss them with others before choose a provider services .
d. Can't stand it old ( perishability ) Services cannot be saved . Easy disappearance service does not matter if request services remain due easy to advance arrange employees or people who will provide services . However characteristics service easy vanished difficult If request service is unstable or fluctuating . _ According to Christopher Lovelock ( 1999: 13) Service is a process and a system . Meaning of Service as a process is that service generated from three input processes, namely people ( customers ), materials and information . As something system , service business is a combination between Service Operating System and Service Delivery System . Marketing service emphasizes the service delivery system , namely how a process delivers services to its patients .
The accuracy of the strategy in marketing services , namely whether the services provided can be satisfactory patient the . Hospitals can do it by comparison between perceived service _ patient ( service performance or perceived service ) and expected services patient ( expected service ). So quality services as a whole is a totality of every element mix services .

Service Classification
In essence , it is not an easy thing to generalize marketing services , because industry very self service various . Classification services can help understand limitations from industry services and use experience industry other services that have the same problems and characteristics to be applied and applied to a service business .
According to Philip Kotler ( 2005: 112) components Services can be a minor or major part of all bids made. This offer can be divided into four categories , namely: a. Tangible goods pure Only includes items that can be seen , such as: soap , toothpaste or salt. In this case there is no service that accompanies the product.
b. Tangible goods with services addition Consists of tangible goods accompanied by one or more additional services _ Power pull consumers , for example : sale a car that is accompanied by a guarantee . https://equatorscience.com/index.php/jabter c. Mixture Consists of goods and services in equal proportions , such as: a must restaurant supported by food and service .
d. Main services accompanied by additional goods and services Consists of main services with additional services and or complementary goods, for example: airline passengers buy transportation services.
e. Pure Service only consists from services , such as: service guard babies , psychotherapy , and others.

Manage Service Quality
In effort differentiate A company services with other companies is to provide higher quality services from competitors consistently and in general services are higher in quality experience and trust , therefore consumers _ feel more risk in the purchase (Philip Kotler, 2003: 467) then it will make some consequences , as follows: a. User services or consumers Services are usually more dependent on promotions from word of mouth rather than advertising company services . b. Consumers really rely on prices , personnel and instructions physical to judge quality services . c. If consumers are satisfied, they will be very loyal to the service provider. Of these three things, companies must increase their competitive differentiation, their service quality and productivity. Service quality must start from customer needs and end with customer perceptions. This means that a good quality image is not based on the point of view of the service provider, but based on the perception or point of view of the customer, because the customer is the one who consumes and enjoys the service, so it is they who will determine the quality of the service (Supranto, 2003: 393).
According to Parasuraman, et all (Philip Kotler, 2005: 122), there are five gaps that result in the failure of service delivery, in order to provide high service quality to consumers, namely: a. The gap between consumer expectations and management perceptions. Management doesn't always understand exactly what customers want. b. The gap between management perceptions and service quality specifications.
Management may understand exactly what customers want but do not set a specific service standard.
c. Gaps between service quality specifications and service delivery. Personnel may be poorly trained or unable or unwilling to meet established standards. d. Gaps between service delivery and external communications.
Consumer expectations are influenced by the statements of company representatives and company advertisements.
e. The gap between the service experienced and the service expected. This gap occurs when there is a wrong perception about the quality of the service.
According to Christopher Lovelock ( 1999: 229) defines quality service as follows: "Quality is the degree of excellence intended and the control of variability in achieving that excellent, in meeting the customer requirements." quality is level good quality as expected and supervision to achieve good quality to be able to fulfill desire consumer .
Problems quality now not just the only weapon competition but it has become a " must ticket paid" to get into the world of business. According to American Society For Quality Control , quality is a whole traits and characteristics from something product or service in terms of ability to fulfill existing needs _ determined or latent . ( Creepers Lupiyoadi , 2006: 168) In increasingly competitive _ in the service business world health , forcing hospital management to have superiority compete with supply higher quality services compared its competitors and conduct marketing incentives to be able compete as well as increase trust customers so that they are still recognized existence . To fulfill appetite customers , please know types service marketing .
According to Philip Kotler ( 2005: 117) there is three type marketing in industry services namely: a. Marketing external ( external marketing) Describe the activities undertaken by the company to prepare price , distribution and promotion service to customers .
b. Marketing internal ( internal marketing) implying company services that need to train and motivate employees who deal with customers effectively as well as all personnel supporters to work together as team to provide customer satisfaction . _ c. Marketing interactive ( interactive marketing) Refers to the employee's expertise in serving client Because user service evaluate quality services not only through quality technically but also quality functional . Therefore, service providers must provide a high touch and high technology.

Service Quality
There are several definitions that state about quality service services , namely: "The ability to satisfy the needs and expectations of customers" ( Begman and Klefsjo , 1994: 16); "Service quality as a result of what consumers receive and how they receive it" (Webster, 1989); "Service quality as 'Perceived by customers and steams from a comparison of their expectations of the service they will receive with their perceptions of the performance of their service providers" (Parasuraman, et. all: 1985). In other words, there are two factors main influence _ quality services , namely expected service and perceived service , explaining that if the service received or perceived is as expected then quality service well received and satisfactory . If the services received exceed hope customer then quality service perceived as ideal quality . Whereas If services received are lower than expected hence the quality service will perceived bad or unsatisfactory .  : Philip Kotler (Marketing Management, 2003: 463) Thus is it good or not quality services depending on ability provision services in fulfilling hope consistent wearer . _ Customer expectations shaped by past experiences _ (past experiences ) , talks from mouth to mouth (word of mouth) and promotions company service (advertising) Then compared . Elhaitammy next express understanding _ service superior service _ (service excellence), namely a attitude or way of employees in serving customers satisfactorily (Willy Arafah , 2004).
Goals and benefits from In general, service excellence has four elements tree that is : speed , accuracy , friendliness and convenience . Fourth element that , is a unity integrated services , that is services or services to be imperfect when there is one from element the ignored . To achieve superior results then every employee should own skills , including : look good and behave friendly , showing passion for work and always ready to serve , calm at work, not high heart Because feel needed , master work and can communicate well, can understand Language cue as well as capable handle patient complaints properly .
According to Philip Kotler ( 2005: 123) that determinants quality service should be a concern in upgrading quality from service services , namely: a. Tangible  Ability to assist customers and provide services quickly or promptly. e. belief ( assurance) Knowledge and courtesy of employees, as well their ability to elicit trust and confidence in customers .

Servqual Models
one _ approach quality services that are widely used as references in research marketing is the SERVQUAL (Service Quality) model developed by Parasuraman, Zeithaml and Berry in their series of studies on six sector services , namely: repair household appliances , credit cards , insurance , long-distance telephone lines , banking retail and brokerage securities . SERVQUAL is built on base exists two-factor comparison The key is perception customer on the real service they receive (perceived service) with the real service expected (expected service). If the reality is more than expected then service can be said quality , and vice versa . In short , quality services can be interpreted as how much difference between reality and hope customer on the service they receive. Customer expectations are basically the same as what kind of service a company should provide to customers . Customer expectations the based on the information submitted from mouth to mouth , need personality , past experience and communication _ external . ( Creepers Lupiyoadi , 2006: 181) In order produce something quality service , company _ expected to measure services that have been provided to its customers through the scale measurement based on the results of research by several previous experts . In this case SERVQUAL has application scale measurement called the multiple-item scale which is the result of research by Parasuraman, Zeithmal and Berry. The scale with the good validity and reliability used company to better understand expectations and perceptions customer will the desired service , as well as to date as tool measure to improve superiority managerial , many SERVQUAL methods used as quality research standards service . ( Creepers Lupiyoadi , 2006: 183) Type format Likert can be used RA Likert (1932) in developing a scaling procedure Where scale represent something bipolar continuum . Where there are five dimensions main quality services , consists from : tangible, empathy , reliability, responsiveness, assurance that will described in 25 questions later arranged based on scale Likert starts from category 5 (Not Good) to 1 (Very Good).

Patient Loyalty
According to Christopher LoveLock and Lauren Wright ( 2002: 104) Loyalty Customer as follows: "Loyalty is a willingness to continue patronizing a firm over the long term, purchasing and using its goods and services on a repeated and preferably exclusive basis, and voluntarily recommending it to friends and associates." It can be interpreted that loyalty is a desire customer to continue connection trading with a hospital for a long time , where purchase and use service service , repeated service , prefer _ specialty as well as willingness to recommend to others. Patients who are loyal to a hospital are considered as source resources that consistently provide benefits to the company . Loyal patients continue to benefit and survive https: If patient still get more profit from consume service hospital services rather than switching to a brand or service other hospital services .
Whereas according to Jill Griffin's opinion ( 1995: 4) explained that Loyalty as follows : " Loyalty is defined as non-random purchase expressed over time by some decision making unit." From definition on seen that loyalty more lead to something desire the intended patient with exists purchase in a manner routine and based on the unit of intake decision .
According to Creepers Lupiyoadi ( 2006: 195) loyal patients will talk about things positive about quality service service House A pain to others, recommend service service House A pain to others, pushing friends and relations business For do business with House pain A, make House pain A as choice main and reproduce use or affairs business in Century future . Loyal patients are source the most income dependable . Very they are loyal or loyal to product or service certain Can So throughout time they will use product or service the . This means that it is the patients who play a role big in donate income and profit House Sick as well as continuity from House Sick the .

Characteristics Loyalty Customer
Loyal customers are asset not priceless for House Sick Because characteristics from loyal patients , according to Jill Griffin ( 1995: 31) , namely : a. Make purchases regularly. b. Buying outside the product or service line. c. Refuse other products. d. Demonstrate immunity from the attractiveness of competitors (not easily affected by the attractiveness of similar products from competitors). Furthermore , Jill Griffin (1995: 13) suggests the advantages that a hospital will get if it has loyal customers or patients, namely: a.
Reducing marketing costs, because attracting new patients is more expensive. b.
Reducing transaction costs, such as: contract negotiation costs, order processing. c.
Reducing customer turn over costs , due to fewer customer replacements. d.
Increase cross sales which will enlarge the company's market share. e. A more positive Word of Mouth , assuming that loyal patients also mean those who are satisfied with the service.
f. Reducing failure costs, such as: replacement costs, and others. Loyal patients will not move to another heart and replace or use other brands of products or services, even if they are given lures or get tempting temptations. Because there is a long-term relationship between producers and consumers that has been built. This can happen because it begins with the process of meeting consumer needs and attention to consumers from the start. 4% : Customers are dissatisfied and then make demands. 65-90% : Customers do not demand, but do not buy the goods or services again. In paying attention to the survival of its business, every hospital must always strive to provide the best service in order to provide satisfaction to its patients. Patient satisfaction is a person's level after comparing the perceived performance or results with the expectations obtained from these services. So, the level of satisfaction is a function of the difference between perceived performance and expectations obtained (Edy Supriyadi, 2005: 23).

The Effect of Service Quality on Patient Loyalty
As previously stated, loyal patients will be created if they are satisfied. According to AM Moorison (1989) states that in order to satisfy patients, an organization or hospital must do the following two things, namely: a. Prepare the good and needed by the patients. b. Perform quality service . _ According to Parasuraman, quality the products or services produced company will assessed jointly and carefully by the patients , so that if one from second factor This is not paid enough attention to by business managers or the hospital As a result they will not get a good market . Perceived quality _ the patient is the level satisfaction patient the . Hence , satisfaction _ patient is a measure to know the quality offered by the service hospital service . It also means quality can fulfill expectations of patients that they will make a purchase or use service services repeatedly ( Edy Supriyadi , 2005 : 28).
Perceived quality _ the patient is the level patient satisfaction _ , therefore they are repulsive measure to find out quality services provided by the hospital. It means satisfaction _ patient will achieved and also means quality services provided can fulfill hope the patient himself. Satisfaction patient This is the basic capital for the hospital in forming loyalty customer , where Loyal patients are the most valuable assets for hospitals to improve profitability or profit company (Edy Supriyadi , 2005: 28).

Framework
In this study want to know whether there is influence between two variables in context service services at Krakatau Medika Hospital in Cilegon, namely: quality service and loyalty customer . Quality service consists of five dimensions , namely: tangible, empathy , reliability, responsiveness , assurance. Whereas loyalty customer consists of two factors , namely: desire patient to return visit or use (intentions to return) as well as willingness patient invite or recommend to others (intentions recommend) . Framework thoughts can be presented in pictures following : https://equatorscience.com/index.php/jabter

Hypothesis Formulation
Based on above description and description framework thought , researcher will formulate hypotheses the as following :

First hypothesis
Ho : ρ = 0 : None influence positive between dimensions quality service to desire patient to return visit or use (intentions to return) .
Ha : ρ > 0 : There is a positive influence between the dimensions of service quality on the patient's desire to return to visit or use (intentions to return) .

First sub-hypothesis
Ha1 : There is a positive relationship between the Tangible dimension and intentions to return .
Ha2 : There is a positive relationship between the Empathy dimension and intentions to return .
Ha3 : There is a positive relationship between the Reliability dimension and intentions to return .
Ha4 : There is a positive relationship between the Responsiveness dimension and intentions to return .
Ha5 : There is a positive relationship between the Assurance dimension and intentions to return .

Second hypothesis
Ho : ρ = 0 : There is no positive influence between the dimensions of service quality on the patient's willingness to invite or recommend to others (intentions to recommend) .
Ha : ρ > 0 : There is a positive influence between the dimensions of service quality on the patient's willingness to invite or recommend to others (intentions to recommend) .

Second sub-hypothesis
Ha1 : There is a positive relationship between the Tangible dimension and intentions to recommend .
Ha2 : There is a positive relationship between the Empathy dimension and intentions to recommend .
Ha3 : There is a positive relationship between the Reliability dimension and intentions to recommend .
Ha4 : There is a positive relationship between the Responsiveness dimension and intentions to recommend .
Ha5 : There is a positive relationship between the Assurance dimension and intentions to recommend .

Research Method
Sugiyono (2002: 57) Population is a generalization area consisting of objects or subjects that have certain quantities and characteristics determined by researchers to be studied and then drawn conclusions. This study used the Census Method with the entire research population as respondents. The target or object population in this study were all patients who received health services at Krakatau Medika Hospital in Cilegon on September 17 -October 7 2007.
The sample is part of the number and characteristics possessed by the population. The samples taken were 100 people for trials and 200 people for research as respondents consisting of customers/patients of class I, II, VIP service units and suite rooms, namely: inpatient asoka, flamboyant, cempaka, orchids, jasmine and chrysanthemum with specific patients who want to go home and after being treated for three days, as well as some outpatient care with specific old patients at nurse station B and nurse station C.
Sampling was carried out using technical convenience sampling due to time and cost constraints. The sampling procedure was carried out by means of Probability Sampling , namely where sampling provides equal opportunities or opportunities for each customer/patient of Krakatau Medika Hospital as the selected population. The sampling technique used is Simple Random Sampling , namely the technique of taking samples from all members of the population at random. The type of data collected in this study is primary data which is quantitative in nature.
Survey technique used in this research by distributing questionnaires to patient respondents at Krakatau Medika Hospital in Cilegon, where previously they conducted a https://equatorscience.com/index.php/jabter survey at the research location. Questionnaire as a research instrument addressed to respondents, divided into questions regarding the quality of hospital services according to customer perception (perceived service) and patient loyalty (expected service) at Krakatau Medika Hospital in Cilegon.In this study, the independent variable (IV) is the quality of hospital services which consists of 5 dimensions, namely: tangible, empathy, reliability, responsiveness, and assurance. Customer perceptions (perceived service) of the overall quality of service in this study will be measured by questions adopted from 25 items of the SERVQUAL instrument (Parasuraman et.al, 1991) which have been adjusted for patients in assessing the quality level of a hospital's service. Whereas For variable bound (DV) is loyalty patient be measured with questions that have arranged form desire patient For return visit or use and availability patient invite or recommend to person other , as well associated with whole dimensions quality perceived service _ by the patients .
Based on Scale LIKERT each respondent answered question with give circle on the number answers that have provided . Number answer consists out of 5 answers namely : For answer No Good given point 1 Less Good given point 2, Enough Good given point 3, Ok given point 4 and Very Good given point 5.

Result and Disccusion
Respondents in this study were outpatients and inpatients at Krakatau Medika Hospital. Data collection was carried out by distributing the questionnaires directly to the respondents so that there was no wrong selection of respondents and avoiding information bias. The data collection and evaluation process lasted for one month. The distributed questionnaires totaled 400 questionnaires and as many as 300 questionnaires were filled in completely and correctly. Respondents in this study were dominated by employees of state-owned enterprises with an age range of 31-50 years.

Result Tangibles Analysis
In the Tangible measurement, patients are asked to answer five questions to assess the effect of the Tangible dimension of the quality of hospital services on customer (patient) loyalty.
Based on calculation statistics descriptive in table 4.4 is obtained overall results _ customer assume that dimension Tangibles from quality service Hospital services are a very important factor for patients to be able to return visit or use (Intentions To Return) and so willing invite or recommend to others (Intentions To Recommend) in using the service Krakatau Medika Hospital services , which can be seen in the results of the mean of 10.77 with the standard deviation of 2.14.  Output SPSS 20 (2022) According to customer from fifth dimensions Tangible, which needs to be addressed is "Information service hospital services in the form of brochure " Because seen from mark the lowest Mean is 2.07 in other words that what is expected by patients and their families is that the hospital provides convenience , such as clear and correct information about the whereabouts of somewhere , as well system adequate communication . _

Empathy analysis
In measuring Empathy, patients are asked to answer five questions to assess the influence of the Empathy dimension of the quality of hospital services on customer (patient) loyalty. Based on the calculation results, the following values are obtained: Based on the descriptive statistical calculations in table 4.5, the overall results show that customers consider that the Empathy dimension of hospital service quality is a very important factor for patients to be able to return to visit or use (Intentions To Return) and to be willing to invite or recommend to others ( Intentions To Recommend) in using the services of the https://equatorscience.com/index.php/jabter Krakatau Medika Hospital, which can be seen in the results of a mean of 11.66 with a standard deviation of 3.26.

According to customers from the five dimensions of Empathy, what needs to be addressed is "Providing services to all patients regardless of social status and others."
because it can be seen from the lowest value of the Mean which is 2.19 in other words that what is expected by patients and their families is that the hospital has an attitude of concern for the environment / certain communities and special attention to all its customers, especially for the less fortunate.

Reliability Analysis
In measuring reliability, patients are asked to answer five questions in order to assess the effect of the reliability dimension of the quality of hospital services on customer (patient) loyalty. Based on the calculation results, the following values are obtained:  Output SPSS 20 (2022) Based on the descriptive statistical calculations in table 4.6, the overall results show that customers consider that the Reliability dimension of the quality of hospital services is a very important factor for patients to be able to return to visit or use (Intentions To Return) and to be willing to invite or recommend to others ( Intentions To Recommend) in using the services of the Krakatau Medika Hospital, which can be seen in the results of a mean of 9.15 with a standard deviation of 2.27.
According to customers from the five dimensions of Reliability, what needs to be addressed is "The hospital makes corrections, if an error occurs in providing services" because it can be seen from the lowest value of the Mean, which is 2.12, in other words that what is expected by patients and their families is satisfaction in receiving any form of service that has not been applied properly, such as having a flexible attitude or being alert in dealing with every customer problem. In measuring Responsiveness, patients are asked to answer five questions to assess the effect of the Responsiveness dimension of the quality of hospital services on customer (patient) loyalty. Based on the calculation results, the following values are obtained: Based on the calculation of descriptive statistics in table 4.7, the overall results show that customers consider that the Responsiveness dimension of hospital service quality is a very important factor for patients to be able to return to visit or use (Intentions To Return) and to be willing to invite or recommend to others ( Intentions To Recommend) in using the services of the Krakatau Medika Hospital, which can be seen in the results of a mean of 8.80 with a standard deviation of 2.37.

Responsiveness Analysis
Responsiveness dimensions , what needs to be addressed is "Doctors, nurses and all hospital employees have the ability to resolve patient complaints" because it can be seen from the lowest value of the Mean, which is 2.05, in other words that what patients and their families expect is to focus on all their customers, such as providing attention and assistance to every patient who needs it, not just thinking about profit.

Assurance analysis
In measuring Assurance, patients are asked to answer five questions to assess the effect of the Assurance dimension on the quality of hospital services on customer (patient) loyalty. Based on the calculation of descriptive statistics in table 5, the overall results show that customers consider that the Assurance dimension of the quality of hospital services is a very important factor for patients to be able to return to visit or use (Intentions To Return) and to be willing to invite or recommend to others ( Intentions To Recommend) in using the services of the Krakatau Medika Hospital, which can be seen in the results of a mean of 10.71 with a standard deviation of 2.83. Based on the calculation results, the following values are obtained: https://equatorscience.com/index.php/jabter  Output SPSS 20 (2022) According to customers from the five dimensions of Assurance, what needs to be addressed is "The hospital has guarantees of patient safety and trust in the quality of service." because it can be seen from the lowest value of the Mean, which is 1.97, in other words that what patients and their families expect is quality hospital services, taking into account two important things, namely: who are our customers and what are the expectations of our customers, as stated in the culture KERIS company.

Analysis of Intention To Return
In measuring Intentions To Return , patients are asked to answer one question to assess whether using the services of Krakatau Medika Hospital can generate a desire to return to visit. Based on the calculation results, the following values are obtained: Based on calculation statistics descriptive in the table above, obtained The mean result is 2.20 by standard deviation of 0.951 indicates that the patients feel less impressed and dissatisfied with the services provided by Krakatau Medika Hospital so that the form of relationship that occurs is delaying or thinking especially first if you want to come back visit or use services the hospital service .

Intention To Recommend Analysis
In the Intentions To Recommend measurement , patients are asked to answer one question to assess whether using the services of Krakatau Medika Hospital can generate a  Based on the descriptive statistical calculations in the table above, the Mean result is 2.38 with a standard deviation of 0.812 indicating that the patients are quite satisfied with the services provided by Krakatau Medika Hospital so that the form of relationship that occurs is willing to invite or recommend others to use the hospital services.

Hypothesis First And Subhypotheses
Based on results calculation of questionnaire data on testing the null hypothesis is presented in table as following :  Output SPSS 20 (2022) first hypothesis is tested influence between fifth dimensions quality service hospital services to loyalty customer (Intentions To Return). hypothesis zero along alternative formulated as following : https://equatorscience.com/index.php/jabter Ho : None influence positive between dimensions quality service to desire patient to return visit or use (Intentions To Return).
Ha : There is a positive influence between the dimensions of service quality on the patient's desire to return to visit or use (Intentions To Return).
Based on the calculation results in Table 4.11 with the measurement of the Correlation Coefficient, the translation can be interpreted as follows:

Influence between Tangible Dimensions Against Intentions To Return.
Respondents answer 5 use questions know perception customers with a desire to return visit or use services services of the hospital , can be seen from the mean value is 10.77 and standard deviation of 2.14 ( Table 4.4) as well r** value ( Coefficient Correlation ) of 0.408 with ρ ( Degrees Significance ) is 0.000 ( Table 4.11) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence between Influence between dimensions Empathy towards Intentions To Return.
Respondents answer 5 use questions know perception customers with a desire to return visit or use services services of the hospital , can be seen from the mean value is 11.66 and standard deviation of 3.26 ( Table 4.5) as well r** value ( Coefficient Correlation ) of 0.468 with ρ ( Degrees Significance ) is 0.000 ( Table 4.11) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence between dimensions Empathy on Intentions To Return, and strength connection the own medium level .

Influence between dimensions of Reliability to Intentions To Return.
Respondents answer 4 use questions know perception customers with a desire to return visit or use services services of the hospital , can be seen from the mean value is 9.15 and standard deviation of 2.27 ( Table 4.6) as well r** value ( Coefficient Correlation ) of 0.421 with ρ ( Degrees Significance ) is 0.000 ( Table 4.11) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig. Level (0.05)

then the Null Hypothesis (Ho) is rejected, which means there is influence between dimensions of Reliability to Intentions To Return, and strength connection the own medium level . _ Influence between Responsiveness dimension to Intentions To Return.
Respondents answer 4 use questions know perception customers with a desire to return visit or use services services of the hospital , can be seen from mean value of 8.80 and standard deviation of 2.37 ( Table 4.7) as well r** value ( Coefficient correlation ) of 0.525 with ρ ( Degrees Significance ) is 0.000 ( Table 4.11) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence

between dimensions of Responsiveness to Intentions To Return, and strength connection the own medium level . _ Influence between the Assurance dimension of Intentions To Return.
Respondents answer 5 use questions know perception customers with a desire to return visit or use services services of the hospital , can be seen from the mean value is 10.71 and standard deviation of 2.83 ( Table 4.8) and r** value ( Coefficient Correlation ) of 0.496 with ρ ( Degrees Significance ) is 0.000 ( Table 4.11) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence between dimensions of Assurance on Intentions To Return, and strength connection the own medium level . _

Hypothesis Second And Subhypothesis
Based on results calculation of questionnaire data on testing hypothesis zeros are presented in the table as following :  Output SPSS 20 (2022) hypothesis second test influence between fifth dimensions quality service hospital services to loyalty customer (Intentions To Recommend). hypothesis zero along alternative formulated as following : Ho : None influence positive between dimensions quality service to willingness patient to invite or recommend to others (Intentions To Recommend).
Ha : There is a positive influence between the dimensions of service quality on the patient's desire to return to visit or use (Intentions To Recommend).
Based on the calculation results in Table 4.12 with the measurement of the Correlation Coefficient, the translation can be interpreted as follows: 1.

Influence between Tangible dimension of Intentions To
Recommend. Respondents answer 5 use questions know perception willing customers _ Invite or recommend others to use the service services of the hospital , can be seen from the mean value is 10.77 and standard deviation of 2.14 ( Table 4.4) as well r** value ( Coefficient Correlation ) of 0.383 with ρ ( Degrees Significance ) is 0.000 ( Table 4.12) so it can be concluded that the relationship the characteristic positive and has low level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means

there is influence between Tangible dimensions of Intentions To Recommend, and strength connection the own low level . _ Influence between dimensions Empathy towards Intentions To Recommend.
Respondents answer 5 questions use know perception willing customers _ invite or recommend to others to use service services of the hospital , can be seen from the mean value is 11.66 and standard deviation of 3.26 ( Table 4.5) as well r** value ( Coefficient Correlation ) of 0.532 with ρ ( Degrees Significance ) is 0.000 ( Table 4.12) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there

is influence between dimensions Empathy on Intentions To Recommend, and strength connection the own medium level . _ Influence between Reliability dimension to Intentions To Recommend.
Respondents answer 4 use questions know perception willing customers _ Invite or recommend others to use the service services of the hospital , can be seen from the mean value is 9.15 and standard deviation of 2.27 ( Table 4.6) as well r** value ( Coefficient correlation ) of 0.637 with ρ ( Degrees Significance ) is 0.000 ( Table 4.12) so it can be concluded that the relationship the characteristic positive and has strong level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence between dimensions of Reliability to Intentions To Recommend, and strength connection the own strong level . _

Influence between Responsiveness dimension to Intentions To
Recommend. Respondents answer 4 use questions know perception willing customers _ Invite or recommend others to use the service services of the hospital , can be seen from mean value of 8.80 and standard deviation of 2.37 ( Table 4.7) as well r** value ( Coefficient Correlation ) of 0.558 with ρ ( Degrees Significance ) is 0.000 ( Table 4.12) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho)

is rejected, which means there is influence between Responsiveness dimension to Intentions To Recommend, and strength connection the own medium level . _ Influence between the Assurance dimension of Intentions To Recommend.
Respondents answer 5 questions use know perception customers with a willingness to invite or recommend others to use the service services of the hospital , can be seen from the mean value is 10.71 and standard deviation of 2.83 ( Table 4.8) and r** value ( Coefficient Correlation ) of 0.530 with ρ ( Degrees Significance ) is 0.000 ( Table 4.12) so it can be concluded that the relationship the characteristic positive and has medium level . _ because results calculation ρ (0.000) < Sig.Level (0.05) then the Null Hypothesis (Ho) is rejected, which means there is influence between the Assurance dimension of Intentions To Recommend, and strength connection the own medium level . _

Influence Between Variables Independent ( Quality service ) To Variable dependent (Intentions To Return).
To test influence fifth dimensions the independent variables together ( simultaneously ) _ _ to variable bound used measurement analysis Simple Linear Regression , then result The calculation can be seen in the table below : From the results measurement Simple Linear Regression as a whole , then obtained mark coefficient correlation of 0.317 means there is moderate influence _ between dimensions Quality Service to Loyalty Subscribers , with contributions influence by 30% ( coefficient determination 0.300) and the F-count value of 18.030 at the level significance of 0.000 (alpha 5%) so the probability is much smaller of 0.05 means there is significant and positive influence _ between Tangible, Emphaty , Reliability, Responsiveness and Assurance (IV) to Intentions To Return (DV) are jointly declared acceptable . Then from partial analysis _ it is known that the independent variable is the most dominant own contribution influence to Loyalty The customer is the dimension Responsiveness with an r value of 0.525 and the highest beta value of 0.265 meanwhile own mark β negative of -0.006 in dimensions reliability.

Influence Between Independent Variable (Quality of Service) Against Dependent Variable (Intentions To Recommend).
To test the influence of the five dimensions of the independent variables together (simultaneously) on the dependent variable, Simple Linear Regression analysis measurements are used, so the results of the calculations can be seen in the table below: From the results measurement Simple Linear Regression as a whole , then obtained mark coefficient correlation of 0.459 means there is strong influence _ between dimensions Quality Service to Loyalty Subscribers , with contributions influence of 44.5% ( coefficient determination 0.445) and the F-count value of 32.865 at the level significance of 0.000 (alpha 5%) so the probability is much smaller of 0.05 means there is significant and positive influence _ between Tangible, Emphaty , Reliability, Responsiveness and Assurance (IV) to Intentions To Return (DV) are jointly declared acceptable . Then from partial analysis _ it is known that the independent variable is the most dominant own contribution influence to Loyalty The