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JOB SATISFACTION OF OUTPATIENT PUSKESMAS AND

INPATIENT PUSKESMAS STAFF IN KOTAWARINGIN BARAT

REGENCY

Togar Hasudungan Manurung

, Martha Irene Kartasurya

, Ayun Sriatmi

Administration and Health Policy Department, Faculty of Public Health, Diponegoro University

Public Health Nutrition Departement, Faculty of Public Health, Diponegoro University

Health Adminitration and Policy Departement, Faculty of Public Health Diponegoro University

togarman.dentistry@gmail.com

PAPER INFO ABSTRACT

Received: March

2022

Revised: May

2022

Approved: May

2022

Background: Health staff job satisfaction impacts performance. Puskesmas

have periodically measured customer satisfaction but staff job satisfaction

has never been carried out. From a preliminary study, it was found that the

job satisfaction of Puskesmas staff in Kotawaringin Barat Regency was still

low.

Aim: To find out the difference in job satisfaction of inpatient Puskesmas

staff with outpatient health centers.

Method: Design cross-sectional research with quantitative approach. The

research population of inpatient and outpatient health center staff in

Kotawaringin Barat District. Recruitment of subjects is carried out through

Puskesmas. From 14 outpatient health centers, 3 Puskesmas were selected

and from 4 inpatient health centers, 2 Puskesmas were selected. A total of 40

subjects filled out the questionnaire which was distributed electronically.

Data analysis was carried out with an independent t test to distinguish job

satisfaction.

Results: High job satisfaction at outpatient health centers is on the

supervision factor, and policies are 62%, motivation is 57%, respectively,

while low satisfaction in the physical work environment is 19%, on

occupational safety and security factors, incentives, capitation services are

33% each, and work culture is 38%. High job satisfaction at inpatient health

centers in the form of work culture factors, and capitation services were 68%,

respectively, work results were 63%, and 58% each in the factors of co-

workers, occupational security and safety, opportunities to improve skills and

skills, while low satisfaction in the physical work environment was 16%,

incentives were 16%, workload was 37%, supervision was 42%, and policies

were 42%. There is no significant differencebetween work complacencyin

outpatient health centers and inpatient high school health centers (p=0.317).

KEYWORDS

job satisfaction, Puskesmas, inpatient, outpatients, health workers

INTRODUCTION

Health sector resources are all forms of funds, manpower, health supplies, pharmaceutical

preparations and medical devices as well as health service facilities and technology that are

used to organize health efforts carried out by the government and the community. Human

resources (HR) are at the heart of the healthcare system. One of the main aspects of HR that

has an effect is the measurement of staff job satisfaction. The organization must ensure that the

job satisfaction of its staff is high, which is a prerequisite for increasing productivity,

responsiveness, quality and service (Rivai, 2013).

Hezberg (2003) states that the relationship of an individual to his work is a basic

relationship that can determine the success or failure of the individual in question. Job

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1014 Interdisciplinary Social Studies, 1(8), May 2022

satisfaction is an emotional attitude that pleases and loves his job and can also support the

realization of organizational goals. Mathis and Jackson, give a comprehensive definition of job

satisfaction that includes cognitive, affective and evaluation reactions or attitudes and states

that job satisfaction is a happy emotional state or positive emotion derived from the assessment

of the work or work experience of theperson. Job satisfaction is the result of an employee's

perception of how good their work is and delivers what is considered important.

Outpatient or non-inpatient health centers are puuskesmas that provide outpatient services,

home care, emergency services, and organize hospitalizations in normal delivery services

(Ministry of Health of the Republic of Indonesia, 2019). Inpatient health centers are Puskesmas

that are given additional resources according to the consideration of health service needs to

provide hospitalizations in normal delivery services and other health service inpatient services.

Inpatient health centers are located in rural areas, remote areas and very remote areas, which

are far from advanced referral health service facilities.

According to Herzberg, job satisfaction is caused by the presence of motivational factors

(intrinsic) and hygiene factors (extrinsic). Motivational factors include success in completing

tasks (achievement), rewards (recognition), work it itself (work it self), responsibility

(responsibility), possibility for self-development (possibility of growth), and opportunity to

progress (advancement). Hygiene factors include working conditions, interpersonal relations,

policies and administration, feelings of security at work (job security), salary (pay), position

(status), and supervision techniques (supervision technical). Herzberg (1959) explains that the

factors that determine job satisfaction or dissatisfaction are different. The opposite of job

satisfaction is not job dissatisfaction, but rather no satisfaction; and the opposite of job

dissatisfaction is not job satisfaction but no dissatisfaction.

The Kotawaringin Barat District Health Office has 18pusmas in all existing districts.

Among the 18 health centers, there are4 inpatient health centers and 14 outpatient health

centers, all of which do not have the status of Regional Public Service Agencies. Data in June

2021 from the application of infrastructure and medical devices (ASPAK) shows that the

achievement of Puskesmas infrastructure is only 41.3% and 37.8% of medical devices. This is

still far from the standard (60%) set by the Ministry of Health of the Republic of Indonesia.

The total number of human resources in the Puskesmas is 735 people with the status of Civil

Servants (PNS) , Regional Contract Workers (TKD) and Voluntary Workers. Puskesmas never

measure job satisfaction periodically.

Research on job satisfaction of Puskesmas staff conducted by Agung Gunawan et al at the

Cipaku Health Center, Ciamis Regency (2019) found that 56% satisfied staff were caused by

welfare factors, relationships between colleagues, quality of supervision, job characteristics,

and opportunities for development/promotion (Gunawan and Kusniawati, 2019). Determinants

of job satisfaction in 3 Puskesmas of Merangin Regency representing mountainous,

transmigration, and urban areas carried out by Novia Susianti (2019) are financial incentives,

relationshipswith colleagues, and motivation. The job satisfaction of 194 staff at 22 health

centers in North Konawe Regency conducted by Sri Rahayu et al (2020) was influenced by

social aspects in n workers, working conditions relations, and supervision or supervision. Job

satisfaction in 119 Sri Langka Provincial Public Health Inspectors in the pre-Covid-19 era by

Kumarasinghe and Samaranayake (2020) stated that 73% were dissatisfied with their work.

The highest level of satisfaction with intrinsic factors in the form of responsibilities, and duties

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1015 Interdisciplinary Social Studies, 1(8), May 2022

resmi/nature of the work. On its extrinsic factors are interpersonal relationships, and

supervision. Thehighest percentage of etidakpuasan on intrinsic factors is kemajuan, and

achievement. On extrinsic factors areopinions an and payments, as well as the policy of the

organization.

There are different variations in job satisfaction in each Puskesmas, each region, and there

has never been a periodic measurement of job satisfaction at the Puskesmas which is the interest

of researchers to conduct research on the difference in job satisfaction between outpatient and

inpatient health centers in Kotawaringin Barat Regency.

METHOD

The research conducted was observational using atan survey (quantitative) shorthand. Due

to the era of the Covid-19 pandemic and the very high number of confirmed cases, the research

instrument uses an e-questionnaire. The job satisfaction questionnaire was developed by the

researcher with reference to the intrinsic and extrinsic factors of job satisfaction of the Herzberg

model with 13 question items. Data collection was carried out in July 2021. Assessmentof the

criteria on the instrument in the form of lack of satisfaction and satisfaction.

As a population, namely the staff of the main health center in the outpatient health center

and the inpatient health center. Two inpatient health centers and 3 outpatient health centers (1

inner-city health center, 2 out-of-town health centers). Puskesmas staff vary greatly and the

number is small both in terms of profession, staffing status, and education, maka pemilihan

samples are carried out purposively. Determination of sampel based on the following criteria:

1) Inclusion criteria: Staff with civil servant and TKD status, actively working for at least 1

year, minimum education in Upper or vocational M Middle School, and willing to be

respondents.

2) Exclusion criteria: Staff with the status of volunteers, internship personnel.

The questionnaire was sent throughthe Head of Puskesmas which was forwarded to the

staff until the respondents collected 40 samples with details of 21 respondents from outpatient

health centers and 19 respondents from inpatient health centers.

RESULTS AND DISCUSSION

The characteristics of respondents to the staff of outpatient health centers and inpatient

health centers in Kotawaringin Barat Regency are compiled based onstaffing status, gender, and

final education. A description of the characteristics of respondents can be seen in Table 1.

Table 1. Distribution of Respondent Characteristics

Characteristic

Outpatient Health Center

Inpatient Health Center

Staffing status:

- Civil Servants

- Regional Contract Labor

54,5

45,5

Gender:

- Man

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1016 Interdisciplinary Social Studies, 1(8), May 2022

- Woman

Education:

- High School

- DIII/DIV

- Bachelor

66,7

54,5

46,7

33,3

45,5

53,3

Sum

52,5

47,5

Table 1 shows that civil servants in outpatient health centers are greater in number than

inpatient health centers. Meanwhile, the number of respondents in outpatient health centers and

inpatient health centers is the same number. The existence of TKD is carried out to meet

various health professions that must exist in Puskesmas both from the type of profession and

the number. Male respondents were larger in outpatient health centers compared to inpatient

health centers. Respondents in outpatient health centers with the last education in High School

were 2 times the number of respondents in inpatient health centers. Respondents

withabackground in DIII / DIV education are greater in number in outpatient health centers,

but for Bachelor's education, the number is greater in inpatient health centers. Cumulatively

respondents with more DIII/ DIV education. Currently the Ministry of Health stipulates that

every health profession is at least DIII. As an effort, it is to provide educational assistance for

health workers who are not yet DIII and work in government-owned health care facilities.

In describingthe vari abell of this study in the form of numerical data, the presentation of

data in the form of mean, standard deviation, minimum, maximum, and Shapiro-Wilk (Agus

Riyanto, 2011). Data distribution and normality tests can be seen in Table 2.

Table 2. Distribution of Job Satisfaction Data for Inpatient Health Centers, Outpatient

Health Centers and Normality Tests

Variable

Mean

Minimum

Maximum

Sig.

Shapiro-Wilk

Outpatient Health Center

18,57

2,29

0,467

Inpatient Health Center

19,21

1,58

0,217

From Table 2, it can be explained that the variable job satisfaction of outpatient health

centers and inpatient health centers is normally distributed with a p value of >0.05. In

outpatient health centers, the data is categorized as dissatisfied if x≤18 and the category is

satisfied if x>19, then outpatient outpatient Puskesmas staff are 47.6% (10) and outpatient

outpatient health center staff are 52.4% (11). The job satisfaction of the inpatient health center

when grouped into 2 categories, namely dissatisfied and satisfied, maka category less satisfied

if x≤19 and the category satisfied if x>20. After the data were processed, it was obtained that

the number of inpatient Puskesmas staff who were not satisfied with working was 68.4% (13)

and those who were satisfied with working were 31.6% (6).

To find out what variables make the satisfaction of outpatient health center staff

andinpatient health center can be seen in Table 3.

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1017 Interdisciplinary Social Studies, 1(8), May 2022

Table 3. Distribution of Satisfaction Answers for Respondents of Outpatient Puskesmas and

Inpatient Puskesmas

Question

Outpatient Health

Center

Inpatient Health Center

Satisfaction

How colleagues in Puskesmas

run services or programs

What about the division of

workload given to you

What about the results of the

work you have done while

working at the Puskesmas

How to implement your

security and safety in doing

work at the Puskesmas

What about the conditions of

your work environment

(comfortable workspace, desk

chairs, medical devices,

computers/printers) provided

by the Puskesmas

How is the supervision

(monitoring-evaluation)

carried out by the Head of

Puskesmas on your good work

How is the work culture of

Puskesmas that has been

carried out so far

What about the

welfare/incentive money you

receive

What about the capitation

services you receive

What is your chance to get a

position in the organizational

structure of the Puskesmas or

outside the Puskesmas (Dinas

Kesehatan)

How is your opportunity to

improve your skills

andwork/program era

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1018 Interdisciplinary Social Studies, 1(8), May 2022

How is the work motivation

given by the Head of

Puskesmas

What about the policies of the

Head of Puskesmas while you

are working.

Source: Researcher Data, July 2021

From Table 3, it can be seen that job satisfaction of outpatient Puskesmas is in the form of

supervision, policies of the Head of Puskesmas, and motivational factors. While f actors of job

dissatisfaction are on factors of the physical work environment, work security and safety,

incentives, capitation services, and work culture. Job satisfaction of inpatient health centers is

in the factors of work culture, capitation services, work results, colleagues, occupational

security and safety, opportunities to improve skills and skills. Meanwhile, the dissatisfaction

factor is in the physical work environment, incentives, workload, supervision, and Puskesmas-

style kep policies.

The factor of job satisfaction in the outpatient health center that is a factor of job

dissatisfaction at the inpatient health center is supervision, and the policy of the Head of the

Puskesmas. Factors of job satisfaction in inpatient health centers that are factors of

dissatisfaction in outpatient health centers are occupational security and safety, capitation

services, and work culture. Similarity of job satisfaction factors between outpatient health

centers and inpatient health centers was not found. The similarity of the dissatisfaction factoror

low level of satisfaction between outpatient health centers and inpatient health centers is in the

factors of the physical work environment and incentives.

Physical Working Environment Conditions

The physical work environment is all things that are around the workplace and can affect

staff either directly or indirectly. A physical work environment that is directly related to the

staff and is near the staff such as tables, chairs and so on. Indicators of the physical work

environment in the form of lighting or lighting rwork money, air circulation, noise, mechanical

vibrations in the workplace, odors in the workplace, color layout, decoration, and safety of the

workplace. A good work environment will create staff job satisfaction that makes maximum

performance results (Flippo, 1997).

Dissatisfaction with the physical work environment in comparison with the achievements

in the application of infrastructure and medical devices of the Kotawaringin Barat Regency

Health Office as of June 2021 has only reached 56.6% of which facilities are 90.7%,

infrastructure 41.3%, and medical devices 37.8% of the minimum standard set by the Ministry

of Health of the Republic of Indonesia is 60% (Ministry of Health of the Republic of Indonesia,

2019). From observations made that thecondition of the Puskesmas lighting at the time of

service expects lighting from incoming sunlight. The number of light bulbs is only available 1

light bulb with low power per room with a height position of ± 4 meters, in addition to the

amount of electrical power capacity that is not in accordance with the needs of the Puskesmas.

The size of the room both service and administration is very minimal (<12 m

) so that it places

the equipment and mobeler close to each other or stacked together. Use a computer that is

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1019 Interdisciplinary Social Studies, 1(8), May 2022

queued up and if it has a long-standing damage to be repaired. The number of medical devices

is limited and has never been maintained regularly. Often borrowing tools from other rooms

because the tools in the room or program kits are not available / damaged. The room is smelly

due to the low humidity of the room and the non-smooth air circulation in the service room,

especially in the action room where the walls are not crowded.

Incentive

Incentives are compensation above or beyond the salary or wages provided by the

organization. Incentive programs are tailored by providing additional pay based on

productivity, sales, profits, or cost-cutting efforts. There are 4 policy bases in incentive

distribution, namely referring to the comparison between position positions and expertise in an

organization (internal similarity), referring to the calculation of giving between one

organization and competing with competitors (competition with external), referring to the

presence or absence of staff performance (staff contributions), and a combination of extenal

competitiveness design, internal alignment, and emlpoye contributions adjusted to the

objectives of the organization where the right person gets paid the right one to achieve the

right goals in the right way (management). Proportional incentives can motivate and satisfy

employees and vice versa if disproportionate can lead to complaints, decreased achievement,

job satisfaction and decreased worker morale (Milkovich, 2008).

The understanding of incentives in this study is the welfare money provided by Puskesmas

which comes from the management of various existing budget sources. Puskesmas has its own

policy of providing incentives. This is due to the difference in the budget sources of each health

center, namely Bantuan Operasional Kesehatan, Jaminan Kesehatan Nasional, Anggaran

Pendapatan Belanja Daerah, and retribution. Policies differ both in the utilization of division

and the timing of its division. Local governments provide monthly incentives to staff who have

the status of civil servants by calculating the number ofactive work, while staff with the status

of regional contract workers do not receive incentives (Ministry of Health of the Republic of

Indonesia, 2019). The incentives received from the Puskesmas are not in accordance with

theperformance carried out by the staff, because the achievement of performance, especially in

public health efforts (SMEs) is different programs as well as technical implementation,

indicators and targets. There are SME programs that are very difficult to achieve their

performance even though various efforts have been made, but still the achievement is low and

vice versa. The concept of implementing SMEs is community empowerment.

Test t Difference in Job Satisfaction

Table 2 above categorizes that the job satisfaction of outpatient health center staff is greater

than that of inpatient health centers. To find out statistically whether there is such a difference

in satisfaction can be seen in Table 4.

Table 4. Test t Differences between the Work of Outpatient Health Centers and Inpatient

Health Centers

Puskesmas Type

Mean

Std. Error

Mean

p Value

Levene’s Test

t-test

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1020 Interdisciplinary Social Studies, 1(8), May 2022

Outpatient Health Center

18,57

0,500

0,051

0,317

Inpatient Health Center

19,21

0,363

p Value: Equal variances assumed

From Tabel 4 it is known that the p value values of both Levene's test and t-test are above

0.05 (p>α) which means that at alpha 5% there is no significant difference in the

averagesatisfaction of work in outpatient health centers with inpatient health centers.

The results of this study are almost the same as those conducted by Festy DU et al (2020)

that the job satisfaction of Puskesmas staff in Southeast Minahasa Regency during the Covid-

19 pandemic was influenced by compensation, working conditions, policies, and interpersonal

relationships. Likewise, research by Mesfin Aklilu et al (2020) at 24 health centersin the capital

Addis Ababa (Ethopia) that the dissatisfaction of Puskesmas staff is caused by income, career

development, availability of human resources, and workload. At the Bangkinang Kota Health

Center in Kampar Regency by Zulher (2020) that the dissatisfaction with the work of the

inpatient Puskesmas staff was work ethic, work environment, and workload. At the Kalisat

Health Center, Jember Regency by Heri S (2021) that the dissatisfaction with the work of the

outpatient Puskesmas staff is in the workload factor, and the size of the National Health

Insurance service (capitation services).

This research is not in accordance with what was conducted by Dhita WL et al at 3

Puskesmas in Kotabaru Karawang District (2019) that the work environment and work culture

do not affect the job satisfaction of Puskesmas staff. The findings made by Sarah N et al at the

Bojongsoang Health Center, Bandung Regency (2020) that the staff was satisfied with the

working environment conditions of the Puskesmas 53.2%. Likewise, research conducted by

Rina Z et al at the Sijunjung Regency health center in 90 respondents (2020) that the

dissatisfaction of Puskesmas staff was influenced by gender, organizational climate, and

leadership.

CONCLUSION

There is no difference in staff job satisfaction between outpatient health centers and

inpatient health centers. The work of the outpatient Puskesmas is in the faktor supervision, the

wisenessof the Head of the Puskesmas, and motivation. In inpatient health centers in the form

of work culture, capitation services, work results, colleagues, occupational security and safety,

opportunities to improve skills. The factor of the samework etidakpu satisfaction between the

outpatient health center and the raw at inpatient health center is in the lingkungan physical

work and incentive factors.

It is recommended that the West Kotawaringin District Health Office summarizethe

number of achievements of infrastructure and medical devices in stages in each Puskesmas

which is closely related to improving aspects of environmental conditions andphysical work.

Reviewing the utilization of incentives (performance allowances) for civil servants in

Puskesmas based on performance results and providingincentives also for staff with TKD

status. Puskesmas are advised to measure job satisfaction periodically before conducting a

customer satisfaction survey.

Job Satisfaction of Outpatient Puskesmas and Inpatient Puskesmas Staff in Kotawaringin Barat Regency

1021 Interdisciplinary Social Studies, 1(8), May 2022

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