THE RELATIONSHIP BETWEEN SERVICE DELIVERY AND WORK ENGAGEMENT ON NURSE PERFORMANCE AT BALI MANDARA HOSPITAL 2022

ABSTRACT


INTRODUCTION
Health Human Resources are health workers who are involved, work and devote themselves to various kinds of health efforts and management.Nursing services are a form of health services where in this case nurses are one of the health workers who play a role in providing nursing care according to their authority and scientific field which is carried out independently or in collaboration with other members of the health workforce (Sesrianty et al., 2019).
Human resources that have a relatively large proportion, the most presence in hospitals, as well as having the longest time in terms of interacting with clients are nurses.Nursing services are the center of attention in every hospital because this service is a basic activity that can be a benchmark for assessment of health services in hospitals, especially in inpatient rooms (Kurniati & Efendi, 2012).
Performance is the achievement of a person's achievements in an organization that are influenced by individual, organizational, and psychological factors (Panjaitan, 2018).Employee performance is influenced by 3 variables, namely the individual variable (I), the organizational variable (O), and the psychological variable (P).Nurse performance can be influenced by a variety of factors, namely individual variables that include abilities and skills, background, and demographics; organizational variables that include resources, leadership, rewards, structure, and job design; and psychological variables that include perception, attitude, personality, learning and motivation.
The performance of the nurse can be seen in accordance with part of the nurse's function as a provider of nursing care services (Syafawani, 2020).Good performance is the first step in achieving the company's goals.Substandard nurse performance can be caused by several factors such as poor nurse skills, lack of work motivation possessed by nurses, to factors of poor work atmosphere that affect the performance of the nurse concerned (Perceka, 2018).Therefore, it is necessary to make efforts to improve the performance of nurses, although this is not easy because of many influencing factors, one of which is the performance appraisal itself.
Performance appraisal is a process by which a company or institution evaluates or assesses the performance of its nurses.Nurse performance assessment is a measurement of the efficiency, competence and effectiveness of the nursing process and activities carried out by nurses in caring for patients to maintain, improve and motivate nurse behavior (Zulkarnaen, 2018).Assessment of nurse performance is carried out to determine nurse satisfaction and to improve the implementation of nurse work, inform nurses that the nursing care provided to patients is not satisfactory, as well as to promote positions, raise salaries, improve communication between superiors and subordinates and determine the training required by nurses who are judged to need special guidance.
A nurse is a person who receives a special education and is assigned to provide nursing care.The discipline of nurses in their work as a provider of nursing care is very important for nurses and other health workers in order to achieve the goals of health institutions, prevention of complaints, healing and recovery of patients from diseases/ accidents (Hardin & Silmi, 2021).The work discipline of the nurse exerts a noticeable influence on the results of work.If work discipline is not improved, it will directly have an impact on reducing the performance of the driver so that the ultimate goal of the company is not achieved.Bali Mandara Regional General Hospital is a type B regional general hospital that has been part of the UPTD of the Bali Provincial Health Office since the establishment of the Decree of the Governor of Bali Number 115 of 2016 dated December 28, 2016 concerning the Establishment of Organizational Structure and Work Procedures.Bali Mandara Regional General Hospital was established to provide services to the wider community with the vision of "Becoming a Quality Hospital By Prioritizing Service, Education and Research Towards a World-Class Hospital in 2025".Based on the Decree of the Governor of Bali, in its financial management, Bali Mandara Hospital has become a Regional Public Service Agency since January 1, 2018.
Performance measurement is carried out against the established Key Performance Indicators (IKU).The achievement of indicators based on the Work Plan at Bali Mandara Hospital, Bali Province in 2021 in the Fulfillment of Individual Health Efforts and Public Health Efforts with performance indicators of the Service Percentage program that meets the Standard Operating Procedures (SPO) at the UPTD of Bali Mandara Hospital is targeted to reach 100% and its realization reaches 85.45%.
Based on the annual profile of Bali Mandara Hospital in 2020, the provision of salaries and benefits for health workers that are paid is targeted at 100%, and those that have been successfully achieved are 98.48%.As for the target in 2021 of 90% and achieved by 87.07%.
Compensation is all income in the form of money, direct or indirect goods that the employee receives in exchange for services provided to the company (Gibson et al., 2008).Service services are the provision of additional money outside of salaries carried out by the institution in recognition of employee contributions and work achievements shown by employees to the institution.The purpose of providing services is to provide motivation to all employees to improve the quality and quantity of their work.
Another important factor in nurse performance is work engagement which is a positive passion and a sense of fulfillment at work where an individual has vigor, dedication, and passion (absorption) at work.The characteristic of a worker who has work engagement is that the individual feels compelled to strive to continue to advance to achieve challenging goals, and always wants success (Bakker & Leiter, 2010).In addition, work engagement also reflects the energy of workers brought to their work.
Based on the results of a preliminary study conducted through interviews and observations of several inpatient room nurses at Bali Mandara Hospital, data was obtained by most nurses revealing that they were not satisfied with the payment system for medical services provided by the hospital.The services provided are not in accordance with work risks, workloads and responsibilities for work.
In addition, there are also several things that indicate that the nurse's work engagement is still lacking, such as when working less excited, delaying work, chatting some things outside of work, lack of enthusiasm in completing work, not happy in providing services and some rushing home before returning home.These things can have an impact on the performance of nurses in a hospital.
Based on these problems, researchers are interested in conducting research on the Analysis of the Relationship between Service Delivery and Work Engagement on the Performance of Inpatient Room Nurses at Bali Mandara Hospital in 2022.

METHOD
This study used an observational design with a cross-sectional approach method (Creswell & Poth, 2016).In this study, variable measurements were carried out at one time that had been determined by researchers which aimed to analyze the effect of service delivery and work engagement as free variables on the performance of inpatient room nurses as dependent variables.
The population in this study was inpatient room nurses at Bali Mandara Hospital, which amounted to 268 people.The sampling technique used is probability sampling with proportionate stratified random sampling technique.The number of samples that met the inclusion criteria and exclusion criteria was 241 people.The variables used in this study are service delivery and work engagement as free variables.The bound variable in this study was the performance of inpatient room nurses.
Bivariate analysis was carried out to analyze the relationship between service delivery and work engagement variables with nurse performance variables using the Chi Square test.Multivariate analysis aims to look at the relationship of independent variables with dependent variables controlled with role variables.The statistical test used is the Multiple Logistic Regression multivariate test.Based on the description above, the hypothesis is compiled as follows: H1: There is a relationship between the provision of services and the performance of inpatient room nurses at Bali Mandara Hospital in 2022.
H2: There is a relationship between work engagement and the performance of inpatient room nurses at Bali Mandara Hospital in 2022.The quality of work of inpatient room nurses at Bali Mandara Hospital can already be declared Good.This is shown by the dominance of the Good work quality statement which amounted to 222 people or reached 92.1 percent.Respondents with poor work quality were 19 people or 7.9 percent.The discipline of inpatient room nurses at Bali Mandara Hospital can already be declared Discipline.This is shown by the dominance of the Discipline which amounts to 195 people or reaches 80.9 percent.Respondents who were declared Lacking in Discipline were 46 people or 19.1 percent.Based on table 4 above, showing the results of the analysis of the relationship between service delivery and the quality of nurses' work there is a significant relationship.This is indicated by a p-value that is smaller than the error rate set in this study (α = 0.05).Based on table 5 above, it shows that the results of the analysis of the relationship between service delivery and nurse discipline have a significant relationship.This is indicated by a p-value that is smaller than the error rate set in this study (α = 0.05).Based on table 6 above, showing the results of the analysis of the relationship between work engagement and the quality of nurses' work there is a significant relationship.This is indicated by a p-value smaller than the error rate set in this study (α = 0.05).Based on table 7 above, showing the results of the analysis of the relationship between work engagement and nurse discipline there is a significant relationship.This is indicated by a pvalue smaller than the error rate set in this study (α = 0.05).The statistical analysis used is a multiple logistic regression test, with hypothesis test results obtained from each research variable as follows: 1.There was a positive and significant influence between service delivery on the performance of inpatient room nurses with a significance value of 0.001 which means it is smaller than the error rate in this study (α = 0.005).2. There was a positive and significant influence between work engagement on the performance of inpatient room nurses with a significance value of 0.000 which means it was smaller than the error rate in this study (α = 0.005).Thus, it can be concluded that there is a relationship between service delivery and work engagement to the performance of inpatient room nurses at Bali Mandara Hospital in 2022.

DISCUSSION H1: The Effect of Service Delivery on the Performance of Inpatient Room Nurses
The results of the analysis test on the variables of service delivery on nurse performance showed that there was a positive and significant influence between service delivery and nurse performance.(Gibson et al., 2008) states that employee performance is influenced by individual variables, organizational variables, and psychological variables.Organizational variables include resources, leadership, rewards or compensation, structure, and job design.(Hasibuan, 2014) states that the award of compensation must be determined on the principle of fairness and decency and with due regard to applicable laws and regulations.The amount of services paid to each employee must be fair and adjusted to work performance, type of work, job risk, responsibilities, worker position and meet consistency requirements.
Eligibility in providing compensation means comparing the amount of service with other companies engaged in similar business fields.If the service in the company concerned is lower than other companies, then the company/ agency will get problems, namely in the form of a decrease in employee performance which can be known from various forms due to employee dissatisfaction with the service.
The principle of compensation is according to the fact that (Hasibuan, 2014) compensation must be paid on time and do not cause delays, so that employee confidence in the company's bona fide, calmness, and concentration of work will be better.Companies must understand that repayment will be used by employees and their families to meet their needs, where those needs cannot be delayed.
The results of this study are in line with (Tambunan & Aulia, 2019) research which states that the principle of fairness in the provision of medical services is a variable that affects the performance of nurses.Similarly, the study (Risma, 2020) found that the service and compensation variables had a positive and significant effect on the performance of Public Health Center employees.
This means that health care institutions that have employees in this case are nurses who feel that the provision of services is fair, feasible and reasonable, and on time will have a higher level of performance than nurses who feel unfair, unfit and reasonable, and not timely in providing services.So that the provision of services will affect the performance of a nurse, in this case related to the nurse of the inpatient room at Bali Mandara Hospital.

H2: The Effect of Work Engagement on the Performance of Inpatient Room Nurses
The results of the analysis test on the work engagement variable on nurse performance showed that there was a positive and significant influence between work engagement and nurse performance.
The results of this study are in line with the theory put forward by (Schaufeli & Bakker, 2010), that vigor (spirit) is a strong outpouring of energy and mentality during work, the courage to try your best in completing a job and perseverance in facing work difficulties.
Dedication as one aspect of work engagement means feeling very strongly involved in a job and experiencing a sense of meaningfulness (significance), enthusiasm, inspiration, pride, and challenge.High dedication is related to the way employees work which is able to cause enthusiasm and challenges in completing their job duties.
Absorption is also one of the important aspects that represents Work Engagement.In working, workers are always full of concentration and serious about a job so that workers will feel that time seems to pass so quickly and find difficulties in separating themselves from work.
The results of this study are in line with the research conducted by (Manalu et al., 2021) the results that moral distress and work engagement have a significant effect on nurse performance.In line with research (Manalu et al., 2021) that shows that work engagement has a positive and significant influence on employee performance.
The quality of nurses' work can be viewed from the aspects of passion, dedication, and passion.Based on the results of the study, it was found that these three aspects have been fulfilled at the Bali Mandara Regional Hospital.Through these results, it can be seen that good nurse performance will increase morale, dedication, and involvement in their work so as to improve the quality of work.

CONCLUSION
From this study, the following conclusions were obtained; (1) the description of the provision of inpatient nurse services at Bali Mandara Regional General Hospital is classified as Fair, Decent and Reasonable, and Timely, (2) the picture of the work engagement of inpatient room nurses at Bali Mandara Hospital is good in terms of vigor aspects, dedication aspects, and passion aspects, (3) the performance of inpatient room nurses at Bali Mandara Regional General Hospital has been good in terms of work quality indicators and discipline indicators, (4) there is a significant relationship between the provision of services and the quality of work of inpatient nurses at Bali Mandara Regional General Hospital, and (5) there is a significant relationship of work engagement to the quality of work of inpatient nurses at Bali Mandara Regional General Hospital