The Influence of Total Service Quality Strategy (TQS) and Pharmacy Service Quality on Patient Satisfaction and Patient Family Involvement in the Blud Pharmacy Installation at Tamiang Layang Regional General Hospital, East Barito Regency

: The Influence of Total Service Quality Strategy (TQS) and Pharmacy Service Quality on Patient Satisfaction and Patient Family Involvement in the BLUD Pharmacy Installation at Tamiang Layang Regional General Hospital, East Barito Regency. This study aims to examine the influence of Total Service Quality Strategy (TQS) and Pharmacy Service Quality on Patient Satisfaction and Patient Family Involvement as intervening variables in the Family of Patients Installed in the BLUD Pharmacy Installation at Tamiang Layang Regional General Hospital, East Barito Regency. The population in this study was 118 people, data was taken from questionnaires distributed to respondents. Data were analyzed using SmartPLS Version 3. The results of the study explained that the Total Service Quality Strategy (TQS) had a positive and significant effect on patient satisfaction, Pharmacy Service Quality had a positive and significant effect on patient satisfaction, the Total Service Quality Strategy (TQS) had a positive and significant effect on patient family involvement, Pharmacy Service Quality has a positive and significant influence on patient family involvement, Patient satisfaction has a positive and significant influence on patient family involvement, patient satisfaction mediates the influence of Total Service Quality Strategy (TQS) on patient family involvement, Patient satisfaction mediates the influence of service quality pharmacy towards the involvement of patient families in the BLUD pharmacy installation


INTRODUCTION
The increasing economic status of the community has an impact on the community regarding quality services.In accordance with Minister of Health Regulation Number 30 of 2022, everyone has the right to receive safe and quality services in accordance with service standards.Hospitals must change their management paradigm towards a consumer perspective, empowering employees and improving service quality.In order to survive and develop, in a rapidly changing and competitive environment, improving service quality and customer or patient satisfaction is an important strategy that cannot be ignored by policy makers in hospitals.Improving quality in health services, apart from being oriented towards quality service processes, is also oriented towards quality health service results that are in accordance with the wishes of customers or patients (Dwiyono, 2018).
In accordance with the Decree of the Minister of Health of the Republic of Indonesia No. 983 / Menkes / SK / cannot be separated from overall hospital services.According to the Regulation of the Minister of Health of the Republic of Indonesia No. 72 of 2016, Pharmaceutical Service Standards are benchmarks used as guidelines for pharmaceutical personnel in providing pharmaceutical services.Pharmaceutical service is a direct and responsible service to patients related to pharmaceutical preparations with the aim of achieving definite results to improve the patient's quality of life.The Hospital Pharmacy Installation (IFRS) is the only unit in the hospital that procures pharmaceutical goods, manages and distributes them to patients, is responsible for all pharmaceutical goods circulating in the hospital, and is responsible for the procurement and presentation of ready-to-use drug information.for all parties in the hospital (Aditama.T.Y, 2018).
An increase in the number of prescription sheets submitted to IFRS is an indication of increasing profits and improving service quality.The income contributed by the Pharmacy Installation section for hospitals is very useful for the operational costs of health Based on the research "Service Quality and Patients' Satisfaction in Medical Tourism" conducted by Rad (2010) shows that four variables, namely reliability, responsiveness, assurance and empathy have a positive effect on patient satisfaction.Patawayati (2013), also in the research "Patient Satisfaction, Trust and Commitment: Mediator of Service Quality and its Impact on loyalty (An Empirical Study in South East Sulawesi Public Hospital) shows that all service quality variables (tangibility, reliability, responsiveness, assurance and empathy) have a positive effect on patient satisfaction.Commitment to quality begins with a statement of dedication to a shared mission and vision, as well as empowering all participants to realize that vision.Total Quality Service (TQS) is a strategic and integrative management system that involves all managers and employees and uses qualitative and quantitative methods to continuously improve organizational processes, so that they can meet and exceed customer needs, desires and expectations.Total Quality Service includes five main aspects, namely customer focus, total linkage, measurement, systematic support and continuous improvement (Sari V.P, 2010) Based on the research "Measuring Consumer Satisfaction in Health Caresector: The Applicability of Servqual" conducted by Newman (2001) in Chakraborty (2010) shows that service quality variables (reliability, assurance, access, communication, responsiveness, courtesy, empathy, and tangibles) have an influence positive impact on customer satisfaction.From the survey results, several supporting data were obtained regarding the development of inpatient unit patients at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency.From the evaluation of medical record unit report data, it was found that the number of inpatient visits had fluctuated over the last three years, where every time a diagnosis occurred, a doctor's prescription was always given.The number of visits in 2021 for health insurance, health insurance, ark mas and general was 5703 patients, then there was a decrease in the number of inpatient visits in 2020 by 5101 patients and in 2021 there was an increase of 5662 patients.Apart from that, the number of prescription sheets entered at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency from 2020 to 2021 fluctuated, namely in 2020 the number of prescription sheets entered was 5340 (93.63%) prescriptions, then in 2020 experienced a decrease in the number of prescription sheets entered by 4958 (97.19%) prescriptions and in 2021 there was an increase in the number of prescription sheets entered by 5183 (91.54%) prescriptions.
Based on data on the number of patient visits and the number of prescription sheets entered at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency which experienced fluctuations or increases and decreases, this is allegedly because the level of customer satisfaction with the quality of the pharmaceutical services provided is not yet optimal and not appropriate.with what patients expect and has the potential to result in a decrease in income for pharmaceutical installations.Data obtained from the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency, shows that hospital management is targeting 80% of inpatients to purchase medicines at IFRS. for hospital pharmacy services is that the waiting time for ready-made medicines is ≤ 30 minutes and for concocted medicines is ≤ 60 minutes, but there are still many patients who complain that the waiting time for taking medicines is too long.The absence of errors in administering medication is 100%, but based on the preliminary survey conducted, it is known that there are still errors in administering medication to patients.Customer satisfaction is ≥ 80%, but after conducting a preliminary survey, it was discovered that at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, an assessment of patient satisfaction surveys had never been carried out so it was not yet known what the patient satisfaction score was at the pharmaceutical installation.Prescription writing according to the formulary is 100%, but based on the preliminary survey conducted it turns out that there are still many prescriptions written that do not comply with the established formulary.Meanwhile, currently patient service and patient satisfaction are becoming the main focus.The BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, has never carried out a quality assessment based on the Minimum Hospital Service Standards in the field of pharmacy according to the Republic of Indonesia Minister of Health No. 129 of 2008.

According to the
Another problem at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency is that there is no suggestion box available, causing patient complaints to not be known directly.By providing a suggestion box, patients should be able to convey their complaints, so that the hospital management cannot know for certain what services the patient is complaining about, so that management can make policies to improve the quality of services at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency, and currently, if the pharmaceutical unit is late in handing over the medicine, the patient without thinking will upload the video to social media, and this has happened very often, while the pharmaceutical installation always serves patients in accordance with the applicable Operational Standards and applicable policies to prevent errors or It is often called a medication error which can endanger patients when using the drug, but sometimes this is considered to slow down service for patients, because patients want fast service.The next problem is Total Service Quality (TQS) where several employees of the Pharmacy InstallationBLUD of the Tamiang Layang Regional General Hospital, East Barito Regency do not focus on customers, and do not appear to be totally involved with the needs of patients and their families, so some patients and families assume that the employee service is poor.The BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency has not made continuous improvements.
The management is facing problems with the low intake of prescriptions from inpatients to IFRS which is still below the target to be achieved.Even though the main IFRS pharmacy is open 24 hours including Sundays and national holidays, there is a complete range of medicines of good quality and far from expired, the prices are competitive with prices in local pharmacies and patients are encouraged to buy medicines at IFRS, but the number of patients who buy medicines at IFRS is still far below the expected target because patients and patient families believe that IFRS does not provide total service.
This research was previously conducted by Margareta Husada, 2018, who stated that TQS greatly influences patient satisfaction, as well as the quality of services provided, but this research is not in line with research by Royi Anderson, 2017, which states that TQS does not really influence patient satisfaction in health clinic.Meanwhile, it is known that if a patient is dissatisfied with the service, the patient's family will be involved in the dissatisfaction.Based on this explanation, the question in this research is: "The Influence of Total Service Quality Strategy (TQS) and Pharmaceutical Service Quality on Patient Satisfaction and Patient Family Involvement in the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency".

LITERATURE REVIEW
Total Service Quality (TQS) Total Quality Service (TQS) is a concept about how to instill and develop service quality in each phase of service delivery and involves all personnel in the organization (Tjiptono 2018) defines Total Quality Service (TQS) as a strategy, an integrated management system, which involving all managers and employees, and using various methods, both qualitative and quantitative methods, to continuously improve processes within the organization so that they can meet customer needs, desires and expectations.Service quality improvement programs must be accompanied by appropriate implementation strategies.If not, it's the same as a cake recipe without instructions on how to cook it.The methods a company uses to implement a quality improvement strategy are much more important than just a comprehensive list of quality elements.There are at least three types of approaches in order to implement total quality service (TQS), namely the project management approach, the ISO 9000 standard approach, and the Deming approach.

Quality of Pharmaceutical Services
The demands of patients and the public for quality pharmaceutical services require a change in services from the old paradigm (drug-oriented) to the new paradigm (patient-oriented) with the Pharmaceutical Care Philosophy (pharmaceutical services) (Hartini and Sulasmono, 2017).Pharmaceutical service practice is an integrated activity with the aim of identifying, preventing and resolving drug problems and health-related problems.Currently, the reality is that most hospitals in Indonesia have not carried out pharmaceutical service activities as expected, considering several obstacles, including the ability of pharmaceutical personnel, limited knowledge of hospital management regarding the function of hospital pharmacy, hospital management policies, limited knowledge of related parties regarding hospital pharmacy services.As a result of this condition, hospital pharmaceutical services are still conventional and only product-oriented, namely limited to supply and distribution (Kepmenkes, 2004).
Service quality is an important part that needs attention from health service provider organizations such as hospitals.Packaging the quality of services to be produced must be one of the marketing strategies for hospitals that will sell services to service users (patients and their families).Hospital management must always try to ensure that the service products offered remain viable or sustainable so that they can continue to capture new market segments.The superiority of a health service product will depend greatly on the unique quality of the service shown and whether it meets the customer's expectations or desires (Muninjaya, 2016).Service quality is the expected level of excellence and control over that level of excellence to fulfill customer desires (Lovelock, 2018).Basically, the definition of service quality focuses on efforts to fulfill customer needs and desires and the accuracy of delivery to match customer expectations.In other words, there are main factors that influence service quality, namely expected service and perceived service. .Quality must start from customer needs and end with customer perceptions (Kotler, 2018).This means that a good quality image is not based on the point of view or perception of the service provider, but based on the point of view or perception of the customer.Customer perception of service quality is a comprehensive assessment of the superiority of a service.Quality and service are the means to achieve satisfaction and bonding.The overall goal of a business is to produce satisfied and loyal customers who will continue to do business with the company.Therefore, providing high quality and excellent service is a must if you want to achieve the goal of satisfied and loyal customers.Piercy, et.al, (2018:6) defines service as an activity or performance to create customer benefits by providing changes that can be accepted by customers.Meanwhile, to obtain this according to Zeithaml and Bitner, (2018:75) customer service is service that appeared to support the company's core products.
Regarding service quality, Sureshcandar, et.al (2018:365) identified 5 service quality factors that are important in the view of consumers, namely; (1) core services or core products; (2) elements of service delivery; (3) systematic service delivery; (4) form of service; and (5) social responsibility.There is a very significant relationship between distribution and customer satisfaction and loyalty, so it can be said that the distribution felt by consumers, especially in helping consumers make it easier and smoother to obtain products/services, will provide a separate assessment for consumers.
Some of the definitions put forward are that service quality is a necessity for a company to provide high quality and excellent service to achieve the goal of satisfied and loyal customers based on their perception of the speed of service provided, ease of service and availability of products/services, so that service quality can be influenced by speed of service, ease of service and availability of product support facilities.If this perception meets customer expectations, then the service quality is considered good.So as service quality improves, customer satisfaction can be achieved and repeat purchases will become more frequent.The implication of quality as a characteristic of product appearance or performance is a major part of the company's strategy in order to achieve sustainable excellence, either as a market leader or as a strategy to continue to grow.
Bitneretal (2018), through his research, stated that service is the consumer's overall impression of the inferiority or superiority of the organization and the services it offers.Meanwhile, Cronindan Taylor (2017) stated that to estimate the quality of a company, until now there has been no research that is considered objective, but usually by measuring the performance of the services consumed by consumers.The superiority of a service product depends on the uniqueness and quality demonstrated by the service, whether it meets the customer's expectations.One way for service companies to remain competitively superior is to consistently provide services of higher quality than their competitors.Customer expectations are formed by past experiences, word of mouth and promotions carried out by service companies and then compared.
From the limitations mentioned above, it can be concluded that service quality, as received or felt by consumers, comes from a comparison of what the service company feels it offers with their perception of the performance of the company providing the service.The five gaps mentioned above will really help management to determine the type of quality service that will be provided to its customers.Because marketing activities that are oriented towards fulfilling consumer needs and desires will give rise to feelings of satisfaction in consumers.Today, delivering quality services is considered an essential strategy for companies to be successful and survive.Implementing quality management in the service industry is a basic requirement if you want to compete in the domestic market, let alone the global market.This is because service quality can contribute to customer satisfaction, market share and profitability.Therefore, managers' attention is now prioritized on understanding the impact of service quality on profits and other financial results in the company.
Greising (1994) states that the relationship between service quality and profit is not directly related, several previous studies have found an important relationship with service quality.Marketing and profitability variables are intervening variables between service quality and financial impact, namely in the form of behavioral intentions.(certain behavioral tendencies).Behavioral intentions are what explains whether a customer will stay or move to another company.This will have an impact on the company's financial condition, both positive and negative.Furthermore, customers who have not experienced service problems have a significantly better perception of service quality than customers who have just experienced service problems, even though they have been resolved satisfactorily.Thus, the behavioral intentions of a customer may be different in nature between those who never have problems.The same goes for consumers whose problems are resolved and which are not, because resolving a service problem does not simply erase the customer's memory of the service failure.From this description, it can be understood that the relationship between service quality and profits is not direct, or in other words, a variable between behavioral intentions is needed.Therefore, the focus of attention in this research is only trying to connect the two, namely the behavior shown by customers as a result of the quality of service they have received.

Patient Satisfaction
There are several experts who provide definitions of customer satisfaction/dissatisfaction.Day in Tse and Wilton, 1988 states that customer satisfaction or dissatisfaction is the customer's response to the evaluation of the perceived discrepancy (Disconfirmation) between previous expectations and the actual product performance felt after use (Tjiptono, 2018).The word satisfaction comes from the Latin "satis" (meaning good enough, adequate) and "facio" (doing or making).Satisfaction can be defined as "an effort to fulfill something" or "make something adequate.")describes satisfaction as "the good feeling that you have when you achieve some thing or when some thing that you want to happen does happen"; "the act of fulfilling a need or desire"; and "an acceptable way of dealing with a complaint, a debt, an injury, etc".Satisfaction can be interpreted as a person's feeling of satisfaction, pleasure and relief due to consuming a product or service to get the same service or product.
According to Oliver (in Supranto, 2018) defines satisfaction as the level of a person's feelings after comparing the performance or results they feel with their expectations.The level of satisfaction is a function of the difference between perceived performance and expectations.If performance is below expectations, customers will be very disappointed.If performance meets expectations, then customers will be satisfied.Meanwhile, if performance exceeds expectations, customers will be very satisfied.Customer expectations can be formed by past experiences, comments from relatives as well as promises and information from various media.Satisfied customers will be loyal longer, be less sensitive to price and give good comments about the company.According to Kotler and Keller (2017), satisfaction is a person's feeling of happiness or disappointment that arises after comparing the expected performance (results).If performance falls below expectations, customers are dissatisfied.If performance exceeds expectations, the customer is very satisfied or happy.Efforts to achieve total customer satisfaction are not easy, Mudie and Cottom state that total customer satisfaction is impossible to achieve, even if only temporarily (Tjiptono, 2018).Based on the descriptions of several experts, it can be concluded that satisfaction is an individual's feeling of joy, satisfaction because the expectations and reality of using and providing services are fulfilled.And basically the definition of customer satisfaction includes the difference between expectations and perceived performance or results.This understanding is based on the disconfirmation paradigm.If a consumer is satisfied, he will have a great opportunity to make a repeat purchase or buy another at the same company in the future.A consumer who is satisfied tends to say good things about the product and company in question to other people.Therefore, satisfied buyers are the best advertisement.
Actually, the concept of customer satisfaction is still abstract.Achieving satisfaction can be a simple process, or complex and complicated.In this case, the role of each individual in the service encounter is very important and influences the satisfaction that is formed.To be able to know the level of customer satisfaction better, it is also necessary to understand the causes of satisfaction.Customers are more likely to be disappointed with services than goods, but they also rarely complain.One reason is because they are also involved in the service creation process.
Understanding consumer needs and desires, in this case patients, is an important thing that influences patient satisfaction.Satisfied patients are a very valuable asset because if the patient is satisfied they will continue to use the service of their choice, but if the patient is dissatisfied they will tell other people twice as much about their bad experience.To create patient satisfaction, a company or hospital must create and manage a system to obtain more patients and the ability to retain patients (Pohan, 2017).
Marketers use satisfaction as a very important variable to measure the marketing of health care services with repeated purchasing habits or behavior (intention to return) which produces maximum satisfaction measures.Because patient values and expectations determine the interpersonal aspects of quality, patient satisfaction is an indicator of care, communication to providers regarding whether the patient's needs and expectations have been met.Patient satisfaction is also an important measure of a supplier's effectiveness in meeting patient needs and expectations and can be a predictor of patient interest in returning.Many experts provide definitions of customer satisfaction.According to Kotler and Keller (2009: 177) emphasize that customer satisfaction is the level of a person's feelings after comparing the perceived performance (or results) compared to their expectations.According to Azrul Azwar (2016), the measurement of quality health services refers to the implementation of good professional standards and codes of ethics, which basically includes an assessment of patient satisfaction regarding: doctor-patient relationship, service comfort (amenities), freedom of choice.(choise), technical knowledge and competence (scientific knowledge and technical skill), service effectiveness (effectiveness).Security measures (safety).
There are similarities between several of these definitions, namely regarding the components of customer satisfaction (expectations and perceived performance/results). Generally, customer expectations are customers' estimates or beliefs about what they will receive if they buy or consume a product (goods or services).Meanwhile, perceived performance is the customer's perception of what they receive after consuming the product provided or the service they have experienced.
According to Kotler (2019) customer satisfaction is a person's feeling of happiness or disappointment that arises after comparing their perception or impression of performance which is below expectations, the customer is dissatisfied.But, if performance exceeds expectations, customers are very satisfied and happy.If the perceived performance is below expectations, the customer will feel disappointed, if the performance meets the customer's expectations, the customer will feel satisfied, whereas if the performance exceeds expectations then the customer will feel very satisfied.This satisfaction will certainly be felt after the customer concerned consumes the product.According It is the family's primary responsibility to initiate and coordinate health services provided by health professionals, such as when to seek health care and whether to pursue or ignore treatment options.The function of family health care covers various aspects of life, including differences in the concepts of health and illness, and often these matters are not discussed within the family until problems arise (Kaakinen et at., 2018).Another thing that causes diversity in care practices is health beliefs related to seeking health care and following health care actions (Friedman et al., 2017).Families who effectively seek health services and apply a prosperous lifestyle in their own way are "strong families" namely families who are able to assertively seek and verify information obtained, make different decisions, and negotiate well with the health care system, not only by passively accepting and obeying (Friedman et al, 2017).

RESEARCH METHOD
The research approach uses a quantitative approach, this study aims to examine the influence of Total Service Quality Strategy (TQS) and Pharmacy Service Quality on Patient Satisfaction and Patient Family Involvement as intervening variables in the Family of Patients Installed in the BLUD Pharmacy Installation at Tamiang Layang Regional General Hospital, East Barito Regency.The population in this study was 118 people, data was taken from questionnaires distributed to respondents.Data were analyzed using SmartPLS Version 3.

DISCUSSION
The Total Service Quality Strategy (TQS) has a positive and significant effect on patient satisfaction at the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency.It can be seen that the results of the analysis prove that the Total Service Quality Strategy (TQS) has a positive and significant effect on patient satisfaction in the BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency.Based on the phenomena that occur, it is known that there are still errors in administering medication to patients.Customer satisfaction is ≥ 80%, but after conducting a preliminary survey, it was discovered that at the BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency, an assessment of patient satisfaction surveys had never been carried out so it was not yet known what the patient satisfaction score was at the pharmacy installation.Prescription writing according to the formulary is 100%, but based on the preliminary survey carried out it turns out that there are still many prescriptions written that do not comply with the established formulary.Meanwhile, currently patient service and patient satisfaction are in the spotlight.The BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, has never carried out a quality assessment based on the Hospital Minimum Service Standards (SPM) in the field of pharmacy according to the Indonesian Minister of Health No. 129 of 2008.
The next problem is Total Service Quality (TQS) where several employees of the BLUD Pharmacy Installation at Tamiang Layang Regional General Hospital, East Barito Regency do not focus on customers, and do not appear to be totally involved with the needs of patients and their families, so some patients and families think that the service employees at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency do not carry out continuous improvements.The management is facing problems with the low intake of prescriptions from inpatients to IFRS which is still below the target to be achieved.Even though the main IFRS pharmacy is open 24 hours including Sundays and national holidays, there are complete medicines of good quality and far from expired, the prices are competitive with prices in local pharmacies and patients are encouraged to buy medicines at IFRS, but the number of patients who buy medicines IFRS is still far below the expected target because patients and patient families think that IFRS does not provide total service.Pharmacy officers should focus on patients, Pharmacy officers have a relationship with patients when providing drug services, Good pharmacy employees will be evaluated through their performance, The government helps health workers get education on how to serve patients well, Pharmacy officers continue to make improvements to the services provided.Total Quality Service (TQS) is caring for users by providing the best service to facilitate easy fulfillment of needs and realize satisfaction, so that users are always loyal to our institution.This research is in line with research by Risma Sari, 2019, which states that TQS influences patient satisfaction.
The quality of pharmaceutical services has a positive and significant effect on patient satisfaction at the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency.It can be seen that the results of the analysis prove that the quality of pharmaceutical services has a positive and significant effect on patient satisfaction at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency.The phenomenon that occurs in the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency is that there is no suggestion box available, causing patient complaints to not be known directly.With the availability of a suggestion box, patients can convey their complaints, so that the hospital management cannot find out directly.It is certain what service the patient complains about that hinders the management in making policies to improve the quality of service at the BLUD Pharmacy Installation at the Tamiang Layang Regional General Hospital, East Barito Regency, and currently if the pharmacy unit is late in handing over the medicine then the patient without thinking will upload the video to social media, and this has happened very often, while pharmaceutical installations always serve patients in accordance with applicable Operational Standards and applicable policies in order to prevent errors or often called medication errors which can harm patients when using the drug, but sometimes this is considered to slow down service for patients, because patients want fast service.The pharmacy officer should have provided an estimate of the waiting time for ready-made medicine services, the pharmacy officer should have provided an estimate of the waiting time for the compounded medicine service, the officer must ensure that there are no incidents of medication administration errors, the officer will provide satisfaction to the patient, the pharmacy officer will provide the medicine according to the prescription written in the formulary .
In accordance with the theory that Pharmaceutical Services is a direct and responsible service to patients related to Pharmaceutical Preparations with the aim of achieving definite results to improve the patient's quality of life.This research is in line with research by Indra Priana, 2018, which states that the quality of pharmaceutical services influences patient satisfaction.The Total Service Quality Strategy (TQS) has a positive and significant effect on the involvement of patient families in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency.
It can be seen that the results of the analysis prove that the Total Service Quality Strategy (TQS) has a positive and significant effect on the involvement of patient families in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency.Based on the phenomena that occur, it is known that there are still errors in administering medication to patients.Customer satisfaction is ≥80%, but after conducting a preliminary survey, it was discovered that at the BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency, an assessment of patient satisfaction surveys had never been carried out so it was not yet known what the patient satisfaction score was at the pharmacy installation.Prescription writing according to the formulary is 100%, but based on the preliminary survey carried out it turns out that there are still many prescriptions written that do not comply with the established formulary.Meanwhile, currently patient service and patient satisfaction are in the spotlight.The BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, has never carried out a quality assessment based on the Hospital Minimum Service Standards (SPM) in the field of pharmacy according to the Indonesian Minister of Health No. 129 of 2008, the next problem is Total Service Quality (TQS) where several employees of the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency do not focus on customers, and do not appear to be totally involved with the needs of patients and their families, so some patients and The family believes that the employee service at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency is not making continuous improvements.The management is facing problems with the low intake of prescriptions from inpatients to IFRS which is still below the target to be achieved.Even though the main IFRS pharmacy is open 24 hours including Sundays and national holidays, complete medicines are available with good quality and far from expired, prices are competitive with prices in local pharmacies and patients are encouraged to buy medicines at IFRS, but the number of patients who buy medicines at IFRS is still far below the expected target because patients and patient families believe that IFRS does not provide total service.Pharmacy officers should focus on patients, Pharmacy officers have a relationship with patients when providing drug services, Good pharmacy employees will be evaluated through their performance, The government helps health workers get education on how to serve patients well, Pharmacy officers continue to make improvements to the services provided.
Total Quality Service (TQS) is caring for users by providing the best service to facilitate easy fulfillment of needs and realize satisfaction, so that users are always loyal to our institution.This research is in line with research by Anjar, 2012, which states that TQS influences patient family involvement.
The quality of pharmaceutical services has a positive and significant influence on the involvement of patient families in the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency.It can be seen that the results of the analysis prove that the Quality of Pharmaceutical Services has a positive and significant influence on the involvement of patient families in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency.The phenomenon that occurs in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency is that there is no suggestion box available, causing patient complaints not to be known directly.With the availability of a suggestion box, patients can convey their complaints, so that the hospital management cannot find out.exactly what services are complained about by patients that hinder the management in making policies to improve the quality of service at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, and currently if the pharmaceutical unit is late in handing over the medicine then the patient without thinking will upload the video to social media, and this has happened very often, while pharmaceutical installations always serve patients in accordance with applicable Operational Standards and applicable policies in order to prevent errors or often called medication errors which can harm patients when using the drug, but sometimes this is considered slow down service to patients, because patients want fast service.The pharmacy officer should have provided an estimate of the waiting time for ready-made medicine services, the pharmacy officer should have provided an estimate of the waiting time for the compounded medicine service, the officer must ensure that there are no incidents of medication administration errors, the officer will provide satisfaction to the patient, the pharmacy officer will provide the medicine according to the prescription written in the formulary .In accordance with the theory that Pharmaceutical Services are a direct and responsible service to patients related to Pharmaceutical Preparations with the aim of achieving definite results to improve the patient's quality of life.So this research is in line with research by Indira Tamara, 2017 which states that the quality of pharmaceutical services influences the involvement of the patient's family.
Patient satisfaction has a positive and significant effect on patient family involvement in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency.
It can be seen that the results of the analysis prove that patient satisfaction has a positive and significant effect on the involvement of the patient's family in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency.The phenomenon that occurs at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency is that several patients feel dissatisfied with the services provided by the staff at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, so this makes the family feel that it is necessary make a complaint about this.However, there is no suggestion box available, causing patient complaints not to be known directly.
With the availability of a suggestion box, patients can convey their complaints, so that the hospital management cannot know for sure what services the patient is complaining about, thus hindering the management in making policies to improve quality of service at the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency.The BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency should be required.The requirements for purchasing medicines are quite easy as long as they comply with the doctor's prescription.The completion time for the medicines is in accordance with the estimate.The costs/tariffs are adjusted to the medicines purchased.The behavior of the implementer reflects a good officer.Handling complaints., suggestions and input are carried out appropriately.
In accordance with the theory, according to Pohan in Aggrianni, 2017, the definition of patient satisfaction is the patient's expectations that arise from the actions of health workers as a result of the performance of health services during the process of interacting in an effort to provide services.The results of this research are in line with research by Ana Yuliana, 2018, which states that patient satisfaction influences family involvement.
Patient satisfaction mediates the influence of the Total Service Quality Strategy (TQS) on patient family involvement in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency.It can be seen that the results of the analysis prove that patient satisfaction mediates the influence of the Total Service Quality Strategy (TQS) on the involvement of patient families in the BLUD pharmacy installation at the Tamiang Layang Regional General Hospital, East Barito Regency.Based on the phenomena that occur, it is known that there are still errors in administering drugs to patients.Customer satisfaction is ≥ 80%, but after conducting a preliminary survey, it was discovered that at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, an assessment of patient satisfaction surveys had never been carried out so it was not yet known what the patient satisfaction score was at the pharmaceutical installation.Prescription writing according to the formulary is 100%, but based on the preliminary survey carried out it turns out that there are still many prescriptions written that do not comply with the established formulary.Meanwhile, currently patient service and patient satisfaction are in the spotlight.The BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, has never carried out a quality assessment based on the Hospital Minimum Service Standards (SPM) in the field of pharmacy according to the Indonesian Minister of Health No. 129 of 2008, the next problem is Total Service Quality (TQS) where several employees of the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency do not focus on customers, and do not appear to be totally involved with the needs of patients and their families, so some patients and The family believes that the employee service at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency is not making continuous improvements.The management is facing problems with the low intake of prescriptions from inpatients to IFRS which is still below the target to be achieved.Even though the main IFRS pharmacy is open 24 hours including Sundays and national holidays, complete medicines are available with good quality and far from out of date, prices are competitive with prices in local pharmacies and patients are encouraged to buy medicines at IFRS, but the number of patients who buy Medicines in IFRS are still far below the expected target because patients and their families believe that IFRS does not provide total service.Pharmacy officers should focus on patients.Pharmacy officers should have a relationship with patients when providing drug services.Good pharmacy employees will be evaluated through their performance.The government helps health workers get education on how to serve patients well.Pharmacy officers continue to make improvements to the services provided.
Total Quality Service (TQS) is caring for users by providing the best service to facilitate easy fulfillment of needs and realize satisfaction, so that users are always loyal to our institution.The results of this research are in line with research by Sila Tariani, 2019, which states that patient satisfaction mediates the influence of TQS on family involvement.
Patient satisfaction mediates the influence of pharmaceutical service quality on patient family involvement in the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency.It can be seen that the results of the analysis prove that patient satisfaction mediates the influence of the quality of pharmaceutical services on the involvement of patient families in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency.
The phenomenon that occurs in the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency is that there is no suggestion box available, causing patient complaints to not be known directly.By having a suggestion box available, patients can convey their complaints, so that the hospital management cannot find out directly.It is certain what service the patient complains about that hinders the management in making policies to improve the quality of service at the BLUD pharmaceutical installation at the Tamiang Layang Regional General Hospital, East Barito Regency, and currently if the pharmacy unit is late in handing over the medicine then the patient without thinking will upload the video to social media, and this has happened very often, while pharmaceutical installations always serve patients in accordance with applicable Operational Standards and applicable policies in order to prevent errors or often called medication errors which can harm patients when using the drug, but sometimes this is considered to slow down service for patients, because patients want fast service.The pharmacy officer should have provided an estimate of the waiting time for ready-made medicine services, the pharmacy officer should have provided an estimate of the waiting time for the compounded medicine service, the officer must ensure that there are no incidents of medication administration errors, the officer will provide satisfaction to the patient, the pharmacy officer will provide the medicine according to the prescription written in the formulary .
In accordance with the theory that Pharmaceutical Services is a direct and responsible service to patients related to Pharmaceutical Preparations with the aim of achieving definite results to improve the patient's quality of life.This research is in line with research by Haritama, 2013 which states that patient satisfaction influences and mediates service quality on family involvement.

CONCLUSION
Based on the results of the research and discussion, several conclusions were obtained as follows: 1.The Total Service Quality Strategy (TQS) has a positive and significant effect on patient satisfaction at the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency 2. The quality of pharmaceutical services has a positive and significant effect on patient satisfaction at the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency 3. The Total Service Quality Strategy (TQS) has a positive and significant effect on the involvement of patient families in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency 4. Quality of Pharmaceutical Services has a positive and significant influence on patient family involvement in the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency 5. Patient satisfaction has a positive and significant effect on patient family involvement in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency 6. Patient satisfaction mediates the influence of the Total Service Quality Strategy (TQS) on patient family involvement in the BLUD pharmacy installation at Tamiang Layang Regional General Hospital, East Barito Regency 7. Patient satisfaction mediates the influence of pharmaceutical service quality on patient family involvement in the BLUD pharmaceutical installation at Tamiang Layang Regional General Hospital, East Barito Regency Indonesian Minister of Health No. 129 of 2008 concerning Minimum Service Standards for Hospitals, the standard Wilkie (2019) defines it as an emotional response to the evaluation of the consumption experience of a product or service.Engel, et ISSN: 2581-8341 Volume 06 Issue 11 November 2023 DOI: 10.47191/ijcsrr/V6-i11-26, Impact Factor: 6.789 IJCSRR @ 2023 7225 * Corresponding Author: Marya Yully Cristine Volume 06 Issue 11 November 2023 Available at: www.ijcsrr.orgPage No. 7220-7232al (2017) state that customer satisfaction is a post-purchase evaluation where the alternative chosen is at least the same as or exceeds customer expectations, while dissatisfaction arises if the results (outcome) do not meet expectations.Satisfaction is a person's feeling of happiness or disappointment that arises after comparing their perception/impression of the performance (or results) of a product and their expectations (Kotler, Philip, 2018).
toHansemark and Albinsson (2014)  overall customer satisfaction indicates an attitude towards a service provider, or an emotional reaction to the difference between what customers expect and what they receive.Meanwhile, according to Bitner and Zeithaml (2013) customer satisfaction is a customer's evaluation of a product or service in terms of whether the product or service has met the customer's needs and expectations.Taking from previous scientists, defining family as a group united by ties of marriage, blood, or adoption, which constitutes one household unit: such as interacting and communicating with each other in their respective social roles (Kaakinen et al., 2010 ).Kaakinen et al.(2018)  said that this definition does not include many different groups who consider themselves to be a family or carry out family functions such as economic, reproductive functions and also the socialization of children.Based on this, it can be stated that the definition of family is a married couple with biological or adopted children, living together of the same sex (gay and lesbian), single parents with children, family ties such as two sisters living together or grandparents who raise grandchildren without their parents (Kaakinen, 2018).According to Ostergard (2014) a family is a group of individuals who are bound by strong emotional bonds, have a sense of belonging, and have a desire to be involved in each other's lives.A family has a structure which is defined by Denham (2015) in Kaakinen (2020) as a set of relationships that are regulated within the family and between families and their social environment.Apart from changes in the life cycle, the structure and patterns of family interaction will experience modifications according to the flow, such as in the event of separation, divorce and death (Ningsih, 2017).The following are the various forms of family according to Kaakinen (2018): Family Form Nuclear Dyad Composition The nuclear family consists of a married couple and no children Nuclear The nuclear family consists of husband, wife and children (can be legal or not legal within the marriage bond ) Binuclear Family consists of two post-divorce families with children as members of both Extended Nuclear Families and relatives who are related by blood.Blended Families consist of husband, wife, and children from previous relationships.Single Parent Consists of one parent and child Commue Consists of a group of men, women and children.Cohabitation (domestic partners) Consisting of unmarried men and women sharing about home life Homosexual Consisting of couples of the same gender Single person (adult) Consisting of one person in the household.It can be concluded that family refers to two or more individuals who depend on each other for physical, emotional, economic and psychosocial support.Family functioning is a result of family structure and as an individual and cooperative process that dynamically involves each other and diverse environments over the life course (Kaakinen et al., 2017).The basic function of the family is to meet the needs of the family members themselves and the needs of the wider community (Friedman, Bowden, and Jones, 2017).The family function in health care is one of five family functions (affective function, socialization, reproduction, economics, and health care) which causes the provision of physical needs; such as food, clothing, shelter, and health care(Friedman et al., 2002).Kaakinen et al., (2018) said that the family is the main system where individuals learn how to maintain health, protect health, and restore health.