the influence of employee ability, hospital's ethic and leadership to

18
The Influence of Employee Ability, Hospital’s ethic and Leadership to Service Quality through the Employee Commitment: A Study on Indonesian Type A Government Hospital Dr. Ria Mardiana Yusuf Management Department Hasanuddin University-Indonesia [email protected] Abstract Purpose – The purpose of this paper is to confirm the direct and indirect influence of Employee Ability, Perceived ethic and Leadership to service quality through employee commitment. To this influence, the author purpose to compare the theoretical mindset against the implementation of theory as a confirmation by using the empirical testing. Design/methodology/approach – A Survey instrument comprising a construct of employee ability, perceived ethic, leadership to commitment of employee and service quality was develop. By using the personal survey, data was collected from the paramedics, nurses and inpatient of health care insurance of type A government Hospital. One hundred and sixty (160) respondent of paramedics and front liners are classified into the segments of nurses (also take another function as front liners), general practitioners and the specialist doctors. Meanwhile, the customers at the sum of 160 respondents are classified according to the classes of hospitalization services. thus altogether the sample are at the total of 320 respondents. This study also using the self perception, leadership evaluation and customer evaluation questionnaires. The influences among variables also analyzed by using structural Equation Modeling method. Findings – The results of the analysis shows that: (1) The survey instrument was shown to be reliable and valid, (2) The implementation of hospital ethic is more emphasized on the nurses (as a front liners), (3) The study proves that there is a direct and indirect influence among variables of employee ability, hospital’s ethic, leadership to the service quality through the employee commitment. (4) The direct influence of employee commitment variables against the inpatient health care satisfaction was negative significant. Research Limitation – Analyses are developed within the context of a government single hospital of type A. According to the time sequence of study, this field of study research considered for purpose only (one time study), and was not conducted for experimental study. Practical implication – The result of this study highlights how actually the theoretical of employee ability, hospital’s ethic, leadership, employee commitment and due to the service quality. Therefore hospital’s management could improve their employee ability, application of their hospital’s ethic effectively, leadership style and their service quality through their employee commitment. Originality – This paper’s main contribution is to propose and empirically test of set of construct complement of the influence of employee ability, perceived of hospital’s ethic, leadership upon the service quality through the employee commitment direct and indirectly in the type A Hospital. Keywords: employee ability, hospital’s ethic, leadership, employee commitment, and service quality Paper type: Research paper

Upload: vuongdang

Post on 16-Jan-2017

214 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: The Influence of Employee Ability, Hospital's ethic and Leadership to

The Influence of Employee Ability, Hospital’s ethic and Leadership to Service Quality through the Employee Commitment: A Study on

Indonesian Type A Government Hospital

Dr. Ria Mardiana Yusuf Management Department

Hasanuddin University-Indonesia [email protected]

Abstract

Purpose – The purpose of this paper is to confirm the direct and indirect influence of Employee Ability, Perceived ethic and Leadership to service quality through employee commitment. To this influence, the author purpose to compare the theoretical mindset against the implementation of theory as a confirmation by using the empirical testing. Design/methodology/approach – A Survey instrument comprising a construct of employee ability, perceived ethic, leadership to commitment of employee and service quality was develop. By using the personal survey, data was collected from the paramedics, nurses and inpatient of health care insurance of type A government Hospital. One hundred and sixty (160) respondent of paramedics and front liners are classified into the segments of nurses (also take another function as front liners), general practitioners and the specialist doctors. Meanwhile, the customers at the sum of 160 respondents are classified according to the classes of hospitalization services. thus altogether the sample are at the total of 320 respondents. This study also using the self perception, leadership evaluation and customer evaluation questionnaires. The influences among variables also analyzed by using structural Equation Modeling method. Findings – The results of the analysis shows that: (1) The survey instrument was shown to be reliable and valid, (2) The implementation of hospital ethic is more emphasized on the nurses (as a front liners), (3) The study proves that there is a direct and indirect influence among variables of employee ability, hospital’s ethic, leadership to the service quality through the employee commitment. (4) The direct influence of employee commitment variables against the inpatient health care satisfaction was negative significant. Research Limitation – Analyses are developed within the context of a government single hospital of type A. According to the time sequence of study, this field of study research considered for purpose only (one time study), and was not conducted for experimental study. Practical implication – The result of this study highlights how actually the theoretical of employee ability, hospital’s ethic, leadership, employee commitment and due to the service quality. Therefore hospital’s management could improve their employee ability, application of their hospital’s ethic effectively, leadership style and their service quality through their employee commitment. Originality – This paper’s main contribution is to propose and empirically test of set of construct complement of the influence of employee ability, perceived of hospital’s ethic, leadership upon the service quality through the employee commitment direct and indirectly in the type A Hospital.

Keywords: employee ability, hospital’s ethic, leadership, employee commitment, and service quality Paper type: Research paper

Page 2: The Influence of Employee Ability, Hospital's ethic and Leadership to

I. Introduction Every person does not want sickness befall him. However, to maintain one's health condition is not an easy thing. In addition to illness is uncertain events (unpredictable), irregular (irregular), and may rarely occur. The incident also brought pain to someone who does little financial consequences and economic burden a person. Incidence of illness resulting economic burden for the patient or his family was often seen as a "disaster" (catastrophic illness). The situation is unpleasant, to most people due to payment of medical services directly from the bag (out-of-pocket). Health insurance is a way to cope with risks and uncertainties incident pain. Besides the uncertainty of the implications of the costs that accompany such events will be able to overcome pain, by paying a sum of money that relatively small amounts but regularly (called premiums) to the insurance institute. Problems arise when the delivery of health care programs and national attention paid to rapidly escalating medical errors and patient safety, healthcare organizations have recently expanded different employee initiatives that promise to enhance healthcare quality management programs (Gowen et al., 2006). For the case of Indonesia, Mohammad (2001) stated that the implementation of comprehensive health insurance is still hampered by several things, namely the basic policy of the health system and health care systems are not yet clear, the attitude of the politicians who consider health care as a responsibility of health departments, and the low level of public confidence toward health insurance. Presumably, comprehensive travel medical insurance for the people of Indonesia (in the eyes of Mohammed) is still long and requires a political commitment of governments at the central and regional levels. The insurance company consultant Health-Grades examined comprehensive data from 2000 to 2002 and concluded that about 195,000 deaths in U.S. hospitals can be attributed to medical errors. Furthermore, errors inflate medical costs due to longer and more costly hospital stays (Nordgren et al., 2004). Data released by the Juran Institute says that two thirds of the cost of health insurance coverage expenditure is dominated by the low quality of service (Mehring and Koretz, 2004). One of the largest service provider and a state-owned enterprises the government of Indonesia, PT. Askes involves involving health providers of health insurance companies, namely the hospital. As an equal partner health insurance companies, hospitals into healthcare providers the most important. While insurance companies act as intermediaries participant health insurance and hospitals that provide health services (Murti (2000). The involvement of the hospital as the provider is no doubt the urgency. So much for the important role these hospitals so that the various discussions about customer satisfaction, explicitly measured from satisfaction of hospital services. Especially in terms of customer satisfaction aspects of the service facilities provided by hospitals, and human factor (Oswald et al, 1998) Basically, the measurement of customer satisfaction on health insurance (healthcare insurance) is more focused on customer satisfaction on hospital services. However, measurement of satisfaction is hard to do (Oswald et al., 1998; Ford et al., 1997, Sheth and Mr Mital, 1997; Dube et al., 1996). This is because the customer difficulties in evaluating the clinical aspects of the service. Therefore, Oswald et al. (1998) focuses on customer satisfaction measurement Attitudes aspects of the caregivers and the facility Itself. As for the Ford et al. (1996) found that in measuring competitive advantage and survival of a company's health insurance (healthcare organization) is to measure the patient's perception of the quality of hospital services. Sheth and Mr Mital (1997) also states that the dimensions of service quality in the insurance services industry consists of two, namely the quality of treatment (quality of cure) and the quality of care (quality of care) that kesemuannya it is an assessment of the quality of hospital services. Between these two dimensions, the quality of

Page 3: The Influence of Employee Ability, Hospital's ethic and Leadership to

care (quality of care) became the focus of customer ratings of hospitals (Oswald et al., 1998, Rutledge, and Nascimento, 1996). Services are intangible products produced by the various parties within an organization, including hospitals. The theory of interactive service quality manyebutkan that the optimization of service is determined by the first on the optimization of internal services to internal stakeholders, and will result in optimum services to external stakeholders (Boshof and Mels, 1995). This signifies that the indication of the achievement of optimal external services if the climate has been created to serve one another among fellow employees. Climate of mutual service is largely determined by the rules of ethics and values prevailing among the employees, the employee's ability to serve, as well as the leadership style of employees (Mayfield and Mayfield, 2002). In addition to several variables, the quality of hospital services is also determined by the commitment given by the employee. Organizational commitment be the attitudinal component to increase organizational effectiveness (Herbiniak and Alutto, 1972; Buchanan, 1974; Porter et al., 1974; Porter, Crampon and Smith, 1976; Steers,1977a; Stevens, Beyer and Trice, 1978), and one of indicator of effectiveness of the organization is the excellences of service quality. At the same time, much less research has looked into the concept of overall firm customer orientation and analyzed what customer orientation means in terms of processes, policies, and employees. Because of the intangible nature of services and their high level of customer interaction and integration, customer orientation can be expected to play a crucial role in terms of economic success for service companies. In addition to researchers who have analyzed the role of service employees as a dimension of service quality (e.g. Parasuraman et al., 1988; Dabholkar et al., 2000), studies that explicitly address the concept of customer orientation of service employees are Kelley (1992), Brown et al. (2002), Donavan et al. (2004), and Hennig-Thurau and Thurau (2003). In the context of service quality research, it has been demonstrated that the behavior of service employees affects the customers’ perception of the service (Bitner et al., 1990). Specifically, researchers have identified employee-related aspects of the service as dimensions of the customer’s service quality assessment. For example, three out of five service quality dimensions of Parasuraman et al.’s (1988) Servqual measure directly or indirectly address the behavior of employees (i.e. responsiveness, assurance, and empathy). Similarly, Dabholkar et al. (2000) identify personal attention and comfort as provided by a provider’s employees as components of service quality. However, as the service quality construct represents a customer-sided view, it is a natural consequence that none of these authors uses a company perspective when modeling the different facets of employee behavior that impact service quality. Therefore, a service provider gains only limited information on the managerial action that is needed to select and train their service employees. In addition to the theory of interactive marketing, this research paper therefore also adopts the theory of COSE (Customer Service Employee Orientation) that stems from the theory of personal interactions (Argyle, 1967). In this regard, hence the topic concerning the influence of working ability, hospital ethics, leadership behavior on employee commitment and quality of inpatient services General Hospital Type A in South Sulawesi, becomes a topic of research analysis in this research paper. II. Literature Review Employee commitment Literally, the commitment has meaning, that is a promise. Promise between two parties that involves individual, or group of individuals as subjects who perform the activity, to other subjects. Promise or commitment to one's commitment can be directed to various things, such as a promise between individuals with the work that is referred to as professional

Page 4: The Influence of Employee Ability, Hospital's ethic and Leadership to

commitment, a promise made by a group of individuals with an organization called the commitment of the organization or company, or also known as management commitment. Commitment is a personal bond to some course of action. Personal or self-commitment involves a promise to do the best one can in every situation and to be the best that he/she can be (Demir et al, 2009). Smith (1996), defined organizational commitment as the measure of strength of the employee’s identification with, and involvement in, the goals and values of the organization.” Organizational Commitment may also enhance individual's perceptions of P-O fit. Because Organizational Commitment is related to the degree to which employees take ownership of company values and prefer to help the firm (Mowday et. al., 1979), which would likely increase the perceived congruence between individual and company characteristics. Organizational commitment can also be defined as an earnest and persistent effort conducted by the company to provide services through standards set by the company or agency that has authority in that field. This definition is taken based on the depiction of Kotler (2000:440) on a few large companies, such as Marriott, Walt Disney, and fast food companies Mc.Donalds in which he states that: “Company such as Marriot, Disney, and McDonald’s have thorough commitments to service quality. Ray Kroc of McDonald’s insisted on continually measuring each McDonald’s outlet on its conformance to QSCV: quality, service, cleanline, and value.”. These companies are very concerned and has a strong commitment and clear. In the sense that through the commitment of large companies as above can improve the quality of service to customers. Even McDonalds make an assessment on a regular basis and constantly to quality, service, cleanliness, neatness, attitude and behavior of employees in providing services. Assessment is, of course with the involvement of the various divisions and ask directly to the consumer what needs to be addressed in order to improve customer satisfaction. Basically the description of the concept of commitment itself, and how that commitment to grow and evolve, it is very difficult to be described (Mullins, 1995). Mullins stated that the concept of commitment as a company that grew from the concept of employee commitment. This commitment to grow together with the loyalty felt by employees of the company, as a result of the strong involvement of employees within the company. Therefore, in reviewing the concept of commitment, can be used a variety of viewpoints. Argyris (1998) looked at the commitment based on its formation sources. He divides commitment into two parts, namely the commitment of external and internal commitment. External commitments established by the work environment, because of the demands to complete the tasks and responsibilities by employees. Given these demands, it also arises what is called the reward and punishment. Reward and punishment is what encourages its employees to commit. While the internal commitment is a commitment that is formed from within a person to complete various tasks, responsibilities and authority based on the reasons and motivations they have. According to Allen and Meyer (1990), organizational commitment has three components, namely affective commitment, continuance commitment, and normative commitment. Affective commitment implies employees' emotional attachment to the organization. Continuance commitment refers to employees' feelings of obligation to remain with the organization. Normative commitment is based on the costs that employees would have to incur if they decided to leave the organization. Work Ability, Employee Commitment and Customer Satisfaction Robbins (1996) suggest that the ability is the capacity of a person in work, which was formed among others by education, training, work experience and work ethic. This capability is

Page 5: The Influence of Employee Ability, Hospital's ethic and Leadership to

suspected as the process of enriching a person's ability to work. The term of commitment has been used to describe such diverse phenomena as the willingness of social actors to give their energy and loyalty to social systems (Kanter, 1968), an awareness of the impossibility of choosing a different social identity or of rejecting a particular expectation, under force of penalty (Stebbins, 1970), the organizational identification or organizational involvement (Patchen, 1970; Hall and Schneider, 1972). Work Ability, Employee Commitment and Customer Satisfaction Martin and Nicholls (Mullins, 1995) states that there are three main pillars of building a model of employee commitment to the company or management, namely:

1. A sense of belonging to the organization, namely pillar model of management commitment that builds on the expansion of information to employees, employee involvement in company activities, and dividing the company's success to employees.

2. A sense of excitement in the job, the pillars of management commitment that builds on employee interest in work that is being lived today. This feeling is manifested in the form of a sense of pride (pride) employees at the company, and beliefs of employees in the company.

3. Confidence in management, namely the confidence of employees to the organization as a whole, including the company's leadership, dedication to the company's leadership, and leadership skills within the company.

Naumann (1993) and Kaldenberg et al. (1995) found that differences in ability (experience and expertise) in close association with the employee's commitment to the company, management or organization. While Mowday, Porter, and Steers (1982) in Johnston et al. (1990), found that there are three factors that the antecedent is committed by someone within the company. One of them is the factor of personal ability, which among others formed by the level of education, and age of a person. This indicates that there is a causal effect between the ability to work with the commitment of employees within the company. Generally, various studies show the effect between the ability to work with labor productivity (Simanjuntak, 1985). But there are several studies that linked the effect of work ability with climate or culture provide the best possible service to customers (Riyanto, 2002). The findings, indicate that work ability is a predictor for quality of service that can satisfy the customer. Another expert who confirms the influence of satisfaction is the ability to work with Robbins (1996), he states that every person has the ability of different cognition, making the advantages and disadvantages for them in optimizing their performance, which will affect how they can satisfy the customer them (Shmith, et al, 1992). Simanjuntak (1985) stated that the quality and working ability of employees to provide knowledge directly to employees to develop themselves, and utilize all existing facilities around the employees are to smooth the task of the employee concerned. So that the utilization and support the organization will strongly support the ability of employees to perform that can satisfy the customer (Herrington and Weaver, 2008; Eisenberger, et al., 1979, Gottfredson, 1986). Commitment as variable can also be treated as a mediating variable between the various exogenous variables to endogenous variables namely Morrow's model, in which it states that job involvement is the endogenous variable and the two forms of organizational commitment are the variables which mediate the relationships between the PWE and career commitment, the exogenous variables, and job involvement, the endogenous variable (Cohen, 1999). Currivan (1999) found that employee commitment to the organization becomes a variable that mediates the effect between job satisfaction and employee turnover. So that it can be stated that the work ability of employees can affect customer satisfaction. Based on the hypothesis that the exposure is then constructed in this study as follows:

Page 6: The Influence of Employee Ability, Hospital's ethic and Leadership to

Hypothesis 1: The thought that there was a significant direct effect between work ability of employees to customer satisfaction. Hypothesis 2. Suspected that there are significant indirect effects between work ability of employees to customer satisfaction through employee commitment. Hospital's Ethics, Employee Commitment and Customer Satisfaction Studies have attributed the influence of institutional ethics and employee commitment have been carried out. Among them is Murphy (1995), which states that today's CEOs of the world's leading companies have announced their commitment through satement of value of each company. As is the statement of value is none other than the statement of ethics. Weaver (1999) also found that the higher the commitment of top management leadership in ethics is to give effect to the implementation of the ethics program to be run by the company. The same thing was expressed also by Robbins and Coulter (1996) that the "code of ethics require a commitment from top management". Similarly, corporate ethics, the ethics of the hospital also implemented as a corporate ethics. Hospitals Ethics should ideally be used as a constraint of the practice of hospital services (Bowie, 1998). Even the contents of corporate ethics that very clearly requires a commitment to implement the optimization of service at the hospital stakeholders. Therefore without the commitment of the application of ethics to guide human behavior in the hospital and serving patients with the best will not be realized (Hadiwardoyo, 1989). Thus the assertion that the hospital ethics require support leadership commitment which would encourage the strengthening of the commitment of subordinates. Effect of hospital ethics with customer satisfaction is explicitly stated in the Code of Indonesia Hospital also known as “Kodersi”. In particular “Kodersi” Chapter 3 on the obligations and responsibilities of hospitals to patients. It is explained in this chapter that hospitals must provide good service, quality and continuous. This means that hospitals are required to provide quality services, which can give satisfaction to their patients. The basic principle is the hospital ethics of humanity and justice in the hospital treating the stakeholders. This means that it is obligatory for paramedics and hospital staff to treat hospital patients with best interest (Hadiwaradoyo, 1989). Robbins and Coulter (cq. Murphy, 1995) conducted a survey of some of the world's major companies, including Exxon, Sara Lee, Du Pont, Bank of Boston, and Wisconsin Electric Power in US. Large companies are entering the three main points in their code of conduct, as follows (1) Be a dependable organization citizen, (2) Do not do anything unlawful or improper that will harm the organization; and (3) Be good to customer. To strengthen his study then Murphy (1998) states that of 100 studies on corporate codes of conduct, he found that one-third of the code of ethics contains about maintaining relational ties with competitors, suppliers, and customers. While 20 percent of the code of ethics contains about quality products and quality service. Assertions from experts proves that there is a relationship between ethics (whether it's hospitals, and companies) with customer satisfaction. Exposure based on the research hypotheses to be tested in this paper as follows: Hypothesis 3. Alleged that the hospital ethics have a significant direct impact on customer satisfaction. Hypothesis 4. Alleged that the hospital ethics significant indirect effect on customer satisfaction through employee commitment.

Page 7: The Influence of Employee Ability, Hospital's ethic and Leadership to

Behavior Leadership, Employee Commitment and Customer Satisfaction The effect of leadership behavior with the commitment of employees is clearly suggested by Yukl (1998) in models of power and influence. In the model illustrated that situational factors into the supporting leadership behaviors that will lead to positive and negative impact on their subordinates. The positive impact that arises is the formation of commitment and obedience from subordinates. While the negative impacts are happening resistance to behaviors that have demonstrated leadership. Smith (1996) also found that there are positive and significant influence among the leadership behavior with employee commitment. Smith's findings in principle from by Buchanan (1974) who found that managers in business or government environment that constantly contribute to the institution and always try to fulfill his promise to encourage greater commitment from their subordinates. Cook and Wall (1980) also found that when the trust of employees of the company's leadership has been built up through fair treatment, the commitment of employees will gradually wake up anyway. Heiseberger and Huntington (1986) include leadership behavior as one of the support organization that can affect employee commitment and loyalty. Yukl (1998) stated that the end result is going to happen from the behavior of a leader is the success or failure of an organization (company). Viewed from the side of the company's success in increasing the quality of corporate intangibles (including service quality) and productivity which will increase sales and profits. Judging from the customer side, then one measure of corporate success is customer satisfaction. Therefore according to Yukl (1998) leadership behavior indirectly affects customer satisfaction which is a review of success or failure of a company from the customer side. This opinion is also reinforced by Smith (1996) who found that leadership behavior has a positive effect on productivity. This means that the leadership behaviors that are considered good by the subordinates will spur the productivity of employees in providing services that can satisfy the customer. Thus it can be said that there is a relationship between leadership behavior with customer satisfaction. Then the following hypothesis: Hypothesis 5. Allegedly there is a direct significant influence between variable of satisfaction pealnggan leadership behavior. Hypothesis 6. Allegedly there are significant indirect effects between variables perialku leadership to customer satisfaction through employee commitment. Employee and Customer Satisfaction Commitment Research related to employee commitment and its influence on customer satisfaction, has been mostly done by experts, including Butler and Dynan in 1988 (in Natalisa, 1999). The results of their study of the First Pennsylvania Bank found that in order to improve the quality of service the customer, the bank restructured the corporate culture and employee commitment. Dubbinsky and Hartley (1986) in Johnston et al. (1990) found that commitment employees will greatly affect the behavior of employees, including the behavior of a service that can give satisfaction to the company's stakeholders. Another finding states that employees who have a high commitment to have the intention to leave the company (Mathieu and Zajac, 1990), will overcome their stress (Begley and Czajka, 1993), and will perform satisfactorily (Mathieu and Zajac, 1990). Natalisa (1999) found that the commitment of the leadership of airline management has a positive effect on customer satisfaction.

Page 8: The Influence of Employee Ability, Hospital's ethic and Leadership to

Currivan (1999) found that there is a reciprocal relationship between employee commitment to the satisfaction achieved by both internal and external corporate stakeholders (Lincoln and Kalleberg, 1990). Thus these studies reinforce the impact of employee commitment to quality services that satisfy the company's stakeholders. However, this limits the review of this research papers on deterministic influence between employee commitment to satisfaction. Thus the following hypotheses are: Hypothesis 7. Suspected that there was a significant direct effect between employee commitment to customer satisfaction. To conclude this section, herewith the construct of causal influence between variables depicted in the conceptual framework of this research paper is given below:

III. Methodology The sample was drawn from nurses (the hospital’s frontliners), doctor’s also inpatient healthcare insurance, with the cross sectional and explanatory research design. By using 320 respondent of those internal (160 respondent) and external (160 respondent) hospital’s stakeholder, this research also using 24 indicators that split into questionnaire. The survey questionnaires asked nurses, doctor’s and inpatient healthcare about ability, implementations of perceived ethics, leadership style, also commitment and satisfaction due to their services. The structural Equation modeling also used by this research to make test of the hypothesis. To test the validity and reliability of data used goodness of fit (GOF) test to the suitability index of each construct or variable models are built. GOF test applied to construct a variable working ability, hospital ethics, leadership behavior, commitment to employee and customer

EMPLOYEE COMMITMENT

CUSTOMER SATISFACTION

WORK ABILITY

HOSPITAL ETHICS

LEADERSHIP BEHAVIOR

Figure 1. Conceptual Framework among Work Ability, Hospital Ethics, and Leadership Behavior through Employee Commitment on Customer Satisfaction.

���

���

���

���

���

���

���

��

Page 9: The Influence of Employee Ability, Hospital's ethic and Leadership to

satisfaction. The results showed (as discussed below) states that all meet the criteria of goodness of fit index. Analysis (Model Test Results) When appropriate measurement model has been established, the next step is to teste the full structural model. Structural equation modeling is a tool for testing the causal relationship among the latent variables, explaining the causal effects and assigning the explained and unexplained variance (Joreskog and Sorbom, 2004). The relationships hypothesized were tested using AMOS to complete the standardized parameter estimates and t-values. The structural equation modeling confirms this conceptual model perfectly because of causal relationships among these variables. The result is summarized in Table 1. Table 1. Parameter Estimation Regession Weights Overall Work Ability, Hospital Ethics, Leadership Behavior, Employee Commitment and Customer Satisfaction.

Hypothesis Loading Factor (�)

Critical Ratio

(t hitung)

Probability (p) Description

H1 0.354 0.000 Significant H2 0.102 2.828 0.000 Significant H3 0.094 2.258 0.000 Significant H4 0.518 2.888 0.000 Significant H5 0.707 3.922 0.000 Significant H6 0.072 2.004 0.000 Significant H7 -0.538 2.664 0.000 Significant

Table 2. Goodness of Fit Index Work Capability Construct Model Effects, Hospital Ethics, Leadership Behavior, Employee Commitment and Customer Satisfaction. �

Criterion Cut-off Value Model Result Model Evaluation Chi-Square X2 Lower value expected 141.295 Good Probability � 0.05 0.238 Good CMIN/DF � 2.00 1.580 Good GFI � 0.90 0.927 Good TLI � 0.95 0.980 Good CFI � 0.95 0.984 Good RMSEA � 0.08 0.060 Good

IV. Result This study analyzed the effects of direct and indirect variables work ability, ethics hospitals and hospital leadership behavior on customer satisfaction through employee commitment. The results obtained are contained significant influence directly and indirectly between work ability, ethics hospitals and hospital leadership behavior on customer satisfaction through employee commitment. From the aspect of workability, Luthans (1998) states that the capability is realized by the employees they have and arising from within the employee, would psychologically affect the employee thinking power. Furthermore, the power of thought will encourage cognitive state employees and employees can make a good run the learning process to improve their

Page 10: The Influence of Employee Ability, Hospital's ethic and Leadership to

performance (Hunter et al., 1984; Bell & Kozlowsky, 2000). The learning process was necessary given the complexity and uniqueness of the character of the design work owned hospitals. This is evidenced by the path coefficients to work kemampan customer satisfaction and employee commitment for 0.35 and 0.10 with the positive direction, which is indicated also by the value of CR> of 2.0, which is equal to 2.828 which is greater than t table (1.96). These findings support the findings of Mowday, Steers and Porter, and Johnston (Johnston, 1990), they found that there are three factors that a person in committing antecedent. The third factor is the influence in a person, non-organizational factors, and influence the organization. Of these factors, associated with the ability to work is the influence of factors in a person. Which, if examined properly, this factor has a broad meaning. Influence in a person is, among other means of work ability, motivation, willingness, and personality. In spite of it all opinion Mowday et al. This has been confirmed to influence the ability to work on employee commitment in the work. Argyris (1998) stated that one of the source of commitment is the inner person, which is categorized as an internal commitment. This means that the better assessment of paramedics and frontliners of their ability in dealing with hospital patients, or the more they feel able to complete the tasks performed every day (especially their main task in the hospital), then the commitment of the paramedics and the frontliners hospitals will be greater. Test the hypothesis that the influence of the hospital ethics of employee commitment and breadth of our customers find that there is a significant direct effect between the hospital ethics with a commitment of employees. This is evidenced by the acquisition value of the path coefficient is positive, which is equal to 0.52, and t test values (CR) is> than 2.0, that is equal to 2.888, and 0.094 with CR 2.258. This indicates that the commitment of paramedics and hospital based assessment frontliners paramedics, nurses and hospital patients are affected ethics. These findings are consistent with previous studies concerning the relationship between ethics and commitment stating that it contains ethical values (values) greatly influence the attitudes and behaviors of a person, or even the organization as a whole (Murphy, 1995; Weaver, 1999; Sims , 1994; Robbins, 1996). Yousef (2000) states that some studies have found that there is a relationship between work ethic inspired by the values of religious affiliation (Protestant Ethic's, Islamic Ethic s) with employee commitment to the organization. This is confirmed also by Megliro (cq. Yousef, 2000) by stating that employees will be more satisfied and more committed at the time of their value in line with the value of the supervisor. Nystrom (1993) found that the norms and values espoused by an organization of health insurance affects the organizational commitment. It appears that Nystrom did not distinguish between the notion of norms or values with corporate ethics, which in principle is the same. Ethics according to Luthans (1998) derived from the norms or values (can be derived from religion) that apply to an organization. The hypothesis suggesting that the behavior of top management leadership of the Government General Hospital Type A in South Sulawesi has a significant influence on commitment and customer satisfaction. Test results of this hypothesis suggests that the top leadership behavior directly affects the hospital significantly to the commitment and customer satisfaction with the path coefficients for 0.072 and 0.71. This result is evidenced by the acquisition of the CR > 2.0, and a large loading factor, ie 2.004 and 3.922 are greater than 2.0. The results of this study are consistent with the findings stating that there is a relationship between leadership and commitment and performance of their subordinates (Bass, 1990; Yukl, 1985 in Smith, 1995) as well as the success of an organization. This behavior becomes a reflection of the behavior of its employees. Therefore leadership behaviors that can be a positive example for employees, will be able to direct employees to optimize their performance. With optimal performance will cause the company's performance

Page 11: The Influence of Employee Ability, Hospital's ethic and Leadership to

will increase as well, so that the expected increase in sales turnover (Blau, 1985). The increase in sales turnover indicates that customers are satisfied with the product or service a company. As customer satisfaction is one indicator that shows that a company or institution has achieved success (Yukl, 1998:194). The results of an analysis of employee commitment to the department of Type A in South Sulawesi and its influence on customer satisfaction. Demonstrate the significance of direct influence, but the results are inversely proportional. Namely the path coefficients of -0.54, and the value of CR = 2.664. This means that the higher the commitment of paramedics and hospital frontliners based on their assessment and inpatient hospital, it is precisely the lower level of satisfaction. Allegations that the commitment of employees (paramedics and frontliners) in the General Hospital Type A in South Sulawesi has a significant effect on customer satisfaction has been proven through testing hypotheses. Based on hypothesis testing, the test results indicate the receipt of allegations stating that there is a significant direct effect between employee commitment to customer satisfaction, although the influence coefficient has a negative value, which is equal to -0.54. The significance of these effects is marked by the acquisition of CR values > 2.0 in all segments of the respondents, as well as t test values (CR) which is greater than t table (1.645), which amounted to 2.953. These results indicate that there were conflicting influences between employee commitment to customer satisfaction. There are three points of view or groups of variables that can be analyzed (based on expert opinion) in explaining the relationship between employee commitment to satisfaction, among others (1) those variables that describe characteristics that must be generated jobs of employees, (2) groups of variables that describe the characteristics of firms , and (3) groups of variables that describe the characteristics of the employees in the work (Glisson and Durick, 1988). The three groups of variables will explain the relationship between employee commitment to satisfaction with the result that different also. For example the findings of Bateman and Strasser (1984), which states that the commitment of employees to be the precursor of satisfaction (Glisson and Durick, 1988). Instead Curry et al., 1986 (cq. Glisson and Durick, 1988) found no relationship between these two variables. It seems that the findings or results of the analysis on the relationship between employee commitment to customer satisfaction supports the findings of Curry et al. (Glisson and Durick, 1988). While the explanation for the findings in this paper, will be directed based on the point of view Glisson and Durick (1988), as follows:

1. Based on the point of view of groups of variables that describe the characteristics of work to employees and employee characteristics, found that among the four indicators of building employee commitment, it turns out there are two indicators that have less value to the category (below the median on average), which is believed indicator and indicator values. This phenomenon indicates that the paramedics and frontliners was not always approve hospital policies, hospitals do not seem to merely be a paramedic and frontliners inspiration in the works. In addition paramedics and appears to consider the suitability frontliners personal values with the values of the hospital became a matter that is not too important in their work. This situation is in line with the findings of Harris and Hodgkinson (1990, 1997, cq. Callan, 1992), which states that a regular employee (not on the structural line), or who are at lower levels of management of an enterprise, less the value of reviewing aspects of their work , compared with employees who are at the structural levels of a company.

2. Another cause is the lack of time spent (particularly doctors) to treat patients in the department of Type A in South Sulawesi. As is well known that the paramedics and frontliners (especially physicians) are faced with various interests, including interests of patients (of which not a few) that should they handle every day, the interests of the

Page 12: The Influence of Employee Ability, Hospital's ethic and Leadership to

institution which is a place where paramedics and frontliners the shelter, as well as their own personal interests one. Various interests must be accommodated well by paramedics and hospital frontliners. When various interests can not be accommodated properly, it will cause conflict. Mohammad tried to annunciate a major cause of conflict (TV 7, 2004), which is a result of the weakness of the system prevailing in Indonesia, which led to paramedics (especially doctors) that exist in Indonesia not only be in one hospital, so the time spent serve the patients are very limited in number.

3. Based on the variable characteristics of the company's point of view, the findings in this dissertation also produces something different from previous findings. One of the main characteristics inherent in the character of the hospital can not refuse patients. Unlike the other service companies (eg airlines and banking), if it is felt that the demand for services has exceeded the capacity of available services, the company may refuse to provide service to their customers. Not so in the case of hospital type A (with complete facilities owned) who can not refuse patients. Therefore, frequent overloading of work in hospitals due to the booming number of patients, which will cause the workload to be incompatible with the available capacity. In such conditions the existing mechanism can not function properly. It is therefore not surprising that the paramedics and hospital frontliners on the one hand states have a high commitment to the hospital, on the other hand they feel burdened by their work.

Here is a path diagram of the research model of work ability, hospital ethics, leadership behavior on customer satisfaction through the commitment of hospital staff.

Limitation of the Research a) Assuming that customer expectations have health insurance compare expectations

with reality of the services received, making this study a one-time nature of study,

EMPLOYEE COMMITMENT

CUSTOMER SATISFACTION

WORK ABILITY

HOSPITAL ETHICS

LEADERSHIP BEHAVIOR

Figure 2. Path Diagram of the Influence among Work Ability, Hospital Ethics, and Leadership Behavior through Employee Commitment on Customer Satisfaction.

�����

�����

�����

���

�����

��� ��

�����

������

Page 13: The Influence of Employee Ability, Hospital's ethic and Leadership to

with cross-sectional design. The assessment of customer satisfaction is based on the paradigm of service performance received by the customer. This causes the characteristic or information regarding the respondents expectations for customer service health insurance before and after using the hospital inpatient facilities, have not been identified properly. Therefore for future research would be nice if examined by using a research design is longitudinal.

b) Based on research that is longitudinal, measuring customer satisfaction and dissatisfaction with health insurance for hospital services will use the paradigm of expectancy-disconfirmatiom, the assessment based on comparison of expectations and the reality that customers receive health insurance on inpatient hospital services.

c) Measurement of work ability in this study is based on the measurement of employee perceptions and customer perceptions, where the objectivity of the measurement is somewhat dubious (because there are too many factors that can affect their judgments). Therefore for future research would be nice if work ability assessments made by the leaders direct the authorities to assess the performance of its employees.

d) This study is a case study of one hospital that would make the aspects of the findings is questionable generalization. So for further research should use multiple ruamh type A government-owned hospital that may represent aspects of the generalization of the findings.

V. Conclusion 1. In general, the study found that there was a significant effect between the direct and

indirect variables work ability of employees, ethics ruamh illness, hospital leadership behavior toward hospital employee commitment and customer satisfaction hospitals, based on assessments and perceptions of internal stakeholders type A government hospital in Indonesian. In case this is a paramedic (doctors), frontliners (nurses) and external stakeholders hospital, the inpatient hospital.

2. A significant indirect effects have been found between the ability of employees, hospital ethics, and leadership behaviors hospital to hospital customer satisfaction based on assessment of internal stakeholders in this hospital paramedic (doctors) and frontliners (nurses) as well as external stakeholders hospital (hospital’s inpatient).

3. Finally, we found the significance of the direct influence of employee commitment and customer satisfaction is a negative value with the path coefficient of -0.538. These findings indicate that employee commitment has a significan negative influence proportional to customer satisfaction. The results of this study is not uncommon, as some previous studies stated a positive relationship between employee commitment to customer satisfaction.

To end this research paper, the author would like to conclude that the findings in point 3 is different compared to previous findings and may be caused, among others, (a) Character of hospital management show that physicians faced with a variety of interests, among others the benefit of patients (of which not a few) that they must deal with every day, the interests of the institution which is a place where paramedics and frontliners the shelter, as well as their personal interests respectively; (b) One of the main characteristics inherent in the character of the hospital can not refuse a patient, so that if demand for services has exceeded the capacity of service available, will cause the workload to be incompatible with the available capacity, (c) Frontliners paramedics and hospitals staff at general on the one hand states that they have a high commitment to the hospital,whilst on the other hand they feel burdened by their work. This situation will impact on the service being less than optimal and would impact on customer satisfaction. �

Page 14: The Influence of Employee Ability, Hospital's ethic and Leadership to

References Alpander, Guvenc G. (1990), “Relationship Between Commitment to Hospital Goals and Job Satisfaction: A Case Study of A Nursing Department, Health Care Management Review, Aspen Publisher, p. 51-62. Allen, N.,J., & Meyer, J.,P, (1990). “The measurement and antecedents of affective, continuance, and normative commitment to the organization. Journal of Occupational Psychology, Vol. 63, pp.1-18. Argyle, M. (1967), “The Psychology of Interpersonal Behavior”, Penguin, Baltimore, MD. Argyris, Chris. (1998), “Empowerment: The Emperor New Clothes”, Harvard Business Review, May-Jun, p. 98-105. Askes, P.T. (Persero) Indonesia. (2002), Pedoman bagi Peserta Askes Sosial, P.T. (Persero) Asuransi Kesehatan Indonesia. Aviliani, & Wilfridus, Elu.(1997), “Building Customer Satisfaction Through Service Quality” Manajemen Usahawan Indonesia, No. 05 Th.XXVI May, pp. 8-13. Barney, Jay B., & Ricky W. Griffin. (1992), The Management Of Organizations, Strategy, Structure, and Behavior, Houghton Mifflin Company, USA. Bass, B. M. (1981), Handbook of leadership: A survey theory and research, New York, USA, Free Press. Begley, T.M., & Czajka, J.M. (1993). “Panel analysis of the moderating effects of commitment on job satisfaction, intent to quit, and health following organizational change”. Journal of Applied Psychology, Vol. 78: 552-556. Bell, Bradford S., & Steve W. J. Kozlowski (2002), “Goal Orientation and Ability: Interactive Effects on Self-Efficacy, Performance, and Knowledge”, Journal of Applied Psychology, Vol 87, No. 3, p.497-505. Bitner, M.J., Booms, B.H. and Tetreault, M.S. (1990), “The service encounter: diagnosing favorable and unfavorable incidents”, Journal of Marketing, Vol. 54, January, pp. 71-84. Blau, G., (1985), “The measurement and prediction of career commitment”, journal of Occupational Psychology, Vol. 68, pp. 277-88. Boshoff, Christo, & Gerhard Mels. (1995),”A Causal Model to Evaluate the Relationship Among Supervision, Role Stress, Organizational Commitment, and Internal Service Quality”, European Journal of Marketing, Vol. 29 No. 2, p.23-42. Brayfield, A., H., & crockett, W., H., (1955). Employee attitude and employee performance. Psychological Bulletin, Vo. 52, pp. 396-424. Brown, T.J., Mowen, J.C., Donavan, D.T. and Licata, J.W. (2002), “The customer orientation of service workers: personality trait influences on self and supervisor performance ratings”, Journal of Marketing Research, Vol. 39 No. 1, pp. 110-19. Buchanan, B. (1974) Building organization commitment: The socialization of managers in work crganizations. Adminstrative Science Quarterly, 22, 533-546. Currivan, Douglas B. (2000, “The causal order of job and organizational commitment in models of employee turnover”. Human Resource Management Review,Vol.9, Number 4, 1999, pp. 495 – 524. Curry, J., Wakefield, D., Price J., & Mueler, C., (1986), “On the causal ordering of job satisfaction and organizational commitment”, Academy of Management Journal, Vol. 29, No. 4, pp. 847-58. Cohen, A., (1999), “ Relationships among five forms of commitment; An empirical assessment, Journal of Organizational Behavior. Vol 20, pp. 285-308. Dabholkar, P.A., Sheperd, C.D. and Thorpe, D.I. (2000), “A comprehensive framework for service quality: an investigation of critical conceptual and measurement issues through a longitudinal study”, Journal of Retailing, Vol. 76 No. 2, pp. 139-73.

Page 15: The Influence of Employee Ability, Hospital's ethic and Leadership to

Donavan, D.T., Brown, T.J. and Mowen, J.C. (2004), “Internal benefits of service worker-customer orientation: job satisfaction, commitment, and organizational citizenship behaviors”, Journal of Marketing, Vol. 68, January. Dubé, Lauret, Miraé Claude Bélanger, & Elyse Trudeu. (1996), “The Role Of Emotion: In Health Care Satisfaction”, Journal of Health Care Marketing, Vol. 16, p. 45-51. Eisenberger R., Leonard J.M., Carlson J., & park D. C. (1979), “Transfer effects on contingent positive reinforcement: Mechanism and generality. Journal of Psychology, Vol. 92, pp. 525-533. Fisher, Richard T, (2001), “Role Stress, the Type A Behavior Pattern, and External Auditor Job Satisfaction and Performance”, Behavioral Research In Accounting, Volume 13, pp. 143-170. Fitzsimmons, James A., dan Mona J. Fitzsimmons. (2001), Service Management Operation Strategy, and Information Technology, Third Edition, Mc Graw-Hill International Edition, USA. Ford, Robert C. et al. (1997), “Methods of Measuring Patient Satisfaction in Health Care Organization”, Health Care Management Review, 22 eds., p.74-89. Glisson, Charles & Mark Durick. (1988), “Predictors of Job Satisfaction and Organizational Commitment in Human Service Organizations”, Adminstrative Quarterly, Vol. 33, p. 61-81. Gottfredson G., D., & Gotttfredson D., C., (1985). Victimization in schools, New York: Plenum Press. Gorda, Oka Suryadinatha. (2002), The Influence of Manager Quality, Job Satisfaction, and Organizational Culture against Commitment and Performance of Manager, PhD thesis, Post Graduate Program, Airlangga University, Surabaya. Hadiwardoyo, Purwa. (1989), Etika Medis, Edisi-1, Kanisius, Yogyakarta. Hair, Joseph F. et al. (1998), Multivariate Data Analysis, 4th-ed., Prentice Hall International, Inc., New Jersey. Hair, Lisa Poulter. (1998), “Satisfaction By Design: ‘Place’ Component of The Marketing Mix Takes Center Stage for Some Providers”, Marketing Health Services, Fall, p. 5-8. Hennig-Thurau, T. and Thurau, C. (2003), “Customer orientation of service employees – toward a conceptual framework of a key relationship marketing construct”, Journal of Relationship Marketing, Vol. 2 No. 1, pp. 1-32. Hom, Willard, 2000, “An Overview of Customer Satisfaction Models, “, California Community Colleges, p. 5-27 Herrington, Carmel & Scott, Weaven, (19)”The Relationship between Perceived Organizational Support and the Ability of Frontline Personnel to Build Relationships with Customers?”…………………… Hunter, J. E., Schmidt, F. L.,& Jackson, G. B. (1982) Meta analysis: Cummulating research across studies. Beverly Hills, CA: Sage. Järvelin, Anne-Marie. (2001), Evaluation of Relationship Quality in Business Relationships, PhD thesis, University of Tampere, Tampere. Johnson, Jeff W., (1996), “Linking Employee Perceptions Of Service Climate To Customer Satisfaction”, Personnel Phsychology, Vol 49, p. 831-851. Johnston, Mark W., A. Parasuraman, Charles M. Futrell, & William C. Black, (1990), “Alongitudinal Assesment of The Impact of Selected Organizational Influences on Salespeople’s Organizational Commitment During Early Employment”, Journal of Marketing Research, p. 27: 333-344. Joreskog, K. G., & Sorbom D., (2004), Lisrel, Retrieved October 27, from www. Ssicentral.com.

Page 16: The Influence of Employee Ability, Hospital's ethic and Leadership to

Kaldenberg, Dennis O., Boris W. Becker, & Anisa Zvonkovic, (1995), “Work and Commitment Among Young Professionals: A. Study of Male anf Female Dentist”, Human Relation, pp. 48: 1355-1377. Kanter, (1968), “Commitment and social organization: A study on commitment mechanism in utopian communities. American Sociological Revie, Vol. 33, pp.499-517. Kim, Soonhee, (2002), “Participative Management and Job Satisfaction: Lessons for Management Leadership”, Public Administration Riview, March/April, Vo. 62, No. 2, p. 231-241. Kode Etik Rumah Sakit Indonesia (KODERSI), (2001), Perhimpunan Rumah Sakit Seluruh Indonesia, Jakarta. Kompas, (2002), “Asuransi Swasta “Managed Care” dan “Indemnity”, Askes didn’t Know Didn’t Love”, Kompas, 20 November, h.28-31. Kotler, Philip, (2000), Marketing Management, The Millenium Edition, Prentice Hall International, Inc., New Jersey. Laschinger, Heather K. Spence, Joan Finegan, dan Judith Shamian, (2001), “The Impact of Workplace Empowerment, Organizational Trust on Staff Nurses Work Satisfaction and Organizational Commitment”, Health Care manage Review, Vol. 26 (3), p.7-23. Lincoln, J. R., & Kalleberg, A. L. (1990). Culture, control and commitment: A study of work organization and work orientations in the United States and Japan. Cambridge: Cambridge University Press. Luthans, Fred, (1998), Organizational Behavior, Eight Edition, Irwin McGraw-Hill, New Jersey, USA. Mathieu, J., & Hammel, D. (1983), A cause model of the antecedents of organizational commitment among professionals and non-professionals”, Journal of Vocational Behaviour, Vol. 34, pp. 299-317. Mathieu, J., & Zajac, D. (1990), “ A review of meta analysis of the antecedents, correlates and consequences of organizational commitment”, Psychological Bulletin, Vol. 108, No. 2, pp. 171-94. McFarlin, Dean B., dan Paul D. Sweeney, (1992), “Distributive and Procedural Justice As Predictors of Satisfaction With Personal and Organizational Outcomes”, Academy of Management Journal, Vol. 35, No. 3, p. 626-637. Meyer, J., & Allen, C. (1984), “Testing the sidebet theory of organizational commitment: some methodological considerations”, Journal of Applied Psychology, Vol. 69, pp. 372-98. Mintzberg, Henry, (1971), “Managerial Work: Analysis from Observation”, Management Science, October, p.97-110. Mintzberg, Henry, (1994), “The Rise and Fall of Strategic Planning (Reconceiving Roles for Planning, Plans, Planners”, The Free Press, New York, p.159-172. Mohammad, Kartono, (2002), “Why Healthcare Insurance Not Yet Sold Out”, Kompas, 20 November, h. 31. Mowday, R.T., Steers, R.M., & Porter, L.W. (1979). “The measurement of organizational commitment”.Journal of Vocational Behavior, Vol. 14: 224-247. Mullins, Laurie J. (1995), Management and Organizational Behaviour, Third Edition, Pitman Publishing, London. Murphy, Patrick E., (1995), “Corporate Ethics Statements: Current Status and Future Prospects”, Journal of Business Ethics, Vol. 14, p.575-587. Natalisa, Diah, (1999), Pengaruh Komitmen Manajemen Terhadap Kualitas Layanan Untuk Meningkatkan Kepuasan Pelanggan Maskapai Penerbangan Domestik, PhD thesis, Post Graduate Program, Airlangga University, Surabaya. Nordgren, L.D., Johnson, T., Kirschbaum, M., Peterson, M.L., (2004). “Medical errors: excess hospital costs and lengths of stay”. Journal for Healthcare Quality 26 (2), 42–48.

Page 17: The Influence of Employee Ability, Hospital's ethic and Leadership to

Nystrom, Paul C., (1993), “Organizational Cultures, Strategies, and Commitments in Health Care Organizations”, Health Care Management Review, p. 43-49. Oliver, N, (1990), “Work Reward, Work Values, and Organizational Commitment in An Employee – Owned Firm: Evidence from The UK”, Journal of Human Relations, London Oaks, Vol 43 (6), p. 513-526. Oliver, Richard L., (1996), Satisfaction: A Behavioral Perspective on The Consumer, McGraw-Hill Companies, Inc. New York. Oswald, Sharon L., Douglas E. Turner, Robin L. Snipes, dan Daniel Butler, (1998), “Quality Determinants and Hospital Satisfaction”, Marketing Health Services, p. 19-22. Parasuraman, A. Valerie A. Zeithaml dan Leonard L. Berry, (1985), “A Conceptual Model of Service Quality and Its Implications for Future Research”, Journal of Marketing, 64, p.41-50. Riyanto, Setyo (2002), Pengaruh Komitmen dan Kompetensi Pegawai Terhadap Kepuasan Pelanggan dan Nilai Pelayanan serta Dampaknya Terhadap Loyalitas Pelanggan, PhD thesis, Post Graduate Program, Padjajaran University. Robbins, Stephen P., (1996), Organizational Behavior, Concepts, Controversies, Aplications, 7th-ed, Prentice Hall Inc, New Jersey, USA.. Rutledge, Robert W., dan Patricia Nascimento, (1996), “Satisfaction With HMO’s”, Journal Of Health Care Marketing, p. 23-27. Sage, William, (1996), “Health Law 2000: The Legal System and Changing Health Care Market”, Health affairs, p. 1-9. Sheth, Jagdish N., dan Banwari Mital, (1997), “The Health of The Health Care Industry: A Report Card From American Consumers”, Marketing Health Services, p. 29-35. Sims, Randi L .dan K. Galen Kroeck, (1994), “The Influence of Ethical Employee Satisfaction, Commitment, and Turnover”, Journal of Business Ethics, Kluwer Academic Publisher, Ed- 13, Netherland, p. 939-947. Skinner, Steven & John M. Ivancevich, (1992), Business 21st Century, Richard D. Irwin, USA. Smith, P.B., Peterson, M., Misumi, J., & Bond, M. (1992). A cross-cultural test of the Japanese PM. leadership theory. Applied Psychology: An International Review, 41: 5-19. Smith, Donna McNeese, (1996), “Increasing Employee Productivity, Job Satisfaction, and Organizational Commitment”, Hospital & Health Services Administration, p. 160-174. Stoner, James A., & R. Edward Freeman, (1992), Management, 5th-ed, Prentice Hall, Englewood Cliffs, New Jersey, United States of America. Spreng, Richard A., Scott B. MacKenzie, dan Richard W. Olshavsky, (1996), “A Reexamination of the Determinants of Consumer Satisfaction”, Journal of Marketing, 60 (July), p. 15-32. Sugiharto, I. Bambang, Dr., (1998), “Ethic Dilema in The Managing of Hospital”, Makalah, Seminar Fungsionalisasi Komite Etik Rumah Sakit, Aula R.S. Santo Boromeus, Bandung. Weaver, Gary W., Linda Klebe Trevino, & Philip L. Cochran, (1999), “Corporate Ethics Programs as Control Systems: Influences of Executive Commitment and Environmental Factors”, Academy of Management Journal, Vol. 42, p. 41-57. Woodruff, Robert B., (1997), “Customer Value: The Next Source for Competitive Advantage”, Journal of The Academy of Marketing Science, Spring, Vol. 25, p.133-158. Yoesef, Darwish A., (2000), “Organization Commitment as a Mediator of The Relationship Between Islamic Work Ethic and Attitude Toward Organizational Change”, Jurnal of Human Relations, London, Oaks, Vol 53 (4), p.513-537. Yukl, Gary, (1998), Leadership in The Organization, Tranlation, Prehallindo, Jakarta.Zeithaml, V.A. dan M.J. Bitner, (1996), Service Marketing, The McGraw-Hill Companies, Inc., New York.

Page 18: The Influence of Employee Ability, Hospital's ethic and Leadership to