Hospital Reputation Research Articles

Environmental Management Strategies for Cost-Effective Waste Management in Hospitals

General background: Waste management in hospitals is crucial due to its environmental impact. Specific background: RSU Al Islam HM Mawardi Krian struggles with waste management while adhering to PSAP No. 1 of 2010 and maintaining efficiency. Knowledge gap: Limited research exists on applying environmental management accounting and operational strategies for hospital waste management in line with accounting standards. Aims: This study analyzes the impact of environmental management accounting and strategies on waste management costs at RSU Al Islam HM Mawardi Krian, assessing compliance with PSAP standards. Results: The hospital has implemented processes of identification, recognition, measurement, recording, presentation, and disclosure per PSAP No. 1 of 2010, managing waste effectively and incurring environmental costs. Novelty: Offers insights into aligning hospital environmental cost management with government standards. Implications: Structured environmental accounting and strategies can enhance waste management, improve hospital reputation, ensure regulatory compliance, and potentially increase revenue. Highlights: RSU Al Islam HM Mawardi complies with PSAP No. 1 of 2010 in managing waste costs. Proper environmental accounting improves transparency and operational efficiency. Structured strategies can boost hospital reputation and revenue. Keywords: Environmental Management Accounting, Operational Strategies, Waste Management Costs, Hospital Compliance

Who Makes Decisions in Hospital? A Scoping Review and Meta-Synthesis

Context: The aim of this study was to identify decision-making issues and key decision-makers within the hospital. Methods: This scoping review was conducted by searching the databases of Web of Science, Scopus, and PubMed in January 2024. Additionally, articles related to Newhouse's main article were searched on Google Scholar to identify decision-makers in the hospital and their areas of decision-making. The 37 articles were analyzed using the framework analysis technique with Atlas-ti software. Results: Decision-makers addressed 160 issues, which were identified and categorized into 7 areas: Strategic management, human resource management, financial management, physical resource management, employee compensation payment, service delivery management, and hospital reputation. Additionally, 21 decision-makers were identified and classified into 6 categories: Group of managers, group of physicians, group of nurses, board of directors, government, and political groups. Hospital managers were identified as the primary decision-makers, responsible for making decisions independently in three areas and jointly with the board of directors in one area. Conclusions: It can be concluded that no single decision-maker holds a dominant role in the decision-making process. Several decision-makers exert varying degrees of influence depending on the issue. Among these decision-makers, managers play a more significant role in decision-making than others.

Evaluating perceived value and expected value gaps based on patient experience during outpatient encounters: An empirical study in China

BackgroundImproving the quality of care relies on understanding patients' perceptions and expectations based on their experiences. The study aimed to determine the gaps between patients’ perceived value and expected value, and to identify critical areas for outpatient service improvement. MethodThis cross-sectional study was conducted in China from November 2020 to February 2021. A sample of 572 outpatients, randomly selected from a comprehensive tertiary public hospital, was surveyed using a validated patient perceived value questionnaire. Importance-performance analysis was used to evaluate the differences between patients' perceived and expected value. ResultsThe scores of patients’ expected value for outpatient services were significantly higher than their perceived value in all 29 items and 8 dimensions. The items with the highest and lowest gaps were “short waiting time” (−1.52) and “hospital reputation and popularity” (−0.24) respectively, and the dimensions of price and efficiency (functional value) were located in the quadrant of high expectation and low perception. ConclusionOur findings are useful for hospital administrators and policymakers to identify strategic focus areas and allocate resources rationally and effectively. We suggest healthcare providers should take measures to narrow the gaps, especially in terms of service efficiency and price.

A Cross-Sectional Study on Patient Preferences for Selecting Surgeons for Joint Replacement Surgery in India.

Introduction This study aims to investigate the complex decision-making process of patients in India when choosing surgeons for joint replacement surgery, with a focus on both clinical and non-clinical factors influencing their preferences. Methods This was a cross-sectional observational study conducted at the KIMS-Sunshine Hospitals, Hyderabad, a high-volume tertiary care institute in India, in which patients with end-stage osteoarthritis requiring primary total knee arthroplasty were evaluated using a self-administered questionnaire, which assessed both patient-related and surgeon-related factors in choosing their joint replacement surgeon. Results A total of 210 participants were surveyed among whom the majority were females with an average age of 60.2 years with the majority belonging to the upper-middle-class socioeconomic status (48.6%, N=102). Fifty-nine percent preferred surgeons with over 20 years of experience, and 63.8% were willing to travel out-of-state for recognized expertise. Family recommendations (33.8%) and surgeon reputation (24.3%) were primary factors in surgeon selection. A vast majority (73.3%) preferred surgeons who were skilled in robotic surgery and had foreign training (32.9%). However, the majority (67.6%) did not express any gender preference.The survey highlighted a broad range of informational sources affecting decisions, including financial consideration (63.8%), personal referrals, and online platforms (17.1%). Preferences were also shaped by hospital reputation and insurance options (10.5%), illustrating a nuanced interplay of quality, cost, and personal connections in the selection process. Conclusion The findings of this survey illuminate the intricate and diverse preferences exhibited by patients when selecting a surgeon for joint replacement surgery. A significant rise in patient expectations is evident, underscoring a demand for more personalized, contemporary, and high-quality healthcare services. Importantly, geographical proximity appears to be a diminishing concern in their decision-making process. This trend presents an opportunity for centers of excellence to extend their influence and attract patients on both a regional and national level.

The impact of patient experience dimensions on hospitals reputation and electronic word-of-mouth.

Our objective was to identify the dimensions of the patient experience that directly influence a hospital's reputation and indirectly impact electronic word-of-mouth communication carried out by patients. We collected data from 484 hospital users and analyzed the data using PLS-SEM. Our results show that paying attention to patient preferences and physical comfort, providing information and education, and treating patients' families and friends well tend to have a significant impact on the hospital's reputation. In turn, a hospital's reputation may influence patients to perform electronic word-of-mouth about their experiences.

Analysis of the dimensions of health service quality on patient satisfaction in the polyclinic of surgical sub-specialists of Royal Prima Hospital Medan, the Year 2024

This study focuses on evaluating how different dimensions of health service quality impact patient satisfaction at Royal Prima Medan Hospital's Sub-Specialist Surgery Polyclinic in 2024. Understanding patient satisfaction is crucial as it reflects their expectations, needs, and assessments of the care received, ultimately influencing their loyalty and the hospital's reputation. Using a quantitative non-experimental approach with descriptive and associative analyses, the study involved 133 patients at the polyclinic, with a sample of 60 respondents selected incidentally. Data collection methods included interviews, questionnaires, and secondary data from the hospital. The variables studied were Service Satisfaction, Tangible aspects, Reliability, Responsiveness, Assurance, and Empathy. Ethical considerations were paramount, with approvals from the Health Research Ethics Commission and obtaining Informed Consent from informants/respondents. Validity and reliability tests were conducted on research instruments to ensure data quality. Statistical analysis using Chi-Square tests and multiple logistic regression revealed significant correlations between Reliability, Assurance, Appearance, Responsiveness, Empathy, and Patient Satisfaction. Among these, Empathy emerged as the most influential factor, highlighting the importance of communication, strong relationships, and understanding patient needs in healthcare settings. In conclusion, this study underscores the critical role of service quality dimensions in enhancing patient satisfaction, offering insights for healthcare providers to improve care delivery and patient experiences at Royal Prima Medan Hospital's Sub-Specialist Surgery Polyclinic.

Comparative Analysis Of Service Quality On Patient Satisfaction Levels In Government And Private Hospitals In Medan City In 2022

This study compares service quality to patient satisfaction in government and private hospitals in Medan City in 2022. This study used a survey method using a questionnaire as a data collection instrument. The research respondents were patients who used government and private hospital services. The data collected includes service quality dimensions, such as tangibles, reliability, responsiveness, assurance, and empathy. In addition, the data also consists of the level of patient satisfaction with the services provided by the hospital. Comparative analysis of service quality and patient satisfaction levels was carried out using appropriate statistical techniques, such as testing the difference between two groups of hospitals (government vs. private) using appropriate statistical tests. The results of this analysis will provide an understanding of the differences in service quality between government and private hospitals, as well as the related level of patient satisfaction. This research is expected to contribute to the development and improvement of health services in hospitals, especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City. Especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City. Especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City.

The Effect of Service Quality, Patient Trust and Hospital Reputation on Patient Satisfaction in Jordanian Public Hospital

This study aims to investigate the impact of service quality, patient trust, and hospital reputation on patient satisfaction within public hospitals in Jordan. Employing the partial least squares structural equation modelling (PLS-SEM) tool, the authors analysed a survey sample comprising 400 patients. The findings indicate that service quality, patient trust, and hospital reputation positively influence patient satisfaction. The results of this research have significant implications for healthcare practitioners in Jordan, underscoring the importance of not only providing excellent medical care but also implementing marketing strategies to cultivate lasting relationships with patients.

Hospital Dietary Services

A hospital's dietary service plays a crucial role in improving the health of hospitalized patients and enhancing the hospital's reputation. To ensure a high-quality dietary service, careful planning, proper layout, systematic menu planning, and sufficient assistance and supervision during meal offerings are essential. The dietician or food service manager is responsible for ensuring that patients receive a well-prepared, balanced diet in an aesthetically pleasing manner. The individual in charge of dietary services oversees inpatient catering, diet counselling, and commercial catering. Additionally, they are responsible for education, training, and research.

Elopement: Evidence-based mitigation and management.

Elopement jeopardizes patient safety, affects the hospital's reputation, and results in financial ramifications. In an academic community hospital, executive leadership approached a team of nurse leaders for expertise following the elopement of a vulnerable patient. The team's goal was to identify evidence-based strategies to mitigate future elopement events. Following an extensive literature review and gap analysis, the organization recognized opportunities pertaining to elopement management, including patient assessment, prevention strategies, and facility-wide response when events occur. The nurse leader team thoroughly searched current literature to answer the Population, Intervention, Comparison, and Outcome (i.e., PICO) questions of interest. Following a critical appraisal of 55 articles, 26 were utilized to make practice change recommendations. The body of evidence included a variety of age groups and diagnoses. After the synthesis of the literature, the team provided recommendations to the organization. These recommendations included the assessment of patient-specific risks and the implementation of elopement prevention measures as fundamental elements for incidence reduction. The team partnered with multidisciplinary stakeholders for the revision of policies, processes, and electronic medical record documentation. The organization monitored elopement events and the duration of each event throughout the phases of implementation. Pre-implementation data, collected from January to June 2021, demonstrated 34 individual elopement cases lasting an average of 118 min each. In comparison, post-implementation data collected during the same time frame in 2022 found only 12 events lasting an average of 24 min each. The organization implemented evidence-based recommendations to standardize the facility's approach to elopement. With structured assessment, precautions, and response, the organization demonstrated a notable decline in the number and duration of elopement events. Hardwiring processes, analyzing data, and adjusting expectations within an evidence-based framework should assist the organization's drive to further enhance patient safety surrounding elopement events.

Applying Early Warning Score (EWS) in hospitals for adult mortality risk factors

The mortality rate among adult hospital patients is a significant indicator in assessing the quality of care and health services. High mortality rates can affect a hospital's reputation, reduce the credibility of medical personnel, and trigger public anxiety. Failure to recognize the worsening of a patient's condition can delay appropriate life support management. This scoping review aims to identify and analyze the Early Warning Score (EWS) application for adults with risk factors for death in regional general hospitals (RSUD). The scoping review was conducted by searching literature using electronic databases from January 2018-May 2023, such as PubMed, ScienceDirect, LibMed UGM, and hand searching. Relevant articles were selected based on inclusion criteria. The results contained two main themes: factors related to mortality in adult patients and the benefits of implementing EWS on the clinical outcomes of adult patients. Implementing EWS in adult patients with high-risk factors for mortality at Regional General Hospitals can help identify the worsening of the patient's condition early, reducing the risk of death. Increasing awareness of the importance of EWS, EWS training, and consistent use of EWS according to hospital protocols can help reduce mortality and improve overall patient clinical outcomes.

Are temporal trends in retained foreign object rates after surgery in Switzerland impacted by increasing coding intensity? A retrospective analysis of hospital routine data from 2000 to 2019

ObjectivesRetained foreign objects (RFOs) after surgery can cause harm to patients and negatively impact clinician and hospital reputation. RFO incidence based on administrative data is used as a metric of...

Social Media Usage by United States Plastic Surgery Subspecialty Fellowship Programs.

United States plastic surgery fellowship programs in four major subspecialties (hand, microsurgery, craniomaxillofacial, and aesthetic) were identified and evaluated for social media presence on Instagram, Facebook, and Twitter. Platform-specific parameters were collected and statistically analyzed in aggregate. There were a total of 25 Instagram accounts, four Facebook accounts, and three Twitter accounts across all investigated subspecialties. Hand surgery had the greatest social media presence on Instagram (19.5%) and Twitter (3.4%). Microsurgery had the greatest presence on Facebook (4.7%). Between 2015 and 2022, Instagram was the platform with the greatest increase in adoption by fellowship programs. Geographically, microsurgery and craniomaxillofacial accounts were primarily owned by Midwest programs (66.7%, 100%), and aesthetic primarily by programs in the South (83.3%). Number of Instagram posts and followers were not significantly correlated with hospital reputation (P = 0.12, P = 0.63). Social media is underutilized by plastic surgery fellowship programs. While Instagram metrics such as posts and followers are not correlated with hospital reputation, the skewed distributions of fellowship accounts, both geographically and across platforms, represent areas of potential growth.

The Trends of In-Patient Mortality between 2018 and 2019 at Kisumu County Level Four Hospital, Kenya

Introduction: Due to a lack of information on patient mortality, healthcare planners rarely use local data for resource allocation and hospital management. This results in missed opportunities to build hospital capacity to address common causes of death, as well as a poor hospital reputation, fewer patients seeking hospital care, increased medical errors, and increased inpatient mortality.
 Objective: To determine trends of hospital mortality between 2018 and 2019 at Level Four Kisumu County Hospital, Kenya.
 Methods: The study was a cross sectional retrospective study design. The study targeted files of patients who died between January 2018 and December 2022. Systematic sampling was used in which every file per ward was given a serial number. Each department formed a stratum. Sample size was determined using Yamane Taro formula (N/1+N(e2) which yielded 203 as sample size from population of 680. The risk of death based on the presence or absence of doctor and nurse was analyzed by odds ratio. Chi-square was used to check association of appropriateness of facility, delay of care and distance and mortality. Variation in ward mortalities was analyzed using ANOVA to assess and data presented as line graphs.
 Results: According to the current study, the medical ward had the highest 2-year in-hospital mortality rate of 13.86%, while obstetrics and gynecology (reproductive health) had the lowest mortality rate of 0.47 percent. Infections were responsible for 42% of hospital deaths in patients under the age of 35, while noncommunicable diseases were responsible for 41% of hospital deaths in patients over the age of 60. According to the study, 3% of hospital deaths could have been avoided. When a nurse and a doctor were all present, there was a significant difference in the odds of a patient dying (OR=0.697). Comorbidity was a significant risk factor for death among patients who died in 2018 and 2019 (p=0.05). Patient characteristics such as age, education level, and gender were not associated with hospital deaths (p>0.05).
 Conclusion: The study found that 3% of hospital deaths were avoidable. More deaths occurred in medical ward from infectious diseases such as pneumonia and pulmonary TB among patients aged <35 years while non-communicable diseases such as cancer, hypertension and diabetes mellitus were important causes of death among the people aged >60 years. The results seem to suggest that more deaths occurred during rainy season between February and August. Patient factors such as age, sex and education level were not significantly associated with hospital mortality. Comorbidities particularly the non-infectious diseases were associated with more deaths.

What are the key factors influencing newly graduated nurses' preference for choosing their workplace? A best-worst scaling approach.

The literature cites many factors that influence a nurse's decision when choosing their workplace. However, it is unclear which attributes matter the most to newly graduated nurses. The study aimed to identify the relative importance of workplace preference attributes among newly graduated nurses. A cross-sectional study. We conducted an online survey and data were collected in June 2022. A total of 1111 newly graduated nurses in South Korea participated. The study employed best-worst scaling to quantify the relative importance of nine workplace preferences and also included questions about participants' willingness to pay for each workplace preferences. The relationships between the relative importance of the workplace attribute and the willingness to pay were determined using a quadrant analysis. The order according to the relative importance of workplace preferences is as follows: salary, working conditions, organizational climate, welfare program, hospital location, hospital level, hospital reputation, professional development, and the chance of promotion. The most important factor, salary, was 16.67 times more important than the least important factor, the chance of promotion, in terms of choosing workplace. In addition, working conditions and organizational climate were recognized as high economic value indicators. Newly graduated nurses nominated better salaries, working conditions, and organizational climate as having a more important role in choosing their workplace. The findings of this study have important implications for institutions and administrators in recruiting and retaining newly graduated nurses.

The Effect of Hospital Reputation on Job Satisfaction of Healthcare Professionals

Araştırmanın amacı sağlık çalışanlarının kurum itibarı algılarının iş tatminine etkisini tespit etmektir. Araştırmada İstanbul ilinde faaliyet gösteren kamu hastanelerinde görevli 462 sağlık çalışanından veri toplanmıştır. Araştırmanın örnekleminin belirlenmesinde kolayda örnekleme tekniği kullanılmıştır. Veri toplama sürecinde çevrimiçi anket formları kullanılmıştır. Verilerin analizinde SPSS 25 paket programı kullanılmıştır. Araştırmanın modelinin test edilmesinde regresyon analizi kullanılmıştır. Analizler sonucunda çalışanların kurum itibarı algılarının katılımcıların iş tatminlerini yüksek düzeyde etkilediği sonucuna ulaşılmıştır. Kurumsal itibarın vizyon ve liderlik, finansal performans, ürün ve hizmetler, sosyal sorumluluk ve duygusal çekicilik boyutlarının iş tatminini olumlu yönde etkilediği tespit edilmiştir. Çalışma ortamı boyutunun ise iş tatmini üzerinde anlamlı bir etkiye sahip olmadığı sonucuna ulaşılmıştır. Araştırma bulguları kurum itibarının sağlık çalışanlarının işlerinden elde ettikleri tatmini arttırmada önemli bir unsur olduğunu göstermektedir.

Factors Influencing Word-of-Mouth Behaviour at Outpatient Department YPK Mandiri Hospital, Jakarta

The purpose of this study was to determine the factors that influence the word-of-mouth behavior of patients seeking treatment at YPK Mandiri Hospital, Jakarta. The factors studied were doctor's expertise, doctor's communication, nursing, ancillary, and administration services, hospital reputation, and the physical structure and facilities of the hospital. Data were collected by a questionnaire distributed to patients receiving outpatient treatment. The number of samples obtained is 162 samples. A convenience sampling technique was used in this study. Data analysis was performed using the Partial Least Square-Structural Equation Modelling (PLS-SEM) approach using SmartPLS software. The results showed that doctors’ expertise, doctors’ communication, hospital reputation, and the physical structure and facilities of the hospital are related to word-of-mouth behavior. Nursing, ancillary, and administrative services are not related to word-of-mouth behavior.

Istorijat i značaj Vojne bolnice u Kragujevcu

he Military Hospital in Kragujevac, with its turbulent history and rich military medical documentation, represents one of the most important institutions of the 19th and 20th centuries. Throughout its history, it has been home to a whole array of excellent nurses, doctors, and surgeons who, through their dedication, contributed to the hospital's reputation in the city and the country. From the moment in the 1830s when the idea of its formation began to emerge, only a few could have foreseen that it would become one of the most significant military hospitals in the country. The first military hospitals in Kragujevac, which were predecessors to the Šumadija Permanent Military Hospital, were quickly closed, often due to a lack of doctors and hospital equipment. Furthermore, the 1830s and 1840s were still marked by folk medicine, primitivism, and charlatans (soothsayers, fortune-tellers, quacks, and the like). It was only with the Law on the Organization of the Ministry of War in 1864 that the establishment of the Permanent Military Hospital in Kragujevac was foreseen. This undoubtedly marked a turning point in the establishment of the Military Hospital because immediately after the enactment of this law, the project for constructing a modern building with all the necessary hospital furniture and medical equipment for treating soldiers began. The construction of the hospital building lasted for three years, and as soon as it opened, it started treating and caring for patients (both military and civilian). The hospital was staffed by significant surgeons and doctors (Leonard Lontki- jevic, Đorđe Đoka Vladisavljevic, Lazar Gencic, Roman Sondermajer, Moša Eli, Milorad Glišić, and many others). Throughout its existence, the hospital underwent several reorganizations and professional expansions (which significantly influenced its reputation). It treated soldiers from the front lines of the Serbian-Turkish War, which took place from 1876 to 1878, as well as soldiers and wounded from the Balkan Wars and both World Wars. As one of the four most important military hospitals (the other three were in Belgrade, Niš, and Požarevac), the hospital collaborated with various humanitarian organizations and actively participated in the treatment and rescue of soldiers. When the Second World War ended in 1945 with the Allied victory, the Military Hospital in Kragujevac continued its operations (surgery was very advanced), and Kragujevac became a modern industrial and university city. The hospital continued its active work until its closure in 1957 when the construction of a new hospital building began, following the idea of Đorđe Vulkan, the hospital's director during the Second World War. Today, the Kragujevac Military Hospital represents an important part of national and local history with special historical significance. Besides its architectural value (it was one of the most beautiful buildings in the city at the end of the 19th century), the Military Hospital was a key medical center for military and civilian patients during the Balkan Wars and especially in World War I. From the perspective of the development of the medical profession, a host of significant Serbian doctors originated from the Military Hospital, including Dr. Mosa Eli, a Jew after whom Clinic 4 is named today. At one point, it was also a significant center for Serbian surgery, where excellent surgeons trained abroad practiced. Its doctors participated in the First Congress of Serbian Physicians and Naturalists in Belgrade, which was an important step in its local and regional reputation. All of this has given the Military Library in Kragujevac a distinctive silhouette of a military-medical institution with great historical, architectural, and cultural significance. As an institution with a rich history, the Kragujevac Military Hospital deserves attention and respect from both us and future generations. From its inception to the present day, it has gone through a long and challenging journey through several wars fought by the Serbian people. Alongside it, healthcare and healthcare institutions in the Šumadija region and the entire region have started and gradually developed. The Kragujevac Military Hospital has had a significant impact in the fields of military and civilian medicine. Through the provision of healthcare to soldiers, the advancement of medical practice, humanitarian work, and serving as a symbol of remembrance, the hospital has played a crucial role in Serbia's healthcare system and society.

Application the Risk-Based Maintenance for Optimizing the Overall Medical Devices Safety

The purpose of this study was to identify risks to patients as a result of sudden device failure during the delivery of medical treatment services. Which, can affect the reputation of hospitals following the exposure of patients' lives to various risks like death, injury, and misdiagnosis. Furthermore, a sudden failure will lead to increased economic losses as a result of increased maintenance costs. Of (20) medical devices, (6) high-risk devices were selected, such as a ventilator, diathermy, anesthesia, BiPAP, oxygen concentrator, and electrosurgical devices. A quantitative statistical analysis based on risk-based maintenance is used to evaluate the effectiveness of the reliability of the medical device and its risks to patient lives. The results show that the reliability of the chosen medical device has declined, with higher maintenance costs due to excessive maintenance or the type of maintenance policy used. Therefore, this study provides evidence that hospitals must adopt a risk-based maintenance approach to prevent sudden failure while in service. In addition, these medical devices have various complex parts that must adopt a combination of maintenance schedules. Based on Risk-Based Maintenance's experience in improving patient safety in public hospitals in the 20 most successful OECD countries.

Mitra Sejati Medan Hospital Reputation Restoration Strategy in the Case of Swapped Baby

A good reputation is one of the main factors for successful performance, but its implementation is still being questioned in various agencies or organizations in Indonesia. This qualitative study aims to analyze and evaluate the success of the reputation restoration strategy for Mitra Sejati Hospital in Medan after the baby are swapped. This research involved two key informants (public relations and supervisors) who handled the case. The collected data were analyzed using the Miles and Huberman analysis techniques. The results of this study informed that Mitra Sejati Medan Hospital was quite slow in providing an initial response, so that the case was spread through the media. Furthermore, the hospital then used three stages, namely mortification, compensation, and collective action. Following up on the findings in this study, the reputation management of Mitra Sejati Medan Hospital must be further optimized through various training and special learning resources.