Low Quality Of Service Research Articles

Comparative governance of for‐profit provision of public services: Investor‐owned firms versus cooperatives as internet providers

AbstractResearch SummaryWe examine the comparative governance of for‐profit provision of public services, distinguishing between two types of for‐profit providers: investor‐owned firms (IOFs) and cooperatives. We argue that because cooperatives are owned and operated by those who benefit directly from the positive externalities generated by public services they are well suited to serving poor or high cost communities that may be underserved by IOFs, and that this will be especially true when they serve less diverse communities or needs. We test and find support for these predictions in the context of internet service provision in the United States. Our study thus offers a discriminating alignment perspective on the provision of public services, while also shedding light on the role of cooperatives in addressing societal grand challenges.Managerial SummaryPublic infrastructure and services provide two types of benefits: specific benefits to their users and general benefits to the communities they serve. Investor‐owned for‐profit firms only capture value through the payments they receive from users, however, so they may provide poorer quality service to poor or rural communities, causing such communities to be left behind. In this study, we argue that cooperatives—which are owned and controlled by members of the community themselves—represent a potential solution to this problem. Using internet service provision in the United States as a context, we show that cooperatives are more likely to enter rural and low‐income communities where existing firms are providing low quality service, and to provide higher quality service when they do so.

Evolutionary game model for the behavior of private sectors in elderly healthcare public–private partnership under the condition of information asymmetry

Chinese elderly healthcare services face problems of poor service quality, difficulty in eliminating hidden quality risks, and inadequate government supervision, primarily due to information asymmetry and insufficient supervision among providers, users, and regulatory bodies. The study addresses two key questions: How does information asymmetry influence private sector strategies in elderly healthcare public–private partnership (PPP), and what regulatory models can overcome the potential shortcomings? The study examines the influence of information asymmetry, particularly on "experience" and "credence," crucial for governance and service quality in elderly healthcare PPPs in China. By developing the novel methodology of evolutionary game theory and employing MATLAB simulations, this study analyzes private sector behavior under two distinct regulatory models. The research findings reveal a significant disparity, under the traditional "single" model; private sectors often prioritize low-quality services driven by self-interest or inadequate penalties, while the collaborative model incentivizes them to deliver higher-quality services influenced by factors such as public participation, reputational incentives, and penalties. Therefore, the paper proposed a multifaceted regulatory model based on strengthening third-party evaluation mechanisms, encouraging public participation, and refining reward and penalty systems. This proposed model will not only significantly contribute to regulatory effectiveness and quality services within elderly healthcare PPP projects, but will also serve as a reference point for government decision-makers responsible for quality services within PPP projects.

When the Internet Gets Under Our Skin: Reassessing Consumer Law and Policy in a Society of Cyborgs

Abstract In this article, the authors identify and explore the phenomenon of consumer cyborgification and ask what the legal and ethical implications of this emerging trend are. They consider whether fundamental legal principles, concepts, and assumptions in various EU acts and directives are adequate to address these challenges or whether these need to be reassessed in light of novel forms of vulnerability. They also ask what alternatives might be suggested. In the era of the consumer Internet of Things (IoT), consumer expectations of privacy, security, and durability are changing. While the consumer uses of the IoT often revolve around improving efficiency (e.g., of the body, the home, the car) and enhancing experiences through datafication of our bodies and environments and personalization of services and interfaces, the power of IoT companies to influence consumer behaviours and preferences is increasing in part because the hybridization of humans and machines. Cyborgification allows our behaviours to be individually and continuously monitored and nudged in real time. Our bodies and minds are reflected back at us through data, shaping the narratives we tell about ourselves and our surroundings, and this is creating new lifeworlds and shaping our preferences, roles, and identities. This presents novel benefits, as well as risks in the potential exploitation of novel vulnerabilities. With technology under the skin, both metaphorically (in relation to products that become a sensory accessory to the body and influence the perception and physical reality of one’s body and lifeworld) and literally (in the form of microchips, cybernetic implants, and biometric sensors and actuators), cyborg consumers are more vulnerable to manipulative practices, unfair contractual terms, automated decision-making, and to privacy and security breaches. Cyborg consumers are therefore more susceptible to damage, financial and physical, caused by defective products, low-quality services, and lax cybersecurity. Law, policy, and practice must go further than merely enhancing transparency and consent processes and prohibit practices and business models that are premised on manipulating the need to anticipate and manage the working of technologies under the skin, i.e., that which undermines consumer and public interests systematically. The law needs to be agile and responsive to the changes the IoT has established in the consumer–producer relationship. Consumer laws, including the contractual/consenting process itself, must be reviewed and reimagined to ensure more robust protections.

PENGARUH KUALITAS PELAYANAN DAN PERSEPSI NILAI TERHADAP KEPUASAN KONSUMEN DALAM PEMBELIAN PRODUK BAHAN BANGUNAN PADA UD. TARU GUMANA

Business competition has a significant impact on the industry, especially the fulfillment of consumer satisfaction perception which is the main problem, the weakness of the building store industry in meeting consumer satisfaction occurs in UD. Taru Gumana is caused by the low quality of service and the perception of value obtained by consumers. The purpose of this study is to determine the partial and simultaneous influence of service quality and value perception on consumer satisfaction in purchasing building material products at UD. Taru Gumana. This study is a quantitative study involving a sample of 96 respondents using the non-probalility sampling method. The data analysis technique used in this study uses hypothesis testing. The data collection technique uses questionnaire distribution. The results of the study stated that service quality and value perception had a positive and significant effect on consumer satisfaction and service quality and value perception together had a significant effect on consumer satisfaction. Furthermore, the implications of this research can build a way to increase consumer satisfaction, one of which is by paying attention to strengthening value perception so that the expectations desired by consumers can be realized and also inseparable from improving service quality.

The Plan to Integrate Medical Education with the Service Delivery System in Iran from an Educational Perspective: A Scoping Review

Introduction: Education in medical sciences is one of the most basic structures of societies, the most desirable outcome of which is improving the health level of individual members of society. Therefore, the current study was conducted to review the plan of integrating medical education with the service delivery system in Iran from an educational perspective. Method: This was a scoping review study. Data were collected using keywords in Magiran, ISC, SID, Pubmed, Scopus, Web of Science and Google Scholar databases in the period from 2001 to 2024. Screening and selection of documents was done according to Prisma instructions. Results: In the initial search, 180 articles were found, with 19 included in the study. The results showed that the growth of the workforce, socialization of education, progress in the field of medicine, and increase in research rank are the strong points of this project. However, more attention is paid to the issue of treatment than education, conflict of interests, and low quality of services in hospitals. Education and lack of research funds are among the existing matters. Conclusion: The integration of medical education with healthcare services has successfully achieved its primary goals. Nevertheless, it seems that medical education in universities has been under the shadow of the debate on health provision and medical services, and education and research have benefited less from the positive effects of integration.

Passenger Queue Simulation Analysis and Optimization at The Check-in Counter of Yogyakarta International Airport

Air transportation has a role in providing services to deliver people and goods in a relatively shorter time. Queues will increase due to the relatively low quality and quantity of service. This can happen at the Yogyakarta International Airport check-in counter. This research uses a comparison method between the queuing system and arena software. The queuing system used is a single channel-single phase. The airlines that will be studied are Lion Air and Super Air Jet. The samples used respectively were 65 passengers and 61 passengers from Lion Air and Super Air Jet airlines. Data collection was carried out during peak hours. With this passenger movement simulation model, it is possible to determine the length of queue experienced by passengers at each check-in counter, the time to be served, and the check-in counter staff that must be provided. The length of time queuing for passengers for each airline is that for Lion Air the length of time queuing at the check-in counter is 18,6 minutes with an additional 1 officer from before and for Super Air Jet it is 28,5 minutes with an additional 1 officer from the previous check-in counter.

Assess the efficacy of China's Inter-provincial Government Services policy: A quantitative evaluation based on PMC-Index model.

To face with the challenges of governance in the digital age, such as insufficient coordination between regional governments and low quality and efficiency of government services, China has proposed the Inter-provincial Government Services Policy. The policy is capable of realizing the government's ability to handle service matters for the public in different regions, thus facilitating the regional government's coordination and upgrading the level of government services. This paper collects and organizes the texts of 28 Inter-provincial Government Services policies, and uses ROSTCM6 text mining software to screen and identify the policy text content. Then a quantitative evaluation method based on the PMC model is proposed to examine the consistency and efficacy of the policy in this paper. The results show that: (a) The policy design is generally considered to be rational, with the majority of policies rated as excellent and a few rated as acceptable. There are no policies considered bad or perfect. From a certain point of view, these policies show obvious advantages in terms of policy nature, policy content and policy function. (b) The equilibrium of various policy indicators implies a high level of policy consistency. It indicates the overall coherence and coordination of the policies, contributing to enhanced predictability, credibility, and operationalization of policies, thereby establishing the foundation for their effective implementation. (c) There are still several weak points with the current policies, including the narrow scope of areas, the lack of medium- and long-term planning, and the insufficiently scientific nature of the instruments, evaluations and citations. This paper presents optimization recommendations aimed at addressing the aforementioned issues, which include expanding the scope of the policy, bolstering the long-term impact of the policy, and enhancing the quality of decision-making.

The Influence of Work-Life Balance on Service Quality in Government Apparatus with Job Satisfaction as a Mediator Variable

In the government sector, public services are part of the duties of the state apparatus to provide services to the community and loyalty to the state. The quality of government public services is a very important factor in public satisfaction. Employees who have a good work-life balance will provide quality services to the community. Work life balance in employees is influenced by job satisfaction including relationships with colleagues and leaders. Dissatisfaction felt by employees will lead to poor service quality. However, it is not yet known how work-life balance affects service quality. This study aims to examine the effect of work-life balance on employee service quality, through the mediation of job satisfaction. This explanatory quantitative research involved 262 employees in Langkat Regency. Data analysis using the Structural Equation Model (SEM) operated through the SmartPLS program. The results show that job satisfaction mediates the effect of work life balance on employee service quality. The results of this study contribute to the problem of low employee service quality which is influenced by work life balance and mediated by job satisfaction.

Challenging PPIUCD Removal: A Case of Hysteroscopic Extraction from the Uterine Fundus

Intrauterine contraceptive devices offer reliable and reversible contraception. However, there are still challenges that persist in their management, particularly regarding deeply embedded PPIUCDs (Post-Partum Intrauterine Contraceptive Devices). We present a case study of a 30-year-old woman who had two caesarean deliveries and sought PPIUCD removal to plan a future pregnancy. On speculum evaluation, the threads of the device were undetectable with no abnormal health symptoms. Subsequent ultrasound analysis confirmed the presence of PPIUCD, positioned obliquely within the uterine cavity. The first removal attempt under aseptic precautions with an IUCD hook was unsuccessful. The second attempt was guided by ultrasound and hysteroscopy, which successfully eliminated the IUCD. The case highlights the intricate challenges in managing PPIUCDs and emphasizes the importance of proactive management strategies. By integrating advanced techniques like hysteroscopy, healthcare providers can navigate these challenges effectively, enhancing patient care and satisfaction. Intrauterine contraceptive devices have become a reliable and convenient method of birth control due to their high effectiveness and reversibility. Long-acting contraceptives provide reliable and lasting protection against unintended pregnancy, making them a popular choice for individuals looking for a hassle-free contraception method. The PPIUCD technique involves implanting an IUCD within 48 hours following either vaginal delivery or caesarean surgery to block sperm survival and prevent endometrial foreign body reactions.[1] The acceptability rate for PPIUCD implantation is 36.25%.[2] The placement of the PPIUCD is preferable since it does not interfere with breastfeeding.[3] The prevalence of modern contraceptives among married women who have reached reproductive age has gradually increased globally, rising from 55.0% in 2000 to 57.1% in 2019.[4] According to the recent India National Family Health Survey, the contraception prevalence rate among currently married women under 15 to 49 increased from 54% in 2015-16 to 67% in 2019-21. Intrauterine devices comprise only 2.1% of all contraceptive techniques used in family planning. However, all government facilities offer free IUCD services.[5] Complications like bleeding, pain, infection, perforation, and expulsion contribute to 20–40% discontinuation rates.[6] Younger women using IUDs are more likely to experience adverse effects than older women.[7] The limited progress was attributed to factors such as the low quality of services offered, restricted access, and misconceptions about techniques held by providers and users. Despite their effectiveness, IUDs can lead to potential complications. One such issue is the occurrence of lost or embedded IUDs, which are rarely observed, with approximately 1-2 cases per 1000 insertions.[8] This case report illustrates the difficulties encountered in removing embedded IUDs and underscores the significance of exploring alternative techniques to manage challenging cases safely and effectively.

Improving the Quality of Traditional Market Services Based on the Indonesian National Standard (SNI) in the Case of Rau Market, Serang City

Traditional markets have a strategic function as a driver of the local economy that can increase employment opportunities and local revenue (PAD). The low quality of service and competitiveness of traditional markets are the main problems that hinder their function and role. The purpose of this study is to determine the priority scale for improving the service quality attributes of traditional markets by referring to the Indonesian National Standard (SNI). This study took Rau Market in Serang City as a case. Research respondents were taken randomly from the population of traders in the market and were also strengthened by interviews with buyers and market managers. Data from interviews with trader and buyer respondents were analyzed using the Importance Performance Matrix (IPM) method. The results of this study indicate that there are nine service quality attributes that are considered very important by customers but their performance levels are considered still unsatisfactory, namely market cleanliness, waste collection, public facility conditions, market drainage, waste and garbage management, the ability of officers to supervise the conformity of goods prices with the facilities provided, the ability of officers to supervise the quality of goods, the ability of officers to give strict sanctions to violators of the rules, the ability of officers to supervise the price of goods. The results of the study can be a reference for the Regional Government in allocating budgets for traditional markets by prioritizing aspects of market management and maintenance. Keywords: Importance Performance Matrix, customer satisfaction, service quality

On the incentive properties of revenue cap regulation

Revenue cap regulation (RCR) is increasingly common in the energy sector because it purportedly reduces the regulated firm's disincentive to promote conservation. In comparison with price-cap regulation, RCR can yield higher prices, greater energy conservation, lower service quality and decreased cost-reducing innovation. The distortionary effects of earnings sharing on investment in cost-reducing innovation may be lessened under RCR. These properties hold even when the regulated firm is further constrained with a price cap that is set equal to the minimum price that satisfies the RCR constraint.

Kualitas Pelayanan Dalam Pengurusan Perizinan Tanda Daftar Usaha Pariwisata (TDUP) Pada Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu Kota Pematang Siantar

The process of obtaining a Tourism Business Registration Certificate (TDUP) at the Integrated Investment and Licensing One-Stop Office in Pematang Siantar City, issues related to service quality have been identified. The problems is the low quality of service, permit issuance is often not fulfilled or takes a significant amount of time. This research aims to evaluate the quality of services provided in the process of obtaining (TDUP) at the Integrated Investment and Licensing One-Stop Office in Pematang Siantar City. The research method used is qualitative descriptive. Data is collected through observation, interviews, and documentation. The theoretical framework used in this research is the service quality theory by Zeithhaml, with indicators including tangible evidence, reliability, responsiveness, assurance, and empathy. The research results indicate that the quality of service in the process of obtaining a Tourism Business Registration Certificate has not reached an optimal level. This is evident from various indicators, such as the incompleteness of facilities, including toilet facilities in the service area and fully functional computers to support online systems. Employees involved in serving the public have not fully mastered their core tasks. Responsiveness in service is also lacking, as many individuals feel that the employees handling the Tourism Business Registration Certificate process provide slow and complicated responses. The assurances given by employees regarding service completion times are not in line with the promised deadlines.

Chinese Consumers' Satisfaction with Online Shopping Platforms

With the rapid development of Internet technology, China's online shopping industry is also expanding rapidly, becoming an important part of global e-commerce. This article investigates Chinese consumers' satisfaction levels with Taobao, Jingdong (JD.com), and Pinduoduo, three of the country's most popular e-commerce sites. The article reviews the historical development of these platforms, their market positioning, and some of the unique spending habits of Chinese consumers. This paper analyzes several key factors that affect consumer satisfaction, including delivery accuracy, price, information quality, payment convenience, and security. The way that these aspects are handled by each platform greatly affects the buying experience of users. Technological innovations on platforms such as Taobao, such as AI-driven recommendations, have dramatically improved user experience and satisfaction. Jingdong has improved its delivery efficiency and customer satisfaction by building its own logistics system, and Pinduoduo's logistics are both slightly inadequate in comparison. However, Jingdong's logistics during peak hours still needs to be improved. The paper also points out that while price is a very important factor for consumers when choosing a platform, Pinduoduo still needs to find a balance between low price and service quality. Lastly, future studies can explore how cross-border e-commerce and the behavioral inclinations of various user groups could impact the platform's subsequent development stage. These findings suggest that continued attention to these factors can provide online shopping platforms with strategies to increase consumer satisfaction and improve service quality, as well as provide new ideas for academic research.

Research on the Current Status of Pension Models for Individuals with Mental Disorders in China

Objective: By analyzing the existing literature, this paper aims to explore the current situation of the pension model for patients with mental disorders in China and put forward corresponding suggestions for improvement. How: This study analyzes the current situation of the pension model for patients with mental disorders in China by referring to the views of experts and scholars, relevant cases and statistical data through the literature and review of CNKI. Focusing on the existing elderly care service system, policy support and social cognition, this paper reveals the main characteristics and existing problems of the current Chinese elderly care model for people with mental disabilities. By comparing the advanced pension models at home and abroad, this paper puts forward some suggestions on strengthening policy support and improving service system. Results: The research shows that China's existing pension models mainly include family care, institutional pension and community service. The main problems facing: insufficient service supply, shortage of professional talents, social cognition and discrimination. Home care is still the main way, more than 70% of people with mental disorders rely on home care, but face great pressure and challenges; The construction of institutional elderly care and community service systems is gradually developing, but there are still insufficient resources, low service quality, and uneven distribution between urban and rural areas. Policy suggestions: Strengthen the construction and improvement of community support system; Improve professional training to ensure service quality; Use scientific and technological means to assist the elderly and ease the shortage of human resources. It is suggested that we should strengthen the construction of community support system and improve the level of professional service in the future. Conclusion: In China, the mode of nursing care for patients with mental disorders is in the transition period, and family nursing is still the mainstream, but it also faces great challenges. Institutional care and community services have developed, but they are not yet sufficient to replace the role of the family. The future development direction should be multi-dimensional, forming a diversified and three-dimensional elderly care service network.

Examining bus service quality among clusters of commuters: the case of Maputo Metropolitan Area, Mozambique

ABSTRACT The Maputo Metropolitan Area's bus transport service is comprised of both formal and informal operations, characterized by declined service quality. To improve service quality, the Maputo Metropolitan Transport Agency is transitioning to formal operations. The study aims to determine who experiences substandard bus service and where, to inform targeted actions. Data from 8,095 bus users were analysed using cluster analysis, Sankey diagrams, and multicriteria analysis, revealing four distinct behavioural clusters (C1–C4). C1 (Non-frequent-early evening) and C4 (Non-frequent-early morning) commuters experience low and very low service quality, respectively, needing increased bus frequency and easy-to-board buses. C2 (Non-frequent-daytime) commuters enjoy high service quality but could benefit from dedicated bus lanes to further improve frequency and convenience. C3 (Frequent-short travel time) commuters experience very high service quality but require direct bus lines from the suburbs to the CBD to reduce travel costs. The study findings form a basis for targeted bus service improvements.

SWOT Analysis of Indonesian Coastal Tourism Destination Marketing in the International Office

This study examines the marketing strategy of beach tourism destinations in Indonesia through a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis approach. The background of this study is based on the importance of beach tourism as a major economic sector that contributes significantly to national income, especially in countries with great beach tourism potential such as Indonesia. The research method used is a SWOT analysis to identify the strengths, weaknesses, opportunities, and threats faced by beach tourism destinations in Indonesia. The results of the study show that the main strengths of Indonesian beach tourism destinations include pristine natural beauty, rich underwater ecosystems, supporting facilities, and rich local culture. However, weaknesses such as lack of infrastructure, ineffective promotion, and low service quality are still major challenges. Opportunities include increasing global interest in Indonesian beach tourism, advances in information technology, and sustainable tourism trends. Meanwhile, threats such as intense global competition, natural disasters, and marine pollution require mature risk management. The conclusion of this study emphasizes the need for innovative and sustainable marketing strategies to improve the global competitiveness of Indonesian beach tourism. Practical recommendations include improving infrastructure, more effective promotion, and developing sustainable tourism.

BRMECQN: Design of an efficient integration of Bioinspired Routing Model with Energy efficient Clustering for high QoS Wireless Networks

In this dynamic domain of communication in wireless network technology, the need for advanced models that boost the Quality of Service (QoS) parameters concerning energy efficiency, speed, throughput, packet delivery ratio, and minimization of jitter is of prime concern. Traditional routing and clustering methods in wireless networks are often confronted with limitations such as suboptimal resource utilization, reduced energy efficiency, and lower QoS metrics. In this regard, the present work introduces an innovative integration of bioinspired routing models with energy-efficient clustering to enhance the performance of wireless networks. A novel Fan-Shaped Clustering approach is employed in the proposed model for a proper grouping of the network nodes, which can reduce the energy consumption and enhance the load balancing across the network. The model performs a further integration of Elephant Herding Optimization and Bat Optimization algorithms following the clustering. This integration has been done to develop an optimal route finding mechanism between the clustered nodes through its bioinspired approach, to utilize the global search capability of Elephant Herding Optimization, and the proficiency of Bat Optimizations in local searches. The proposed model, when tested empirically on different configurations of networks, presents significant improvements over methods in practice. The results suggest a 10.5% improvement in energy efficiency, an improvement in speed of 8.3%, a rise in throughput of 3.5%, an improvement in Packet Delivery Ratio of 4.5%, and a reduction in jitter of 1.9%. These have been substantial improvements indicating that the proposed model overcomes the limitations of the existing ones and at the same time places a new benchmark in the performance of wireless networks. The impact of this work is immense, providing a scalable and efficient solution for next-generation wireless networks. This integration of bioinspired algorithms in the routing and clustering of the network shall open new avenues for research and development into the field with the potential of more resilient, efficient, and high-performing wireless communication systems. This work, therefore, adds immense impetus to the development of wireless network technologies to uphold higher QoS and better resource management in an era of ever-growing digital communication demands.

Multi-objective discrete Cuckoo search algorithm for optimization of bag-of-tasks scheduling in fog computing environment

Internet of Things (IoT) applications are mostly time-sensitive and require reliable executions. The majority of IoT applications experience low quality of service (QoS) because of the intrinsic delay in utilizing the far-distant cloud infrastructures. To experience better QoS, fog computing as a complementary facility for cloud infrastructure is extended near the IoT devices. The bag of tasks (BoTs) IoT applications include a number of independent tasks each of which needs a certain amount of processing time so it is favorable to experience the lowest total execution time, makespan, for all applications. In addition, reliable execution guarantees the business continuity of IoT applications. Therefore, this paper presents a fog computing scheduler for the execution of BoT IoT applications in the fog platforms to minimize makespan and maximize the reliability execution at the same time. To this end, a new reliability model is presented. Then, the BoTs scheduling issue is formulated into a multi-objective discrete optimization problem with makespan and reliability optimality viewpoints. To solve this combinatorial problem, a multi-objective discrete cuckoo search algorithm (MoDCSA) is extended. The proposed MoDCSA optimization algorithm takes the benefit of several discrete operators each of which is smartly invoked. The quality of gained results from simulations of extensive scenarios verifies the effectiveness of the proposed MoDCSA scheduling algorithm which has 2.27%, 3.89%, 5.45%, 5.40%, and 4.55% improvement in terms of makespan and 1.99%, 5.11%, 6.39%, 7.95%, and 7.78% improvement in terms of reliability against MoBLA, MoGA, MoGWO, MoSA, and MoGSA comparative algorithms respectively.

Clinical Leadership of Nurse at Inpatient Room University of Sumatera Utara Hospital in 2023

Clinical leadership is an appropriate competency for nurses in improving quality and patient safety through innovation and creativity in nursing practice. Unoptimal clinical leadership skills are a problem for hospital management and affect the low quality of service. Based on interviews in a preliminary survey with eight nurses at inpatient room University of Sumatera Utara Hospital, it was found that the implementation of clinical leadership has not been effective. This study aims to describe clinical leadership (demonstrating personal qualities, working with others, managing services, improving services, and setting direction) of nurses at inpatient room University of Sumatera Utara Hospital in 2023. This research is a descriptive analysis research using quantitative research methods with a cross-sectional research design. A total of 58 respondents were selected by total sampling. Data collection was collected through interview method with direct interview technique guided by semi-structured questionnaire. Data were analyzed by univariate analysis. The results showed that the clinical leadership ability of nurses at inpatient room University of Sumatera Utara Hospital was classified as good, with a value in the range of 172.6. The clinical leadership skills were distributed in 1 indicator with a very good category (working with others), 3 indicators with a good category (demonstrating personal qualities, managing services, and improving services), and 1 indicator with a not good category (setting direction). The conclusion of this study is that nurses at inpatient room University of Sumatera Utara Hospital do not all have good clinical leadership. Based on the results of the study, it is recommended to the University of Sumatera Utara Hospital to provide management support to improve nurses clinical leadership abilities. Keywords: Clinical Leadership, Nurses

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.