Hospital Service Quality Research Articles

Description of JKN Patient Satisfaction with the Quality of Dental Health Services in Hospitals

The National Health Insurance (JKN) with a pre-payment financing system, which uses a capitation system for primary health services including dental and oral health services. The implementation of JKN also requires increased access and quality of health services, both at the First Level Health Facility and Advanced Health Facilities. The implementation of JKN requires support from promotive and preventive public health efforts so that the community remains healthy and does not get sick easily, and is useful in helping to control the burden of the necessary state budget. First-level health facilities that play a role in providing promotive and preventive health services are important, one of which is the Community Health Center or Puskesmas.
 The purpose of this study was to determine the description of JKN patient satisfaction with the quality of dental health services. The type of research used is a literature study with the method of collecting library data, reading and recording, and processing materials. The data used comes from textbooks, journals, scientific articles, literature reviews which contain an overview of JKN Patient Satisfaction with the Quality of Dental Health Services at the Hospital.
 National Health Insurance patient satisfaction in receiving this service is divided based on 5 SERVQUAL dimensions, namely tangibility, reliability, assurance, responsiveness and four. The quality of health services is health services that can satisfy every user of health services in accordance with the average satisfaction level of the population and its implementation in accordance with professional standards and ethical codes.
 Conclusion: The level of patient satisfaction with health services based on reliability (Reliability), responsiveness (Responsivines), Assurance (Assurance), direct evidence (Tangiable), human relations (Empaty) is a very satisfied category.

An Efficient Healthcare Data Mining Approach Using Apriori Algorithm: A Case Study of Eye Disorders in Young Adults

In the public health sector and the field of medicine, the popularity of data mining and its usage in knowledge discovery and databases (KDD) are rising. The growing popularity of data mining has discovered innovative healthcare links to support decision making. For this reason, there is a great possibility to better diagnose patient’s diseases and maintain the quality of healthcare services in hospitals. So, there is an urgent need to make disease diagnosis possible by discovering the hidden patterns from the patients’ history information in developing countries. This work is a step towards how to use the extracted knowledge to enhance the quality of healthcare facilities. In this paper, we have proposed a web-centered hospital information management system (HIMS) that identifies frequent patterns from the data with eye disorder patients using the association rule-based Apriori data mining technique. The proposed framework has the capability to overcome all the key issues and problems in the current hospital information management system regarding data analysis and reporting services. For this purpose, data were collected from more than 1000 university students (China citizens) both online and manually (printed questionnaire). After applying the Apriori algorithm on the collected data, we revealed that almost 140 individuals out of 1035 had myopia (near-sighted disorder), at current age of 22 years, and that there were no male patients found with myopia. We concluded that their clinical relevance and utility can generate favorable results from prospective clinical studies by mapping out the habits or lifestyles that potentially lead to fatal diseases. In the future, we plan to extend this work to fully automate HIMS to help practitioners to diagnose the reasons of various diseases by extracting patient lifestyle patterns.

Implementasi of technology acceptance model (TAM) in electronic documentation of nursing care: phenomenology explorative

Incomplete medical record documentation affects the quality of service in hospitals. The migration of SIMRS is intended to allow hospital services to be integrated. The use of electronic medical records as a nursing care documentation tool needs to be evaluated in terms of the acceptance of technology through three constructs: the effect of benefits, the effect of ease of use of the system, and self-confidence in computing ability. The study aims to explore the nurses’ experiences of the influence of the benefits of using technology, the ease of use of technology, and nurses' self-confidence when using technology. This study used qualitative methodology with an exploratory phenomenological approach. Data were collected through FGDs with 12 participants selected by purposive sampling technique and consultation with information technology and nursing management experts. Data analysis used the Collaizi Model. The results obtained from this study indicate that the electronic care documentation system must consider the security system of the medical record and that obstacles to operating the system must be anticipated. Guidelines should be made for the application of 3S nursing care in EMR. Adapting to technology influences self-confidence in computing ability, the belief that technology can complete tasks, the usefulness of technology, and the ease of use of electronic documentation technology. It can be concluded that the evaluation of technology acceptance as early as possible is very important to support the successful use of information systems and provide input for management and policymakers in understanding the process of adaptation to new technologies and the creation of practical guidelines for the successful implementation of information systems.

A fuzzy rough copula Bayesian network model for solving complex hospital service quality assessment

Healthcare tends to be one of the most complicated sectors, and hospitals exist at the core of healthcare activities. One of the most significant elements in hospitals is service quality level. Moreover, the dependency between factors, dynamic features, as well as objective and subjective uncertainties involved endure challenges to modern decision-making problems. Thus, in this paper, a decision-making approach is developed for hospital service quality assessment, using a Bayesian copula network based on a fuzzy rough set within neighborhood operators as a basis of that to deal with dynamic features as well as objective uncertainties. In the copula Bayesian network model, the Bayesian Network is utilized to illustrate the interrelationships between different factors graphically, while Copula is engaged in obtaining the joint probability distribution. Fuzzy rough set theory within neighborhood operators is employed for the subjective treatment of evidence from decision makers. The efficiency and practicality of the designed method are validated by an analysis of real hospital service quality in Iran. A novel framework for ranking a group of alternatives with consideration of different criteria is proposed by the combination of the Copula Bayesian Network and the extended fuzzy rough set technique. The subjective uncertainty of decision makers’ opinions is dealt with in a novel extension of fuzzy Rough set theory. The results highlighted that the proposed method has merits in reducing uncertainty and assessing the dependency between factors of complicated decision-making problems.

Pengaruh Akreditasi Terhadap Peningkatan Mutu Pelayanan Rumah Sakit

Hospital accreditation is one way to assess the quality of hospital services. Improving the quality of hospital services is very important, as hospitals provide the most critical and dangerous services in the healthcare system, and their target activity is human life. The aim of this research was to determine the influence of accreditation on the improvement of service quality after the Covid-19 pandemic. The research used a quantitative method with a cross-sectional approach. The data used in this research were secondary data. The research was conducted at Depok Private Hospital from January to March 2022. The data analysis used the General Linear Model Repeated Measure statistical test.
 The results of the study showed that the value of hospital service quality based on the Greenhouse-Geisser sig 0.035 < 0.05. Thus, it can be said that accreditation affects the quality of hospital services with a trend of increasing service quality values from January to December 2022.
 The conclusion of the study is that the quality of service in hospitals after the Covid-19 pandemic has changed. There are differences in service quality values every month. Service quality tends to improve during the year 2022.

Quality Assurance in The Surgical Ward of Hospital X in Bandung During the Covid- 19 Pandemic

Health services are organised to meet the needs and demands of the community. If fulfilled, it will lead to client satisfaction. Hospital X in Bandung had a BOR of 91,67% in 2021 during the Covid-19 era. This BOR surpasses the WHO standard. Thus the quality of service needs to be assessed. The research was conducted to get an overview of the level of patient satisfaction with inpatient services at the surgical ward of Hospital X in Bandung. The study was conducted using an exploratory, descriptive approach to obtain an objective picture. Data was collected by filling out questionnaires to patients and families of 90 people. Samples were selected purposively with inclusion criteria: respondents must be treated for at least three days. The instrument was prepared concerning the “Hospital Service Quality Assurance” guidelines. The results showed that 53.4% of respondents stated that the quality of inpatient services at Hospital X in Bandung was in an outstanding category starting from the aspect of registration, nurse services, medical services, food and menus, comfort and cleanliness, medical facilities to administration, and finance. Health services carried out by hospitals are constantly changing along with the development of science and technology, and hospitals are preparing for hospital accreditation. It is recommended that hospitals continue to improve the quality of their services so that patient satisfaction with the services received can be maintained.

Patient Satisfaction in Prescription Redemption at the Pharmacy Unit of X Hospital Surabaya

Background: One of the main services in hospitals are the pharmacy department. Pharmaceutical services are expected to be carried out according to established standards, to provide excellent service to patients.
 Aims: To determine the relationship between the quality of pharmaceutical services and patient satisfaction in the pharmaceutical installation of X Hospital Surabaya
 Methods: Quantitative research with cross sectional study design. The inclusion criteria in this study were patients/patients' families, aged 20-65 years, and willing to fill out a complete questionnaire. The independent variable is the quality of pharmaceutical services at X Hospital, the dependent variable is patient satisfaction at the X Hospital pharmacy installation. The study population was all patients both inpatient and outpatient at X Hospital, with a minimum sample size of 53 people.
 Results: Most of the respondents were female (60.38%), aged > 60 years (49.06%) with polyclinic visits mostly 3-4 times and most were college graduates (PT) (43.40%). There was a relationship between satisfaction of respondents with redemption process of drug prescriptions at the Pharmacy Unit of X Hospital Surabaya (p= 0.000 (α≤0.05) and r = 0.498). This shows that the respondents' expectations of the tangible, reliability, responsiveness, assurance and empathy components were well fulfilled. Satisfaction from several of these dimensions indicates a good match between the quality of service at the X Hospital Pharmacy Unit and the level of patient satisfaction.
 Conclusion: The quality of service at the Pharmacy Installation of X Hospital must be maintained and improved to provide satisfaction to the community. Accuracy in carrying out procedures and supported by the optimization of tangible components, reliability, responsiveness, assurance and empathy can certainly be a form of commitment in maintaining the quality of service in hospitals

Sistem Informasi Rumah Sakit

The hospital information system has become increasingly important due to the rapid development of technology. An effective information system can help manage patient data, medical records, doctor scheduling, medicine and medical equipment procurement, and facilitate hospital administration processes. This journal discusses the importance of hospital information systems, the benefits that can be gained, and the things that need to be considered in building and implementing an effective information system. Analysis of information system needs, information system development, training and utilization of the system, and information system maintenance are important factors to consider in building an effective system. With an effective and efficient information system, it is hoped that the quality of hospital services can be improved.

Theoretical Review Study: Peran Dan Fungsi Mutu Pelayanan Kesehatan Di Rumah Sakit

The roles and functions of quality management, known as total management quality, can be interpreted as a system that helps an organization, hospital, or business entity to oversee every activity and duties and responsibilities needed to maintain the quality or quality of service. Efforts to improve the quality of health services are the most important step to increase the competitiveness of Indonesian businesses in the health sector. The purpose of this theoretical review study is to find out how the role and function of the quality of health services in hospitals. The method used is a theoretical review by analyzing and comparing existing theories. The results of this theoretical review study are the role and function of quality as an effort that is carried out continuously, systematically, objectively, and integratedly in determining problems and causes of health service quality problems based on predetermined standards with effectiveness, efficiency, protection and acceptance of health services. It can be concluded that service quality and good quality will greatly influence health services in hospitals. Patients getting comprehensive health services will increase patient satisfaction in the treatment program so that the quality of health services will increase. Hospitals also need to improve the quality of quality health services. Quality also has a function as a reference or benchmark in managing the quality provided by a hospital. So that in its implementation it is necessary to carry out monitoring and evaluation.

Pentingnya Akreditasi Rumah Sakit Bagi Pelayanan Kesehatan: Hospital Application Study

Hospitals in guaranteeing good service quality and patient safety must be proven through accreditation. Accreditation is carried out by submitting an application to the Hospital Accreditation Commission (KARS). Hospital Accreditation is a way of monitoring the implementation of measuring hospital performance indicators. The purpose of writing this scientific article is to find out the importance of improving the quality of hospitals, especially for hospital structures and health workers. The method in this scientific article is to compare cases from several hospital studies that apply the accreditation process and the literature collected at the editing (re-examination) stage. The data is then processed and analyzed and conclusions drawn. The findings from the study of the application of hospitals in the importance of holding accreditation are to improve the quality of hospital services, improve hospital patient safety, increase protection for patients, the public, human resources for hospitals and hospitals as institutions and support government programs in the health sector. It can be concluded that the importance of hospitals carrying out accreditation is to ensure good service quality and patient safety must be proven through accreditation. Accreditation is carried out by submitting an application to the Hospital Accreditation Commission (KARS). Suggestions made for hospital agencies, namely hospitals that have obtained national accreditation status are required to make strategic improvement plans in accordance with the surveyor's recommendations to meet hospital service standards that have not been achieved.

Do Patients Go Home at Their Own Request? A Study of the Quality of Hospital Services during the Covid-19 Pandemic

Covid-19 is categorized as a non-natural disaster. At the Undata Palu Regional General Hospital (RSUD), there are still problems related to PAPS (Going Home On Own Request), so this needs serious attention from the hospital. The purpose of this study was to determine the relationship of service quality from the aspect of physical evidence (tangibles), responsiveness (responsiveness), reliability (reliability), assurance (assurance), and empathy (empathy) with the desire to go home on their request (PAPS) patients during the period the covid-19 pandemic in the inpatient unit of Undata Hospital Palu. This type of research was an analytic survey with a cross-sectional approach. The sample in this study was all inpatients at Undata Hospital Palu, totaling 96 people, with an accidental sampling technique. The data were collected and analyzed using computer-based software in univariate and bivariate ways. The results showed that there was a relationship between service quality from the aspect of physical evidence (tangibles) (p=0.002), responsiveness (p=0.049), reliability (p=0.001), assurance (p=0.005), and empathy (p = 0.018) with the desire to go home on own request (PAPS) of patients during the covid-19 pandemic in the inpatient unit of Undata Hospital Palu. It is hoped that the Undata Palu Regional General Hospital can improve the quality of service and reduce patients who go home at their own request by improving better service standards, which are, of course, following Islamic values to serve others.

Consumer Legal Protection for Patients and the Quality of Health Services in Hospitals

BACKGROUND: Health development is part of Indonesia’s national development. It is implemented by creating a social security system run by the Social Security Administrator for Health (Badan Penyelenggara Jaminan Sosial Kesehatan/BPJS Health) based on Law No. 24 of 2011. AIM: This study analyzes the legal protection for BPJS health participants who are hospital inpatients. It also discusses their rights and obligations that are yet unfulfilled. METHODS: This research uses the juridical doctrinal or normative method. This is descriptive research with a qualitative approach. RESULTS: As patients, BPJS health participants’ rights are legally protected by Law No. 36 of 2009 on Health and Law No. 44 of 2009 on Hospitals. Unfortunately, some participants often experience problems when they require hospitalization. For instance, there is usually a lack of information on the provision of treatment rooms. Another issue is that the BPJS patients often only obtain a 3-day hospitalization facility as the fee allocation from BPJS health has run out. CONCLUSION: Thus, it is concluded that there is adequate legal protection for BPJS health patients who are hospitalized both as consumers and as BPJS health participants. However, there are still issues with its application. The participants who feel harmed by the treatment may file a lawsuit on consumer protection concerning the inadequate services or a lawsuit on malpractice if there are violations.

Analysis of Patient Satisfaction at Outpatient Installation in the Hospitals: A Systematic Literature Review

Background: A hospital is a public facility that offers services to improve individual health status. One of the services offered by the hospital is an outpatient installation. As healthcare institutions, hospitals need to optimize their quality to ensure patient satisfaction with outpatient services. Method: This research is a systematic literature review that contains reviews of several studies using the PRISMA method. Related articles carry out by https://sinta.kemdikbud.go.id/journals/index/page. Inclusion criteria are the research articles must be published between the years 2018-2023, journals indexed by SINTA 1 or 2, and research subjects who were undergoing outpatient care at hospitals in Indonesia. There were 6 research articles that were close to the inclusion criteria and were determined to be the study material in this study. Results: The results of studies found that the quality of hospital services significantly influences the level of patient satisfaction. The dimensions of satisfaction including tangible, reliability, assurance, responsiveness, and empathy have a significant influence on patient satisfaction, so hospital management should be able to fulfill the five dimensions of satisfaction. Efforts can be made to improve quality by identifying indicators of patient expectations and needs regarding comfort when accessing outpatient services at hospitals Conclusion: Assessment of patient needs can be evaluated by satisfaction surveys or by providing compliant services centers. Thus, the patient's expectations can be used as an improvisational study in optimizing available facilities, the reliability, and responsiveness of officers, as well as the attitude shown by officers toward outpatients at the hospital.

Factors Affecting Patient Loyalty of Outpatient of the Social Security Administrator Healthcare

The quality of hospital services is a crucial thing that can be a factor causing patients to be loyal or not. The results of the initial survey found that patients still experience dissatisfaction with the services provided by health workers. The aim of the study was to analyze the factors that influence outpatient BPJS Health Patient Loyalty at Bhayangkara Palembang Hospital in 2021. This quantitative study used a cross-sectional study design which was conducted at Bhayangkara Palembang Hospital which took place from July to August 2021. The study sample was 258 people Accidental sampling . Survey data were analyzed using the Chi Square test and logistic regression. Univariate results showed that the majority of respondents were aged 26-35 years, namely 107 (41.5%) respondents, female, 148 (57.4%) respondents, and had a high school education level, namely 130 (50.4%) ) respondents. Bivariate results There is an effect of image on outpatient Health BPJS Patient Loyalty, there is an effect of comfort on Outpatient Health BPJS Patient Loyalty, there is an effect of service on Outpatient Health BPJS Patient Loyalty, there is an effect of guarantee on Outpatient Health BPJS Patient Loyalty and the variables that have the most influence on Outpatient Health BPJS Patient Loyalty at the Palembang Bhayangkara Hospital in 2021 is a service variable. Suggestions in this study are that the results of this study can be used as input in making policies or standard operating procedures for effective services between health care providers and patients visiting the hospital.

The effect of Professional Nursing Practice Model Training (MPKP) with the implementation of Pillar IV Nursing Care Delivery System (Pillar IV NCDs) at a Hospital in Kotamobagu, Indonesia

Background: Professional Nursing Practice Model Training (Model Praktik Keperawatan Profesional; MPKP) is one of the efforts to improve the quality of service in hospitals in nursing services to minimize errors or omissions that can occur. The training carried out is expected to be able to improve the implementation of pillar IV NCDS in hospitals. Aims: This study aimed to determine the effect of MPKP training with the application of pillar IV NCDS at the General Hospital of the Evangelical Masehi Church Bolaang Mongondow Monompia Kotamobagu. Methods: This research is a quantitative research type with a pre-experimental research design one group pre-test post-test design. This research was conducted in August 2022 as many as 52 nurse respondents working at the Monompia GMIBM Hospital Kotamobagu. Results: From the survey, it shows that the intervention will increase the number of nurses implementing the Pillar IV Nursing Care Delivery System (Pillar IV NCDs) including the assessment element (from 76.9% to 90.4%), nursing diagnosis (from 36.5% to 75.0%), planning (from 51.9% to 88.5%), action or measurement (from 84.6% and 92.3%), evaluation (from 46.2% to 90.4%), and nursing care notes (78.8% and 98.1%). There are differences in the implementation of pillar IV NCDS before and after being given MPKP training (p-value: <0.001). it is known that education level and the work experience of the nurses will significantly determine the success of the training, respectively with p value of <0.001 and 0.004. Conclusion: From the survey, we may note how the Professional Nursing Practice Model Training (MPKP) affecting the number of nursing implementing the Pillar IV NCDs. Data from the results can be used as recommendation to the hospitals' human resources department in designing their program in order to increase the nurses' competences.

Literature Review: The Effect of Interpersonal Communication on Service Quality in Hospitals

Effective interpersonal communication between the hospital and the patient will provide maximum service quality results. This business will also have a positive impact. The quality of hospital services is not solely related to the completeness of medical equipment, but also relates to interpersonal communication between the hospital and the patient that is well established so that it will give satisfaction to the patient. In addition, it will also have the effect of healing and treating patients' illnesses which in principle depend on interpersonal communication in the form of advice, input, and empathy given by the medical team to bring to the patient. So that interpersonal communication is very influential on the quality of hospital services. The purpose of this study was to determine the effect of interpersonal communication on the quality of service in hospitals. The method used in this study is a literature review, where researchers use methods to be able to identify and review, evaluate and interpret previous research. The results showed that interpersonal communication has a positive impact on the quality of service in hospitals. The majority of people who use hospital services will also consider the interpersonal communication that exists between patients and hospitals, this is also related to the comfort provided by hospitals to patients.

The Influencing Factors of Customer Experience And Its Effect On Brand Equity In Seto Hasbadi Hospital Bekasi

<div><p><em>As consumers of health services, patients are increasingly aware of their rights and demand quality health services. The high quality of hospital services is expected to lead to satisfaction and positive patient experiences, which can positively affect the hospital's brand. Brand equity is a precious hospital asset to face a competition between hospitals. Seto Hasbadi Hospital faces stiff competition in Bekasi City with 40 other hospitals. In this study, Seto Hasbadi Hospital wanted to find out how the marketing activities affect the customer experience, which affects the Customer-Based Brand Equity (CBBE). This research uses marketing variables: physical environment, interpersonal care activity, technical process, administrative process, core services, service communication, access convenience, social responsibility, customer experience, and customer-based brand equity (CBBE). The number of samples in this study was 376 respondents with data analysis using Structural Equation Modeling with SmartPLS software. Marketing activities that positively and significantly impact customer experience are the physical environment, access, convenience, and social responsibility. The customer experience variable positively and significantly affects the Customer-Based Brand Equity variable. Because the R square value of the Customer-Based Brand Equity is very small, further research can look for other factors that can affect the brand equity of Seeto Hasbadi Hospital</em><em></em></p></div>

Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality - Learning from a Government-led Initiative.

Patient feedback plays a significant role in hospital service improvement. However, how to encourage patient feedback that can guide hospital service improvement is still being explored. By examining patient feedback data related to a tertiary hospital in China that was collected from the "12345" Government Service Convenience Hotline (GSCH), the paper discusses the learnings from GSCH in encouraging patient feedback and how quality improvement initiatives have effected the number and types of complaints made by patients and their families via GSCH. The study retrospectively collected and analyzed complaints on a Tertiary General University-affiliated hospital made via GSCH between 2016 and 2020. Patient care process-related complaints were coded using the health care complaint analysis tool (HCAT) and other complaint data were categorized based on the nature of the complaints. The autoregressive integrated moving average (ARIMA) models and mosaic plots were used to observe complaints trends and different complaint variables, respectively. The relationship between various quality improvement initiatives introduced since 2018 and patient complaints was also tested. Close to 67% (n=2688) of calls made to the GSCH hotlines about the hospital were classified as a complaint including 60.6% vs 39.4% related to patient care process and nonpatient care process, respectively. For patient care process-related complaints, specifically against departments and personnel, 57.72% (n=961) were on clinical departments and 55.87% (n=471) were on doctors. Comparing the proportion of the complaint data in different categories in the two-year period of 2017-2018 and 2019-2020, an increase in management problems (47.73% vs 58.50%, P<0.001) and decrease in relationship problems (33.65% vs 25.69%, P=0.002) were recorded. A unified, transparent, and impartial GSCH platform greatly encourages feedback from patients and families. Feedbacks provide evidence to guide health care organizations in improving the overall experience of patients and the quality of services that they provide.

The Effect of Lean Approach on Hospital Service Quality and Inpatient Satisfaction

Measurement of the service quality is very important, especially to improve service quality and get loyal customers in a private hospital using a lean service approach. This research aims to determine the effect of a lean service approach based on variables including overproduction, waiting time, transportation, excess processing, inventory, motion and satisfaction defects. This study used a quantitative method approach with a cross-sectional design. The population were treated in the inpatient ward of Malahayati Hospital, Medan. The sample size was 110 patients, determined by Rao formula. The sampling technique was a purposive sampling technique with inclusion criteria of patients who were hospitalized for more than three days on March 2021. Data obtained were analyzed with the logistic regression tests. The results showed all variable have significant effect on the inpatient satisfaction including over production (p = 0.019), followed by waiting time (p = 0.012), transportation (p = 0.011), excess processing (p = 0.017), inventory (p = 0.010), motion (p = 0.015), and satisfaction defects (p = 0.010). Based on multivariate analysis concluded that hospital service quality affects inpatient satisfaction based on the waste inventory (4.567 times) as the highest and waste transportation (2.786 times) as the lowest. This study has strongly suggested that the hospital management should maintain over production waste and other waste variables in order to improve the service quality.

Patient Safety Culture in a Tertiary Hospital: A Cross-Sectional Study.

Patient safety (PS) culture is the set of values and norms common to the individuals of an organization. Assessing the culture is a priority to improve the quality and PS of hospital services. This study was carried out in a tertiary hospital to analyze PS culture among the professionals and to determine the strengths and weaknesses that influence this perception. A cross-sectional descriptive study was carried out. The AHRQ Questionnaire on the Safety of Patients in Hospitals (SOPS) was used. A high perception of PS was found among the participants. In the strengths found, efficient teamwork, mutual help between colleagues and the support of the manager and head of the unit stood out. Among the weaknesses, floating professional templates, a perception of pressure and accelerated pace of work, and loss of relevant information on patient transfer between units and shift changes were observed. Among the areas for improvement detected were favoring feedback to front-line professionals, abandoning punitive measures and developing standardized tools that minimize the loss of information.