Beyond the Basics: Assessing the Dimensions of Health Center Services in East Idi Sub-district, East Aceh District

This study endeavors to assess the Quality of Health Center Services in East Idi District, East Aceh Regency, with a specific focus on the sub-district of East Idi. Utilizing a descriptive qualitative analysis, primary and secondary data were collected through observation, interviews, and documentation. The study employed data reduction, presentation, and conclusion as analytical techniques. Findings revealed shortcomings in the physical evidence aspect (Tangibles) of the UPTD Puskesmas Idi Timur, East Aceh Regency, concerning inadequate facilities and infrastructure. The reliability of the health center service process was deemed unsatisfactory due to undisciplined and unprofessional staff. However, responsiveness scored well, with puskesmas staff demonstrating alertness and receptiveness to community inquiries. Guarantees, ensuring convenience in obtaining health services, were positively acknowledged. Employees' empathy received favorable assessments, showcasing a friendly demeanor and openness to public feedback.Despite these positive aspects, the study reiterated concerns about the unreliability of health center staff, emphasizing the need for discipline and professionalism. While responsiveness and guarantees were praised, continuous efforts are required for sustained improvement. The overall emphasis is on enhancing the quality of health services by addressing the identified areas of deficiency and promoting a culture of professionalism and empathy among health center personnel.


Introduction
Quality is a standard that must be achieved by a group or institution or organization regarding the quality of human resources, quality of work methods, processes and work results in the form of products or services (Bell et al., 2012;Harvey & Green, 1993).Services can basically be defined as the activities of a person, group or organization either directly or indirectly to meet needs.Moenir said that service is a process of fulfilling needs through the activities of other people directly.In this service standard there are also service quality standards (Nurhadi, 2021).Meanwhile, quality is a dynamic condition associated with products, services, people, processes and the environment that meet or exceed the expectations of those who want it.
Policy Public service is a process of helping others in certain ways that require sensitivity and interpersonal relationships to create satisfaction and success.Every service produces a product, both in the form of goods and services (Birkland, 2019;Hill, n.d.;Hill & Varone, 2021) The quality of puskesmas health services in the context of fulfilling the needs of public health services is determined by two factors.The first is the puskesmas factor which is related to the quality of health services and patient satisfaction.That is, as long as the quality of health services meets patient satisfaction, then the level of conformity will be high and the community will need puskesmas.The purpose of conformity is that there is a similarity in purpose, the puskesmas can provide good service to the community and the community receives services in accordance with expectations.Conversely, as long as the quality of health services does not meet the level of patient satisfaction, the level of conformity will be low, resulting in community health centers being abandoned.
The quality and satisfaction of puskesmas services are important, interconnected.Health center as a health service provider requires HR human resources, who are able to provide quality services for the community, because patient satisfaction depends on the quality of service.A service is considered a patient-defined high-quality service.The services provided are in accordance with the needs and expectations of the patient.Puskesmas can also provide quality services, of course, always trying to improve optimal health services for the whole community.With the Health Center Health Center is very beneficial for families who can not afford.Because it can provide the needs of qualified community services, namely health services that are easy to reach.The health center has the following functions: a. Center for driving health-oriented development b.Family and community empowerment center c.First stratum health service center The Puskesmas has a special treatment room, namely the Emergency Room Service (ER) which is a part of the hospital that provides initial treatment for patients who suffer from illness and injury, which can threaten their survival.Every hospital must have an emergency room that provides medical services 24 hours a day.The ER applies a priority treatment system based on the emergency level of the patient's condition.Here is the explanation: Category I Need immediate help:People who need immediate treatment and must be treated by the medical team after arriving at the ER, are categorized as patients with critical, life-threatening conditions.
1. Category II Emergency:Patients in critical condition and in great pain, eg patients with severe chest pain, difficulty breathing or severe fractures, and seizures.
2. Category III Potentially worsening:People who need treatment for at least 30 minutes upon arrival at the ER, are in the important or urgent category, namely patients with serious conditions such as heavy bleeding, ordehydrationheavy.Based on Figure 1.1 above, it can be seen that the scheme of the UPTD service queue system for the East Idi Health Center in East Aceh Regency starting with the patient arriving and taking the queue card, then the patient waits in the waiting room, then the patient will be called according to the queue number, then the patientreceive services, namely examination in the doctor's room, followed by taking medicine and finally the patient is allowed to go home.The total number of personnel by profession in the field of service is 72 people with a total of 1 General Practitioner and also 1 Dentist who are trying to be able to provide and improve good service.Meanwhile, it can be seen from the condition of the East Idi community in East Aceh Regency with a population of 7,257 people in 2022 with various economic levels, there are still many people who need the services of the puskesmas.Where researchers have conducted research to prove that there is true data at the beginning where, in the aspect of Physical Evidence (Tangibles) it is not sufficient, such as service equipment where the facilities and infrastructure are inadequate as in medical devices, such as Dental Units for examining damaged teeth, Instrument Sets for tools for examination or surgery if a patient is injured, First aid services must be provided so that treating patients is faster and accurate, checking toolsuch as Blood Sugar Sticks, Cholesterol Sticks, and Uric Acid Sticks which often run out to be one of the main complaints of patients at the health center who should be provided more from the center, medicines that are sometimes unavailable or incomplete which causes patients to have to wait for the drug stock to arrive, AndThe puskesmas rooms also need air conditioning or fans because the puskesmas rooms are not available so that employees often feel hot and uncomfortable.In the Reliability aspect, it is classified as unsatisfactory, in which the discipline of medical personnel is not disciplined, employees still come and go home not according to predetermined working hours and sometimes the puskesmas staff is not in place during working hours.This makes people have to wait to get health services.In the aspect of Responsiveness (Responsibility) is adequate where employees will explain and answer all public questions and will provide solutions or suggestions regarding questions asked by the public, employees also listen to or respond to criticism and suggestions given by the public.In the aspect of assurance (assurance) is adequate whereprovide good service and in accordance with applicable rules or procedures, Puskesmas employees also provide information clearly and use language that is easily understood by the community, Puskesmas employees also listen to complaints and criticism from the community.In the aspect of Empathy, it has been well implemented, seen from the attitude of the employees who are friendly and kind, and the officers will also ask patients or the community what they need and help by directing or explaining so that the community understands.The assessment of service quality as measured by empathy has been running according to community expectations.

Category IV
Then the problem is wherethe puskesmas building which has many cracks, there are several rooms whose cracks are so severe that they cannot be reused and the puskesmas also lacks rooms for general poly-policies according to their respective expertise to make it easier for employees to serve.
Based on the formulation of the problem that has been put forward by the author, in this case the aim of the research is to find out how "Quality Health Center Services in East Idi District, East Aceh Regency".

Literature Review
It aims to provide a comprehensive overview of the current state of knowledge in a particular field, identify gaps, and highlight areas for further research.

Service
Service basically has a definition as the activity of a person, group or organization either directly or indirectly to meet needs.Service is an activity or a series of activities that are invisible (cannot be touched) that occur as a result of interactions between consumers and employees or other things provided by service-providing companies intended to solve consumer/customer problems.(Hakim, 2017)

Elements of Public Service
According to Zeithaml, Berry and Parasuraman (Parasuraman et al., 1988;Zeithaml et al., 1990) which identifies five groups of characteristics used by consumers in evaluating the quality of services, including: a. Tangiable(Physical evidence), an observable and tactile service.Infrastructure that is required for the service process and is displayed in a variety of ways by the provider.Customer satisfaction will be significantly impacted by aspects of the physical look offered.b.Reliability(Reliability), consists of the capacity to deliver satisfactory services in a timely and accurate manner as well as dependability that is exercised with caution, courtesy, and grace.. c.Responsiveness(Responsiveness), consist of the officers' commitment to providing prompt, courteous service to clients and their professionalism at work.d. assurance(Guarantee), covers the legality of the service and the officers' reliability so that clients are relieved of risk and uncertainty about danger.e. Empathy(Empathy), Including consideration for comprehending the requirements of clients, convenience in communication, and nondiscrimination against clients.The public service process is supported in its progression by a number of aspects or components.. Based on the explanation above, it can be concluded that the elements of public service are the process system in service procedures and methods, personnel, facilities and infrastructure, and the community as customers.

Principles of Public Service
Public services are carried out in a series of integrated activities that are open, simple, smooth, precise, complete, reasonable and affordable.(Suhartoyo, 2019).Therefore, it must contain the following principles: a.The rights and obligations of the giver and the recipient of public services are also clear and can be known by everyone.b.Arrangements in each public service must be adjusted to the needs and affordability of the community based on the rules that have been stipulated in existing laws while ensuring efficiency.c.The quality of products and results of public services must strive to always ensure security, comfort, transparency, and guarantees of legal certainty that can be calculated.d.If the public services requested by government agencies are expensive, the government agencies involved are obliged to provide opportunities for the public to participate in their organizations in accordance with existing laws and regulations.

Public Service Standards
Service standards are uniform measures or specifications that are mandated in public administration and that service providers (government) and service users (community) must adhere to (Oktoria et al., 2020).Every public service implementation needs to have published service standards as an assurance of the certainty of the services provided (Stewart & Walsh, 1992).The range of minimal requirements for public services that will be decided upon includes: a. Service Procedures: standard procedures for services must be established, including procedures for complaints (Brennan & Douglas, 2002).b.Time of completion: A typical service completion period, encompassing complaint procedures, must be determined (Bottani & Rizzi, 2006).c.Product and Service Standards: The standards and outcomes for products and services must be established based on the predetermined parameters (Stufflebeam, 2000).d.Service Charge: To enhance the quality of services, rates and service fees must be established with explicit facts about the services' delivery method included in the framework (Berry, 1995) f.Officers who provide services have competence, that is, have the ability and skills and have an attitude in providing services.Based on what has been said above, it can be concluded that there are six public service standards, namely procedures in service, turnaround time, service products, service fees, infrastructure facilities, and service officers who have competence.

Service quality
In Zaenal Mukarom and Muhibudin Wijaya Laksana (Mukarom & Laksana, 2015a, 2015b) Quality is a special form of a production or service that has the ability to satisfy people's needs.Quality of service is also an activity provided by public service providers who are able to provide services and can fulfill expectations, desires and needs and can be able to provide satisfaction to the community.According to Joseph M. Juran (Juran, 1992(Juran, , 2003) ) defines quality as: "Quality as suitable / suitable for use (fitness for use), which implies that a product or service must be able to fulfill what is expected by the wearer".
Public service can be interpreted as providing services (serving) the needs of people or communities who have an interest in an organization and this is done in accordance with the basic rules and regulations that have been determined and these interests come from the needs of the people or the community (R. B. Denhardt & Denhardt, 2000;J. V Denhardt & Denhardt, 2015).
Public services consist of two categories, namely basic services (substantial) and administrative services.These basic services concern basic human needs, example education, health, infrastructure, etc.While administrative services regarding services in data collection as a consequence of status as a citizen, for example, such as KTP, Family Card, permits in business, etc.
In service quality has six main principles including (Stamatis, 2018): a. Leadership.
The quality strategy in a company must have initiative and commitment from top management (Ahire & O'shaughnessy, 1998).Top management must lead the company to improve its quality performance.Without leaders and top management, improving quality has little impact on the company.b.Education All personnel working in a company must receive quality education.Aspects that need to be emphasized in this education include several quality concepts as business strategy, implementation tools and techniques, quality strategy, and the role of the executive in implementing quality strategy (Breyfogle III et al., 2000).c.Planning In the strategic planning process includes measurement and quality objectives used in directing the company to achieve its vision (Falshaw et al., 2006).

d. Reviews
The review process is the single most effective tool for management to change organizational behavior (Sims, 2002).This process is a mechanism that guarantees consistent attention in achieving quality goals.e. Communication Communication is very important in a company (Spaho, 2011).Communication must be carried out with all employees, customers and other company stakeholders.f.Awards and recognition Rewards or recognition are important in implementing a quality strategy (Allen & Kilmann, 2001).As every employee who achieves needs to be given an award and the achievement is recognized.That way it will increase motivation, work morale, and a sense of pride in the organization, which ultimately makes a major contribution to the consumers served.

Definition of Health Center
In order to take the position of hospitals and clinics, which are in charge of people's health, Puskesmas are community health facilities situated in subdistricts (Rantung et al., 2021).As a healthcare facility, this puskesmas has contributed to preserving and enhancing the general state of community health (Anita et al., 2016).In charge of carrying out health development in a work area is Puskesmas, a technical implementation unit of the district/city health office.In order to take the position of hospitals and clinics, which are in charge of people's health, Puskesmas are community health facilities situated in subdistricts.As a healthcare facility, this puskesmas has contributed to preserving and enhancing the general state of community health.In charge of carrying out health development in a work area is Puskesmas, a technical implementation unit of the district/city health office (Anita et al., 2016;Laksono et al., 2019) The goal of health development organized by the puskesmas is to support the achievement of national health development goals, namely increasing awareness, willingness and ability to live as well as for people who live in the working area of the puskesmas so that the highest degree of health is realized (Adisasmito, 2007;Sulaiman, 2021)

Research methods
To ensure that the provisions provided allow for the achievement of all goals, primary and secondary data were the basis for the research methods employed in this study, which employed a qualitative approach and a descriptive analysis research design.Observation, interviews, and documentation are the methods used to acquire data.Techniques for analyzing data involve data reduction, data visualization, and conclusion or confirmation (Miles et al., 2014).

Results and Discussion
1) Overview of the research location.
West Seuneubok hamlet, East Idi District, a subdistrict of East Aceh Regency, is the site of this study.In the East Aceh District, there are 7,257 thousand people living there, including 3,102 men and 4,155 women.
2) Organizational structure of UPTD Idi Timur Health Center 2023 3) Based on the results of field research it is known that the quality of service at the UPTD puskesmas is measured according to Zeithaml, Berry, and Parasuraman to find out the quality of service that consumers have actually felt, there are indicators of service quality that lie in the dimensions of service quality, namely: a. Tangibles(Physical Evidence) Is convincing proof of the consideration and care that service providers give to their clients.When analyzing the quality of UPTD Puskesmas services, especially for new customers, the tangibles component is crucial since it will help to build the company's reputation (Nadapdap & Afriani, 2022).Neglecting to consider physical quality could lead to confusion or even harm the company's established reputation.
Based on the study's findings, issues were identified in the field, specifically with the physical facilities and infrastructure at the puskesmas.These issues included the lack of completeness in medical devices, such as damaged dental units needed for examinations, instrument sets for use during exams or surgery if a patient is injured, the need for first aid services to treat patients more quickly and accurately, the frequency with which patients at the health center complain about blood sugar, cholesterol, and uric acid sticks, among other things, and the fact that the center should provide more medications.

b. Reliability(reliability)
Relates to the business's capacity to deliver services exactly as promised.In the event that the services rendered do not meet the expected standards, customer satisfaction would suffer (Zeithaml et al., 1990).The capacity of the business to offer services suitably and, in this instance, satisfy client expectations, is what makes up the reliability component..The medical staff's lack of discipline, their irregular work schedules, and the fact that some employees of the puskesmas occasionally failed to report for duty during regular business hours resulted in patients having to wait for medical personnel who were supposed to provide care, according to the researchers' analyses of the puskesmas.These results were still deemed inadequate.

c. Responsiveness(Responsiveness)
One way of gauging the quality of a service is by looking at how responsive and aware a service officer is when serving customers.In order to relate pertinent informant messages to specific service demands, this dimension-which aims to assist service users-will quickly and appropriately deliver services.Additionally, employee attitudes can have a big impact on responsive service (Nishii et al., 2008).An essential component of this is being watchful and truthful when answering the community's inquiries and demands..It is evident from the study's findings that workers at the East Idi Health Center in the Idi Timur District of the East Aceh Regency were either competent or offered services that were enough.In addition to explaining and responding to any inquiries from the public, staff members will also offer recommendations or answers.
Staff members also hear feedback and ideas from the general public and consider them.

d. Assurance
To build customer trust in puskesmas, employees must demonstrate assurance and certainty by their expertise, demeanor, and abilities.A guarantee is necessary for every service that is provided.The skills and expertise of employees are required in order to improve good and quality service through service assurances.UPTD Puskesmas Idi Timur, Idi Timur District, East Aceh Regency, is deemed sufficient based on the results of the research conducted.The Puskesmas employees adhere to applicable rules and procedures, provide good service, and use easily understood language when providing information to the community.Additionally, the Puskesmas employees listen to community complaints and criticism..

e. Empathy(Empathy)
Good, kind service should be the hallmark of an empathic mindset.If service personnel treat customers with kindness and without discrimination, they will be satisfied.In this manner, customers will feel more at ease, much like a smiling service representative who inquires about their needs.. Officers who exhibit a friendly and kind demeanor are likely to have demonstrated a high degree of empathy, according to the study's findings.In addition, officers will inquire about the needs of patients or the community and provide assistance by guiding or clarifying concepts so that the public is aware of them.Consistent with community expectations, the evaluation of service quality based on empathy has been conducted.
f. Building Public health services are provided via government-owned infrastructure, one of which is the Puskesmas building.One of the things that helps make an activity to realize a goal or function to be accomplished happen is building infrastructure.Therefore, in order to achieve the goals of quality health care, building maintenance is crucial.Therefore, achieving the goals of quality health services depends in large part on building upkeep..According to the study's findings, despite the Puskesmas's lack of rooms, several of its rooms were unusable because of several problems, including cracks in the structure and its rooms.As a result, the Puskesmas had an inadequate amount of rooms.The delivery of health care is negatively impacted by this.

1) Inhibiting Factors for UPTD Health Center Services
There are various challenges facing the UPTD of the East Idi Health Center, East Idi District, East Aceh Regency.It is clear from the above interview results that the discipline-related barriers that exist at the UPTD Puskesmas Idi Timur, Idi Timur District, East Aceh Regency Lack of discipline among Puskesmas staff members and their irregular schedule for coming and going from work make it difficult to deliver quality service.Inadequate facilities and infrastructure include medical equipment, health check kits with frequently running out supplies like uric acid, cholesterol, and blood sugar sticks, and medications..Because the Puskesmas rooms are unavailable and employees frequently feel warm, the Puskesmas rooms also require air conditioning or fans.The Puskesmas building has also sustained significant damage, including numerous rooms with severe cracks that prevent them from being reused.Additionally, the Puskesmas lacks rooms designated for general poly-policies based on their respective areas of expertise, which would facilitate employee service.
Facilities will be the primary instrument to help expedite the completion of projects.The foundation for the community's satisfaction with these services is the availability of infrastructure and facilities to deliver fundamental and auxiliary services throughout the service process.Inadequate facilities and infrastructure can make it challenging for service officers to fulfill their responsibilities, which in turn hinders the provision of highquality public services that meet community demands.
The UPTD of East Idi Health Center, East Idi District, East Aceh Regency is working to address a number of challenges in the provision of public services, including talking with the East Aceh district head about how to enhance infrastructure and facilities.Regarding these efforts, the process entails obtaining data on infrastructure and facilities, organizing infrastructure and facilities, and then submitting bids for construction additions and repairs.

Conclusion
Based on the problems raised in this study, several conclusions can be formulated as follows: 1. Tangibles(Physical Evidence)inadequate, such as service equipment where the facilities and infrastructure are inadequate as in medical devices, such as Dental Units for examining damaged teeth, Instrument Sets for tools for examination or surgery if a patient is injured, First aid services must be provided so that treating patients is faster and accurate, checking toolsuch as Blood Sugar Sticks, Cholesterol Sticks, and Uric Acid Sticks which often run out to be one of the main complaints of patients at the health center who should be provided more from the center, medicines that are sometimes unavailable or incomplete which causes patients to have to wait for the drug stock to arrive, AndThe puskesmas rooms also need air conditioning or fans because the puskesmas rooms are not available so that employees often feel hot and uncomfortable.2. reliability(reliability)classified as unsatisfactory, in which the discipline of medical personnel is not disciplined, employees still come and go home not according to predetermined working hours and sometimes the puskesmas staff is not in place during working hours.This makes people have to wait to get health services.3. Responsibility(Responsiveness), seen from the aspect of responsivenessprovide good service and in accordance with applicable rules or procedures, Puskesmas employees also provide information clearly and use language that is easily understood by the community, Puskesmas employees also listen to complaints and criticism from the community.4. assurance(Guarantee), seen from the aspect of ability and attitude in providing services.Internal medicsprovide good service and in accordance with applicable rules or procedures, puskesmas employees also provide clear information, puskesmas employees also listen to complaints and criticism from the community.5. Empathy(Empathy), it has been well implemented, judging from the friendly and kind attitude of the employees, and the officers will also ask patients or the public what they need and help by directing or explaining so that the public understands.6.The Puskesmas building is inadequate, where the Puskesmas building needs improvement for convenience in providing health services.

Recommendation
Based on the above conclusions, the following suggestions can be submitted: 1.
To obtain or support optimal service, facilities and infrastructure must be completed immediately, such as the Puskesmas building, poly rooms, Dental Units, Instrument Sets, medicines, and other health check tools so that the UPTD Idi Timur Health Center medical services can be can be carried out effectively and efficiently.2.
For puskesmas employees, it is better to carry out a thorough and periodic evaluation and monitoring of performance so that there will be improvements in terms of discipline.needs to be increased again so that they are more responsive in carrying out their duties, this must be done immediately so that the medical services provided can be carried out properly.

3.
In terms of service, the Puskesmas is also expected to improve reliability to provide services accurately, by providing services according to the schedule set by the Idi Timur Puskesmas, the attitude of the officers also needs to be improved.4.
Puskesmas employees need to have a place or container for suggestions and criticism from service users regarding the services provided by the Puskesmas, in the form of suggestion boxes, via SMS, telephone provided at each Puskesmas, as well as socialization regarding the programs provided by the Puskesmas.Puskesmas, with socialization can become even more with the community.5.
Puskesmas employees need to provide health services to patients quickly, precisely and provide information as clearly as possible, this is intended so that the community feels satisfaction in health services at the UPTD Puskesmas Idi Timur, by providing services according to the Minimum Service Standards (SPM) and Standards Service Procedure (SOP).
Serious condition but not emergency:Patients with moderate injuries or symptoms, for example patients with foreign bodies that enter the eye without any change in visual acuity, ankle sprains, migraines or earaches.4. Category V Not urgent: Patients with minor injuries or symptoms, which have been experienced for more than a week, such as a rash or mild aches and pains, fall into the fifth category or non-urgent conditions.Schematic of the Idi Timur UPTD Service Queue System source: UPTDEast Idi Public Health Center, East Aceh District, 2022.

Figure 4 . 3
Figure 4.3 Organizational structure of the East Idi Health Center UPTD 2023

Table 1 .2 Service Time UPTD East Idi Health Center
From table 1.2 it can be seen the service time inUPTDEastern Idi Public Health Center, East Aceh District.However, this has not been implemented properly.So therefore the need for employee orderUPTDEast Idi Public Health Center in East Aceh District in workers.UPTDEast Idi Public Health Center in East Aceh District who want to seek treatment, therefore good service is needed in terms of service and in terms of service delivery.
. e. Infrastructure and Facilities: Public service providers provide infrastructure and facilities at an acceptable standard (Bennett & Iossa, 2006).f.The proficiency of service people should be assessed by establishing the necessary criteria for knowledge, abilities, attitudes, and conduct (Ten Cate & Taylor, 2021).According to the Minister for Empowerment of the State Apparatus Number 63 of 2003 concerning Public Service Standards.The service standards are: a.The service procedure is simple and uncomplicated.b.Exact Completion Time based on a predetermined schedule.c.Service fees do not burden service users.d.Service products have high quality services that meet the needs and expectations of service users.e. Facilities and infrastructure function to support the smooth process of service, including form certificates.