PHYSICIAN PERFORMANCE ANALYSIS BASED ON INDIVIDUAL , PSYCHOLOGICAL AND ORGANIZATIONAL FACTORS IN MEDICAL RESUME FILLING

Correspondention Author: Sayyidah Mirfat, Master of Hospital Management Faculty of Medicine Universitas Brawijaya, Email: sayyidah. mirfat11@gmail.com DOI: http://dx.doi.org/ 10.21776/ub.jam.2018. 016.03.17 Data and information available in medical record documents are one of the parameters to assess the quality of health services in hospitals. Indicators of good and complete medical records that are the completeness of contents, accurate, timely and fulfillment of legal requirements aspects(Lihawa and Mansur, 2015). The complete medical record is a medical record that has been filled in entirely by the doctor in less than 24 hours after completing outpatient services or after an inpatient is decided to go home(Depkes RI, 2002).Incomplete medical records can have inaccurate information(Ridho, et al., 2013).Completeness of medical records of inpatients in Dr. RSUD Moewardi Surakarta in April 2008 totaled 256 incomplete documents from a total of 2901 documents(Rahmadhani, Sugiarsi, and Pujihastuti, 2008). Abstract: This study aims to determine the influence of Individual, psychological and organizational factors on the performance of physicians in the medical resume completeness.The research design is observational research with a cross sectional approach. The population of this study is all physician who becomes a doctor in charge of serviceand medical resume documents that are the responsibility of the physician. The instrument in this study was a questionnaire given to the physician. Partial Least Square (PLS) was used as data analysis method.The results showed that 34.4% of respondents had complete medical resume <50%. Also, some doctors did not know the importance of a medical resume in National Health Insuranceera. Psychological factor has the most significant direct effect coefficient on physician performance with immediate effect coefficient of 0.334.The conclusion of this studyare the Individual factors had a negative but not significant effect on physician performance,psychological factors have a negative and significant impact on physician’s performance,and organizational factors have a positive but not significant impact on physician performance. The hospital should facilitate a gathering event for doctors and facilities for external training for doctors can be awarded as rewards to the best performing physician.

Baptis Hospital at Batu is one of the C type public hospitals in Batu City.This hospital has a patient bed capacity of 134 TT (beds) and has been accredited in the 2012 version of the KARS (Hospital Accreditation Commission) with the title of plenary graduation.Baptis Hospital at Batu has been working with BPJS since January 1, 2014.One indicator of service that has not been reached at Baptis Hospital at Batu is the completeness of filling in medical records 24 hours after completion of service amounting to 77.23% of the standard 100% (January-December 2016 period).The incompleteness of this medical record has resulted in a decrease in the quality of medical records and legal aspects of medical records.
In the era of National Health Insurance, Medical Resumes are important because they are one of the requirements for National Health Insurance claims (BPJS Kesehatan, 2014), so that a preliminary study is conducted regarding the completeness of the Medical Resume.The results of the preliminary study at Baptis Hospital at Batu in January 2017 obtained medical record unit evaluation data in December 2016 from 465 Medical Resumes totaling 100 files that were not filled.Lack of Medical Resume completeness makes BPJS claims late so that it can disrupt hospital finances.Doctor In Charge Of Service is a person who is required to complete a Medical Resume.Completeness of the Medical Resume is one indicator of Physician Performance.This shows that Physician Performance in filling Medical Resumes is still not standardized and needs to be improved.Gibson, Ivancevich dan Donelly (1997),states that there are three variables that affect individual performance consisting of different variables (abilities and skills, experience and demographics), Organizational variables (resources, supervision, rewards, structure, and job design), and Psychological variables (perception, attitude, personality, learning, and motivation).
The results of the interview with the medical record officer obtained information that the Medical Resume was completed by the Doctor In Charge Of Service itself after the patient was declared home.Doctor In Charge Of Service guest is the most significant contributor to Medical Resume incompleteness.Guest doctors, most of whom are permanent doctors at other hospitals, come to the Baptis Hospital at Batu, not every day.When there are not many guest Doctors In Charge Of Service, so they are often in a hurry when they have to complete the medical record, especially the Medical Resume.This study aims to determine the effect of Individual, Psychological and Organizational factors on Physician Performance in the completeness of Medical Resume filling at Baptis Hospital at Batu.

METHOD
This research is quantitative research.The research design was an observational study with a cross sectional approach.The study was conducted at the Baptis Hospital at Batu.The time for the study began from March-May 2017 with a preliminary study in January 2017.The population of this study was all doctors (specialist doctors and general practitioners) who became a doctor in charge of service and treated patients in the Baptis Hospital at Batu, with a total of 32 doctors and Medical Resume documents that are the responsibility of the doctor.The research sample for doctors was determined by the total sampling method.The Medical Resume which is the responsibility of the doctor during the study (March-May 2017) will be sampled with a simple random sampling method.
The method used by giving a questionnaire to doctors to determine the influence of Individual, Psychological and Organizational factors on Physician Performance in completing the Medical Resume.Interviews and observations were also carried out to support the results of the study.Independent variables measured included individual physician factors, physician psychological factors, and hospital organizational factors.

Characteristics of Respondents
Characteristics of respondents in this study indicate that most of them are aged 31-40 years.The gender of the respondents has a similar comparison between men and women.Most respondents are specialist doctors, contract employment status and less than five years of employment.The majority of doctors have good knowledge about medical records regarding legal aspects, benefits, and people who have the right to fill medical records.Perception of the doctor's ability to complete the Medical Resume in the moderate category.Then the average Psychological factor variables are in a good category indicating that doctors tend to agree with statements in variable X2.The perception indicator of work has the lowest average value  shows that there are still doctors who do not know the benefits of Medical Resumes in the National Health Insurance era.

Data Analysis Results
The results show that the knowledge indicator (X1.1) has a loading value of 0.861 and the ability indicator (X 1.2) is 0.788.This means that knowledge is the dominant indicator in measuring individual factor variables.Then among the variables of Psychological factors, personality has the highest loading value of 0.806.This means that personality is the dominant indicator in measuring Psychological factor variables.Furthermore, the Organizational factor variable measurement model also informs that supervision has the highest loading value of 0.799, so it is the dominant indicator in measuring Organizational factor variables.The path diagram of this research model is presented in Figure 1.   through the most significant direct effect coefficient.
The results of the analysis inform the variables that have the most significant direct effect coefficient on Physician Performance are Psychological factors with a direct effect coefficient of 0.334.This shows that Psychological factors are the most influential variables or have a dominant influence on Physician Performance.

Characteristics of Respondents
The majority of doctors at Baptis Hospital at Batu who are respondents are classified as a very productive age of 15-49 years, with a service period of 0-5 years.Long working as a doctor, makes doctors increasingly understand their responsibilities.The longer the doctor works, it is hoped that more and more will realize the benefits of filling medical records (Akbar and Kirana, 2012).The level of education and length of work a person influences the performance of an employee (Faizin, 2008).

Data Analysis Results
Individual factors have a negative effect but not significant on Physician Performance.This means that the better the Individual factor is less likely to reduce Physician Performance, but the The influence of Individual factors on Physician Performance produces t-statistics of 0.197.Thus it means that there is no significant influence of Individual factor variables on Physician Performance.Furthermore, the influence of Psychological factors on Physician Performance produces tstatistics of 4,502, which means that there is a sig-nificant influence of Psychological factor variables on Physician Performance.Then the third variable, namely the influence of Organizational factors on Physician Performance produces t-statistics of 0.211, so it can be interpreted that there is no significant effect of Organizational factor variables on Physician Performance.

Dominant Influence
Exogenous variables that have a dominant influence on endogenous variables can be known decrease is not significant and vice versa.The results of this study are different from the results of the study by Palumbo,et al. (2005),which states that cognitive abilities and work knowledge are positively correlated with one's performance.This is also not in accordance with the results of the studyJaya (2012),which revealed that workability had a significant effect on the performance of employees of the Tanjung Jabung Barat District Education Office.
This is probably since most doctors at Baptis Hospital at Batu are guest doctors, so even though the knowledge of medical records and the ability to be able to complete medical records, especially Medical Resumes is good, the performance is not good.Medical Resume Charging requires sufficient time while doctors often have limited time because they have to handle many patients.Doctors have three practice places when finished providing services to patients the doctor tends to leave the place immediately because they have to work immediately in another place.When patients have to be served at the Baptis Hospital at Batu quite a lot, doctors tend to delay to complete the Medical Resume.
Psychological factors have a negative and significant effect on Physician Performance.This means that the better the Psychological factors will reduce Physician Performance, and vice versa.Psychological factor variables (X2) have four indicators, namely attitude, personality, learning, and motivation.This result is as stated by Margareth (2013),that motivation has a negative influence on employee performance.But this result is not in accordance with the results of the studyIndriana, Natajaya dan Sunu (2014),that is there is positive and significant influence between teacher attitudes toward their profession and teacher performance.
Many studies have stated that Psychological factors have a positive effect on performance.This study provides different results compared to previous studies.This is probably due to Physician Performance at Baptis Hospital at Batu is not directly influenced by Psychological factors of doctors.The results of interviews with respondents stated that most doctors, especially guest doctors, did not in-tentionally complete the medical record documents including the Medical Resume due to dissatisfaction with the hospital.Some doctors assume that the hospital does not fulfill the doctor's wishes, such as service facilities, facilities for training, and communication between doctors and hospital management.Brahmasari dan Suprayetno (2008),stated that job satisfaction has a positive and significant effect on performance, which means high job satisfaction will improve performance.Conversely, low job satisfaction will reduce performance, such as conditions at Baptis Hospital at Batu.
Research conducted byNur (2013)provide results that conflict and work stress negatively affect employee performance, meaning that the higher the level of conflict that has a negative impact on performance.Also, the higher the job stress level of employees will have a negative impact on improving employee performance (Nur, 2013).This is like the conditions at Baptis Hospital at Batu, some guest Doctors In charge Of Service feel the management cannot fulfill their needs.Conflict arises between hospital management and specialist doctors, which results in a decrease in Physician Performance including in completing the Medical Resume.
Research on nurse performance in Namibia shows that several factors can negatively affect performance, namely lack of recognition of employees who work well, quality of work, lack of a formal performance appraisal system and poor working conditions.Most hospitals in Namibia do not provide special rewards for nurses with good performance.The compensation system applied is not based on performance, so most nurses feel that their hard work is not recognized.Also, a high workload, a limited number of human resources and a less conducive work environment also have an impact on the decline in nurses' performance.(Awases, Bezuidenhout and Roos, 2013).
Another factor that might affect is the doctor's limited time to complete the Medical Resume.Although the doctor's psychological factors (attitudes, personality, learning desires, and motivation) are good, because of a large number of patients who have to be served at the polyclinic, the patient is hospitalized and must go to another practice at an-other hospital, so the doctor cannot complete the Medical Resume.Also, some specialist doctors cannot be visited every day, so that a new Medical Resume will be filled when the doctor visits/practices at Baptis Hospital at Batu.
Organizational factors have a positive but not significant effect on Physician Performance.This means that the better the Organizational factor is the tendency to improve Physician Performance, even though the increase is not significant.Organizational factors studied consisted of resources, leadership, rewards, organizational structure and work design.The results of this study mean that the Organizational factors offered by Baptis Hospital at Batu have been able to improve Physician Performance.The dominant indicator of Organizational factors from the results of this study is a supervision indicator provided by Baptis Hospital atBatu to doctors, which consists of periodic guidance on Medical Resumes and reprimand when filling out a Medical Resume is incomplete.
Job satisfaction and work quality of employees can differ from one another.This difference can be influenced by the Organizational climate where the Individual works.If the Organizational climate is perceived positively, it will create a sense of comfort in work, and there will be a sense of satisfaction in work which will ultimately produce good quality work.On the contrary, employees who perceive Organizational climate negatively will appear boredom at work, decreased work enthusiasm, so that work productivity falls and finally good work quality cannot be achieved perfectly (Idrus, 2006).
Organizational factors can affect Psychological factors.Koesmono (2007),stated that leadership and task demands had a positive effect on Organizational Commitment.Besides, that leadership and task demands have a positive effect on work stress, while work stress has a positive effect on job satisfaction (Koesmono, 2007). Hughes, et al. inKoesmono (2006),states that in a worker two things can provide motivation, namely the problem of compensation and hope.Provision of compensation can have a negative impact if the implementation is unfair and inappropriate which in turn causes dissatisfaction with employees.The size of the compensation given to employees should depend on the size of the contributions and thoughts conveyed by workers to the company (Koesmono, 2006).Research conducted byKoesmono ( 2006),provides results that Organizational culture has a direct effect on motivation, job satisfaction, and employee performance.
The results of an insignificant analysis are likely to occur because of the minimal sample size.Also, most of the facilities at Baptis Hospital at Batu are given to permanent doctors, such as facilities for external training.Most doctors complete the Medical Resume that is not complete in the polyclinic, so it feels uncomfortable.Besides that, medical committee meetings were only attended by permanent doctors and general practitioners with contract status, so that the visiting specialist doctors who were the majority of doctors at Baptis Hospital at Batu could interact with their colleagues and submit complaints to the hospital management.
The limitations of this study are the results of the R-square variable Physician Performance shows that the contribution of Individual factors, Psychological factors, and Organizational factors to Physician Performance is 11.1%, while the remaining 88.9% is the contribution of other variables not discussed in this study.

CONCLUSIONS AND RECOMMENDA-TIONS Conclusion
Based on the results of this study it can be concluded that Individual factors have the negative but insignificant effect on Physician Performance in the completeness of Medical Resume filling, with knowledge indicators as the dominant indicators.Furthermore, Psychological factors had a negative and significant effect on Physician Performance in completing the Medical Resume.Psychological factors are the dominant variables in influencing Physician Performance in MedicalResume completeness at Baptis Hospitalat Batu, with personality as the dominant indicator.Then the Organizational factor had a positive but insignificant effect on Physician Performance in the completeness of the Medical Resume filling, with the supervision indicator as the dominant indicator.

Recommendation
Somethings that might be applied include the hospital facilitates gathering events for doctors so that the interaction between doctors can be well established, medical committee meetings can take time on weekends or evenings so the majority of doctors can attend, and facilities for external training for doctors can be given as a reward to the best performing doctors (complete Medical Resume, complying with hospital policy, discipline, minimum number of complaints from patients).
The hospital should also conduct socialization to doctors regarding the benefits and legal aspects of medical records, especially the Medical Resume.Socialization on how to fill out a Medical Resume should also be carried out, both in general and personally for doctors who cannot attend the socialization.Because some doctors still think that the only thing required is diagnosis and therapy.
This Gibson theory should be retested at another hospital with a doctor's respondent, to find out if Gibson's theory can be applied to doctors and hospitals with all its specialties.Hospitals that are the place of research should have Organizational factors and Individual factors similar to Baptis Hospital at Batu.Research with a qualitative approach can also be developed to better determine the factors that influence Physician Performance, especially concerning the completeness of the Medical Resume.Also, research can be carried out by developing other types of variables outside this research variable.

Figure 1
Figure 1 Pathway of the research model pathSource: Primary data processed, 2017

Table 4 Testing the direct effect hypothesis
Source: Primary data processed, 2017