THE EFFECT OF IMAGE AND SERVICE QUALITY ON CUSTOMER COMMITMENT WITH TRUST MEDIATION (A Study at PUSKESMAS In-Patients, Jakenan, Regency of PATI)

Community health center as a community health service center has an important value in building a healthy and productive society. The existence of in-patient service at a public health center has been highly expected by the public who suffer from illnesess. The general public expects the nearest health center to resolve arising issues related to their illnesses. The purpose of this study was to test the effect of the Image and the Service Quality on Customer Commitment with Trust mediation. The data compiled were analysed by Linear Regression. The findings show that the Image and Service Quality significantly show a direct effect to Trust and Customer Commitment, but the Trust variable do not mediated Image and Customer Commitment. The majority of in-patients are farmers and they are more likely to feel safe and confident when treated in health centers.

are among others capable of handling the patients' illness, the friendly service, the alert ness of personnel for both medical and non-medical cases. It is expected to beformed so that theservice user satisfaction and community health centers will trus the health center. Thus, they will be involved in the health program scarried out by the in-patient health center, Jakenan district, Pati Regency.
Process of changes that occur in health centers, especially in-patient, both internally and externally runs so rapidly, especially changes in public expectations about the quality of health services. Along with the implementation of regional autonomy, each district government is competing to improve the management of the assets of the region, especially in the field of health. Changes or shifts involve the paradigms for strategic development, repair and improvement of structures and services that have been performed at PHC agencies. On the other hand, to get a commitment from customers, health centers should constantly strive to foster trust among other customers by constantly improving the image and quality of its services.
Therefore, this study aims to examine and analyze the Effect of Image and Service Quality on Customers Commitment with ConfidenceMediation. (Studies on In-patient health center, JakenaDistrict, Pati Regency)

Image (Corporate Image)
According to previous studies, the company image key in gaining consumer confidence is via financial services distribution (Flavian et al., 2005). Definitions company image expressed by Adbel- Salam et al. (2010), namely the general impression left in the minds of consumers as a result of the collection of feelings, ideas, attitudes and experiences with companies that are stored in memory.On the basis of these explanations, corporate image, shortly, can be explained as all kinds of impressions that the community makes about a corporation. Corporate image is a valuable, tangible entity, which is hard to imitate, and it can help to obtain superior, sustainable financial performance (Marteson, 2007, p. 546).Corporate image is defined as the "overall impression" left in the customers' mind as a result of accumulative feelings, ideas, attitudes and experiences with the organization, stored in memory, transformed into a positive/negative meaning, retrieved to reconstruct image and recalled when the name of the organization is heard or brought to ones' mind (Dowling, 1988;Gronroo, 1988;Bitner, 1990;Keller 1990;Fombrun, 1996;Kazoleas et al., 2001;Hatch et al., 2003).Thus, corporate image is a result of communication process in which the organizations create and spread a specific message that constitutes their strategic intent; mission, vision, goals and identity that reflects their core values that they cherish (Leuthesser and Kohli, 1997;Van Riel and Balmer, 1997;Bravo et al., 2009). This is consistent with Keller's (1993) worldwide vision of brand image. Corporate image could be considered as a type of brand image in which the brand name refers to the organization as a whole rather than to its sole products/services. Reflected the company's image of reliability of the company is among others the ability of management to manage the company, the company's commitment to quality products and services. This is consistent with what is proposed by Smith and Donald (1998) that the image of a company is determined by the company's reputation and professionalism, ethical standards and customer orientation. Thus, the image is a picture of the performance or success of the company that will have an impact on the company's efforts in conducting marketing activities.
Anonymous (1988) explains that the image of the company has agreat impact on sales, earnings and valuation. Thus it can be said that the company's image may have an influence on the confidence (trust) of customers to the company, which in turn affects customer satisfaction. Meanwhile, according to Fornell (1992) image of the company is believed to influence purchasing decisions, where a good image will stimulate purchases. Corporate image is believed to influence the purchasing decisions, for example: A good image will stimulate buyers to simplify the rules of the purchase decision-making process (Gummesson, 1993quotedin John, Bambang SukoPriyono, 2005. In this context, the image of the company belongs to the issue of attitudes and beliefs in terms of the attitude of consciousness (awareness), customer satisfaction and consumer behavior.
In service marketing, the image or the image of the object is something that is felt by visitors who are well impressed in the are a being visited so that they feel safe, interested, feel at home and encourage colleagues to follow their footsteps (BuchoriAlma2000:285). Definition of the image is a mental image of an object or concept. Good image of anorganization will have abeneficial impact, because a bad image will cause the loss (Webster, 1995). Image is the sum of beliefs, one's impressions on an object. The object in question can be a person, location, organization, and so forth (Private Basu2000:112). Image is considered to have the ability to influence customers' views on the goods and services offered (ZheithamlandBitner1996).

Service Quality
In an increasingly competitive environment service quality as an essential strategy for success and survival has attracted increasing interest in over the past 20 years (Ismail et al., 2006).
According to Parasuraman et al., (1985) Service quality of is the quality of services involving a comparison between expectations and perceptions of consumers on the performance of the services they receive (gap analysis). Meanwhile, according to Parasuraman et al., (1991) and Grönroos (1995) Quality of service is an over all evaluation of the function of the actual services received by the customer (technical quality) and how the service is delivered(functional quality). Pasuraman et al., (1988) and Kotler (1997) define the quality of service as consumers' assessment of the level of service received (perceived service) with the level of service expected (expected service) and services received (perceived service).
Service quality is one of the important things that must be considered by the manager of the company. Service quality is the expected level of excellence and control over the level of excellence to meet consumer desires (Lovelock, 1988). Collier(1995) defines service quality management as a study of how marketing division operates together through technology so that the staff can plan, create and submit a package that benefit the customer in relation with their services. Companies must constantly ask themselves: what do customers want from us, and how can we improve current customer perception (Hong and Goo, 2004;Law et al., 2004). Consequently, there is a huge body of marketing literature that is concerned with service quality, customer satisfaction, and customer loyalty as three distinctive elements that service organizations should strive for (Hong and Goo, 2004;Law et al., 2004;Ismail et al., 2006). Dimension of Service Quality Parasuraman et al., (1990) identified five dimensions of quality in services, namely: Tangibles, Reliability, Responsiveness, Assurance and Empathy.

Trust
According to Crosby et.al., (1990) trust is the belief that service providers can use it as a tool to establish a long-term relationship with the buyers who will be served. According to Morgan and Hunt (1994), trust implies is that if one party has confidence in the reliability and integrity with the partner. They assert that the target of the firms is to develop customer trust beyond customer satisfaction to retain their customers in a long term period. In other words, customer trust is likely to be a strong driver of customer retention (Ranaweera and Prabhu, 2003).
Meanwhile, according to Billy Yulianto and PurwantoWaluyo (2004) trust is a willingness or confidence in an exchange partner to establish long-term relationships to generate positive performance. According to Moorman, Desphande and Zeltman (1993: 82) the trust is a desire to rely on a trusted partner. Ganesan (1994) revealed that trust is necessary to build credibility. Credibility is the service user's belief that the service provideris capable of providing effective performance and has the expertise. Therefore, it can be concluded that trust can be built on the basis of three indicators, including service user's confidence (trust) in the integrity, reliability and credibility of the service provider. Parasuraman et al., (1991) formulate that a customer relationship with a company requires trust. According to Morgan and Hunt (1994), trust is separated and considered as two different but related things. The first concept is a perception of trust and the second is the concept of trusting behavior. Perception of trust and behavior trust is essential for the stability and continuity of the relationship between the two parties are interconnected. Morgan and Hunt (1994) states that trust exists when a group believes in the natural reliability and integrity of the partners. Trust is the expectation that the individual holds with respect to a partner's reliability. Reliable group need to have high integrity and reliability, in association with quality, namely: being consistent, competent, honest, fair, responsible, helpful and kind. According Hreviniak (1974) a relationship is characterized by a high value of trust that will have an impact on the group to form a stronger commitment in a relationship. This is supported by social exchange theory to explain the provisions of the relationship through the principle of reciprocity namely'distrust' resultingin distrust which thereby demotivating commitment, converting transactions into only one short-term exchange (Mac Donald, 1981;Morgan and Hunt, 1994).
Relationships are built on trust of customers to the service providers enabling service providers to better meet customers' needs and this is a fundamental step in constructing a long-term relationship. Determinant in the continuity of the relationship, trust, if it is doubted the customers may be reluctant to continue the relationship.

Commitment
The level of customer commitment to a company is indicated by the expected outcome of a new product launch by that company, the actual sales of the company's product, and the strength of customers' psychological identification with the company's brand (Ogba& Tan, 2009).
Commitment is a desire to maintain the fabric of the relationship in the long term (enduring desire) (Moorman, Despande and Zaltman, 1992: 316). Moorman et al., (1992) defines commitment as an ability that is aimed at maintaining a relationship value. Morrow in Ruyter and Wetzels (in Moh Suharto, 2006) emphasize this change starting from the growth of the concept of relational commitment that does not emphasize on the domain theory of segmentation and commitment. According to Morgan and Hunt, (1994) a group identifies that commitment between exchange partners is the key to achieving valuable results and trying to develop and maintain these valuable attributes in their relationship.
In the context ofservices, customers face uncertainty stemming from lack of clarity, less popular services and length of delivery. Uncertainty shows potential service failures and negative results. The quality of perspectives customer relationships acquire depends on the ability of service providers to reduce the sense of uncertainty. The time constraints and in consistency of potential service delivery in meeting expectations, may result in uncertainty in therelationalcontext. The quality of the relationship s a healthy indicator of the future, ensuring the exchange relations of services in the long run. Faced with the uncertainty, problems often arise in a complex exchange of services. Quality relationship that would cause to a strong bond offering assurance that the service providers would continue to meet customer expectations and would not deliberately change information, or otherwise harm the interests of customers. The best guarantee of the future performance of the customer is a continuous history of personal interaction that must be free of errors. Interaction partners'intention of continuity is found in the continuity of relationships in the future (RuyterandWetzels, in Mohammad Suharto, 2006).
According to Morgan and Hunt, (1994) commitment and trust are the key because they give encouragement to marketers to maintain a working relationship with the investment as a cooperation of partner exchange, fight against alternative short-term interests of the desired expectations for long-term gains with the existing partners, view potentially high-risk actions with caution because of the belief that their image does not take chances. The purpose of the above statementis that commitment and trust lead directly to the cooperative behavior that is conducive to the success of marketing relationship.
Commitment in the concept of long-term relationship plays a very important role because many long-term relationships are based on the commitment of both parties. According to Dwyer et al., (in Word Lesmana, 2008), in the marketing of services, commitment is formulated in the form of explicit or implied agreements to continue the relationship between two or more parties"implicit and explicit pledge of relational continuity between exchange partners". .
According to Allen and Meyer (in Sarwoto, 1997:44), commitment to customer (customers' commitment) is defined as a condition that is perceived by employees that can lead to a strong positive behavior towards its institutions. Consumers' commitment consists of three elements, namely: Affective commitment, i.e. how much a customer is emotionally bound, knows and is involved in the organization. Continuance commitment is an assessment of the losses associated with leaving the organization. Normative commitmenti.e. consumers' feelings about responsibilities given to the agency.

Hypothesis Development 1.5.1. Effect of Image on the Patients' Trust
Anonymous in the Journal ofSmall BusinessReport, April 1988, the research found a positively significant relationship between thec ompany's image and the customers' trust. Florensisca study (2005) found that the image of the company gave significant positive effect on customer trust. Pitaloka study (2006) found the same thing. Similarly, Russell Lascey's research in the Journal of Marketing Theory and Practice (2007) found a significant and positive relationship between the trust and the company's image. This shows that the trust of patients is determined by the image of the company, so it can be expressed in hypothesis1: H1 : The better the image of company (hospital), the higher will be the level of trust of patients.

Effect of Service Quality on Patients' Trust
According to Parasuraman, Zeithaml and Berry(1988), service is a concept that accurately represents the core performance of a service, namely being compared to reliability (Excellence) in a service encounter made by consumers. In other words, the patients' trust is closely related tothe quality of service provided. Mogan and Hunt(1994) statethat there is a positive effectof service quality on customer trust. Research by SunaryantiSriRahayu (2007) found that trust mediated the effect of service quality on the image of the company. While Rusdin (2007) found a significant and positive effect of service quality on customers'trust. Therefore, it can be stated in hypothesis 2: H2 : The moreexcellentquality of service, the more the levelof trustof patients.

Effect of Image on patients' Commitment
A good corporate image is reflected on the reliability of the company, management capability, and commitment to the company. According to Smith and Barclayin (1997), the image of a company is determined by the company's reputation and professionalism, ethical standards and customer orientation. This shows that the commitment of the patients is determined by the image ofthe company. Russell Lacey (2007) found a positive relationship between the image of the company to the customer's commitment through themediation of trust. Research by Word Lesmana (2008) found thatthe image of the company (hospital) has a significant positive effecton the patient or customer commitments. Thus, it can be stated in hypothesis 3: H3 : The better the image of the company(Hospital), the higher the patients' commitment.

Effect of Service Quality on the Patients' Commitment
Fornell et al., (1996), Zeithaml, Berry andParasuraman (1996) suggested the behavioral consequences came from service quality. The model proposed to focus on the strength of consumer buying behavior is influenced by the service quality and the behavior begins with an assessment of service quality. If the quality of service is highly valued by the consumers'purchasing behavior, it will give a good impression or interest. This will strengthen the consumer relationship with the company. However, if under valued, consumers'buying behavior is not good or not interested and this will weaken the relationship with the company. Farida Jasfar study (2003) found that service quality had a significant and positive effect on customers' commitment. Another study conducted by the Word Lesmana (2008) and M.Suharto (2006) independently discovered the same thing, namely the quality of services having a significant and positive effect oncustomers' commitment. This shows that the commitment of patients is determined by the quality of the service, so that it can be expressed in hypothesis 4: H4 : The more excellent the servicequality,the higher the patients' commitment.

Effect of Trust on Patients' Commitment
Mogan and Hunt (1994) state that trust and commitment are likely to affect the variables in forming long-term relationships between the company and its customers. Russell Lacey (2007) found the significant and positive effect of Trust relationship towards customers' commitment. Thorsten HT, Kevin P. Gwinner and Dwayne D. Gremier (2002) found that the Confidence Benefit / Trust had positive effect on customers' commitment. Research by Imam Ashari (2006) found that there was a significant effect of trust on customers' commitment. While Moh.Harsono (2007) in his research found that the trust has a positive influence on customers' relational commitment. This shows that the commitment of patients is determined by the trust, so that it can be stated in hypothesis 5: H5 : The higher the level of trust, the higher the level of patients' commitment.

Population and Sample of the Study
The population in this study consisted of all in-patients at Jakenan Health Center, Pati Regency, employing purposive sampling method to get the respondentsin this study, where thesample selection was based on certain characteristics or criteria, which has nothing to do with the previously known characteristics of the population (Husein Umar, 2001:92 andWGulo, 2002). The respondents were sampled from all patients aged 17 to 55 years, withat least 3days of treatment and more than once being hospitalized. The number of samples taken reached +100 (Rao, 1996).

Techniques of Analysis
A relationship built on trust of customers to the service providers enables service providers have a commitment to customer needs and this is one of the most fundamental step in a long-term relationship. Data analysis aims to examine and analyze the effect of independent variables of Image and Service Quality on Commitment throughTrust. Multiple regression equation was used as follows:

Mediation Test
Mediating variable serves to mediate the relationship between the dependent and independent variables (Ghozali, 2005;160).To know in detail the direct and indirect influence of the independent variable on the dependent variable, path analysis was used as follows director indirect influence of the independent variables on the dependent variable. It can be seen through the comparison as follows: a.Ifb1xb5>b3 the influence of independent variables on the dependent variable is not directly, but through mediation. b. Ifb2xb5>b4 the influence of independent variables on the dependent variableis not directly, but through mediation. c. Ifb1xb5<b3 the influence of independent variables on the dependent variable is direct. d. Ifb2xb5<b4 the influence of independent variables on the dependent variableis direct.

Descriptive Statistics
There were 112 sets of questionnaires. They were distributed to the respondents who are in-patients. There were 100 respondents meeting the criteriaas in-patients in the health center, so the number could be exactly processed further. Respondents in this study noted that females had the largest percentage of 60% or 60 respondents and percentage of male respondentswith40% or as many as 40respondents. Age criteria were dominated by the first respondent aged from 46 to 55 years as many as 47people (47%), and the second from 36 to 45 years as many as 25 people (25%), and the third of 26 to 35 years were 17 (17%), and subsequently aged 17 to25years as many as11 people (11%). Job criteria were as certained as farmers were 46 people (46%), private sector numbering 26 people (26%), workers numbering 20 people (20%), civil servants and students each numbering 4 people (4%). Thus, the composition illustrates that respondents whose jobs are farmers is the most dominantin this study. So, from this statistical description, it is envisaged that this clinicis needed by the general public, so that it is important to keep its reputation, excellent services and maintain public confidence (trust) in the health centers. Thus, community health centers becomesnecessary.
Respondents the average value (mean) of 3.75 means that the Image variable(X1) is some what disagreed (ATS). The middle value (median) is 4 meaning that respondents some what agreed (AS). And the value of the mode of the table above is 5 meaning that respondents agree (S). This illustrates that the general image of PHC Jakenan opinions of the respondents are not too bad but not too good.
The average value (mean) of respondents in the above table ranged between 4.40 meaning that the variable Quality of Service is somewhat agreed (US).The average value of the middle (median) of respondents is 4.68 meaning that respondents agreed (S). And a mode value is 5 meaning that respondents agreed. This illustrates that the quality of public health services Jakenan pretty good according to the respondents.
The average value (mean), median and modus of respondents'sare 5. Itare means that they agree with the variable of Trustand Committment to perform (S). This illustrates that respondents' confidence to PHCof Jakenan well.

Research Intrument Test 3.2.1. Validity Testing
Technique of Factor Analysis was used in validity test, which is to test whether the statements or indicators could be used to confirm a factor or construct or variable. If each of the questions is an indicator measuring the variable, it will have a high loading factor value of above 0.4. The criteria for selection of items were based on factor analysis; usually employing the limits of the degree of trust or the value samples of Kaiser-Mayer-Olk in Measure of Sampling Adequacy is of (KMO)> 0.5. If the KMO value is above 0.5 and the value of loading factor is > 0.4, then the sample is considered valid for further analysis.
The Image Variable has KMO-its MSA of 0.678,The Service Quality variable has KMO-its MSA 0.851, The Trust variable has KMO-its 0,862 above 0.5 while its significance is of below 0.05, thus the existing samples for all variables are fulfilled and the factor analysis can be further performed. All of the indicators of variabes used to measure the statement, all are declared valid because all of them are above the loading factor of 0.4 ranging from 0.413 to 0.729. Thus, it can be concluded that all the variables and the selected samples are feasible for further analysis.
Reliability is intended to determine the consistency of measurement instrument in use, so that the instruments have consistent results when used repeatedly at different times. A variable is said to be reliable if the Cronbach's Alpha value is >0.6 (Nunnally, 1969 in Imam Ghozali, 2001). Based on the reliability test results with respect to variables of Image, Service Quality, Trust and Commitment above all of items were stated as reliable or reliable answers because each of them has aCronbach's alpha>0.6. Thus, it proves that the respondent's answers to the statement are consistent or stable over time.

Regression Analysis
Regression analysis was used to analyze the effect of the Image variable, and the Service Quality on the Trust variable with regression research model that can be described in the following:

Model 1
The results of the regression output isobtained: Y1=0.147X1+ 0.77X2. It means that both variables: Image and Service Quality have a positive and significant effecton the Trust variable. The significance of Image 0.034<0.05 and Service Quality 0<0.05.The highest and dominant influence is the Service Quality 0,77 then the other. (Source: research dataprocessed).
The degree of effect of independent variables on the dependent variables can be viewed from the determination coefficient (Adjusted R Square) which is of 0,77 or 77%, meaning that the variables of Image, Services Quality are able to explain the Trust variable by 77% while the remaining 23% is explained by other variables out side the study model.
Image has a positive and significant effect on Trust of In-patients at Jakenan Health Center, Pati Regency. Image has a positive and significant impact on patient Jakenan Health Center in Pati regency. Standardized Beta Coefficients is known to have a value of 0.147 and p=0.034 for significance Standardized Beta Coefficient indicates a positive sign and significance under α=0.05 (0.034 <0.05) meaning that H1 is accepted or image has apositive and significant impacton the Trust of inpatients at Jakenan health center, Patiregency is accepted. This is consistent with the results of Anonymous in the Journal of Small Business Report, 1988 that the image of the company has a significant and positive effect on customers' trust. Similarly, Russl Lascey (2007) stating the same thing.
The Service Quality has a positive and significant impacton Trust of patients'hospitalizati on at Jakenan Health Center, Pati regency. Standardized Beta Coefficient is known at 0.770 and p=0.000 is for significance. Standardized Beta Coefficient shows a positive sign and significance far below α=0.05 (0.000 <0.05) meaning that H2 is accepted or Service Quality has a positive and significant impact on the Trust of patients being hospitalized atJakenan Health Center Pati regency is there by accepted.
Research resultsare consistent with a research by Mogan and Hunt (1994) stating that the Quality of Service has a positive effect on the Customers' trust. Similarly, SunaryantiSriRahayu (2007) found that trust mediates the effect of service quality on the image of the company.

Model 2
The results of the regression output, it was obtained that: Y2 = 0,175X1 + 0,274X2 + 0,432 Y1. It means that the three variables: Image, Service Quality and Trust have a positive and significant impact onthe Commitment variable. The significance of p=0.042 (4.2%), p=0.032 (3.2%) and the Trust p=0.01(1%) of the third probability is smaller than α=5%. The highest and dominant influence is the Trust 0,432.(Source: research dataprocessed).
The degree of effect of independent variables on the dependent variables can be viewed from the determination coefficient (Adjusted R Square) which is of 0.661 or 66.1%, meaning that the variables of Image, Services Quality and Trust are able to explain the Commitment variable by 66.1% while the remaining 33.9% is explained by other variables outside the study model.
Image has a positive and significant effect on in-patients'commitment at Jakenan PHC, Pati regency. The Standardized Beta Coefficient is known to have a value of 0.176 and p=0.042, which is significant, because the Standardized Coefficients Beta show a positive sign and significance under α=0.05(0.042 <0.05) meaning that the H3 is accepted or that image has a positive and significant effect on in-patients'commitment at Jakenan PHC, Pati regency is accepted.
This study agrees with the results of research Russell Lacey in Journal of Marketing Theory and Practice: Fall2007, which found a positive relationship between the image of the company to the customer's commitment to them ediation of trust. Similarly, research Word Lesmana (2008) found that the image of the hospital to have a significant positive effect on the patient or customer commitments.
The Service Quality variable has a positive and significant effect on inpatients'Commitment at Jakenan public health center, Pati regency. The Standardized Beta Coefficientis known to have a value of 0.274 and p=0.032 for which it is of significance for the Standardized Coefficients Beta shows a positive sign and significance under α=0.05 (0.032 <0.05) meaning that the H4 is accepted or Service Quality has a positive and significant effectonin-patients'Commitment at Jakenan Public Health Center,Pati regency is accepted.
In the context of service uncertainty, it often a rises a complex exchange of services. The relationship quality contributing to a strong bond with the offer of assurance by the service providers would continue to meet customers' expectations and not deliberately change the information or other wise harm the interests of customers. Continuous interaction between partners is found in the continuity of relationships in the future (RuyterandWetzels, in Mohammad Suharto, 2006). In other words, the quality of service is indispensable in shaping the perceptions in the minds of consumers leading to a commitment.
This study agrees with the results of researcher Jasfar Farida(2003) who found the service quality has a significant positive effect on customers' commitment. Another study conducted by the Word Lesmana (2008) andM.Suharto (2006) independently discovered the same thing, namely the service quality having a significant positive effect on customers' commitment.
Confidence (trust) has a positive and significant effectoninpatients'commitment at Jakenan Public Health Center, Pati regency. The value of Standardized Beta Coefficient is known of 0.432 and p=0.001 for significance of Standardized Beta Coefficients, a positive sign and significance far below α=0.05 (0.001<0.05) meaning that the H5or Trust as having positive and significant effects on in patients'commitment at Jakenan District Health Center, Pati Regency is accepted.
This study agrees with Lacey (2007) who found the influence of the relationship of trust on customer commitment is positively significant. Thus, Thorsten et al., (2002) found that the Confidence Benefits/Trust positive effect on consumer commitment. Ashari(2006) found that there is a significant effect of trust on customer commitment.

Mediation Test
To test H6, the test path was used, one of the requirements for test H6 using the path lines were H1 and H5 that must be significantly accepted by each, then just the test path could be calculated.

Figure 2 Path -Image, Trust andCommitment
The results of path analysis showed that the Image, which can directly influence the Commitment, may also indirectly affect image via the Trust(as intervening) and then to the commitment. To test H7, the path test was used with one of the requirements for test H9 using path is that H2 and H5 must be received by each must be significant, then just calculate the path test.

Figure 3 Path -Service Quality, Trust, Commitment
The results of path analys is showed that the Quality of Service may have an impact directly to the commitment variable and may also indirectly affect that of the Service Quality to the Trust (as intervening) and then to the commitment. The amount of direct influence is of 0.274, while the magnitude of the indirect effect is (0.770) x(0.432) =0.333 or total influence to the Services Quality to Commitment =0,274+0,333=0,607. Because β2xβ5 is greater than β4 resulting from the direct influence of the Quality of Service Commitment (0.333>0.274); it means that the Trust variable is a mediating variable that can explain the indirect influence on the Service Quality on the Commitment variable of 0.333 or 33.3%. Based on the above test, the Quality of Service H7 as stated to have positive and significant effect on inpatients'commitment to use Jakenan PHC, Pati regency with Trust mediation is Accepted.

Conclusion
The results of the instrument validity and reliability tests indicate that the instrument used is valid and reliable.The model test indicates that variables of Image, Service Quality significantly affect the Trust.The significance of Image 0.034<0.05 and Service Quality 0<0.05. The highest and dominant influence is the Service Quality 0,77 then the other. Likewise variables of Image, Service Quality and Trust significantly affect the Commitment variable. The significance of Image p=0.042(4.2%), Service Quality p=0.032(3.2%) and the Trust p=0.01(1%) of the third probability is smaller than α=5%. The highest and dominant influence is the Trust 0,432. The Image variable affects directly the Commitment variable. The Commitment variable is not mediated by the Trust variable. The value of direct influence is 0.175, while the magnitude of the indirect effectis (0.147)x(0.432)=0.064. Because 0.064 <0.175, it means that the Trust variable is not a mediating variable. This is possible because the in-patients at Jakenan Health Centerare mostly famers. The patients feel safe, and are convinced by the speedy recovery when treated in the Health Center.
The Service Quality variable affects the Commitment variable as mediatedby the Trust variable. The value of direct influence is of 0.274, while the magnitude of The good quality of service will be easily remembered and is felt by the patient, so the patient will be committed to come back again to ask for its services.Thus, based on this study,it can be concluded that in order to develop the patients' commitment, it is necessary to develop the patient's trust in PHC, through good and excellent services and developing the image of hospitals with high reputation.
The results of the study, showed that the patients at Jakenan health center are fully, in conformity, satisfied with the service. Service quality, which can satisfy the patients will have an impact on the patients' commitment to the organization so that the good image that has been built is maintained. Given that the image variable is less dominant than the other variables, the expected future actors in the health center organization must build professionalism, providing good facilities and infrastructure so that the reputation and quality of service can be better. So the image is a government hospitalis better than private hospitals a sit can improve patients' ultimate trust and there fore the patients will be committed to choosing health centers as the primary choice of health services The variables used in this study are not fully able to explain the research model. Therefore, further studies need to be conducted with employing more variables related to trust and commitment. This condition is reflected in the value of R-adjusted 77% (model1) and 66,1,0% (model 2), that is less than 100% indicating that there are variables that interfere beyond the variables under investigation. In terms of methodology, the sample used is majority farmers and private. Future research needs to be expanded to include respondents with patients and prospective patients which are more common.