The Effect of Brand Image and Patient Satisfaction on Patient Loyalty in Outstanding

The commitment of a consumer to a particular brand, product, or service on the basis of a favorable attitude that is demonstrated in frequent repeat purchases is an example of customer loyalty. The purpose of this research is to investigate how Dr. RSUP. Tadjuddin Chalid Makassar's outpatients feel about the hospital's brand image and how satisfied they are with the care they get there. This kind of research is known as quantitative research, and it makes use of observational studies that are designed in a cross-sectional fashion. Outpatients receiving care at Dr. Tadjuddin Chalid Makassar comprised the study's sample, which included a total of 170 respondents. In the outpatient installation at Dr. RSUP. Tadjuddin Chalid Makassar, the findings indicated that there was a direct influence of Brand Image on patient satisfaction, a direct influence of Brand Image on patient loyalty, a direct influence of satisfaction on patient loyalty, and a direct and indirect influence of brand image on patient loyalty through patient satisfaction. It is recommended that the management of the hospital be able to use a variety of different media to carry out promotions in order to be able to further expand information about the big name and logo of the hospital so that it is more widely known, implement and make policies, and review things that are still lacking, particularly making improvements by adding equipment. as well as the upkeep of the physical infrastructure of the hospital.


Introduction
A hospital has to be capable of formulating an effective plan in order to entice patients who are becoming more selective in their selection of a service provider. Only then will the hospital be able to continue its expansion and remain competitive in the market. Customers of healthcare facilities benefit from the increased variety of options made available to them as a result of the increased competition brought about by the proliferation of newly established private hospitals and the expansion of existing public hospitals. On the other hand, due to this scenario, there is a great deal of rivalry amongst hospitals, and they are required to compete with one another in order to be the best. This is done with the goal of gaining consumer loyalty, which is something that every business, including hospitals, strives to do on a consistent basis (Setiawan, 2011).
In this day and age of cutthroat competition, maintaining a loyal customer base is of the utmost importance. The commitment of a consumer to a particular brand, product, or service on the basis of a favorable attitude that is demonstrated in frequent repeat purchases is an example of customer loyalty. According to Kottler (2002), there are six main reasons why an organization has to work toward gaining the loyalty of its customers.
To begin, an institution's current clients are more likely to become new clients in the future. This means that institutions may expect to reap significant advantages from their loyal clients, including a reduction in the expenses of marketing required to acquire new clients and an increase in revenues. Second, the cost of obtaining new consumers is far higher than the cost of maintaining and expanding upon relationships with current customers. Third, clients who have previously placed their faith in the company for one service or product are more likely to have faith in it for more services or products. Fourth, if the organization has a large number of loyal consumers, it will have lower operating expenses. This is because, according to the Pareto principle, just 20 percent of the company's customers are responsible for 80 percent of the company's profits. Fifth, current clients of an institution have likely already had many pleasant interactions with the institution, which means that the psychological and social costs of doing business with the organization may be reduced. Last but not least, devoted consumers will constantly speak out in defense of the company and may even make efforts to get others to join their ranks or seek their advice.
According to Kotler & Keller (2009), customer satisfaction can be defined as a person's feelings of pleasure or disappointment that arise from comparing the perceived performance of the product (or outcome) against their expectations. In general, customer satisfaction refers to a person's level of happiness with a product or outcome. Customers will get unhappy if the performance does not live up to their expectations. Customers will be pleased with the product or service if it lives up to their expectations. If the performance is better than what was expected, the consumer will be very pleased or content. Ratings of a product's effectiveness provided by customers are contingent on a wide variety of elements, most importantly the nature of a customer's commitment to a particular brand. When a product is associated with a brand that the consumer already has a good opinion of, they often generate a more favorable opinion of the product.
There is a correlation between brand image and associations with brands due to the fact that an increase in the number of times a consumer has consumed or purchased a brand is directly correlated to an increase in the number of times that impressions of the brand have been stored in their minds. There is a presumption that well-known brands are more reliable, always available and easy to find, and have quality that is beyond question, which is why betterknown brands are more frequent. Consumers buy products with well-known brands more frequently because they feel more comfortable with familiar things. Consumers choose for less well-known companies instead (Aaker, 1991).
RSK In eastern Indonesia, the Dr. Tadjuddin Chalid Makassar hospital is a leprosy builder hospital that is currently being construction. Since 2006, the hospital has also been providing care to general patients. The general patients who visited the hospital in 2006 accounted for 19.16 percent of all visits, according to the medical data that were used to compile the number of visits. The findings of the preliminary interview with management suggested that the low number of visits to the polyclinic might be attributed to the prevalence of community stigma around leprosy, which is difficult to eradicate. From Leprosy Hospital to Tadjuddin Chalid Hospital, with a name change that turned out to have a significant effect, which was marked by there is an increasing trend of general patient visits, so that in 2008 the management of Tadjuddin Chalid Hospital took the initiative to change the name of the hospital and in 2018 it became Dr Tadjuddin Chalid Hospital Makassar with efforts to build several new, larger buildings. However, it was seen from the results of observations made during the initial survey that the utilization of general outpatient services was still low. Specifically, there were only about 5 to 6 patients per day for visits to all general outpatient polyclinics. This information was gleaned from the findings of the survey. At the Tadjuddin Chalid Hospital in Makassar, the issue that arises is the poor level of usage (utility) in the outpatient poly services for general patients.
The most powerful indicator to measure the image of Tadjuddin Chalid Hospital is a hospital with a clean environment because Tadjuddin Chalid Hospital has a clean environment. This situation can be said to be an intrinsic advantage of the Tadjuddin Chalid Hospital which can later be developed and is a strategy in facing competition. With a clean environment, people will be more comfortable in obtaining health services and this comfort can also be associated with other communities so that in the end the public's image of the impression that has been in their minds about hospitals that are associated with leprosy sufferers will decrease. This also explains that the image of the Tadjuddin Chalid Hospital is considered positive by the community.
Based on this, the researchers wanted to conduct a study entitled "The Effect of Brand Image and patient satisfaction on outpatient loyalty at Dr. RSUP. Tadjuddin Chalid Makassar", the researcher chose the hospital because before it became a general hospital, the initial image of the hospital was a special leprosy hospital, where there is still a community stigma that is difficult to remove about leprosy in the hospital so that it can affect patient visits. perform services at the hospital.

Methods
During the months of June and July of 2022, this study was carried out at Dr. RSUP. Tadjuddin Chalid Makassar. Quantitative research based on observational studies and a method known as cross-sectional study is the kind of research that has been carried out so far. The total number of general patients that visited Dr. Tadjuddin Chalid Makassar's Outpatient Installation in the year 2021 was 6278. This population was used for the purposes of this research. 170 people participated in the research, making up the sample that was selected via proportionate random sampling. A questionnaire is the instrument that is employed in the process of collecting data. The independent variable in this case takes the shape of brand image and satisfaction, while the dependent variable is loyalty.
The purpose of the univariate analysis that was carried out was to get a general understanding of the research topic by elaborating on the nature of the respondents and describing each variable that was used in the study. The descriptive analysis of the respondents' characteristics, the descriptive analysis of the research variables, and the crosstabulation analysis of the relationships between the respondents' characteristics and the research variables were all components of the univariate analysis. In order to determine the relationship between the independent factors and the dependent variable, a bivariate analysis was carried out. This allowed for a better understanding of how the two variables interacted. The chi square test was the one that was carried out to analyze the data. The frequency distribution based on the characteristics of the sample at the study site is shown in Table 1, and it reveals that the majority of the respondents are between the ages of 36 and 45, with as many as 64 respondents falling into this age range (37.6 percent). In terms of gender, the majority of the respondents were female, with 145 of the total respondents being female (85.3 percent). According to the most recent education, the majority of the respondents (as many as 79 respondents) have completed their high schooling (46.5 percent). When it came to the respondents' places of employment, the majority of them were independent contractors (73 of the total respondents) (42.9 percent). Based on the distance, the majority of the respondents, which amounts to 91 respondents, live more than 5 kilometers away (53.5 percent). According to the number of services, the vast majority of replies came from indefinitely as much as 125   According to the first research hypothesis (H1), the image of the brand does have an impact on the degree of patient loyalty in the Outpatient Installation. It is known, as a result of the statistical research that was carried out, that the patient loyalty in the Outpatient Installation at Dr. RSUP. Tadjuddin Chalid Makassar may be affected by the brand image of the medical facility. A significance value of 0.000 also demonstrates that an impact is substantial; hence, research hypothesis 1 (H1) may be validated under these circumstances.

Results and Discussion
The term "brand image" refers to the connections and perceptions that customers have with various brands (Tjiptono, 2005). Customers who are used to purchasing a certain brand are more likely to have a consistent impression of that brand. An image of a product has a connotation associated with the brand itself in the eyes of a significant number of customers. The perception of a brand will be same across the board. When a consumer has a favorable impression of a brand, he or she is more likely to feel confident in continuing to purchase that brand's goods, which in turn increases the likelihood that the firm will continue to have financial success in the future (Damayanti & Wahyon, 2015).
The ability of a corporation to successfully establish the image of a brand is contingent on the firm's ability to provide customers with products that are of high quality, are convenient, and have a certain level of prestige. Building a solid brand image gives businesses the ability to earn the customers' direct trust. The perceptions, ideas, or experiences that a person has had in relation to a brand, which will eventually shape an attitude towards the brand in question, are the building blocks upon which an image of that brand is constructed (Amanah, 2011). Therefore, customer attitudes and behaviors towards a brand image are one of the crucial components that motivate consumers to purchase a product. This is because consumers are more likely to buy a product that they like. When consumers believe that a product with a trusted brand will provide a sense of security when the consumer uses the product to be purchased, they are more likely to be interested in making a purchase of that product. This is because consumers believe that a product with a good brand image will have a better brand image (Anshori & Hariwan, 2016).
Because devoted patients are the best way to ensure the long-term viability of a healthcare facility, a hospital's primary objective is to build a patient population that feels a strong sense of attachment to its services. The concept of patient loyalty may, in its most fundamental form, be understood as the loyalty of an individual to anything. Patient loyalty is a reflection of a patient's allegiance to a specific brand, which derives its name, patient loyalty, from brand loyalty. This metric is able to offer an indication as to whether or not the patient is likely to move to a different service brand in the event that the product brand undergoes a change in either its pricing or any of its other characteristics.
The second research hypothesis (H2) proposes that there is a correlation between the patient's perception of the brand and their level of happiness with the Outpatient Installation. According to the findings of a statistical study that was carried out, it is common knowledge that patient satisfaction at the Outpatient Installation at Dr. RSUP. Tadjuddin Chalid Makassar is influenced by brand image. A significance value of 0.000 also demonstrates the presence of a substantial impact, which means that research hypothesis 2 (H2) may be validated in this scenario.
According to Dwyer, et al., in Jasfar (2012), trust is a type of consumer faith in a corporate promise that is dependable. Trust is also the fundamental reason for building a connection with the firm. Jasfar (2012). In Jasfar (2012), Berry makes some suggestions on the variables that create the basis for the establishment of long-term partnerships based on trust.
Understanding the link between a hospital's image and the effect that image has on a patient's intentions is very important since patient attitudes and behaviors toward hospitals may be influenced by the image of the hospital.
In order to get patient satisfaction, brand image also plays a very crucial part. This is due to the fact that a positive brand image will earn the trust of the general public. Because customers are prepared to pay more for a hospital with a strong brand image, the hospital will enjoy a variety of benefits and advantages as a result of the strength of its brand image. This is in contrast to the situation at other hospitals. Patients who place a higher priority on the strength of a company's brand image are more likely to believe that the prices or expenses of medical treatments will not be a barrier for them to get such services, provided that the hospital has a brand image that is seen as positive (Puspitasari, 2017).
The term "patient satisfaction" is used in this research because it refers to a reaction to an assessment of appropriateness or discrepancy that a patient feels after making use of or receiving services during a certain period and focus (Giese & Cote, 2009). At first, the hospital served primarily as a location for patients to get treatment; but, in recent years, it has expanded its mission to include the provision of services to the community as a whole. In order for hospitals to be successful in today's fast evolving and more competitive world, hospital management must undergo a paradigm shift in the direction of focusing on the needs of patients. Patient dissatisfaction is most often expressed in relation to the attitudes and behavior of hospital staff, including: delays in the services of doctors and nurses, doctors who are difficult to meet, doctors who are less communicative and informative, the length of the admission process, and the order and cleanliness of the hospital (Aritonang, 2005) The degree to which hospital services are perfected to fulfill the requirements of patients for standardized medical care is what is meant by the term "hospital service quality" (Rahmawati, 2013).
The level of satisfaction experienced by patients is a crucial indication that is often used as a measure of service quality in the healthcare industry. The level of pleasure experienced by patients may influence treatment results, patient retention rates, and allegations of medical negligence. Patients are similar to customers, and patients increasingly consider themselves to be purchasers of health services. Every patient has various rights, the most important of which is the right to get high-quality medical treatment (Prakash, 2010).
According to the findings of the study conducted by Yulistia et al. (2012), there was a direct and substantial beneficial connection between patient satisfaction and the image of the medical facility. There is evidence from supporting research that demonstrates patient satisfaction has a direct influence on the brand image of hospitals (Sciulli & Missien, 2015). According to the findings of the research (Sciulli & Missien, 2015), the level of overall satisfaction has an effect on the level of customer loyalty. This finding suggests that marketers should concentrate on the advantages of brand image in order to reach the desired level of customer loyalty. 0.000 also demonstrates the presence of a substantial impact, which means that research hypothesis 3 (H3) may be validated in this scenario.
Patient satisfaction may be defined as a degree of a patient's feeling that comes as a consequence of the performance of health services that he receives as a result of the patient comparing what he gets with what he expects to get from the healthcare provider (Pohan, 2013). To put it another way, patient satisfaction is the result of receiving a health service; hence, achieving higher levels of patient satisfaction is one of the aims of efforts to improve the overall quality of health care. When it comes to evaluating a product, in this case a service, the perceptions and attitudes of the patient play a significant role in determining whether or not they are satisfied with the product. Patients who utilize these health services may experience pleasure as a result of the prompt service and nice demeanor of the staff members who provide them. Therefore, if the desired degree of satisfaction can be achieved, it may be possible to get a relevant image of the level of service quality that is offered to service consumers. The patient will experience a sense of loyalty to the hospital, which will help the hospital develop a positive image, if the hospital serves patients by providing the finest and most effective service possible, with the goal of continuously satisfying the patients.
Customer loyalty is defined by Griffin (2005) as the act of a patient making multiple purchases of a healthcare service due to their devotion to that service. Price and tariff are just two of the many elements that might play a role in determining whether or not a patient would remain loyal to a healthcare provider. There is no doubt that someone will choose the healthcare facility that, in his opinion, offers the most affordable price/tariff alternative out of the other choices that are offered. In addition to this, there is also the element of habit: for a patient who is used to using a certain hospital service, the likelihood of them moving to one of the other alternatives is reduced (Kotler, 2005).
The loyalty of consumers (patients) of a service product that is provided in hospitals may be increased by service producers (hospitals) by increasing the quality of the services that these hospitals provide to their patients. a feeling of contentment on the part of the patient; hence, the development of this sentiment in the patient will lead to the formation of an attitude of patient loyalty toward the services provided by the hospital.

Conclusion
The results showed that there was a direct influence of Brand Image on patient satisfaction, direct influence of Brand Image on patient loyalty, direct influence of satisfaction on patient loyalty and direct and indirect influence of brand image on patient loyalty through patient satisfaction in the outpatient installation at Dr. RSUP. Tadjuddin Chalid Makassar. It is recommended to the hospital management to be able to use various media to carry out promotions in order to further expand information about the big name and logo of the hospital so that it is more widely known, implement and make policies and review things that are still lacking, especially making improvements by adding equipment. and maintain the hospital's physical facilities.