Factors Affecting Hospital Service Innovation; Literature Review

Innovation at the hospital as a change in the delivery of patient-focused health services by encouraging healthcare professionals to work smarter, faster and better. Service innovation can provide an effective way to create a sustainable competitive advantage for hospitals. This study aims to analyze and examine the factors that influence service innovation in hospitals using the literature review method. The results were obtained from a literature search that discusses the major factors that influence service innovation, namely in the form of a good management system within the scope of the hospital. This big influence is that human resources, starting from the leaders and employees who work in the hospital, must work together for the advancement and empowerment of the hospital.


Introduction
Hospital is a health service institution that plays a role in providing complete individual health services. The role of the hospital, which is quite comprehensive, describes an organization that is very complex, capital intensive, technology intensive, labor intensive, professional and system intensive. In addition, the uniqueness of hospital services is influenced by the values held by patients. The Institute of Medicine (IOM) explained that the quality of health service institutions is aimed at providing safe, effective, patient-centered, timely, efficient, and equitable services, one of which is Patient Centered Care (PCC).
The PCC concept is an innovative approach to health care planning, service and evaluation based on mutually beneficial partnerships between health care providers, patients and families. PCC as a care-friendly and responsive to individual patient choices, needs, and values, and ensures patients make clinical decisions (Medicine, 2001). This concept is to provide services to patients by referring and respecting individuals including preferences / choices, needs, values, which aims to create patient satisfaction, improve the quality of clinical results, reduce excessive and useless medical services, reduce the possibility of malpractice and complaints, and reduce health costs.
In facing free market competition, hospitals must be able to survive and need to formulate appropriate marketing strategies, by carrying out various innovations according to community needs. With the change in the paradigm of hospitals entering free market competition, regulatory developments, people's need for health services is increasing, responding to millennial society, technological developments in the health sector, so hospitals need to make innovations.
Service innovation is to provide new services to customers. In line with this definition, service innovation is creating a new service or significantly improving an existing service. Service innovation can provide an effective way to create a sustainable competitive advantage for a company.
Innovation is a widely studied field. This is critical for any organization looking to achieve and maintain a competitive advantage in the marketplace, although assessing the impact of innovation is a challenge due to the difficulty of isolating and measuring it. In addition, health institutions in the face of improvement need innovation in order to compete and offer new treatments to patients. Curiously, little is known about innovation in health care organizations and their relationship to performance.
Service innovation "has become a term that refers to innovation that occurs in a variety of service contexts, including the introduction of new services or the incremental improvement of existing services. In recent decades, healthcare innovation has increased with product, care and care delivery technologies. improve patient life expectancy and quality of life, and make access to services and pathways of care easier Innovations in health care result in efficiencies, reduced costs and human error.
However, making service innovations is not an easy thing so that in the process there are several things that can influence a service innovation to succeed or not, especially in the health sector in hospitals. For this reason, the authors are interested in examining some of the literature regarding what factors can influence service innovation in hospitals.

Methods
This study uses a narrative literature review model which aims to review and study several literature on the same topic. Determining the title in the literature review, namely the factors that influence service innovation in hospitals by proposing a narrative literature review. Then determine the review questions, namely what factors influence service innovation in the hospital. Then compile inclusion criteria that depend on the review questions asked. Inclusion criteria include population, concept and context. The inclusion criteria in this literature review are 1) Population: hospital. 2) Concept: hospital innovation, service innovation. 3) Context: factors that influence service innovation in hospitals. 4) Literature entered; with quantitative, qualitative, and review designs, published for the last 5 years starting January 1, 2015, in English. 5) Literature will be excluded if the concepts discussed are not published in a peer-reviewed journal. This study uses a search strategy that aims to find literature that has the potential to be selected according to the objectives of the review. Search The search strategy in the literature review is divided into 3 stages.
Initial searches were made of at least two online databases relevant to the topic via Google Scholar, Science Direct, PubMed, ProQuest. The search was carried out on this source and took published data starting from January 1, 2015.

Results and Discussion
Based on the selection results from several article sources based on keywords, Google Scholar totaled 17,400, Science Direct totaled 22,165, Pubmed totaled 10,943 and Proquest totaled 112,475. Then from the initial total search, then filtered based on the year of publication starting from the last 5 years the total number of articles obtained was 6,514. then the article was reselected and issued based on the title and abstract and the duplication that was not suitable so that it became 60 articles. From the 60 articles, they were excluded based on the inclusion criteria into 27 articles. The steps in data extraction can be seen in Figure 2. To examine the level of innovation dimensions in health care (products and processes) that correspond to the competitive advantage of health care

Literature Review
The existence of a level in service innovation is a factor in the innovation itself in the world of health Korea To examine the effect of internal marketing or internal marketing on competitive advantage by means of funding the organization to obtain that competitive advantage.

Literature Review
Internal marketing is one of the factors that influence the achievement of service innovation in hospitals.     In diagram 3, it illustrates the number of articles based on the type of research, where most of the article research methods analyzed used the literature review method, which was 48%. Then the conceptual framework literary method was 33%, the Case Study method was 11% and the Survey method was 8%.

Literature Review
In this section, the authors present the findings of analysis of several literature based on the topics raised, namely the factors that influence service innovation in hospitals. With the rapidly changing competitive environment, organizations including hospitals have concerns about how to increase their competitive advantage. One solution to this problem is internal marketing (IM) which affects employee attitudes and changes the service process with new ideas, which in turn leads to competitive advantage. This is in line with Yeum's (2019) research, which uses three elements of internal marketing: communication, empowerment, and appreciation. IM has a positive effect on service innovation. To get a competitive advantage in an organization comes from how to manage and build communication, education & training, appreciation, empowerment.
Whereas in Hosseini's (2019) paper which aims to study the influence of knowledge management strategies on practice to achieve better service innovation performance in the health sector. In recent theoretical developments, knowledge management activities have a key role in improving innovation performance (Moosavi Jad et al (2017) in Yeum, 2019). Therefore, the achievement of innovation is highly dependent on the knowledge, skills and commitment of employees as key factors in the value creation process. Knowledge management strategies result in more efficient use of human resources, detection of deficiencies in organizational knowledge, more effective and efficient employee learning, provision of goods and services with more added value, customer and employee content, prevention of error repetition, duplication and time economy. 7 .
In general, Hosseini's research shows that this knowledge management practice is linked to innovative excellence. The reason is that the combination of existing and newly acquired knowledge can play an indisputable and extraordinary role in service innovation. In addition, organizations to implement effective knowledge management practices must implement appropriate strategies. They also have to share knowledge with employees. With the management of intellectual resources and new ideas presented by employees, the hospital is able to provide innovative ideas, tools and services, and processes for their therapy section. Overall, there is sufficient support for knowledge management practices based on knowledge management strategies in relation to developing innovations in new services in order to provide better services to patients in hospital services. In addition, according to Roberts (2016), with a design mindset in health service management, a renewal in the world of health also has a big effect.
One of the reasons behind an underdeveloped understanding of service innovation may still be assigned to the predominance of industrial and technological approaches to innovation. If the organization wants to adopt a service-based strategy, it is important to be able to measure the value of this type of innovation, that is, its impact on company performance. thus, disrupting the optimal allocation of their fear resources. Innovation has been widely recognized as the key to organizational success and leadership style is one of the most important dynamic factors in organizational progress or stagnation. Transformational leadership by creating change in the organization can stimulate staff innovation. The results showed a positive and significant relationship between transformational leadership and process and service innovation. In addition, there is a positive and significant relationship between all components of transformational leadership (idealized influence, intellectual stimulation, individual judgment and inspirational motivation) and process and service innovation. The success of service organizations is directly related to employees and how they behave. By creating commitment and responsibility to employees, it causes the organization to grow and survive. The role of transformational leadership encourages employees to think creatively and innovatively.
The increasing demand for health services demands innovation. According to Fox (2015), there are several factors that influence the sustainability of an innovation in the world of health.

Political factors
Politics that focus on one particular policy will greatly affect the sustainability of an innovation and political sustainability is considered to increase when management leaders and organizational culture support innovation. Therefore, the role of the leadership element and the involvement of staff are the main focus of the political segment.

Organizational factors
Flexibility and adaptation of innovation to suit the context and organization have been recognized as proponents of sustainability innovation. Operational governance agreed upon in an organization and effective communication within an organization will increase the sustainability of innovation. Lack of meetings and teamwork leads to a lack of support for innovation and poor sustainability.

Financial Factors
Innovations that have a dedicated, sustainable budget and are sufficient to meet a need are more likely to be used by an organization. The financial factors of this theoretical framework ensure funding sources, planning strategies and evaluation of innovations.

Labor factor
The workforce or staff and their roles will change according to the minimum amount of training attended. Using high quality training resources will also support the sustainability of an innovation. Lack of continuity or not having adequate staff to implement innovations is a threat to sustainability.

Innovation-specific factors
The nature and type of innovation will play a role in the sustainability of the innovation itself. An important feature of an innovation is fluidity and adaptability to respond to changing funding and service requirements based on local decision making and needs. Consequently, innovationspecific factors focus on identifying supports and barriers to innovation strategies and evaluating self-innovation.
These factors are a dynamic collection of characteristics and may be related to one another. As a direct consequence, innovation services are emerging as a research priority to better understand how health care providers can improve health care and promote services by combining and recombining innovative and renewable resources. According to Berry, 2019, one of the factors that influence the success of a service innovation in the hospital is the presence of a strong expertise in marketing a service. Health care needs to learn how to improve marketability so that services can be utilized and utilized optimally.
In the literature Thune (2016) devotes special attention to the role of medical doctors and looks in detail at the role of physicians as inventors, their role in developing new products, and the ways in which these activities are carried out in collaboration with industry. The literature on hospitals as innovative organizations is, as one might expect, primarily internally oriented to hospitals. Some of this literature also has a special focus on use and dissemination, particularly on questions about complementary service innovations, adaptations, and post-implementation improvements. This literature has a learning perspective in organizations and tends to emphasize organizational features and management practices that promote openness and participation in innovation activities among hospital employees.

Conclusion
From some of the literature analyzed, 27 journals were in accordance with the topics and objectives of the study, namely analyzing and examining the factors that influence service innovation in hospitals. Most of the literature analyzed uses the literature review method or literature review. As for the results obtained from the analysis of several literature, there are several activities that the hospital can do such as having a good communication system with members in the hospital organization, especially between leaders and members, empowering members and providing an appropriate and fair reward system so that the organization is strived for. experience change by accepting service innovations. In addition, the existence of the hospital's internal marketing policy increases employee satisfaction and loyalty. If employees are satisfied, it will influence a hospital to increase innovation in its services. There is also a need for a transformational leadership style for hospital leaders. If management in the hospital adopts a transformational leadership style, the organization's ability to increase to create innovation and make the organization experience growth and progress.