As a health service organization, Regional General Hospital, Sigi Regency, must continually provide the community with quality and professional health services. Hospitals, as a facility that offers health services to the community, have a strategic role in achieving quality public health by increasing public health stock. Regarding public health stocks, it has been researched by [1]. Hospitals generally offer various health services, such as medical care services, testing for causes of illness, and emergency services, such as treating accident victims who require emergency treatment and providing treatment by procedures established by law [2]. 

Providing health services quickly and precisely in this era of rapid reform and globalization is necessary because otherwise, it will cause social unrest. Government Regional General Hospitals, in carrying out their functions, always need help with problems such as increasing medical costs (ceteris paribus), which will weaken the purchasing power of health services so that they tend to reduce the number of requests for health services. Conversely, relatively lower prices for health services will strengthen purchasing power and increase the number of requests for health services [3]. The cost of medicines is also a problem for hospitals providing health services. The research results of Alhusni et al. [4] concluded that there is a difference between hospital billing costs and INA-CBGs rates for inpatient services. The difference in costs can be used as a basis for local governments in determining health spending budgets related to infectious diseases at the Health Service, which can be used as additional considerations in determining spending budgets.

Hospital autonomy is a form of reform for public services to increase public trust in hospitals as government institutions in providing public services. The existence of a supervisory board that independently supervises hospital performance aims to achieve good governance patterns so that health services can be maximally improved. The monitoring process must be truly independent without intervention from other parties to be able to reflect the true condition of the Tora Belo Regional General Hospital. A study [5-7]concluded that the role of the supervisory board is much needed by agencies when carrying out their activities, programs, and services. Likewise, with the supervisory board in government agencies, especially the Tora Belo Regional General Hospital, the supervisory board position is a check and balance tool for the hospital, as well as a guidance and monitoring tool on behalf of the hospital owner (Regional Government). So, a supervisory board and reports from the supervisory board are important factors in reflecting the actual state of the Tora Belo Regional General Hospital.

Improving the quality of health services is also greatly influenced by human resource management. Human resource development must continue to refer to hospital demand, goals, vision, mission, organizational plans, HR divisions, and the community's supply of health workers. Human Resource Development can be carried out using two approaches, namely a quantitative approach, including planning the number of health workers needed, and a qualitative approach, covering specific aspects of each element of the Human Resources cycle, namely planning for recruitment, selection, placement, utilization, development, career, supervision, and control as well as employee performance evaluation. Preliminary research on the pattern of human resource development at the Tora Belo Regional General Hospital, Sigi Regency, shows that the hospital management does not yet have a special division for human resource development, so education and training activities are carried out without good planning and selection, and there is no improvement pattern. Career (position promotion) for employees.

Service quality is all activities carried out by an organization to meet consumer expectations. In this case, service is defined as a service or service delivered by the service owner in the form of convenience, speed, relationships, abilities, and friendliness, which are aimed at attitudes and characteristics in providing services for consumer satisfaction. Service quality can be determined by comparing consumers' perceptions of the service they receive/obtain with the actual service they expect/want regarding the service attributes of an organization.

A phenomenon that often occurs at the Tora Belo Regional General Hospital, Sigi Regency, related to the quality of medical personnel service, shows a gap between the quality of ideal nursing services and actual nurses. This is due to the high demands of patients and the low ability of Human Resources to serve patients. Service quality is a unique phenomenon because its dimensions and indicators can differ between people involved in the service. According to Azwar [8], to overcome the differences above, what should be used as a guide is the fundamental essence of health service delivery, namely meeting the needs and demands of service users.

Increasingly tight competition between hospitals and increasingly selective consumer behavior requires the Tora Belo Regional General Hospital, Sigi Regency, as one of the health service providers to continuously improve the quality of its services. To improve the quality of service, it must first be known whether the services provided to patients/customers so far have met patient/customer expectations. Therefore, the Tora Belo Regional General Hospital, Sigi Regency, must always maintain the trust and satisfaction of patients/consumers by improving the quality of service so that patient satisfaction increases.

Based on the phenomena, theories, and research results described previously, the objectives of this research are:

• Analyzing the role of the Supervisory Board in providing internal non-technical guidance and supervision of hospitals at Tora Belo Sigi Regional Hospital

• Analyzing Human Resources development strategies

• Analyzing the quality of service at the Tora Belo Regional General Hospital, Sigi Regency

Literature Review

Optimization: Optimization comes from the primary word optimal, which means best, highest, most profitable, making the best, making the highest, optimizing the process, method, and act of optimizing (making the best, highest, and so on) so that optimization is an action, process, or methodology for making something (as a design, system, or decision) more/entirely perfect, functional, or more effective.

The basic meaning of optimization is the best, the highest, the most profitable, making the best, making the highest, optimizing processes, methods, and optimizing actions (making the best, the highest, and so on). So optimization, in this case, can be interpreted as an action, process, or methodology to make something (as a design, system, or decision) better and more perfect, functional, or more effective.

According to Winardi, optimization is a measure that causes goals to be achieved. Optimization is finding the best solution, not consistently the highest profit that can be achieved if the optimization goal is to maximize profits, or not always the most negligible costs that can be reduced if the optimization goal is to minimize costs. Three elements of optimization problems must be identified: objectives, decision alternatives, and limited resources [9].

Hospital Oversight Board

The Hospital Supervisory Board is a non-structural unit that carries out internal hospital guidance and supervision of a non-technical hospital nature involving community elements. The Supervisory Board is an independent non-structural unit formed and responsible to the Hospital owner [10].

The Supervisory Board functions as the governing body of the Hospital Hospital to carry out internal non-technical guidance and supervision of hospitals in the Hospital Hospital. Duties of the Supervisory Board:

• Determine the direction of hospital policy

• Approve and supervise the implementation of strategic plans

• Assess and approve the implementation of the budget plan

• Oversee the implementation of quality control and cost control

• Supervise and maintain patient rights and obligations

• Supervise and maintain the rights and obligations of the hospital

• Oversee compliance with the implementation of Hospital ethics, professional ethics, and statutory regulations [10]

In carrying out its duties, the Supervisory Board has the authority to:

• Receive and provide an assessment of the hospital's performance and financial reports from the Head/Director of the Hospital

• Receive reports on the results of inspections carried out by the Hospital Internal Audit Unit with the knowledge of the Head/Director of the Hospital and monitor the implementation of follow-up recommendations

• Director of the Hospital by the Hospital Internal Regulations (hospital bylaws) or Corporate Governance Pattern Documents

• Of the duties and functions of the Supervisory Board by the Hospital Internal Regulations (hospital bylaws) or the Corporate Governance Pattern Document

• Coordinate with the Head/Director of the Hospital in preparing Internal Hospital Regulations (hospital bylaws) or Governance Pattern Documents (corporate governance) to be determined by the owner

• Provide recommendations for improvements to Hospital management [10]

The membership of the Supervisory Board consists of: 

• Elements. Hospital owner. The hospital owner appoints the element of hospital ownership

• Professional organizations. The hospital owner determines the elements of a professional organization after coordinating with the professional organization of health workers

• Hospital Association. The hospital owner determines the elements of the association after coordinating with the hospital association

• Community figures. Elements of community leaders are experts in the field of hospitals [10]

Human Resource Development

Human resource development can be done at a macro or micro level. Macro human resource development improves human quality or ability to achieve national development goals, including planning, development, and management. Meanwhile, micro-human resource development is a process of planning education, training, and managing the workforce or employees to achieve optimal results. Human resource development, one of the operational functions of human resource management, contains activities to maintain and improve employee competency through increasing knowledge, skills, abilities, and other aspects. Human resource development is important to implement due to changes in people, technology, work, and organizations.

According to [11], "Development is an effort to provide employees with the abilities that the organization will need in the future." Human resource development is focused on newly recruited employees and employees who have been working for a long time. Development consists of 

• Training to improve skills and knowledge to do specific work 
• Education related to expanding general knowledge, understanding, and background

Furthermore, Simamora [12] stated that Training is a series of activities designed to improve a person's skills, knowledge, experience, or changes in attitude individual. Training is concerned with the acquisition of skills or knowledge specific. Meanwhile, development prepares individuals to assume different or higher organizational responsibilities. Development usually relates to improving intellectual or emotional abilities required to do a better job.

Then De Cenzo et al. [13] added that human resource development consists of 

• Employee training, which is present-oriented training whose focus is employee work. At the moment

• Employee development is future-oriented training the focus is on the personal growth of employees

• Career development. Furthermore

De Cenzo et al. [13] emphasize the principles of The Learning Curve, namely:

• The value of learning will be higher if the lesson is motivated

• Learning requires feedback

• Study habits will tend to occur repeatedly if there is a coercion factor

• Practice will improve performance

• Learning starts quickly then becomes stable

• Lessons must be transferred to work

In detail, the area of human resource development activities is in 4 (four) parts, namely [14]:

• Employee training (employee training)

• Employee education (employee education)

• Employee development (employee development)

• Non-employee development (non-employee development) 

Quality of Health Services

Munro [2] states that the quality of health services is defined as:

• According to patients/society. Patients/communities see quality health services as health services that can meet felt needs and are provided in a manner that is courteous and timely, responsive, and able to cure complaints and prevent the development or spread of disease. The patient's view is critical because satisfied patients will comply with treatment and want to return for treatment

• According to the service provider. Health service providers associate quality health services with the availability of equipment, work procedures or protocols, professional freedom in providing health services by the latest health technology, and how the output or health services are. Healthcare professionals need and expect technical support, administration, and other practical and efficient services in providing quality health services

• According to funders/insurers. Funders/insurers consider quality health services to be efficient and effective health services. Patients are expected to be cured in the shortest possible time to make health service costs efficient. Health promotion efforts to prevent disease will be encouraged so that health service users decrease

• According to the Owner of Health Service Facilities. Owners of health service facilities believe that quality health services are health services that generate income that can cover operational and maintenance costs but with health service rates that are still affordable for patients or the public, namely at the cost level when there are no complaints from public patients

• According to the Health Administrator/Gov. Health service administrators do not directly provide health services but are partly responsible for health service quality issues. The need for supervision of financial and logistical requirements will provide challenges, and sometimes, health service administrators need to pay more attention to priorities, resulting in problems in health services. Focusing attention on several dimensions of health service quality will help health service administrators set priorities and meet the needs and expectations of patients and health service providers

• According to professional ties. Successful implementation of the health service quality assurance approach will lead to patient satisfaction. Thus, the health care task has been considered a heavy burden, sometimes accompanied by complaints/criticism from patients and the public. It will turn into job satisfaction. Guaranteeing the quality of health services will prevent malpractice so doctors can avoid being subjected to patient demands

Quality of Hospital Services

Hospital service quality is the degree of perfection of a hospital to meet consumer demand for health services by professional standards and service standards by using the potential resources available at the hospital reasonably, efficiently and effectively and providing safely and satisfactorily by norms, ethics, law, and socio-culture taking into account the limitations and capabilities of the government and consumers.

According to Parasuraman et al. [15], there are five dimensions of service quality known as ServQual, namely:

• Responsiveness (quick response). The ability of health workers to help customers and their readiness to serve according to procedures and meet customer expectations. This dimension is the most dynamic assessment of service quality. Customer expectations regarding speed of service increase over time in line with advances in technology and health information held by customers. The value of time for customers is becoming increasingly expensive because people feel their economic activities are increasing. Time is money applies to assessing the quality of health services from the economic aspect of its users

• Reliability. Ability to provide health services promptly and accurately according to what is offered. Reliability is considered the most important by customers in various service industries because the nature of service products has non-standardized output, and the products are also very dependent on human activity, so it will not be easy to expect consistent output, mainly since services are produced and consumed simultaneously

• Assurance. Ability to provide health services promptly and accurately according to what is offered. Reliability is considered the most important by customers in various service industries because the nature of service products has non-standardized output, and the products are also very dependent on human activity so it is difficult to expect consistent output. Moreover, services are produced and consumed at the same time. This Assurance Criteria relates to the knowledge, politeness, and characteristics of officers whom customers can trust. Fulfilling these service criteria will result in service users feeling free from risk. This dimension includes friendliness, competence, credibility, and security

• Empathy. This criterion is related to the staff's sense of care and attention to each service user, understanding their needs and making it easy to contact them at any time if they want help

• Tangibles. The quality of health services can also be felt directly by users by providing adequate physical facilities and equipment. Health service providers will be able to work optimally according to their respective skills. There is a need to improve communication facilities and indirect service equipment such as parking spaces and waiting room comfort. The nature of service products cannot be seen, held, or felt, so there need to be other measures that can be felt more realistically by service users, for example, the patient reception room, which is clean, comfortable, equipped with chairs, tiled floors, TV, complete office equipment, neat uniforms, attractive and clean

This type of research is descriptive research that explains in detail the role of the Hospital supervisory board and human resource development on the quality of service at the Tora Belo Regional General Hospital, Sigi Regency, Central Sulawesi Province. The descriptive approach in this research was used to develop concepts and collect facts and did not conduct hypothesis testing [16]. The research location was carried out at the Regional Hospital. Tora Belo, Sigi Regency. The technique for determining informants in this research used purposive sampling. Purposive sampling determines respondents or informants based on certain criteria. Data collection carried out in the research used triangulation techniques. Data processing focuses on data obtained through interviews and other documents. Data analysis was carried out during data collection in the field and after all data was collected using interactive model analysis techniques. Data analysis takes place simultaneously and is carried out at the same time as the data collection process with a flow of stages: data collection, data reduction, data display, and conclusion or verification (conclusion drawing verifying).

This research construct is based on the human resource development model proposed by (2007), which consists of 

• Employee training

• Employee education

• Employee development (employee development)

• Non-employee development, as well as service quality as stated by Parasuraman et al. [15], namely

• Tangible

• Empathy

• Reliability

• Responsiveness

• Assurance

Based on the analysis and discussion that has been carried out, the research findings are as follows:

Optimization of the Supervisory Board

It was discovered that team m council the supervisor who was formed and functions as the hospital's governing body in carrying out internal non-technical guidance and supervision of hospitals at Tora Belo Sigi Regional Hospital, needs to run optimally according to expectations. Has been planned.

Several problems/obstacles that arise or are faced in the form of a team council include barriers to creativity, barriers to perception, barriers to emotions, barriers to expression, mental block, obstacle self-invented, conformity and not challenging real things, the habit of judging too quickly, fear of appearing stupid and excessive caution too much from someone sometimes in no way awareness can cause these obstacles to arise which of course will prevent someone from unleash his creative power. These obstacles would be very unfavorable for the board team supervisor if there are personnel who encounter them. This obstacle is due to examination problems that tend to change and vary.

A supervisory board team is said to perform optimally by consistently producing synergistic performance supported by the following characteristics:

• Goal conscious. All components of the team understand the team goals and each task. Being aware of goals will give components in the team a sense of direction and not quickly lose orientation if dealing with problems, which is a dilemma

• Open communication. Team members can let go of their distance and doubts after a respected person opens up self, is friendly, and does not look down on them. The impact is on members that the team does not feel bound by psychological barriers in the form of doubts, fear of being wrong, and feeling stupid

• Respect and trust. Always be aware that each team consists of a number of members with diverse abilities. Awareness of the importance of the role of each member will foster a sense of mutual respect and need

• Shared leadership. This is a logical consequence of a climate of openness and a sense of mutual respect and trust in each other, characterized by decision-making based on mutual consensus. The involvement of team members in decision-making will increase motivation and self-confidence so that it has the effect of a desire to improve the internal performance of team activities

• Procedure effective work. Work procedures practical demands there is also a division of tasks and roles between members optimally keeping in mind that the essence of Collaboration is the involvement of all parties in the team. However, that does not mean other members cannot help members or anything else at all

Flexible and adaptable. An optimal work team is also a must. It has the characteristics of being flexible/flexible to various situations and can adapt in the face of changes. A team realizes that their solution may not go well because the situation changes or the solution is not good enough, so it needs to be repaired. Below are several alternatives or thinking techniques creative, including:

• Stimulating ideas, Techniques this uses the help of a list of questions, which can spur the creation of new ideas. Select topics to be discussed and record results newly acquired

• Listing Traits. This technique uses the elements of properties consisting of natural things by registering all traits/characteristics as a basis for encouraging the emergence of new ideas. The benefits are getting new ideas and getting ideas for changes based on elements of the nature of an object or actual situation

That relationship forced, a creative thinking technique that stimulates creativity based on free association coercion, is carried out using, among other things: 

• Isolate the elements of the problem to be discussed

• Find patterns of interrelationships between that elements

• Analyze and record the relationships between these elements

• Start developing ideas that just come from relationships and the linkage t

Optimizing Human Resources Development

So that the Regional Hospital. Tora Belo Sigi can have quality and standardized health human resources, so efforts to improve the quality of human resources must be carried out using pre-service education and in-service education, which is carried out in a continuous and planned manner, carefully prepared and based on scientific methods and guided by the skills needed by hospitals now and in the future.

Optimizing the Quality of Health Services

In daily practice, assessing the quality of health services takes work. The main reason is because the quality of service is multi-dimensional. These differences in perspective are caused, among other things, by differences in background, education, knowledge, work, experience, environment, and interests.

Optimizing the quality of health services is seen through the tangible dimension, empathy, reliability, responsiveness, and assurance, but it must also consider the variable perspectives of consumers, professions, and management:

• Consumer factors, namely health services, can meet the needs and expectations of consumers/patients

• Professional factors, namely health services, can meet the needs of patients/consumers, as determined by the health service profession. This dimension is measured using procedures or professional standards that are believed to produce results, and then those results can also be observed

• Management factors, namely the process of health services using the most efficient resources to meet the needs and hopes/desires of patients/consumers

• Based on this description, the researcher developed a new construct that can be used as a basis for efforts to optimize the role of the supervisory board in carrying out internal non-technical guidance and supervision of hospitals at Tora Belo Sigi Regional Hospital, as well as being able to maximize the human resource development model and quality of health services at Tora Regional Hospital. Belo Sigi

The research construct developed by the researcher can be seen in the following picture:

Figure 1: The Role of the Supervisory Board in Carrying Out Internal Non-Technical Supervision and Supervision of Tora Belo Sigi Regional Hospital Hospitals

Based on the research results developed in analysis and discussion, a conclusion is formulated as the final answer to the research problem as follows:

• Council team, the supervisor who was formed and functions as the hospital's governing body in carrying out internal non-technical guidance and supervision of hospitals at Tora Belo Sigi Regional Hospital, is not running optimally according to expectations has been planned

• Human resource development at Tora Belo Sigi Regional Hospital has yet to be carried out in a sustainable and planned manner, carefully structured and based on scientific methods, and guided by the skills needed by the Hospital now and in the future

The quality of health services at Tora Belo Sigi Regional Hospital is generally reasonable. This means that when service quality increases, patient satisfaction will increase.

1. Ichwan, M. et al. “Health demand in Indonesia: Health stock approach.” Universal Journal of Public Health, vol. 9, no. 5, 2021, pp. 268–275.

2. Munro-Faure, L. and Munro-Faure, M. Implementing total quality management: Menerapkan manajemen mutu terpadu. 2004.

3. Ichwan, M. et al. “Health demand: Empirical study of effective urban household demand in Indonesia.” Open Access Macedonian Journal of Medical Sciences, vol. 9(E), 2021, pp. 812–816.

4. Alhusni, E.A.Y. et al.Ichwan, M., and Suarayasa, K. “Unit cost analysis of COVID-19 patient Madani Palu Hospital.” International Journal of Management Studies and Social Science Research, vol. 3, no. 6, 2020, pp. 127–143.

5. Andi and Trisnantoro, L. “Pelaksanaan pengawasan intern oleh dewan pengawas dalam rangka menuju optimalisasi kinerja studi kasus RSUD BLUD Dr. HM Rabain Kabupaten Muara Enim.” Jurnal Kebijakan Kesehatan Indonesia, vol. 3, no. 1, 2014, pp. 10–18.

6. Farrell, L. et al. “Peran dewan pengawas rumah sakit dalam mengawasi dan menjaga hak-hak pasien (Studi di Rumah Sakit Umum Ananda Purwokerto).” Angewandte Chemie International Edition, vol. 6, no. 11, 2022, pp. 720–733.

7. Purjanto, K.A. “Peran dewan pengawas dalam tata kelola rumah sakit.” Kongres XIII PERSI & Seminar Nasional JCC Jakarta, Nov. 2015, pp. 21–24.

8. Azwar, Azrul. Pengantar administrasi kesehatan. 3rd ed., Penerbit Bina Rupa Aksara, 1996.

9. Siringoringo, Hotniar. Riset operasional seri pemrograman linear. Graha Ilmu, 2005.

10. Mboi, Nafsiah. Peraturan Menteri Kesehatan Republik Indonesia Nomor 10 Tahun 2014 tentang Dewan Pengawas Rumah Sakit. 2014.

11. Aydin, M.D. “Nonverbal immediacy in human resources training and development programs: The case of physicians.” International Journal of Business and Social Science, vol. 4, no. 9, 2013, pp. 156–165.

12. Simamora, Henry. Manajemen sumber daya manusia. STIE YKPN, 2004.

13. DeCenzo, D.A. et al. Fundamentals of human resource management. 11th ed., John Wiley & Sons, 2013.

14. Nadler, L. The handbook of human resource development. John Wiley & Sons, 1984.

15. Parasuraman, A., Valerei A. Zethaml, and Leonard L. Berry. “SERVQUAL: A multiple item scale for measuring consumer perceptions of service quality.” Journal of Retailing, vol. 64, Spring 2015, pp. 12–40.

16. Creswell, J.W. Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications, 2009.