Journal of Management Development

The effect of employee ability, hospital’s ethic and leadership to job satisfaction through the employee
commitment: a study on Indonesian type a government hospital
Ria Mardiana Yusuf,
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Ria Mardiana Yusuf, "The effect of employee ability, hospital’s ethic and leadership to job satisfaction through the
employee commitment: a study on Indonesian type a government hospital", Journal of Management Development, https://
doi.org/10.1108/JMD-12-2016-0311
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 The Effect of Employee Ability, Hospital’s ethic and Leadership to Job
Satisfaction through the Employee Commitment: A Study on Indonesian
Type a Government Hospital

Abstract

Purpose – The purpose of this paper is to confirm the direct and indirect effect of employee
ability, perceived ethic; and leadership to job satisfaction through employee commitment.
Design/methodology/approach – A Survey instrument comprising a construct of employee
ability, perceived ethic, and leadership to commitment of employee and satisfaction of
employee was developed. This study also using the self perception, leadership evaluation and
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customer evaluation questionnaires. The effects among variables also analyzed by used
structural Equation Modeling method.
Findings – The results of the analysis shows that: (1) The survey instrument was shown to be
reliable and valid, (2) The implementation of hospital ethic is more emphasized on the nurses
(as a front liners), (3) The study proves that there is a direct and indirect effect among
variables of employee ability, hospital’s ethic, leadership to the service quality through the
employee commitment. (4) The direct effect of employee commitment variables against the
inpatient health care satisfaction was negative significance.
Research Limitation – Analyses are developed within the context of a government single
hospital of type A. According to the time sequence of study, this field of study research
considered for purpose only (one time study), and was not conducted for experimental study.
Originality – This paper’s main contribution is to propose and empirically test of set of
construct complement of the effect of employee ability, perceived of hospital’s ethic,
leadership upon the service quality through the employee commitment direct and indirectly in
the type A Hospital.

Keywords: employee ability, hospital’s ethic, leadership, employee commitment, service

quality

Paper type: Research paper

1. Introduction
Each person does not want sickness befall them. However, to maintain one's health
condition is not an easy thing. In addition to illness is uncertain events (unpredictable),
irregular, and may rarely occur. The incident also brought pain to someone who has little
financial consequences and economic burden a person. Incidence of illness resulting in
economic burden for the patient or their family was often seen as a "disaster" (catastrophic
illness). The situation is unpleasant, to most people due to payment of medical services
directly from the bag (out-of-pocket).
For the case of Indonesia, Mohammad (2002) stated that the implementation of
comprehensive health insurance is still hampered by several things, namely the basic policy
of the health system and health care systems are not yet clear, the attitude of the politicians
who consider health care as a responsibility of health departments, and the low level of public
confidence toward health insurance. The insurance company consultant Health-Grades
examined comprehensive data from 2000 to 2002 and concluded that about 195,000 deaths in
U.S. hospitals can be attributed to medical errors. Furthermore, errors inflate medical costs
 due to longer and more costly hospital stays (Nordgren et al., 2004). Data released by the
Juran Institute says that two thirds of the cost of health insurance coverage expenditure is
dominated by the low quality of service (Mehring and Koretz, 2004).
One of the largest service providers and a state-owned enterprises the government of
Indonesia, PT. Askes involves involving health providers of health insurance companies,
namely the hospital. As an equal partner health insurance companies, hospitals into
healthcare providers the most important. While insurance companies act as intermediaries of
participant health insurance and hospitals provide health services. The involvement of the
hospital as the provider is no doubt the urgency. So much for the important role these
hospitals so that the various discussions about customer satisfaction, explicitly measured
from satisfaction of hospital services. Services are intangible products produced by the
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various parties within an organization, including hospitals. The theory of interactive service
quality manyebutkan that the optimization of service is determined by the first on the
optimization of internal services to internal stakeholders, and will result in optimum services
to external stakeholders (Boshof and Mels, 1995).
In addition to researchers who have analyzed the role of service employees as a
dimension of service quality (e.g. Parasuraman et al., 1988; Dabholkar et al., 2000), studies
that explicitly address the concept of customer orientation of service employees are Brown et
al. (2002), Donavan et al. (2004), and Hennig-Thurau and Thurau (2003). In the context of
service quality research, it has been demonstrated that the behavior of service employees
affects the customers’ perception of the service (Bitner et al., 1990).
Specifically, researchers have identified employee-related aspects of the service as
dimensions of the customer’s service quality assessment. For example, three out of five
service quality dimensions of Parasuraman et al. (1988) Servqual measure directly or
indirectly address the behavior of employees (i.e. responsiveness, assurance, and empathy).
Similarly, Dabholkar et al. (2000) identify personal attention and comfort as provided by a
provider’s employees as components of service quality. Therefore, a service provider gains
only limited information on the managerial action that is needed to select and train their
service employees. In addition to the theory of interactive marketing, this research paper
therefore also adopts the theory of COSE (Customer Service Employee Orientation) that
stems from the theory of personal interactions (Argyle, 1967). In this regard, hence the topic
concerning the effect of working ability, hospital ethics, leadership behavior on employee
commitment and quality of inpatient services General Hospital Type A in South Sulawesi,
becomes a topic of research analysis in this research paper.

2. Literature Review
A. Theoretical Background
Investigating organisational commitment is important and useful to organisation
leaders as organisational commitment has been found to affect other organisational outcomes,
including turnover intentions (Sims and Kroeck, 1994) and company sales and profitability
(Benkhoff, 1997). Its importance and usefulness underlie the proliferation of studies that
investigate the determinants of organisational commitment (e.g., personal attributes, job
characteristics and work experience - the three broad categories of determinants of
organisational commitment proposed in Steers’ (1977) model in Johnston et al. (1990)).
Other determinants found to have an effect on organisational commitment include job
satisfaction (MacKenzie, 1998) and socialization tactics or practices (Allen and Meyer, 1990;
 Ashfort et al.,, 2007; Buchanan, 1974). There is also evidence that employees’ personal belief
in work ethics had a direct effect on organisational commitment (Ashfort et al.,, 2007).
As ethical values may vary from one person to another, it may be necessary for
leaders in organisations to adopt certain measures to inculcate certain ethical values among
employees in order to manage organisational outcomes. This study investigates the links
between organisational ethics and two measures of organisational outcomes. Specifically, it
investigates whether top management support for ethical behaviour, the ethical climate in the
organisation, and the association between ethical behaviour and career success are associated
with different levels of job satisfaction and also with different levels of organisational
commitment. The findings of this study can contribute to the understanding of how
organisational ethics may be used as a means to generate favourable organisational outcomes.
The link between organisational ethics and job satisfaction can be explained by the
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organisational justice theory and cognitive dissonance theory. The salient points are
summarised below (see also Koh and Boo, 2004; Viswesvaran et al., 1998). Organisational
justice theory. The concept of organisational justice is central to understanding a wide range
of human attitudes and behaviours in organisations. The underlying premise is that the justice
perceptions of employees affect their job attitudes and organisational outcomes. Leigh et al.
(1988), for example, concluded that employees look more to the broader organisational
environment than to their particular role in attributing their satisfaction to their job. In
particular, perceptions of organisational justice affect job attitudes such as job satisfaction
and turnover intention.
On the conceptual front, fairness heuristic states that perceptions of fairness in one
area effect perceptions of fairness in another area. In the context of this study, it means that
employees who perceive their organisations to be ethical are also likely to perceive their
organisations as being fair to them. This, in turn, is likely to enhance employee job
satisfaction. Hence, organisational ethics and job satisfaction are expected to be positively
linked. More generally, justice judgments affect attitudes, behaviour and decisions across a
wide variety of social contexts and they also play an important role in how employees
respond to organisational outcomes and organisational procedures and process.
In view of the above, if employees perceive strong top management support for
ethical behaviour, a favourable ethical climate, and a strong association between ethical
behaviour and career success in the organisation, then they are also likely to have a higher
level of job satisfaction. The converse is also true. Cognitive dissonance theory. According to
the cognitive dissonance theory (first proposed by Festinger (1942), individuals strive to
minimise dissonance in their environment. Similar concepts include the balance theory, the
congruity principle and the discrepancy theory). Empirical evidence has shown the operation
of the cognitive dissonance theory in finance and marketing. In a nutshell, continued
dissonance results in distress and dissatisfaction with the situation (Viswesvaran et al., 1998).
Essentially, employees desire consistency between their ethical value system and the ethical
climate of their organisation. Assuming that employees generally strive to be individually
ethical, dissonance results if these employees perceive little top management support for
ethical behaviour, an unfavourable ethical climate in their organisation, and/or little
association between ethical behaviour and career success. This dissonance will, in turn,
reduce job satisfaction.
Further, top management sets the organisational climate for, and serves as a referent
group to, employees. Thus, any discrepancy between employees’ internal standards of ethics
and their perceptions of top management will result in a moral conflict and cognitive
dissonance (Dozier and Miceli, 1985; Festinger, 1942). This again reduces job satisfaction.
 More recently, and Kroeck (1994) and Viswesvaran et al., 1998) found that the lack of an
ethical fit (i.e., ethical incongruence) between employees and their organisation can result in
distress and job dissatisfaction, among other things. To summarise, a positive link between
organisational ethics and job satisfaction is expected. That is, a higher level of ethics is
expected to be associated with a higher level of job satisfaction in organisations.
The definition by Brown et al. (2002) is based on Bandura’s social learning theory,
according to which nearly anything that can be learned through personal experience, can also
be learned by observing the behaviours of others, and the consequences of these behaviours.
Thus, leaders are influencing their followers by acting as role models of ethical conduct and
being the object of identification and emulation to followers. Punishments and effects can
facilitate learning in an anticipatory manner and signal about the benefits and costs of
selected (un)ethical behaviours. This social learning process has an important role regarding
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the ethical behaviours in an organisation, and therefore it can be also thought to have an
impact on the ethical organisational culture.
Employees’ attitudes towards ethicality are susceptible to environmental effects
(Jordan, et al., 2011). Therefore leadership behaviour can have an effect on the organisational
culture and organisation’s members’ behaviour. Ethical leadership has been, accordingly,
found to be positively associated with employees’ ethical decision making, prosocial
behaviour, satisfaction, motivation and commitment to the organisation, and negatively
associated with harmful behaviour (Jordan, et al., 2011). Ethical leadership also predicts
employee trust and satisfaction with the leader (Brown et al., 2002) and increases employee
commitment (Jordan, et al., 2011) and their willingness to report problems to management
(Brown et al., 2002). Jordan, et al., 2011discovered that when employees were treated fairly,
they were more committed to their organisation and unethical conduct in the organisation
decreased. In addition, organisational justice, including fair treatment of employees, is related
to a 13-48 per cent lower rate of sickness absences (Elovainio et al., 2002) and to higher work
satisfaction (Tatum and Eberlin, 2008).
The literature covering different factors that effect (ethical) leadership is in its full
extent beyond the scope of this study. Some essential findings are discussed next. When
ethical leadership has been studied in relation to background variables, several studies have
not found differences between men and women. However, those studies that have found
gender differences, female managers have proven to be more ethical in decision-making
processes (for reviews, see Ford and Richardson, 1997; O’Fallon and Butterfield, 2005).
Results have also shown that cognitive moral development is positively correlated with age,
education, and work experience (Jordan, et al., 2011). Study results concerning the effects of
moral development on ethical decision making are, however, mixed (O’Fallon and
Butterfield, 2005). According to some studies, the line of business and size of the
organisation are associated with ethical decision making, but the results are somewhat
contradictory (Ford and Richardson, 1997; O’Fallon and Butterfield, 2005).
Some differences in ethical decision making have also been found between different
managerial levels. Lower level managers are focusing more on internal relations and
employee interactions, whereas higher level managers can affect organisational finance and
implement ethical behaviours into the organisation (Jordan, et al., 2011). In upper
management the focus is also more on external stakeholders, contacts and strategic
management. Middle level managers can face additional pressures in ethical decision making,
as they are acting in between executives and employees, arbitrating their possibly conflicting
expectations. Some studies have shown that practitioners in later career stages display higher
ethical judgement, and that the ability to identify unethical behaviour increases with work
 experience. It has also been found that higher level managers are less likely to detect ethical
problems in their organisation (Jordan, et al., 2011), and that lower level managers are more
pessimistic about the ethicality of their organisation.

B. Previous Study
Koh and Boo (2004) with the title “Organisational ethics and employee satisfaction
and commitment”, examines the relationships between organisational ethics and
organisational outcomes. In particular, it investigates if a higher level of top management
support for ethical behaviour, a more favourable ethical climate in the organisation, and a
stronger association between ethical behaviour and career success can lead to a higher level
of job satisfaction as well as greater organisational commitment. Decision tree results
indicate significance and positive effect of both organisational ethics and job satisfaction on
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organisational commitment. They also indicate significance and positive links between
ethical culture constructs and job satisfaction. However, no significance relationship between
ethical climate and job satisfaction is observed. This may not be surprising as ethical culture
comprises control mechanisms that specifically aim at influencing organisational outcomes
while ethical climate is associated with attitudes and perceptive values that may or may not
effect behaviour (Jordan, et al., 2011). The practical implication to organisational leaders is
that organisational ethics can be used as a means to generate favourable organisational
outcomes. Some possibilities on enhancing organisational ethics have been suggested in an
earlier section.
Dion (2012) with the title “Are ethical theories relevant for ethical leadership?”, The
aim of this study is to know if ethical theories could be connected to some leadership
approaches. In the paper eight leadership approaches are selected: directive leadership, self-
leadership, authentic leadership, transactional leadership, shared leadership, charismatic
leadership, servant leadership, transformational leadership. Five western ethical theories
(philosophical egoism, utilitarianism, Kantianism, ethics of virtue, ethics of responsibility)
are analyzed to see to what extent their basic concepts could be connected to one or the other
leadership approach. A given ethical theory (such as philosophical egoism) could be suitable
to the components of various leadership approaches. Ethical leadership does not imply that a
given leadership approach is reflecting only one ethical theory. Rather, ethical leadership
implies that for different reasons, various leadership approaches could agree with the same
ethical theory. This is what we could call the “moral flexibility of leadership approaches”.
Huhtala (2013), The main aim of the present study is to discover whether the
managers’ self-evaluations of their ethical leadership style are associated with their
assessments of the ethical organisational culture (measured with an eight-dimensional
Corporate Ethical Virtues-model). It aims to hypothesise that the more ethical the managers
evaluate their own leadership style to be, the higher evaluations they give on the ethical
culture of their organisation. The underlying assumption is that ethical managers can enhance
the ethical culture by behaving in accordance with their own values. This quantitative
research was based on a questionnaire study with 902 respondents throughout Finland. A
linear regression analysis was conducted to examine how ethical leadership was related to
ethical organisational culture. Managers who appraised their own leadership style as ethical
also evaluated the ethical culture of their organisations more positively. The result implies
that an ethically behaving leader can develop the culture of his/her organisation towards more
ethical practices. The results also showed that differences in evaluating both ethical
leadership and culture emerged concerning background variables.
 C. Relationship
Work Ability, Employee Commitment and Customer Satisfaction. Robbins (1996)
suggest that the ability is the capacity of a person in work, which was formed among others
by education, training, work experience and work ethic. This capability is suspected as the
process of enriching a person's ability to work. The term of commitment has been used to
describe such diverse phenomena as the willingness of social actors to give their energy and
loyalty to social systems (Kanter, 1968), an awareness of the impossibility of choosing a
different social identity or of rejecting a particular expectation, under force of penalty, the
organizational identification or organizational involvement. Work Ability, Employee
Commitment and Customer Satisfaction. Martin and Nicholls (Mullins, 1995) states that there
are three main pillars of building a model of employee commitment to the company or
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management, namely:
1. A sense of belonging to the organization
2. A sense of excitement in the job
3. Confidence in management
Kaldenberg et al. (1995) found that differences in ability (experience and expertise) in close
association with the employee's commitment to the company, management or organization.
While Mowday, Porter, and Steers (1982) in Johnston et al. (1990), found that there are three
factors that the antecedent is committed by someone within the company. Based on the
hypothesis that the exposure is then constructed in this study as follows:

Hypothesis 1: The thought that there was a significance direct effect between work ability of
employees to customer satisfaction.
Hypothesis 2. Suspected that there are significance indirect effects between work ability of
employees to customer satisfaction through employee commitment.

Hospital's Ethics, Employee Commitment and Customer Satisfaction. Studies have

attributed the effect of institutional ethics and employee commitment have been carried out.
Among them is Murphy (1995), which states that today's CEOs of the world's leading
companies have announced their commitment through satement of value of each company.
As is the statement of value is none other than the statement of ethics. Weaver (1999) also
found that the higher the commitment of top management leadership in ethics is to give effect
to the implementation of the ethics program to be run by the company. The same thing was
expressed also by Robbins (1996) that the "code of ethics require a commitment from top
management".
Robbins (1996) conducted a survey of some of the world's major companies,
including Exxon, Sara Lee, Du Pont, Bank of Boston, and Wisconsin Electric Power in US.
Large companies are entering the three main points in their code of conduct, as follows (1) Be
a dependable organization citizen, (2) Do not do anything unlawful or improper that will
harm the organization; and (3) Be good to customer.

Exposure based on the research hypotheses to be tested in this paper as follows:

Hypothesis 3. Alleged that the hospital ethics have a significance direct impact on customer
satisfaction.
Hypothesis 4. Alleged that the hospital ethics significance indirect effect on customer
satisfaction through employee commitment.
 Behavior Leadership, Employee Commitment and Customer Satisfaction T. he effect
of leadership behavior with the commitment of employees is clearly suggested by Yukl
(1998) in models of power and effect. In the model illustrated that situational factors into the
supporting leadership behaviors that will lead to positive and negative impact on their
subordinates. The positive impact that arises is the formation of commitment and obedience
from subordinates. While the negative impacts are happening resistance to behaviors that
have demonstrated leadership.
Smith (1996) also found that there are positive and significance effect among the
leadership behavior with employee commitment. Smith's findings in principle from by
Buchanan (1974) who found that managers in business or government environment that
constantly contribute to the institution and always try to fulfill his promise to encourage
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greater commitment from their subordinates.

Viewed from the side of the company's success in increasing the quality of corporate
intangibles (including service quality) and productivity which will increase sales and profits.
Judging from the customer side, then one measure of corporate success is customer
satisfaction. Therefore according to Yukl (1998) leadership behavior indirectly affects
customer satisfaction which is a review of success or failure of a company from the customer
side. This opinion is also reinforced by Smith (1996) who found that leadership behavior has
a positive effect on productivity.
Thus it can be said that there is a relationship between leadership behavior with customer
satisfaction. Then the following hypothesis:

Hypothesis 5. Allegedly there is a direct significance effect between variable of satisfaction

pealnggan leadership behavior.
Hypothesis 6. Allegedly there are significance indirect effects between variables perialku
leadership to customer satisfaction through employee commitment.

Employee and Customer Satisfaction Commitment . Research related to employee

commitment and its effect on customer satisfaction, has been mostly done by experts,
including Butler and Dynan in 1988 (in Natalisa, 1999). The results of their study of the First
Pennsylvania Bank found that in order to improve the quality of service the customer, the
bank restructured the corporate culture and employee commitment. Dubbinsky and Hartley
(1986) in Johnston et al. (1990) found that commitment employees will greatly affect the
behavior of employees, including the behavior of a service that can give satisfaction to the
company's stakeholders.
Another finding states that employees who have a high commitment to have the
intention to leave the company, will overcome their stress (Begley and Czajka, 1993), and
will perform satisfactorily. Currivan (1999) found that there is a reciprocal relationship
between employee commitment to the satisfaction achieved by both internal and external
corporate stakeholders (Lincoln and Kalleberg, 1990). Thus these studies reinforce the impact
of employee commitment to quality services that satisfy the company's stakeholders.
However, this limits the review of this research papers on deterministic effect between
employee commitment to satisfaction.

Thus the following hypotheses are:

 Hypothesis 7. Suspected that there was a significance direct effect between employee
commitment to customer satisfaction.

To conclude this section, herewith the construct of causal effect between variables depicted in
the conceptual framework of this research paper is given below:

WORK
ABILITY

H1
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H2

HOSPITAL
H4 EMPLOYEE CUSTOMER
ETHICS COMMITMEN SATISFACTIO
T N
H7
H3

H6
LEADERSHI
P
H5
BEHAVIOR

Figure 1. Conceptual Framework among Work Ability, Hospital Ethics, and

Leadership Behavior through Employee Commitment on Customer
Satisfaction.

3. Methodology
The sample was drawn from nurses, doctor’s and patient healthcare insurance, with the
cross sectional and explanatory research design. By using 320 respondent of those internal
(160 respondent) and external (160 respondent) hospital’s stakeholder, this research also
using 24 indicators that split into questionnaire. The survey questionnaires asked nurses,
doctors and inpatient healthcare about ability, implementations of perceived ethics, leadership
style, also commitment and satisfaction due to their services. The structural Equation
modeling also used by this research to make test of the hypothesis.
To test the validity and reliability of data used goodness of fit (GOF) test to the
suitability index of each construct or variable models are built. GOF test applied to construct
a variable working ability, hospital ethics, leadership behavior, commitment to employee and
customer satisfaction. The results showed (as discussed below) states that all meet the criteria
of goodness of fit index.

4. Analysis Result
When appropriate measurement model has been established, the next step is to teste
the full structural model. Structural equation modeling is a tool for testing the causal
relationship among the latent variables, explaining the causal effects and assigning the
 explained and unexplained variance (Joreskog and Sorbom, 2004). The relationships
hypothesized were tested using AMOS to complete the standardized parameter estimates and
t-values. The structural equation modeling confirms this conceptual model perfectly because
of causal relationships among these variables. The result is summarized in Table 1.

Table 1. Parameter Estimation Regession Weights Overall Work Ability, Hospital Ethics,
Leadership Behavior, Employee Commitment and Customer Satisfaction.

Critical
Loading Probability
Hypothesis Ratio Description
Factor (λ) (p)
(t hitung)
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H1 0.354 2.112 0.000 significance

H2 0.102 2.828 0.000 significance
H3 0.094 2.258 0.000 significance
H4 0.518 2.888 0.000 significance
H5 0.707 3.922 0.000 significance
H6 0.072 2.004 0.000 significance
H7 -0.538 2.664 0.000 significance

Table 2. Goodness of Fit Index Work Capability Construct Model Effects, Hospital Ethics,
Leadership Behavior, Employee Commitment and Customer Satisfaction.

Criterion Cut-off Value Model Result Model Evaluation

Chi-Square X2 Lower value expected 141.295 Good
Probability ≥ 0.05 0.238 Good
CMIN/DF ≤ 2.00 1.580 Good
GFI ≥ 0.90 0.927 Good
TLI ≥ 0.95 0.980 Good
CFI ≥ 0.95 0.984 Good
RMSEA ≤ 0.08 0.060 Good

5. Discussion
This study analyzed the effects of direct and indirect variables work ability, ethics
hospitals and hospital leadership behavior on customer satisfaction through employee
commitment. The results obtained are contained significance effect directly and indirectly
between work ability, ethics hospitals and hospital leadership behavior on customer
satisfaction through employee commitment.
From the aspect of workability, Luthans (1998) states that the capability is realized by
the employees they have and arising from within the employee, would psychologically affect
the employee thinking power. Furthermore, the power of thought will encourage cognitive
state employees and employees can make a good run the learning process to improve their
performance (Bell & Kozlowsky, 2000). This is evidenced by the path coefficients to work
kemampan customer satisfaction and employee commitment for 0.35 and
0.10 with the positive direction, which is indicated also by the value of CR> of 2.0, which is
equal to 2.828 which is greater than t table (1.96).
 These findings support the findings of Mowday, Steers and Porter, and Johnston (Johnston,
1990), they found that there are three factors that a person in committing antecedent. The
third factor is the effect in a person, non-organizational factors, and effect the organization.
Of these factors, associated with the ability to work is the effect of factors in a person. Test
the hypothesis that the effect of the hospital ethics of employee commitment and breadth of
our customers find that there is a significance direct effect between the hospital ethics with a
commitment of employees. This is evidenced by the acquisition value of the path coefficient
is positive, which is equal to 0.52, and t test values (CR) is > than 2.0, that is equal to 2.888,
and 0.094 with CR 2.258. This indicates that the commitment of paramedics and hospital
based assessment frontliners paramedics, nurses and hospital patients are affected ethics.
These findings are consistent with previous studies concerning the relationship between
ethics and commitment stating that it contains ethical values (values) greatly effect the
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attitudes and behaviors of a person, or even the organization as a whole (Murphy, 1995;
Weaver, 1999; Sims , 1994; Robbins, 1996).
The hypothesis suggesting that the behavior of top management leadership of the
Government General Hospital Type A in South Sulawesi has a significance effect on
commitment and customer satisfaction. Test results of this hypothesis suggests that the top
leadership behavior directly affects the hospital significance to the commitment and customer
satisfaction with the path coefficients for 0.072 and 0.71. This result is evidenced by the
acquisition of the CR > 2.0, and a large loading factor, ie 2.004 and 3.922 are greater than
2.0. The results of this study are consistent with the findings stating that there is a relationship
between leadership and commitment and performance of their subordinates (Bass, 1990;
Yukl, 1985 in Smith, 1995) as well as the success of an organization.
The results of an analysis of employee commitment to the department of Type A in
South Sulawesi and its effect on customer satisfaction. Demonstrate the significance of direct
effect, but the results are inversely proportional. Namely the path coefficients of -0.54, and
the value of CR = 2.664. Allegations that the commitment of employees (paramedics and
frontliners) in the General Hospital Type A in South Sulawesi has a significance effect on
customer satisfaction has been proven through testing hypotheses. Based on hypothesis
testing, the test results indicate the receipt of allegations stating that there is a significance
direct effect between employee commitments to customer satisfaction, although the effect
coefficient has a negative value, which is equal to -0.54. The significance of these effects is
marked by the acquisition of CR values > 2.0 in all segments of the respondents, as well as t
test values (CR) which is greater than t table (1.645), which amounted to 2.953.
The three groups of variables will explain the relationship between employee
commitments to satisfaction with the result that different also. For example the findings of
Bateman and Strasser (1984), which states that the commitment of employees to be the
precursor of satisfaction (Glisson and Durick, 1988). Instead Curry et al., 1986 (CQ. Glisson
and Durick, 1988) found no relationship between these two variables. It seems that the
findings or results of the analysis on the relationship between employee commitments to
customer satisfaction supports the findings of Curry et al. (Glisson and Durick, 1988).
While the explanation for the findings in this paper, will be directed based on the
point of view Glisson and Durick (1988), as follows:
1. Based on the point of view of groups of variables that describe the characteristics of
work to employees and employee characteristics, found that among the four indicators
of building employee commitment, it turns out there are two indicators that have less
value to the category (below the median on average), which is believed indicator and
indicator values.
 2. Another cause is the lack of time spent (particularly doctors) to treat patients in the
department of Type A in South Sulawesi. As is well known that the paramedics and
frontliners (especially physicians) are faced with various interests, including interests
of patients (of which not a few) that should they handle every day, the interests of the
institution which is a place where paramedics and frontliners the shelter, as well as
their own personal interests one.
3. Based on the variable characteristics of the company's point of view, the findings in
this dissertation also produces something different from previous findings. One of the
main characteristics inherent in the character of the hospital can not refuse patients.
Here is a path diagram of the research model of work ability, hospital ethics, and
leadership behavior on customer satisfaction through the commitment of hospital
staff.
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WORK
ABILITY

0.35

0.10

HOSPITAL
0.52 EMPLOYEE CUSTOMER
ETHICS COMMITMEN SATISFACTIO
T N
-0.54
H3
0.094

0.072
LEADERSHI
P
0.71
BEHAVIOR

Figure 2. Path Diagram of the Effect among Work Ability, Hospital Ethics,
and Leadership Behavior through Employee Commitment on
Customer Satisfaction.

6. Limitation of the Research

a) Assuming that customer expectations have health insurance compare expectations
with reality of the services received, making this study a one-time nature of study,
with cross-sectional design. The assessment of customer satisfaction is based on the
paradigm of service performance received by the customer.
b) Based on research that is longitudinal, measuring customer satisfaction and
dissatisfaction with health insurance for hospital services will use the paradigm of
expectancy-disconfirmatiom, the assessment based on comparison of expectations and
the reality that customers receive health insurance on inpatient hospital services.
c) Measurement of work ability in this study is based on the measurement of employee
perceptions and customer perceptions, where the objectivity of the measurement is
 somewhat dubious (because there are too many factors that can affect their
judgments).
Therefore for future research would be nice if work ability assessments made by the
leaders direct the authorities to assess the performance of its employees.
d) This study is a case study of one hospital that would make the aspects of the findings
is questionable generalization. So for further research should use multiple ruamh type
a government-owned hospital that may represent aspects of the generalization of the
findings.

7. Conclusion
1. In general, the study found that there was a significance effect between the direct and
indirect variables work ability of employees, ethics ruamh illness, hospital leadership
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behavior toward hospital employee commitment and customer satisfaction hospitals,

based on assessments and perceptions of internal stakeholders type a government hospital
in Indonesian. In case this is a paramedic (doctors), frontliners (nurses) and external
stakeholder’s hospital, the inpatient hospital.
2. A significance indirect effects have been found between the ability of employees, hospital
ethics, and leadership behaviors hospital to hospital customer satisfaction based on
assessment of internal stakeholders in this hospital paramedic (doctors) and frontliners
(nurses) as well as external stakeholders hospital (hospital’s inpatient).
3. Finally, we found the significance of the direct effect of employee commitment and
customer satisfaction is a negative value with the path coefficient of -0.538. These
findings indicate that employee commitment has a significan negative effect proportional
to customer satisfaction. The results of this study is not uncommon, as some previous
studies stated a positive relationship between employee commitments to customer
satisfaction. To end this research paper, the author would like to conclude that the
findings in point 3 is different compared to previous findings and may be caused, among
others, (a) Character of hospital management show that physicians faced with a variety of
interests, among others the benefit of patients (of which not a few) that they must deal
with every day, the interests of the institution which is a place where paramedics and
frontliners the shelter, as well as their personal interests respectively; (b) One of the main
characteristics inherent in the character of the hospital can not refuse a patient, so that if
demand for services has exceeded the capacity of service available, will cause the
workload to be incompatible with the available capacity, (c) Frontliners paramedics and
hospitals staff at general on the one hand states that they have a high commitment to the
hospital,whilst on the other hand they feel burdened by their work. This situation will
impact on the service being less than optimal and would impact on customer satisfaction.

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