The Influence of Professionalism and Work Ethics of Employees on the Quality of Health Services

The purpose of this study was to determine the influence of professionalism and work ethics of employees on the quality of health services at the directorate general of railways, ministry of transportations. The formulation of the problem in this research is whether there is an effect of professionalism and work ethic of employees together on the quality of health services at the Directorate General of Railways, Ministry of Transportation. This research method uses a survey with a quantitative approach. The sampling technique used is simple random sampling. In this study, the number of samples was 72 respondents. The variables studied were professionalism (X1) and employee work ethics (X2) as independent variables, while the quality of health services was the dependent variable (Y). Based on the research results that have been done, it can be concluded that: The research results on the variables of professionalism and work ethic of employees together have a strong and significant positive influence on the quality of health services with a correlation coefficient of 0.799. While the resulting influence contribution (r2) is 0.638, meaning that the variables of professionalism and employee work ethic together contribute 56.0% in influencing the health service quality variable.


Introduction
In the current reform era, public demands for improving the quality of public services are quite reasonable and not excessive, considering that so far people still judge that the quality of public services is still not satisfactory and the performance of public services by the government is still very far from what is expected. The function of the government as a public service provider is still far from the community's expectations.
In this study, the sampling technique used is simple random sampling (Creswell, 2013), which is said to be simple because the sampling of members of the population is carried out randomly without regard to the existing strata in the population. This method is carried out if the population members are considered homogeneous because the sample is representative (Vizcarguenaga-Aguirre & López-Robles, 2020). In this study, the determination of the number of samples taken came from employees of the Directorate General using the formula (Jilcha, 2019) as follows: Based on the above calculation, the number of samples at the Directorate General of Railways, Ministry of Transportation is 72 respondents.

Theory and Concept
In addition to work professionalism, employee work ethics are very influential in health service activities at the Directorate General of Railways, Ministry of Transportations. Ethics is one of the added values in service activities for the service user community (Paris et al., 2013). Quality services need to be supported by good attitudes and behavior from service providers (Ajzen & Gilbert Cote, 2008). For this reason, in providing a service, a bureaucrat needs bureaucratic ethics as the basis and guidelines for acting. The application of bureaucratic ethics is carried out to serve as a moral foundation in providing effective, efficient, and professional services and the Article The Social Perspective Journal, 2021, Vol.1 , No.1(1), 1-18 Quality of Health Services 4 accountability that can influence service management to satisfy the public (Henökl, 2008).
Good governance is still an actual issue to date, especially when it is associated with the spirit of reform in terms of eradicating Corruption, Collusion, and Nepotism (Addink, 2018). It is none other than because many people still hope that the bureaucracy will show good performance and want to appear professionally in providing services. However, apart from the various problems that characterize the bureaucracy, it must be believed that making a professional bureaucracy is not easy. However, this must be done (Setyadiharja et al., 2017). Therefore, like it or not, the bureaucracy must be able to reform itself, become a professional figure with excellent service and act as a servant of the state and public servant, ready or not (Rahim, 2019).
This bureaucratic pathology causes people's perceptions to become negative about bureaucracy (Rian Andhika, 2017). Bureaucratic pathology can arise due to several things, namely the perception and managerial style of officials, lack of knowledge and skills, bureaucratic actions that violate legal norms, manifestations of dysfunctional bureaucratic behavior due to internal situations in various agencies within the government (Meier et al., 2019). This bureaucratic pathology must be observed to create a professional bureaucracy. If this continues, it will create bad governance conditions. To realize good governance that works effectively and efficiently requires work discipline from government employees where discipline relates to one's self-control against various forms of rules, both from oneself and the environment (Nugroho, 2009). Discipline is the awareness and willingness of individuals to obey all applicable rules and norms.
Improving the quality of services in the health sector at the Directorate General of Railways, Ministry of Transportations is one of the agendas that starts with the fact that the actual condition of service quality is still not maximized, which is primarily determined by the quality and attitude of government employees who are not commendable and irresponsible. Thus, the quality of health services at these institutions fulfills community needs by state administrators (Višnjić et al., 2012). However, in many cases, there are still many weaknesses in services within the organization, so that they cannot meet the quality expected by service users (Lee & Kim, 2017). Therefore, service users still complain about the quality of services provided by employees, resulting in a bad name or image.

Result
To predict the magnitude of the influence of the independent variable on the dependent variable, the author uses the formula of determination by squaring the value of the correlation coefficient obtained R2 (Corvello et al., 2020). The influence between the variables of professionalism and work ethic of employees on the variable of the quality of health services, the following analytical calculations are used: The hypothesis (Pernet, 2016) that the author proposes to analyze is as follows: 1) Null hypothesis (Ho): There is no positive and significant effect of the professionalism variable (X1) on the health service quality variable (Y). 2) Alternative hypothesis (Ha) (Killeen, 2005): There is a positive and significant effect of the professionalism variable (X1) on the health service quality variable (Y).
To test the hypothesis, the writer uses Product Moment analysis (Chee, 2015). The Product moment correlation will analysis formula is: Furthermore, to calculate the correlation value between professionalism and the quality of health services at the Directorate General of Railways, Ministry of Transportation, the calculation results are as follows: Based on the results of these calculations, the correlation coefficient found is 0.745. After consulting this value with the previous interpretation guide table, it is known that the correlation coefficient is included in the strong positive category because it is between the interval (0.600-0.799). It shows that professionalism has a positive and strong influence on the quality of health services at the Directorate General of Railways, Ministry of Transportation. Meanwhile, to determine the contribution of professionalism to the quality of health services, the coefficient of determination (r)2 can be calculated using the following formula: Based on these calculations, this means that the professionalism variable of 55.5% affects the quality of health services while other factors influence the remaining 44.5%.

Article
The Social Perspective Journal, 2021, Vol.1 , No.1(1), 1-18 Quality of Health Services 6 Furthermore, to find out whether the influence of professionalism on the quality of health services at the Directorate General of Railways, Ministry of Transportation is significant or not, it is necessary to test its significance using the t formula, which is as follows: From the results of the calculations above, the count value is 9.346, and then this value is compared with the table value for an error of 5%, using a two-part test where dk = nk; 72 -2 = 70, and the table value is 2,000. Based on the results of these calculations, the t-count is rejected, so the alternative hypothesis (Ha) is "accepted." So the conclusion is that t count falls in the area of Ha, which is the accepted hypothesis where the correlation coefficient between professionalism and the quality of health services is 0.745, which is a strong positive and significant, meaning that the coefficient can be applied to the entire population.

b. Hypothesis Testing 2
The Effect of Employee Work Ethics (X2) towards Health Service Quality (Y). The hypothesis that the author proposes to analyze is as follows: 1) Null hypothesis (Ho): There is no positive and significant effect of employee work ethic variable (X2) on health service quality variable (Y). 2) Alternative hypothesis (Ha): There is a positive and significant effect of the employee work ethic variable (X2) on the health service quality variable (Y).
The author uses Product Moment analysis to test the hypothesis between employee work ethics on the quality of health services. The product-moment correlation analysis formula is as follows: To calculate the correlation value between employee work ethics and the quality of health services at the Directorate General of Railways, Ministry of Transportation, the calculation results are as follows: Based on the results of these calculations, the correlation coefficient found is 0.748. After consulting this value with the previous interpretation guideline table, it can be seen that the correlation coefficient is included in the category of strong positive. It shows that the employee's work ethic has a strong positive influence on the quality of health services. Meanwhile, to determine the contribution of employee work ethics to the quality of health services, the coefficient of determination (r)2 can be calculated using the following formula: Based on these calculations, this means that 56.0% of employees' work ethic variables affect the quality of health services while other factors influence the remaining 44.0%. Furthermore, to find out whether the effect of employee work ethics on the quality of health services at the Directorate General of Railways, Ministry of Transportation, is significant or not, it is necessary to test its significance using the t formula, which is as follows: From the calculation results, the count value is 9.436, compared with the t-table value for 5% error in the two-party test and dk = nk; 72 -2 = 70, and a table of 2,000 is obtained.

Article
The Social Perspective Journal, 2021, Vol.1 , No.1(1), 1-18 Quality of Health Services 8 Based on the results of these calculations, the t-count is rejected, so the alternative hypothesis (Ha) is "accepted." So the conclusion is that t-count falls in the area of Ha, which is the accepted hypothesis where the correlation coefficient between professionalism and the quality of health services is 0.748, which is strongly positive and significant, meaning that the coefficient can be applied to the entire population.
c. Hypothesis Testing 3 The Effect of Professionalism (X1) and Employee Work Ethics (X2) together on the Quality of Health Services (Y). The formulation of the hypothesis by using the multiple correlations between professionalism and work ethic of employees together on the quality of health services that the authors propose to analyze is as follows: 1) Null hypothesis (Ho): There is no positive and significant effect of the variables of professionalism (X1) and employee work ethic (X2) together on the quality of health services (Y). 2) Alternative hypothesis (Ha): There is a positive and significant effect of the professionalism variable (X1) and employee work ethic (X2) together on the quality of health services (Y).
Meanwhile, before doing the double correlation hypothesis test between professionalism (X1) and employee work ethics (X2) together on the quality of health services (Y), then first calculate the correlation between professionalism (X1) and employee work ethics (X2), with formula as follows: = y X X R Based on the results of these calculations, the multiple correlation coefficient found is 0.799. After consulting the previous interpretation guide table for this value, it is known that the multiple correlation coefficient is included in the strong category. It shows that employees' professionalism and work ethic have a strong positive influence on the quality of health services at the Directorate General of Railways, Ministry of Transportation. This effect applies to the entire population.
To predict the magnitude of the influence between professionalism and work ethics of employees together on the quality of health services, the Directorate General of Railways, Ministry of Transportation, is carried out by calculating the coefficient of determination, namely the formula squaring the value of the correlation coefficient (r2) below: It means that the variables of professionalism and work ethic of employees of 63.8% together affect the quality of health services, and other factors influence the remaining 36.2%. Furthermore, to test the significance of the double correlation of professionalism and employee work ethic on the quality of health services, the researchers conducted a test by determining the F-count value, which was consulted with the F-table value, with the following formula: So the obtained Fount value of 60.927, this value is then consulted with Ftable, for DK numerator = 2 and dk denominator = (72-2-1) = 69, obtained Ftable value at the set error level is 5% = 3.13. In this case, the provisions apply if F ount is greater than F table , then the multiple correlation coefficient tested is significant; that is, it can apply to the entire population. From the above calculation, it turns out that F ount > F table (60.927 > 3.13) shows that the multiple correlations are strong, positive, and significant and can be applied where the sample is taken. Moreover, a hypothesis that reads:

d. Multiple Regression Analysis
Multiple regression analysis (Denis, 2018) was used to predict how much change in the independent variables professionalism and employee work ethic to the dependent variable quality of health services at the Directorate General of Railways, Ministry of Transportation. Where the multiple regression analysis has expressed the equation: = a + b1X1 + b2X2 With the following formula:    The regression equation of professionalism and work ethics of employees together on the quality of health services are = 0.781 + 0.402 X1 + 0.403 X2. It means that the quality of health services is high and low because professionalism and work motivation can be predicted through the regression equation. Based on these data, employees' highest professionalism and work ethic scores are 75 (5 x 15). 5 is the highest score for each answer, and 15 is the number of question items. Therefore, the value of improving the quality of health services is: If the value of professionalism and work ethic of employees is increased to 75 units, then the value of the quality of health services increases from 0.781 units to 61.131 units. Therefore, it means that the higher the professionalism and the better the employees' work ethic, the higher the quality of health services at the Directorate General of Railways, Ministry of Transportation.

Discussion and Analysis
Based on the proposed hypothesis about the effect of professionalism and work ethic of employees on the quality of health services at the Directorate General of Railways, Ministry of Transportation, it is necessary to discuss the existence of each variable. The research results on the professionalism variable have a strong and significant positive influence with a correlation coefficient value of 0.745, while the coefficient of determination (r²) is 0.555, meaning that the professionalism variable contributes 55.5% in influencing the health service quality variable. While the t-test value of 9.346 is greater than the t-table of 2,000 so it can be concluded that the null hypothesis (Ho), which states that there is no positive and significant effect between professionalism on the quality of health services, is "rejected" and the alternative hypothesis (Ha) which states there is a positive and significant influence between professionalism on the quality of health services "accepted." Although the effect between these two variables is strong and significant, with a coefficient of determination that is only 55.5%, it shows that the professionalism of employees is not maximized. It needs to be improved by increasing the professionalism of employees through organizing training for employees who lack good work skills, establishing character building for all employees by participating in seminars held by the agency, and maximizing and channeling the potential of employees in the fields under their control.

14
The results of the research on the employee work ethic variable have a strong and significant positive influence on the quality of health services with a correlation coefficient value of 0.748, while the coefficient of determination (r²) is 0.560, meaning that the employee work ethic variable contributes 56.0% in influencing the quality variable-health services. The t-test value of 9.436 is greater than the t-table (2,000), so it can be concluded that the null hypothesis (Ho) is rejected, and the alternative hypothesis (Ha) is accepted. Although the effect between these two variables is strong and significant, the coefficient of determination which is only 56.0%, shows that the employee's work ethic in terms of service has not satisfied service users.
It needs to be changed by improving employees' work ethic by providing rewards and punishments for employees with the status of State Civil Apparatus and Non-State Civil Apparatus in terms of service to service users in the relevant agency. In addition, policies that exist within the organization must also pay attention to the needs and interests of employees, especially those who serve as service officers, because by accommodating and paying attention to the interests of service officers, employees will not behave and have bad ethics in carrying out their duties. However, with a coefficient of determination of only 56.0%, employees' work ethic in terms of service has not satisfied service users. Therefore, it needs to be changed by improving employees' work ethic by providing rewards and punishments for employees with State Civil Apparatus and Non-State Civil Apparatus in terms of service to service users in the relevant agency. In addition, policies that exist within the organization must also pay attention to the needs and interests of employees, especially those who serve as service officers, because by accommodating and paying attention to the interests of service officers, employees will not behave and have bad ethics in carrying out their duties. However, with a coefficient of determination of only 56.0%, employees' work ethic in terms of service has not satisfied service users.
The results of the simultaneous analysis show that the professionalism and work ethic of employees have a strong and significant positive effect on the quality of health services. It has been significantly proven from the results of research partially and simultaneously that the quality of health services at the Directorate General of Railways, Ministry of Transportation can be determined by factors of professionalism and work ethic of employees as seen from the correlation coefficient value of 0.799. At the same time, the resulting influence contribution (r²) is 63.8%, and other factors outside the research model determine the remaining 36.2%. The results of the calculated F test of the three variables showed the results of 60,927, which is greater than the F table (3,13). Therefore, it can be interpreted that there is no positive and significant effect of employees' professionalism and work ethic on the quality of health services. Therefore, h null is rejected, and the alternative hypothesis (Ha) is accepted.
The resulting influence between these three variables is strong and significant, with a coefficient of determination of 63.8%. However, with the remaining determination of 36.2%, it shows that employees' professionalism and work ethic have not improved the quality of service to the maximum. Therefore, it needs to be improved by providing creative and innovative services to realize excellent service and customer satisfaction. Creative and innovative services in the form of the latest strategies to facilitate and expedite the fulfillment of both public and community services, such as online

Article
The Social Perspective Journal, 2021, Vol.1 , No.1(1), 1-18 Quality of Health Services 15 technology-based services (making special applications for health services in the form of websites, for example, e-regulation, e-health service, e-information) so that customers can access information easily and quickly.
Based on the preceding, the variables of professionalism and work ethic of employees on the quality of health services indicate that the magnitude of the influence of the variables quantitatively can be explained as follows: a) The author needs to analyze the influence of the variable X1 (professionalism) on Y (quality of health services) because professionalism is a commitment to producing quality work based on the expertise possessed by a person to bring satisfaction to others. People who are called professionals commit (a very responsible behavior or attitude) in carrying out their profession or also called having integrity. Professionalism is always associated with efficiency and effectiveness, which is indicated by expertise (competence), commitment (integrity), and output (output). b) For the effect of the variable X2 (employee work ethic) on Y (quality of health services), the authors need to analyze because the employee's work ethic is a critical and rational reflection on moral values, ethical codes, and moral norms as well as the science of good behavior and moral philosophy. that determine and manifest in attitudes and patterns of human behavior, both individually and in groups c) Finally, this study will prove the influence of the variable professionalism (X) and employee work ethic (X2) on the variable quality of health services (Y). The variable quality of health services is measured by a reliable attitude, has a fast response, provides self-confidence and empathy for service users, and tangible services to provide satisfaction to the service user community with predetermined standards. Identifying the variables of professionalism and work ethic of employees will affect the quality of health services. According to the author, based on the above thinking, the hypothesis states that professionalism and work ethic of employees has a strong influence on the quality of health services at the Directorate General of Railways, Ministry of Transportation, is acceptable. Furthermore, the magnitude of the influence of the two independent variables with the dependent variable also shows how to implement and improve the quality of health services optimally; this fact has been answered by the existence of high professionalism and good employee work ethics.
Practically, the two variables work together, meaning that in the process, employees' professionalism and work ethic can become variables or factors that determine whether the quality of health services is high or low. If professionalism is high and employees' work ethic is good, then the quality of health services will automatically increase. In this discussion, the author concludes that the two independent variables above show a very significant influence, meaning that without high professionalism and good employee work ethics, the quality of health services at the Directorate General cannot be achieved improved or implemented optimally.

Conclusion and Recommendation
Conclusion: The research results on the professionalism variable have a strong and significant positive effect with a correlation coefficient of 0.745. While the value of the coefficient of determination (r²) is 0.555, meaning that the professionalism variable contributes 55.5% in influencing the health service quality variable. The research results on the employee work ethic variable have a strong and significant positive influence on the quality of health services with a correlation coefficient of 0.748. While the value of the coefficient of determination (r²) is 0.560, meaning that the employee work ethic variable contributes 56.0% in influencing the health service quality variable. The results of the research that the variables of professionalism and work ethic of employees together have a strong and significant positive influence on the quality of health services with a correlation coefficient of 0.799. While the resulting influence contribution (r²) is 0.638, meaning that the variables of professionalism and work ethic of employees contribute 56.0% in influencing the variable quality of health services.
Recommendation: the professionalism of employees in the service and health sector needs to be improved immediately, the need for supervisory monitoring to provide high work results, and improve skills through quality training. Employees who lack good work skills establish character building for all employees by participating in seminars held by the agency and maximizing and channeling employees' potential in the fields under their control. The work ethic of employees at the Directorate General of Railways, Ministry of Transportation, is suggested to be improved by implementing moral norms and social sanctions for employees who violate regulations, seriously increasing compliance with applicable legal rules within the organization, improving work ethics employees through rewards and punishments for employees with the status of State Civil Apparatus and Non-State Civil Apparatus in terms of service to service users in the relevant agency. In addition, existing policies within the organization must also pay attention to the needs and interests of employees, especially those who serve as service officers. The quality of health services at the Directorate General of Railways, Ministry of Transportation is suggested to be improved through creative and innovative services so that excellent service is realized and is customer satisfaction oriented. Creative and innovative services in the form of the latest strategies to facilitate and expedite the fulfillment of both public and community services, such as online technology-based services (making special applications for health services in the form of websites, for example, e-regulation, e-health service, e-information).