1. Issues in Social and Environmental Accounting
Vol. 4, No. 2 December 2010
Pp 168-185
The Effect of Service Delivery Performance
and Corporate Social Responsibility on
Institutional Image and Competitive Advantage
and its Implication on Customer Trust
(A Survey of Private Hospitals in Solo Raya)
Yadi Purwanto
Faculty of Psychology and Social Sciences
Muhammadiyah University Surakarta, Indonesia
Abstract
This paper investigates private hospitals performance measured by service delivery, corporate
social responsibility, institutional image and competitive advantage with the effect towards
customer trust. The data was collected from 420 patients from 21 private hospitals in Solo Raya
including Solo city, and 6 regencies: Boyolali, Klaten, Sukoharjo, Wonogiri, Karanganyar, and
Sragen. This study indicates that service delivery performance and corporate social responsibil-
ity is lesser and lower than patients hope for. Private hospitals in Solo Raya do not yet value
image, competitive advantage, and customer trust. Service delivery performance and corporate
social responsibility have positive effects towards institutional image and competitive advan-
tage. Institutional image and competitive advantage have reciprocal effects. The effect of ser-
vice delivery performance towards customer trust, but corporate social responsibility do not
have direct effect towards customer trust. From suggested finding result that private hospital
repairs service delivery performance, physical facilities, also personnel contact performance to
increase corporate social responsibility, to increase institutional image and competitive advan-
tage to increase customer trust.
Keywords: service delivery performance, physical support, contact personnel, private hospi-
tal, corporate social responsibility, institutional image, competitive advantage, customer trust,
patient trust.
Introduction planned in the program Healthy Indone-
sia 2010 (Kepmen 1202/Menkes/SK/
Health is a prerequisite for the quality of VIII/2003). To support the program it
human resources, which is one of The was required the participation of society,
Millennium Development Goals targets including private hospitals.
in 2015 (UNDP, 2007) and has been
Yadi Purwanto is Senior Lecturer of Philosophy of Science, Advanced Statistics, Professional Ethics, Industrial and Organisational Psychol-
ogy at Master of Psychology Program, Graduate Studies, Muhammadiyah University Surakarta, Indonesia, email: yadipurwanto@ymail.com

2. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 169
The highest growth of private hospitals not only satisfying (superior satisfaction)
in Indonesia for the period 1989-2000 but more superior than its competitors
and 2000-2005 are in Central Java and (superior customer value). When cus-
East Java, which are 43.1% and 44% tomers do not get superior value, then it
(Department of Health Ministry, 2006). will tend to lose trust in the institution of
While the largest number of hospitals is the hospital. A poor hospital image can
in Central Java (172 units), so it has the trigger low patient trust. Trust is built
largest number of private hospitals (72 from the performance of it’s services,
units). institutional commitment to run a busi-
ness vision and corporate social respon-
Whereas the Solo Raya is an area with sibility consistently and creating a good
the highest hospital growth in Central image of the institution so that bear to a
Java, but the rate of its BOR (Bed Occu- superior satisfaction than its competi-
pation Rate) is average 49.1% (much tors. If the service delivery performance,
lower than ideal BOR which is 65%). corporate social responsibility activities
On the other hand every year 75 thou- and institutional image cannot produce a
sand patients go to Malaysia for having competitive advantage of the hospital
treatment which more than 19 000 peo- continuously, the hospital will be diffi-
ple came from Central Java, and 9000 of cult to maintain and enhance the patient
them came from the great Solo Raya. trust. If this condition is continued, it
strongly suspected will lead to loss of
Facts of the low of BOR, high number customer loyalty and long-term profit.
of who take medical treatment abroad, Therefore, to increase patient trust
and pre survey outcome show low point through competitive advantage and insti-
at indicator which indicates the low trust tutional image is by increasing service
of patients to the private hospital. delivery performance and corporate so-
cial responsibility so that the hospitals
Hospitals need to continually build con- are able to expected to maintain the trust
fidence in the patient through the means and profits in the long term.
of satisfying patients and providing bet-
ter services value than the competitors.
Through competition strategy the com- Literature Review
panies will continue to maintain its supe-
rior position, as the nature of competi- Sustainability of private hosipital depend
tion can lead to creativity and efficiency on long term profit. The profit can be
which in turn benefit the patient. Hospi- maintained if costumer takes satisfaction
tal as part of the community, it has a of service. James J. Zeboga and Clay
social responsibility (CSR, corporate (2006) found that customer trust and
social responsibility). Kotler and Lee satisfaction effect on repurchase inten-
(2005) state that CSR is commitment to tion.
improving the welfare of societies
through the means of professional busi- Trust is the belief that service providers
ness practices and resource utilization. can be trusted, reliable and able to fulfill
In the highly competitive advantages, his promise. Trust is also a result of the
the private hospitals are required to be overall performance of service provid-
able to deliver value to a patient that is ers, social and ethical behavior, image

3. 170 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
and ability to satisfy customers (functional and emotional, such as prod-
(Shamdasani & Balakhrisna, 2000; Dav- uct, service, prestige and psychological)
enport, 2007; Barnes, 2003; Gao, 2005) are perceived by the cost (money, time,
effort, and psychological) to be paid by
Meanwhile, hospital service delivery the customer. Customers will compare
performance is the result of the overall with any other value providers, in the
system of services operation, which con- gradation value of the inferior to supe-
sists of components which are visible rior. (Kotler, 2009; Bowen & Maken,
and not visible by the customer. Visible 2006; Zeithaml & Bitner, 2006; Cra-
service operations consist of contact per- vens & Piercy, 2009; Best 2009).
sonnel and physical facilities. The com-
ponents are the elements those also ap- In accordance with the opinion of Kotler
plied in the marketing mix that formed (2009), the clients of hospitals basically
an integral whole and the services deliv- carry out a business information search,
ered to the patient (Lovelock & Wright, the process of evaluating the options,
2005; Kotler, 2009; Nguyen & Lebanc, make choices and assessing each hospi-
2002). tal service performance, either based on
his own experience, or the others, and
But not only the service delivery per- also including the impression gained
formance determine patients to choose from a series of marketing activities,
health services, however hospital institu- relationships with patients, government
tion is part of the environment, because and society and how the hospital pre-
it is part of social capital. The company sents itself as a whole in the minds of his
has social responsibility. The role of so- patients, including a willingness of the
cial accountability is expected to re- hospital in doing its corporate social re-
spond to their social environment as a sponsibility.
manifestation of sensitivity and concern
for the business entity to the community. The hospital's success in providing ser-
(Kotler & Lee, 2005; Carol 1996; vices depend on how much the patient
Branco & Rodrigues, 2006). Factor that believes or believe the chosen hospital
is not less important is the consideration capable of providing satisfaction and
of patient to hospital image of its role in superior value compared to other hospi-
the welfare of society and its contribu- tals. Customer trust is a development of
tion in community development. In their past experiences and the perceived ac-
mind, image and competitive advantage tion, corporate image and character, and
in providing the best service becomes an willingness to bear the risk due to the
important consideration (Kotler, 2009; choice, the feeling to be safe and confi-
Nguyen & Leblanc, 2002, Foley & Ken- dent on the company's services (Barnes,
drik, 2006). Private hospitals can be 2006).
viewed as a company that requires a
competitive advantage. Competitive ad- Customers always assess whether ser-
vantage is created through its ability to vice providers can be trusted or relied
provide superior customer value, namely upon in fulfilling his promise
its ability to provide the highest satisfac- (Sirdeshmuhk et al, 2002). Therefore the
tion than its competitors. Customer company must maintain its image and no
value is the ratio between the benefits image without profitability, accountabil-

4. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 171
ity and sustainability efforts (Wreden, and a touch of excellence personnel such
2005). Customers are the source of as doctors, and paramedics. Both are the
profit, in other words between service determinants of service delivery per-
providers and customers must have con- formance that directly deliver quality
fidence; without confidence customers service itself. Stamatis (1996) stated ser-
are not likely to be faithful (loyal). Trust vice quality is a commitment to realize
is the belief of a party concerning the the customer-oriented concept by estab-
purpose and behavior of other parties lishing a service performance standards,
(Kreitner and Kenicki, 2001). Trust is a measure performance, set benchmarks,
mental construct as a mediator of satis- identify and provide examples of behav-
faction with customer loyalty (Bloemer ior and maintain customer attractiveness
et al, 2002). at all times in an effort to increase sales.
Kotler (2009) stated that service delivery
Hospitals need to continue building trust is the main way of differentiating a ser-
through the efforts of satisfying patients vice company. Kotler (2009) also as-
and providing better value of services serted that the inanimate environment
than its competitors. Through the com- and contact personnel effect on customer
pany's competitive strategy will continue satisfaction. The quality of services is
to maintain its superior position, as the not based on perceptions of the service
nature of competition can lead to crea- provider's point of view, but based on
tivity and efficiency which in turn also customer perception. The quality begins
benefit the patient. Hospitals are part of with customer needs and ends on the
the communit, so they have a social re- perception of customers (Kotler, 2009).
sponsibility (CSR, corporate social re- Quality service is also the main ingredi-
sponsibility). Kotler and Lee (2005:3-5) ent in the formation of associations or
stated that CSR is committed to improv- the image of the company's reputation,
ing the welfare of surrounding commu- as suggested by Aaker and Keller
nities through the efforts of professional (1990), the image or reputation can be
business practices and resource utiliza- defined as an assessment of the quality
tion. A healthy company would not associated with the name. Nguyen and
negatively impact the community in the Leblanc (2002) concluded the positive
form of destruction of nature, environ- effects of physical support and contact
ment and social development, otherwise personnel of the corporate image.
the company can give each other a posi-
tive contribution to the society as nearest Public awareness of the importance of
patient. CSR was also increasing willingness of
people to buy and accept higher prices,
Hospital with its service may shows its as demonstrated CSR survey conducted
existence in competition, because the by Deka Research and Global Market
quality of service is a way to be per- Scan International (2006) on 1,000 re-
ceived by customers as well as a meas- spondents in five major cities: Jakarta,
ure of how well the level of service pro- Bandung, Semarang, Surabaya and
vided in accordance with customer ex- Medan claimed 73.7% of respondents
pectations (Bouman and Wiele, 1992). agreed to pay 10% more expensive for
Quality of service is the performance of the products produced by socially and
technical operation and physical support environmentally responsible living

5. 172 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
(Marketing, 05/VII/Mei/2006, p.11-12). progressive countries which have high
social trust, there is a strong social capi-
The hospital is a social entity and part of tal so that strengthen competitiveness
social capital. The company should ob- (Nation Competitive Advantage).
serve its social environment, among oth-
ers, the community, consumers, workers, Relation to CSR in health service institu-
governments and other parties which tions with competitiveness, was de-
become the supporters of the company scribed by Wineberg and Rudolph (Info
operational because the company runs Askes, 2006:31,32) "Corporate social
the business activities by accessing their responsibility program makes a com-
social environment. The term is often pany more competitive." Companies that
called corporate social responsibility. are able to apply CSR, basically showed
Kotler (2005) says: corporate governance, which is manage-
ment system based with internal-external
"Corporate social responsibility is focus value-based. The concept of CSR
a commitment to improve commu- has overlap with the concept of corpo-
nity well being through discretion- rate governance (CG), and business
ary business practices and contri- ethic. According Wineberg and Rudolph
butions of corporate resources… (Info Askes, 2006:32) CSR is more
Corporate social responsibility as a based on the values (value-based) and its
'business' commitment contributes focus to external stakeholders, while not
to sustainable economic develop- neglecting the internal stakeholders.
ment, working with employees, CSR can help the company to show obe-
their families, the local commu- dience to the law and also can keep the
nity ,and society at large to im- company from a variety of risks law-
prove on their quality of life '... suits, lost business or lost a partner risks
"Corporate social responsibility as to corporate image (brand risk).
a business operating in a manner
that meets or exceeds the ethical, Company reputation can become a so-
legal, commercial, and public ex- cial capital, because of the popularity of
pectations that society has of busi- a company will also raise the image of a
ness". region, the image of a region will also
raise the corporate image. In this condi-
The word "social" in corporate social tion, Galbreath (2005: 981-982) sug-
responsibility refers to the notion of gested the reputational asset can be the
"social capital" (Branco and Rodrigues, part of the intangible assets.
2006: 119). By the form of powerful
social capital, it will bring the impact on According to Polonsky and Jevons
competitive advantage in surrounding (2006), CSR activities is required in or-
communities and also in the elements of der to build "a socially responsible
the community, including the company. brand" and to prevent reputation dam-
Fukuyama (2002) states that a sense of age. This statement is reinforced by the
trust and mutual trust (social trust) deter- results of research Yoon; Gurhan-Canli
mine the ability of a nation to build com- and Schwarz (2006) that CSR is useful
munities and institutions in it, in order to to rebuild a company which has a bad
achieve progress and competitiveness. In reputation. Chen, Lai and Wen (2006)

6. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 173
examines the influence of the "Green trend since the 1990s, such as the BET
Innovation Performance" toward the (The Business Enterprise Trust) Award,
corporate advantages in Taiwan, and the as was reported by Trevino and Kathe-
result is the green innovation efforts can rine (1999), the BET Awards are given
keep the sustainability of the company's to companies that gave birth to an activ-
products, because it is considered to ity or product CSR-oriented and philan-
have a competitive advantage and can thropic projects that have the "courage,
gain the trust from the consumers. Com- integrity and social vision." CSR activi-
petitive advantage has superiority over ties with many variety to enhance the
competitors by delivering the greater company image. The company's reputa-
customer value. (Keegan and Green, tion is not only determined by the fame
2008; Best, 2009). Positive image is the of products and the service itself, but
determinant of competitive advantage also because the public perception of
and can increase the customer trust. ethical standards in business, one of
Thompson Teo and Liu (2007; Flavian, which is business ethics in the form of
Guinaliu and Torres, 2005) shows that social responsibility. CSR can be viewed
there is significant influence of the im- as a form of nonverbal communication
age or reputation of customer trust. companies in establishing a system for
communication with the outside world.
The traditional view to build competitive In fact, CSR can be a means of formal
advantage is focused on build a posi- and informal communications for the
tional superiority (Porter, 2003) which is company to the surrounding community.
based on the competition, which in- Formal communication is communica-
cludes to the cost leadership or differen- tion through mass media such as press
tiating. Each type of competitive advan- releases in newspapers, radio and televi-
tage can build a relationship to the mar- sion and other advertising, whereas in-
ket or focus on target segments. The re- formal communication is more of "The
lation with the competitive advantage Grapevine" which is rather to describe
based on cost leadership. Wegmiller what was happening, and what can be
(2006:29-33) stated that although finan- felt directly. Trevino and Katherine
cial stability is important at the not-for- (1999) adds that the informal communi-
profit oriented hospital but it is more cation can become news, rumors, im-
important to enlarge the public trust pression or perceptions, which in some
without leaving the community benefits degree directly to enhance the credibility
for the surrounding community as well of the company.
as improving their whole image.
Patients in the selection of the hospital
In addition to the delivery of services, will consider bids that provide the high-
hospitals also need to develop communi- est value. They want maximum value,
cation with the surrounding community, with minimal cost, both monetary, time,
however institutions may not be able to energy and physical cost. Kotler (2009)
live safely, comfortably and prospec- stated the value of customers is the dif-
tively in the future if these institutions ference or ratio of total customer benefit
do not build mutual relationships with and total customer cost. Total customer
the surrounding environment. Especially benefits is a set of benefits perceived by
this social vision has become a global customers of certain products and ser-

7. 174 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
vices. Total customer cost is a set fee izational behavior, such as business
that was sacrificed by the customer to name, architecture, variety of products
evaluate, acquire, use, and dispose of the and or services, traditions, ideologies,
product or service. Consumers are not and also a picture of quality communi-
easy to choose the hospital services be- cated by each person who interacts with
cause not all hospitals may be tried one client organizations (Kotler, Bowen and
by one. Consumers will gather informa- Makens, 2006). Institutional image can
tion and select various alternatives, in- also become an important icon in the
cluding comparing his experience with competition, because consumers know
the experience of others. Consumers will the products and services through the
be helped to understand the hospital ser- image. In the field of hospital services
vices offered through a set of institu- Cooper (1997) described the positive
tional characteristics that make up the influence the quality of physicians, care
image of the institution. Institutional facilities and technology, diagnostic fa-
image is defined as beliefs, attitudes, cilities, the quality of overall care, inter-
stereotypes, ideas, and behaviors rele- personal relationships, employee aware-
vant to a person against an object, per- ness of personal needs of patients, main-
son or organization (Belanger, Mount, tenance of patient experiences of hospi-
and Wilson, 2002). So institutional im- tal services suggests , location and rates
age a result of various institutional ac- of hospital image.
tivities to be communicated to the public
either through verbal communication,
non-verbal, formal, informal, direct and Research Methods
indirect thus forming the perception of
the institution. Institutional image is the This research is a verification or ex-
individual's perception of the institution planatory surveys, which is a type of
in the form of associations inherent in research to find out the relationship be-
consumer memory. Customer perception tween variables by testing the hypothe-
can be determined by the image or repu- sis. Research design is ex post fact.
tation of the institution (Zeithaml, Bit-
ner, 1996: 114). Data Sources and Methods of Data
Determination
Consumers will tend to use the product
or service institutions which they say The primary data source is the patients,
have a good image or images that are while the secondary data source ob-
consistent with their expectations. Per- tained from the hospital management
sonal experience, information received annual report of Department of Health
from others, and promotion conducted and Hospital Association of Indonesia.
by institutions all have an impact on cus- The collected data is cross section data
tomer perception of the image of institu- during 2008. This study uses 420 re-
tion (Kurtz, Clow, 1998:24). spondents of patients from 23 private
hospitals of Solo Raya, with VIP stratifi-
Institutional image can be described as cation, Class I, II, and III. And was used
an overall condition of the institution in random sampling with weighting com-
the minds of audiences associated with plex sample. Data obtained by using (a)
such physical attributes as well as organ- Interviews, (b) Observations, and (c)

8. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 175
Questionnaire, and follow up result by Operational definition of variables,
using Focus Group Discussion. dimensions, indicators, measures and
scales used are shown in Table 1.
Table 1. Operational Definition of Variables
Variable/ Sub The Concept of Variable/ Indicator Scale
Variable Sub Variable/ Dimension
Service Deliv- A performance that con- The elements that consist of Ordinal
ery Perform- sists of physical support physical support and personnel
ance and contact personnel contact
(ξ-1)
Physical sup- Physical facilities, ambient Availability and quality of physi- Ordinal
port condition and servicescape cal facilities, technology and
which measured by avail- environment
ability, convenience and
attractiveness
Nguyen and Availability (X------1.1) Availability / completeness and Ordinal
Leblance the
(2002) easy of using facilities
Pires (2005), Convenience (X------2.1) Leisure, feasibility, safety, tran- Ordinal
Ozcan (2007), quility, cleanliness, beauty, suffi-
Gustafon cient of light, and air
(2007)
Johnston and Attractiveness (X------3.1) Attractiveness, strategic, pres- Ordinal
Clark (2008) tige, new, and the uniqueness of
Zeithmal the supporting facilities
(2006)
Contact Service delivery process appearances of Medical labor, Ordinal
Personnel and make direct contact paramedic and non-medic in
with patients providing services
Nguyen and Appearance (X------4.1) tidiness of medics appearance Ordinal
Leblance (external appearance, clothing,
(2002) tidiness, uniformity), paramedi-
cal and non-medic in providing
services
Pires (2005), Competence (X------5.1) Competence of expertise and Ordinal
Ozcan (2007), experience of medic, paramedic
Gustafon and non-medic when providing
(2007) services
Johnston and Profesionalism (X------6.1) Speed, responsiveness, friendli- Ordinal
Clark (2008) ness, timeliness, simplicity of the
Zeithmal process, ease encountered, and
(2006) clarity of information
Corporate Patients’s perceptions Patient’s views on hospital’s Ordinal
Social Respon- about hospital responsibili- responsibilities to the community
sibility ties around them
(ξ-2)

9. 176 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
Table 1. (continued)
Kotler and Lee Concern for the promotion Patient’s view about hospital’s Ordinal
(2005), Frank, of social issues such issues care on the campaign of danger-
(2007), Schreck -issues and increase public ous social issues, and increasing
(2009) awareness around the hos- the awareness of positive behav-
pital (X------7.2) ior to the community around the
hospital
The involvement of hospi- Patient’s view about the hospi- Ordinal
tals in the social problems tal's involvement in the response
prevention (X------8.2) to the problem which is happen-
ing in the surrounding commu-
nity
Personnel help/ volunteers Ordinal
The patient's view on personnel/
to get involved in social-
volunteers aid to engage in so-
society programs (X------
cial-society program
9.2)
Material help/ donations The amount of material dona- Ordinal
and social facilities in an tions (funds, goods, and drugs);
effort of community devel- personnel; infrastructure facili-
opment (X------10.2) ties, provision of community
empowerment programs
Institutional Perceptions about a hospi- Introduction, the reputation of Ordinal
Image tal institution that reflected personnel competence, technol-
(η-1) like the existing associa- ogy, moral-ethical and overall
tions in memory, feelings
of patients
Hall (2000) Popularity (y------1.1) Introduction to the hospital Ordinal
Foley and Competence reputation (y The view about the reputation Ordinal
Kendrik (2006) ------2.1) for competence of medic, para-
medic and non-medic
Frombun The reputation of health The view about the reputation Ordinal
(1996) technology (y2.1) for technology mastery owned
by the hospital
Reputation for moral and The view of moral-ethical repu- Ordinal
ethical codes (y4.1) tation within the health practices
Reputation of the recovery The view about the reputation of Ordinal
rate of patients (y------5.1) recovery rate of patients
Competitive The patient’s perception Suitability of the benefits gained Ordinal
advantage that a hospital outper- by patient’s sacrificial compared
(η------2) formed other hospitals in with other hospitals
providing value (customer
value)
Benefits All benefits derived from Benefits of facilities, services, Ordinal
the services, personnel and personnel and prestige obtained
image by the patients compared to com-
petitors'
Kotler (2009), Product’s benefits/ facili- Ordinal
The benefits of the facility which
Kotler, Bowen ties (y------6.2)
is perceived compared to com-
and Maken
petitors'
(2006)

10. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 177
Table 1. (continued)
Lovelock Benefits of the services (y Ordinal
The benefits of the services
(2005) ------7.2)
which is perceived compared to
competitors'
Best (2009) Personnel benefits (y------ Ordinal
The benefits of the personnel
8.2)
which is perceived compared to
competitors'
Prestige benefits (y------ Ordinal
The benefits of the prestige
9.2)
which is perceived compared to
competitors'
Cost All costs incurred by the Ordinal
The perceptions about the sacri-
patient's sacrifice to obtain
fices in the service cost, time,
services
energy and psychic than the
competitors
Kotler (2009) Cost of money (y------10.2) Ordinal
Perceptions of determining the
Bowen, and
cost of patients compared to
Maken (2006)
competitors'
Lovelock Cost of time (y------11.2) Perception of time which is sac- Ordinal
(2005) rificed in running the service
compared to competitors
Best (2009) Cost of energy (y------12.2) Perception of energy which is Ordinal
sacrificed in running the service
compared to competitors
Cost of psychic (y------13.2) Perception of psychic which is Ordinal
sacrificed in running the service
compared to competitors
Patient trust Patient trust is the convic- The trust of patients to the reli-
(η3------) tion of the patient to the ability of technological equip- Ordinal
hospital’s integrity and ment, and personnel to achieve
reliability the level of recovery
Shamdasani Trust in the reliability (y Trust in the reliability of the hos- Ordinal
and -----14.3) pital in patient care
Balakhrisna
(2000)
Andreassen and Trust on the quality of Trust in the quality of hospital Ordinal
Lindestad equipment (y-----15.3) technology equipment
(1998)
Teo, Thompson Trust in the professional- Trust in the professionalism of Ordinal
dan Liu (2007) ism of the personnel (y----- the personnel in helping the heal-
16.3) ing
Confidence in hospital Trust in hospital services will Ordinal
services will help the heal- help the healing
ing (y-----17.3)
Trust in hospital communi- Trust in the promise that has Ordinal
cation message content (y-- been communicated to the hospi-
-
--18.3) tal to provide the best services

11. 178 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
Research Model tion, and reciprocal.
To analyze the relationship among vari- The framework of the flow of inter-
ables is used Structural Equation Model- variable relationship is shown in the fol-
ing (SEM), so it can be analyzed on the lowing picture:
measurement equation, structural equa-
Figure 1. Variables Correlation
Description: Finding and Discussion
ξ-1 : (Service delivery performance)
ξ-2 : (Corporate social responsibility/ It is got from the statistical model as
CSR) shown in Figure 2 and 3.
η1 : (Institutional image)
η2 : (Competitive advantage) Based on data from Table 2 we con-
η3 : (Patient trust) cluded that the model has met several fit
models criteria.
The mathematical model equation is:
Model 1: η1 = γ1.1 ξ1+ γ2.1 ξ2 + β2 η2 + Based on the value of λ, it is known that
ζ1 Service Delivery Performance is a vari-
Model 2: η2 = γ2.2 ξ2+ γ1.2 ξ1 + β1 η1+ ζ 2 able that has the greatest influence on
Model 3: η3 = γ1.3 ξ1+ γ2.3 ξ2+ β1 η1+ β2 competitive advantage (0.49), institu-
η2 + ζ 3 tional image (0.40) and patient trust
(0.12) compared with the influence of
The criterion used is that the hypothesis corporate social responsibility (CSR) to
is accepted if the value of student's sta- competitive advantage (0.08), institu-
tistical analysis t was greater than 1.96 tional image (0.09) and patient trust
and is rejected if less than or equal to (0.02).
1.96.

12. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 179
Figure 2
Structural Model of Estimation Value in Research Paradigm Model
Figure 3
T-Value Structural of the Paradigm Research Model
From the computational model of SEM, institutional image amounted to 24.70%.
it obtained the value of direct and indi- The total effect of service delivery per-
rect effects, as summarized in Table 3. formance, corporate social responsibil-
ity, and institutional image to competi-
The total effect of service delivery per- tive advantage are at 33.75%. While the
formance, and competitive advantage to total effect of service delivery perform-

13. 180 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
Table 2. Testing of Research Model
Db 340
Normal Chi Square 1548,82
RMSEA 0,072
p-value 0,00342
Goodness of Fit Index (GFI) 0,93
Adjusted Goodness of Fit Index (GFI) 0,91
Table 3. Direct and Indirect Effect
VARIABLE EFFECTS
Influence Influenced Direct Indirect Total
Service Delivery Performance 5,76% 0,64% 6,40%
Corporate social responsibil-
ity 1,44% 0,04% 1,48%
Institutional Image
Competitive Advantage 16,81% 0,01% 16,82%
Total 24,01% 0,69% 24,70%
Service Delivery Performance 31,36% 0,16% 31,52%
Corporate Social Responsibil- Competitive Advan-
ity tage 1,00% 0,01% 1,01%
Institutional Image 1,21% 0,01% 1,22%
Total 33,57% 0,18% 33,75%
Service Delivery Performance 5,29% 2,56% 7,85%
Corporate Social Responsibil-
ity 0,09% 0,16% 0,25%
Patient Trust
Institutional Image 10,89% 0,01% 10,90%
Competitive Advantage 4,41% 1,21% 5,62%
Total 20,68% 3,94% 24,62%
ance, corporate social responsibility, nificant through increasing institu-
institutional image and competitive ad- tional image by improving competitive
vantage to patient trust amounted to advantages through service delivery per-
24.62%. formance optimizing. While the corpo-
rate social responsibility variable is a
A variable with insignificant effect is catalyst for improving institutional im-
only on corporate social responsibility age and enhancing competitive advan-
(CSR) to patient trust, whereas other tage through social policy.
variables have a significant effect. Strat-
egy to improve patient trust is more sig- Corporate social responsibility is a so-

14. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 181
cial responsibility which may be one food menu. (3) Competence as improve
variable that has a positive impact on their skill specialization and experience
trust, but the research facts of patients of and flying hours.
private hospitals in Solo Raya shows
that corporate social responsibility has (b) Indicators of corporate social respon-
not yet had a significant positive effect. sibility (1) Involvement in preventing
CSR of private hospitals in Solo Raya social problems that are happening such
has not become a strategic policy. as helping the event is happening as the
victims of flooding in areas along the
From tables 3 above, the solution vari- banks of the Bangawan Solo river, land-
ables which is suggested is to improve slide of Karanganyar, and lack of clean
service delivery performance, corporate water. (2) Aids of social facilities for
social responsibility, institutional image community development such as im-
and competitive advantage. Institutional proving rural roads, social facilities,
image effect (10.89%), followed by ser- public toilets, and mosquito fogging.
vice delivery performance (5.29%),
competitive advantage (4.41%), and In order to deepen the understanding of
0.09% corporate social responsibility. the phenomenon the writer held FGD
While institutional image and competi- involving the hospital managerial, the
tive advantage have a reciprocal effect, result shows: the patient trust is a dy-
both are influented by service delivery namic variable as the result a dynamic
performance . interaction of institutional image, com-
petitive advantage, service delivery per-
The descriptive research also shows that formance and corporate social responsi-
the level of patient perception of the bility. Fixation strategy can be started
variables are all relatively moderate, and from service delivery through contact of
the gap between level of importance and personnel and physical support. And
reality is at a great value (PointGap <(- through the corporate social responsibil-
1)), thus indicating that the suggested ity strategy can be concerned on the so-
improvements are comprehensive and cial activity and hospital involvement in
simultaneously involving all indicators. the infrastructure around its environment
But as a logical step, realistic solutions and community development. But it will
have been designed with a priority rank- be difficult to carry because of the lack
ing to see 5 (five) indicator variable with of fund resource and cultural factor
the largest PointGap, namely: shares important significance although it
is not involved as variable. Along with
(a) Performance Indicators of Submis- hospitals in developing countries, the
sion Services (1) Professionalism such fund lacks significance factor. Private
as increase: friendliness, responsiveness, hospitals in Solo Raya are loaded by
speed, ease encountered, accuracy, ease social and religious organizations which
of procedure and the clarity of informa- are mostly social oriented regardless to
tion. (2) Attractiveness such as the in- the economic motive.
crease: the unique interior and exterior,
distinctiveness support facilities, facili- The investigations found that the private
ties information and communication as hospitals in Solo Raya based on all indi-
well as variety and uniqueness of the cators of service delivery performance,

15. 182 Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185
corporate social responsibility, institu- Conclusion
tional image, competitive advantage and
patient trust have not fulfilled the expec- Patient trust is influenced positively by
tations of patients. Professionalism is an the competitive advantage, institutional
indicator as the most important one. image, and service delivery perform-
ance, but is not influenced directly by
This investigation focused on public corporate social responsibility. Competi-
hospitals and yet research on the unit of tive advantage has a mutual positive in-
analysis involves both individual pa- fluence on institution image, but com-
tients and the unit of analysis on all petitive advantage has a greater influ-
types of hospital institutions (such as ence on institutional image rather than
government hospitals, special hospitals, vice versa. Private hospitals are advised
maternity hospitals, hospitals), making to improve both service delivery per-
generalizations which are limited to formance improvement of physical fa-
privatised public hospitals in the Solo cilities and personnel performance and
Raya region. increase social responsibility activities to
enhance the institutional image and
This investigation only focused on the competitive advantage that is expected
influence of selected variables to vari- to increase patient trust.
able of patient trust, namely service de-
livery performance, corporate social re- Limitations
sponsibility, institutional image and
competitive advantage, and based on The weakness of the study was that the
research results, there are still other vari- level of generalization is limited. For the
ables not examined the influence of such purposes of generalization, the next re-
internal environmental conditions of search needs to relate to the broader area
patients another patient the external en- of research and involves a large area,
vironment, as well as conditions micro- and type of hospital such as government
system. hospitals, maternity hospitals, military
hospitals, and specialized hospitals. In
Study of the hospital in Solo Raya has a addition, also to be considered is the
uniqueness, namely the level of BOR inclusion of non-hospitalized patients for
(Bed Occupation Rate) is low, whereas both causal and comparative research
when looking at the ratio of the number that has not been performed in this in-
of beds to population is small. It means vestigation.
that the number of available hospitals
have not been categorized saturated. Further Research
This is possible because of low purchas-
ing power of Solo Raya. Meanwhile, the This research is based on the customer's
government general hospital (Hospital, perspective as a primary data source. To
Military General Hospital) is relatively find a more dynamic relationship, a
used by patients, especially in class of study needs to be done from the com-
subsidy of local government insurance pany perspective, using both employee
either, and public health insurance pro- and management as a source of primary
gram. data.

16. Y. Purwanto / Issues in Social and Environmental Accounting 2 (2010) 168-185 183
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20. Issues In Social and Environmental
Accounting Associate Editors:
Hussain, Mostaq M., University of New Burnswick, Canada
Komsiyah, University of Trisakti, Indonesia
(Issues in SEA) Editors Advisors:
Fuglister, Jayne, Cleveland State University, USA
Gray, Rob, St. Andrews University, Scotland UK
Na’im Ainun, Gadjah Mada University, Indonesia
ISSN : 1978-0591 Syakhroza, Akhmad, University of Indonesia, Indonesia
Hasan Fauzi, Sebelas Maret University, Indonesia Members of Boards:
1. Adams, Carol, La Trobe University, Australia
2. Al-Khadash Husam Aldeen, Hashemite University,
Al-Khadash,
Jordania
3. Aras, Guler Yıldız Technical University, Turkey
Guler,
CALL FOR PAPERS (9th ISSUE) 4. Ball, Amanda University of Canterbury, New Zealand
5. Berman Shawn, University of New Mexico, USA
Berman,
6. Brown Judy, Victoria University of Wellington, New
Brown,
Issues in SEA is an international journal as networking and dis- Zealand
semination means of practices and theory of social and environ- 7. Brown, Alistair, Curtin University of Technology, Australia
Brown
mental accounting. Since Problems of social and environmental 8. Campbell David, New Castle University, UK
Campbell,
in general and in accounting context in specific have been global 9. Choi Jong-Seo, Pusan National University, Korea
Choi, Jong-
10. Crowther David. De Montfort University, United King-
Crowther,
issue, it is necessary for us to share and cooperate to make bet-
dom
ter the corporate financial, social and environmental perform- 11. Donleavy, Gabriel D., University of Macau, China
ance. Issues in SEA publishes rigorous, original and innovative 12. Freeman, Edward University of Virginia, USA
Edward,
scholarly papers dealing with theoretical, empirical, applied, 13. Georgakopoulos, Georgios University of Amsterdam,
Georgios,
surveys, and case studies providing meaningful insights into the The Netherlands
subject areas. 14. Ghazali, Imam University of Diponegoro, Indonesia
Imam,
15. Guthrie, James The University of Sydney, Australia
James,
16. Husted, Bryan ITESM/Instituto de Impresa, Mexico
Bryan,
17. Ibrahim, Daing N University of Sains Malaysia, Malaysia
N.,
Subject Coverage 18. Idris, Kamis Universiti Utara malaysia
Kamis,
Topics include but are not limited to: 19. Jasch Christine Maria, The Institute for Environmental
Jasch,
Environmental accounting Management and Economics, Austria
Social accounting 20. Kent, Pamela Bond University, Australia
Kent
21. Kokubu, Katsuhiko Kobe University, Japan
Katsuhiko,
Ethical issues in accounting and financial reporting 22. Lawrence, Stewart University of Waikato, New Zealand
Stewart,
Corporate governance and accountability 23. Mahoney, Lois, Eastern Michigan University, USA
Accounting for the Costs and Benefits of CSR-related Activities 24. Murray Alan, Sheffield University, UK
Murray,
Accounting and Disclosure of Environmental Liabilities 25. Maunders, Keith, University of the South Pacific, Fiji
Corporate Environmental Strategy 26. Magness ,Vanessa Ryerson University, Toronto Canada
Vanessa
Corporate Social Performance 27. Nik Ahmad Nik Nazli, International Islamic University
Ahmad,
Malaysia, Malaysia
Corporate social responsibility and management control 28. O’Donovan Garry, University of Tasmania, Australia
O’Donovan,
Corporate social responsiveness 29. Orlitzky Marc, University of Redlands, USA
Orlitzky,
Triple bottom line performance 30. Palliam, Ralph American University of Kuwait
Ralph,
31. Parker, Lee University of South Australia
Lee,
32. Pondeville, Sophie Marquet Université University of
Marquet,
Namur, Belgium
Specific Notes for Authors
33. Rahman, Azhar A Universiti Utara Malaysia, Malaysia
A.,
Submitted papers must not have been previously published nor 34. Roberts, Robin, University of Central Florida, USA
Roberts
be currently under consideration for publication elsewhere. All 35. Rasheed, Abdul A., University of Texas at Arlington
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Stefan,
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SEA is published biannually in June and December, so each con- 37. Sen Swagata, University of Calcutta, India
Sen,
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mental Accounting Research and Development (ICSEARD) Bucharest, Romania
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52. Koleva, Petia University of Nantes, France
Petia,
53. Yusoff, Haslinda UiTM, Malaysia
Haslinda,
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M.,
Sebelas Maret University, 55. Selvam, V VIT University, India
V.,
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Rémi,
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