Hrev_master Healthcare in Low-resource Settings 2024; volume 12(s2):12359 Exploring to improve patient satisfaction through organizational factors consolidation of sharia-based nursing care Muh. Abdurrouf,1,2 Nursalam,1 Ahsan,3 Iwan Ardian,2 Intan Rismatul Azizah2,4 1Faculty of Nursing, Universitas Airlangga, Surabaya; 2Faculty of Nursing, Universitas Islam Sultan Agung, Semarang; 3Faculty of Medicine, Universitas Brawijaya, Malang; 4Postgraduate Program of Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Abstract Organizational factors determine patient satisfaction, since nursing care depends on organizations, in which the majority of actions involve nurses to provide holistic nursing care. Spirituality can be an important key, because patients feel all needs are ful- filled, making Sharia-Based Nursing Care (SBNC) a mediator of organizational factors for patient satisfaction. The aim of this paper is analyzing the role of organizational consolidation factors and SBNC model to determine patient satisfaction in Sharia hos- pitals. This analytical correlation study used a cross-sectional design and cluster sampling technique on 260 respondents as the samples, consisting of nurses and patients in patient rooms in X Islamic Hospital, Indonesia. The variables of this study, the orga- nizational factors, SBNC, and patient satisfaction were collected using a questionnaire; all variables were assessed through the use of a questionnaire, and permission to modify or employ the instru- ment was obtained from the original authors, and analyzed using Smart Partial Least Squares (SmartPLS). Organizational factors have significant influence on SBNC (p-value=0.000; β- value=0.786; t-value>1.96), organizational factors have moderate- ly significant influence on patient satisfaction (p-value=0.000; β- value=0.508; t-value>1.96), SBNC has significant influence on patient satisfaction (p-value=0.000; β-value=0.430; t-value>1.96), the consolidation of organizational factors with SBNC influences patient satisfaction (p-value=0.001; β-value=0.338; t-value>1.96). Nurses with good leadership, culture, and who give appropriate rewards can shape the quality of the profession by implementing SBNC; patients feel all needs are fulfilled, especially the spiritual aspect, and satisfaction with the nursing services. Introduction A Sharia hospital is a hospital that provides health services in accordance with Sharia principles or, in other words, applies maqashid Sharia in hospital governance. The characteristics of Sharia hospitals that distinguish them from other hospitals are understanding related to the basic principles of Sharia, the princi- ples of halal and haram, the muamalat principle, the application of the concept of quality in Islam, and upholding Islamic values in hospital organizations.1 The strongest organizational foundation is required for surviving competition in the health industry, since organization is a key player in developing human resources such as nurses, since nurses are one of the most important and largest resources in hospitals.2 In addition, nurses’ performance deter- mines a hospital’s quality of nursing care and services, so if their nurses’ performance of nurses is good, so is the hospital’s manage- ment. Hospital governance is one of the service priorities, given hospitals’ increasingly fierce competition.3-7 The Indonesian Muslim population is 237,531,227, about 96.5%, as in Central Java alone, the population is 35,607,889.8 Muslim population as the second largest population in the world is an opportunity for hospitals to improve their services for Muslims. It is possible to develop Islamic-based nursing services, since nurses are the key to service quality.9 Nursing services are an Correspondence: Muh. Abdurrouf, Doctoral Program, Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia. E-mail: muh.abdurrouf-2020@fkp.unair.ac.id Key words: healthcare; nursing care; organizational; patient satisfaction; Sharia, social factors. Contributions: MA, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing – original draft, review & editing; N, conceptualization, investigation, methodology, validation, and writing – original draft, review & editing; A, conceptualization, methodology, formal analysis, validation, and writing – original draft, review & editing; IA, conceptualization, methodology, formal analysis, validation, and writing – original draft, review & editing. IRA, concep- tualization, methodology, formal analysis, validation, and writing – orig- inal draft, review & editing. All the authors have read and approved the final version of the manuscript and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no conflict of interest. Funding: none. Ethics approval and consent to participate: this research has passed the ethical clearance test by the Medical and Health Research Ethics Committee (MHREC) of Sultan Agung Islamic Hospital’s Health Research Ethics Committee on 25 July 2022 under No. 72/ KEPK- RSISA/VII/2022, and has obtained the respondents’ consent through informed consent, anonymity, confidentiality, fidelity, and autonomy. Patient’s consent for publication: written informed consent was obtained for anonymized patient information to be published. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgments: the authors would like to express their gratitude to all participants in this study and the hospital for their help completing this research. Received: 6 February 2024. Accepted: 20 August 2024. Early view: 4 September 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12(s2):12359 doi:10.4081/hls.2024.12359 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12(s2):12359] [page 59] Non -co mmerc ial us e o nly important part of a hospital’s quality and safety of services and the determining factor of patient satisfaction of treatment outcome, thus nursing care is important to determine patient satisfaction.10-20 Competition between hospitals greatly relies on the service quality aspect, consequently, hospitals are developing services with an Islamic system or Sharia hospital, because of the growing demand for halal products and halal services, particularly hospital and Sharia-based healthcare services.4 Islamic hospitals with Sharia standards have many positive impacts on patients with regard to patient satisfaction. Patient satisfaction is an important goal of service quality in that it reflects the quality of existing ser- vices.21 In general, Sharia nursing care comprises five nursing pro- cesses: assessment, diagnosis, intervention, implementation, and evaluation, on the basis of Islamic-based intellectual, physical, eth- ical, moral, and spiritual. This conforms to the concept of maqashid Sharia, referring to Imam Syatibi, comprised of main- taining religion (khifdz ad-diin), preserving soul (khifdz an-nafs), maintaining offspring (khifdz an-nasl), maintaining reason (khifdz al-aql), and maintaining property (khifdz al-mal).22 Maqashid Sharia is a Sharia hospital with nursing care that has a maqashid Sharia spirit, but there has been no research related to patient sat- isfaction with nursing care in Sharia hospitals and whether these organizational factors can increase patient satisfaction,5 so this should be studied further.7 Patient satisfaction, in addition to Islamic nursing care’s influence, are related to organizational fac- tors. Nurses and organizational factors in hospitals are an integral part since nurses are competent, motivated, and trained, also because of the existing organizational policies in hospitals. Therefore, the organizational factors contributing to determining hospital quality and patient satisfaction include leadership, organi- zational culture, goals or vision and mission, rewards, and training and development. Since nurse performance influences organiza- tional performance, hospital leaders should take nurse perfor- mance into consideration.13 Leadership influences nurse perfor- mance through organizational factors that it is capable of measur- ing the nurse-organization framework.14 Islam believes leadership is a mission; the responsibility is not only for leading nurses, but also for Allah SWT.15 Organizational culture is also correlated with nursing care, framed in Islamic values as norms, beliefs, and val- ues applied in an organization. In Islamic teaching, comprising the Qur’an and Hadith, Islamic organizational culture is a factor that enhances a Sharia nurse’s character.16 Sharia nurses’ performance is influenced by the element of organizational goals expressed in the products and services offered, in which a nurse is a hospital’s extension in translating the vision and mission of nursing service provision.17 Patient satisfac- tion is influenced by nursing care provision and various nursing care models have been developed, one of which is nursing care based on Islamic values and considered appropriate for application in Sharia hospitals. The reflection on organizational factors’ role shows that they influence the nursing care quality and the spiritual dimension also influences patient satisfaction, but there is no research related to Sharia-based nursing services, despite Muslims being the majority population in the world, thus Muslim patients’ spiritual needs are also great. Indonesia boasts hospitals with Sharia-based standards, such as those located in the Central Java Province. On this basis, this research was conducted in one of the Sharia-based hospitals in Islamic Hospital, with regard to the organizational factors, includ- ing leadership knowledge, organizational culture, goals, rewards or salaries, and nurse training and development toward Islamic nurs- ing, in which there is no research related to this, especially those inspired by maqashid Sharia, and Sharia-based nursing care’s (SBNC) role in patient satisfaction. The researchers were interest- ed in examining the role of consolidation of organizational factors with SBNC in improving patient satisfaction, thus the aim of this study is exploring to improve patient satisfaction through organi- zational factors consolidation of SBNC. Materials and Methods Study design This analytic observational research used a cross-sectional design; this design was chosen because this research is quantitative research that analyzes the relationship between cause and effect factors using an observation approach or data collection in one data collection. This study’s exogenous variables are organization- al factors, while the endogenous variables are SBNC and patient satisfaction, with five organizational factors indicators, comprised of leadership, organizational culture, goals, rewards or salary, and training and development. This study’s endogenous variables are SBNC, five indicators of which are: assessment, diagnosis, inter- vention, implementation, and evaluation. Patient satisfaction has five indicators: Reliability, Assurance, Tangible, Empathy, and Responsiveness (RATER). Thus, the study has a total of 15 indica- tors referring to three latent variables. This study has three hypo- thetical paths: firstly, from organizational factors to SBNC; sec- ondly, from SBNC to patient satisfaction; and thirdly, from organi- zational factors to patient satisfaction. Participants The research population comprised nurses and patients in the inpatient rooms of the Islamic hospital, the nurses’ total population was 143. This study’s total respondents were 260, comprised of 130 inpatient nurses and 130 patients treated in inpatient rooms, calculated with the maximum likelihood method, and seven inpa- tient rooms resulted from a calculation using a cluster sampling technique. The samples were selected using the cluster sampling technique, with one of the methods being random sampling (Table 1). For patients, inclusion criteria were as follows: i) being inpa- tients, ii) being literate, iii) identifying as Muslims, iv) falling within the age range of 17 to over 65 years old. Patients meeting any of the following criteria were excluded: i) being outpatients; ii) receiving treatment in the intensive care unit, neonatal or pediatric rooms, or experiencing impaired consciousness. As for nurses, the inclusion criteria were: i) being assigned to inpatient rooms; ii) holding at least an associate degree in nursing at the first level, including those with a senior high school education level who completed a three-year associate degree in nursing, and iii) identi- fying as Muslims. Nurses fulfilling any of the following criteria were excluded: being assigned to the intensive care unit or emer- gency unit. Instruments In quantitative research, the credibility of a study relies on the development of instruments used to measure the underlying con- cepts. The measurement of a variable is designed to achieve con- sistency, adequacy, accuracy, precision, uniformity, and compara- bility in assessing and explaining a specific concept. Therefore, the measurement approach encompasses testimony and confirmation variables that function as representations of constructs.23 This study’s exogenous variables are organizational factors, while the endogenous variables are SBNC and patient satisfaction, with five organizational factors indicators, comprised of leadership, organi- zational culture, goals, rewards or salary, and training and develop- Social and political factors affecting public health [page 60] [Healthcare in Low-resource Settings 2024;12(s2):12359] Non -co mmerc ial us e o nly ment. This study’s endogenous variables are SBNC, five indicators of which are: assessment, diagnosis, intervention, implementation, and evaluation. Patient satisfaction has five indicators: Reliability, Assurance, Tangible, Empathy, And Responsiveness (RATER). Thus, the study has a total of 15 indicators referring to three latent variables. All variables in this study were assessed through the use of a questionnaire, and permission to modify or employ the instru- ment was obtained from the original authors (Table 2).24-29 Upon the variables, a Likert scale was used for the nurses and Islamic nursing care factors, comprised of strongly disagree, dis- agree, neutral, agree, and strongly agree, while, for patient satisfac- tion, the answers were classified into very dissatisfied, dissatisfied, neutral, satisfied, and very satisfied. The variables were ordinally scaled with indicators ranging from 76-100% (good), 55-75% (enough), and lower than 55%. The study’s data were collected using organizational factors, the questionnaire had 27 questions, divided into: questions 1-7 to measure leadership, 8-12 to measure organizational culture, 13-17 to measure purpose, 18-22 to mea- sure reward or salary, and 23-27 to measure training and develop- ment. The questionnaire for patient satisfaction covered RATER, or RATER questionnaire, comprised of 23 questions, divided into: questions 1-6 to measure reliability, 7-9 to measure assurance, 10- 14 to measure tangibility, 15-19 to measure empathy, and 20-23 to measure responsiveness. The variables of SBNC had 25 questions with five processes of SBNC, each process with only five ques- tions. The validity test results for the organizational factors ques- tionnaire have validity values of 0.716 to 0.996 and reliability of 0.876 to 0.990, and the results for the SBNC questionnaire have validity values of 0.656 to 0.993 and reliability of 0.879 to 0.975. The patient satisfaction questionnaire had scores of 0.552 to 0.876, and reliability of 0.851 to 0.906. Data collection This research was conducted at an Islamic hospital, in Indonesia. The data were collected in August 2022. To mitigate potential research bias, various measures were implemented, including the application of multiple inclusion and exclusion crite- ria aimed at reducing biases and ensuring respondent eligibility. The researcher collected the primary data for this study. A total of 260 questionnaires were distributed in August 2022. The data were collected in the following steps: i) conduct research permits in hos- pitals, ii) after obtaining permission for the ethical process at the an Islamic Hospital Ethics Committee Institute, iii) pass the ethical test, the data collection process for inpatient patients who met the inclusion and exclusion criteria, patients first received an explana- tion from researchers about the research carried out in full, an Social and political factors affecting public health Table 1. Calculation of the number of samples with the cluster sampling technique. No Inpatient room name Total (Ni) ∑n = Ni : N Total sample ni = (∑n) x n 1. Inpatient room A 18 0.125 16 2. Inpatient room B 27 0.188 25 3. Inpatient room C 17 0.118 16 4. Inpatient room D 19 0.132 17 5. Inpatient room E 15 0.104 14 6. Inpatient room F 28 0.195 25 7. Inpatient room G 19 0.132 17 8. Total 143 130 Table 2. Instrument source. Variables Indicator Items Sources Organizational factors Leadership 7 Hasibuan, 201924 Organization culture 5 Umar, 200825 Goals 5 Chasanah, 200526 Rewards or salary 5 Hasibuan, 201924 Training and development 5 Kandou, 201327 Total 27 Sharia based nursing care Assessment 5 DSN-MUI, 201728 Diagnosis 5 DSN-MUI, 201728 Intervention 5 DSN-MUI, 201728 Implementation 5 DSN-MUI, 201728 Evaluation 5 DSN-MUI, 201728 Total 25 Patient satisfaction Reliability 6 Nursalam, 202029 Assurance 3 Nursalam, 202029 Reality 5 Nursalam, 202029 Empathy 5 Nursalam, 202029 Responsibility 4 Nursalam, 202029 Total 23 [Healthcare in Low-resource Settings 2024;12(s2):12359] [page 61] Non -co mmerc ial us e o nly explanation carried out orally and in writing; after the patient understands the research being conducted, the researcher requests written informed consent and then the patient who agrees to be a respondent can sign the informed consent sheet, which is in accor- dance with the ethical principles of research, namely informed consent, anonymity, confidentiality, fidelity, and autonomy; the process of filling out the patient’s questionnaire will be accompa- nied by the family, because a complete explanation regarding this research from the enumerator is not only given to the patient but also given to the family as the patient’s guardian or guardian, so that in the process of filling in the patient is accompanied by the family, the filling does not have to be completed at one time, because the patient is given 24 hours to fill out the questionnaire, so the questionnaire can be filled in according to the patient’s wish- es, but if the patient does not have family to look after him then he will be accompanied by an enumerator, after 24 hours the enumer- ator will take the questionnaire back, but before taking it he will check whether it is completely filled in or not, if it is not all filled in then the patient is asked to complete it, and if it is complete it will be collected by the enumerator for further data analysis pro- cess.4 The data that have been collected are then checked for com- pleteness and then processed with Smart Partial Least Squares (SmartPLS). Data analysis The descriptive test uses a frequency distribution test with analysis using SmartPLS. For inferential analysis, a variation and component-based structural equation model was used called Partial Least Squares Structural Equation Modeling (PLS-SEM), PLS-SEM is recognized as an alternative to Covariance-Based Structural Equation Modeling (CB-SEM) in cases where assump- tions cannot be met or when the proposed model is exploratory in nature, lacking substantial empirical evidence. PLS-SEM also facilitates testing the relationships between constructs within the conceptual model. SmartPLS 3.2.8 was employed to execute the PLS-SEM method. This software offers diverse options for gener- ating both outer and inner models to compute latent variable scores within research models. Nonetheless, it is important to note that PLS-SEM has faced criticism from experts regarding its consisten- cy and potential bias.30 PLS and consistent PLS prediction have been introduced to address these concerns, but their development remains ongoing. Given the exploratory nature of this research and the lack of a well-established model, PLS-SEM is suitable for hypothesis testing.31 SmartPLS has the advantage that it is power- ful, since it does not require the data to have a certain measurement scale. Small samples can also be used to confirm the theory, and allow testing a series of relationships between relatively compli- cated variables simultaneously. SmartPLS analysis was carried out using the SmartPLS software covering the measurement model (outer model), structural model (inner model), and hypothesis test. Therefore, in view of SmartPLS’s advantage, it is very suitable that SmartPLS was used as the device for data processing in this research. Based on the guidelines on the outer model or validity test, an indicator is considered valid if its Average Variance Extracted (AVE) value >0.5 or showing all outer loading variable dimension values >0.5. The second test was the structural or inner model test, carried out to predict the causal relation between latent variables. The structural model was evaluated assuming the per- centage of the variances explained by R2, (R square) for the depen- dent variable, and the predicted relevance test (Q-square) called Stone-Geisser was used to measure how well the values observed, produced by the model, are and also the parameter estimates. A Q- square value higher than 0 (zero) indicates that the model has pre- dictive relevance or shows relevance when applied in different areas. On the other hand, a Q-square value lower than 0 (zero) has less predictive relevance, and a bootstrapping procedure was per- formed to observe the structural path coefficient or latent variable’s relation or influence. The hypothesis was tested by testing the t- statistic or bootstrapping the significance of the hypothesis was obtained by comparing the t-table and t-statistic values. The t- statistic value was higher than the t-table or t >1.96 and p≤0.01.32 Ethical considerations This research has passed the ethical clearance test by the Medical and Health Research Ethics Committee (MHREC) of Sultan Agung Islamic Hospital’s Health Research Ethics Committee on 25 July 2022 under No. 72/ KEPK-RSISA/VII/2022, and has obtained the respondents’ consent through informed con- sent, thus patients first received an explanation from researchers about the research carried out in full, an explanation carried out orally and in writing. After the patient understands the research being conducted, the researcher is given informed consent in writ- ing, and then the patient who agrees to be a respondent can sign the informed consent sheet, which is in accordance with the ethical principles of research, namely informed consent, anonymity, confi- dentiality, fidelity, and autonomy. Results Sample characteristics The results show that by age, most of the nurses are from 26 to 35 years old or in their late adulthood (70%) and by educational level, most of the nurses have associate degrees in nursing educa- tion (67.78%). The nurses’ highest age (late adulthood) ranges from 36-45 years old (24.6%), and most of them have a secondary school education level (53.8%) (Table 3). The frequency distribution test shows that most of the vari- ables studied have good levels (Table 4). This is reflected in the results, showing that most of the nurses have good leadership (70%). The organizational culture variable also has a good level (72.3%). For the third variable, organizational goals, most of them have good level (72.3%), and most of them have good level of reward or salary (66.2%); the SBNC variable shows that most of the nurses have good level of assessment (73.8%), and most of the nurses have good level of diagnosis (67.7%), intervention (73.1%), implementation (69.2%), and evaluation indicator (72.3%). Patient satisfaction’s five indicators show that most of the nurses have good reliability (75.4%) and reality indicator (71.5%), most have good assurance (70%), most have good empathy (71.5%), and good responsibility (73.8%) (Figure 1, Table 5). The interpretation of the measurement model in this test is valid since the indicator’s reliability for each part of the outer load- ing is higher than 0.7. The AVE value for all variables is higher than 0.7. The reliability test in this study used a reference to the value of composite reliability and Cronbach’s alpha, in all vari- ables showing values higher than 0.7, all results of which are very reliable in that they are higher than 0.80. In the Fornell-Larcker matrix, the square root of AVE (diagonal) is higher than all values, and the HTMT value is lower than 1, thus we may conclude that the measurement model’s discriminant validity is confirmed. This study’s coefficient of determination shows that the orga- nizational factors determine SBNC by 0.618 (0.618x100=61.8%), thus 61.8% of SBNC is predicted or determined by the organiza- tional factors, while the remaining 38.2% (100-61.8%=38.2%) is Social and political factors affecting public health [page 62] [Healthcare in Low-resource Settings 2024;12(s2):12359] Non -co mmerc ial us e o nly Social and political factors affecting public health [Healthcare in Low-resource Settings 2024;12(s2):12359] [page 63] Table 3. Demographic characteristics of nurse and patient. Variable f % Nurse Age 21-25 years (Late adolescence) 14 10.8 26-35 years (Early adult) 91 70 36-45 years (Late adulthood) 24 18.5 Education Associate degree of nursing 88 67.7 Nurse profession 42 32.3 Patient Age 17-25 years (Late adolescence) 12 9.2 26-35 years (Early adult) 20 15.4 36-45 years (Late adulthood) 32 24.6 46-55 years (Early seniors) 31 23.8 56-65 years (Late elderly) 29 22.3 >65 years old (Seniors) 6 4.6 Education Elementary (Elementary school) 44 33.8 Secondary (Junior high school or senior high school) 70 53.8 High (Bachelor or master) 16 12.3 Table 4. Distribution of variable frequency. Variable Category scale Less Enough Good f % f % f % Organizational Factors Leadership 2 1.5 37 28.5 91 70 Organizational culture 4 3.1 32 24.6 94 72.3 Purpose 6 4.6 30 23.1 94 72.3 Rewards or salary 8 6.2 36 27.7 86 66.2 Training and development 7 5.4 32 24.6 91 70 Sharia-Based Nursing Care Assessment 2 1.5 32 24.6 96 73.8 Diagnosis 4 3.1 38 29.2 88 67.7 Intervention 3 2.3 32 24.6 95 73.1 Implementation 6 4.6 34 26.2 90 69.2 Evaluation 6 4.6 30 23.2 94 72.3 Patient Satisfaction Reliability 3 2.3 29 22.3 98 75.4 Assurance 4 3.1 35 26.9 91 70 Reality 1 0.8 36 27.7 93 71.5 Empathy 1 0.8 36 27.7 93 71.5 Responsibility 2 1.5 32 24.6 96 73.8 Figure 1. Measurement of the outer model. OF, Organizational Factors; SNBC, Sharia-Based Nursing Care; PS, Patient Satisfaction Non -co mmerc ial us e o nly determined by other factors. The next coefficient of determination is the SBNC and organizational factors’ value in determining patient satisfaction, showing the results 78.7% or (0.787x100=78.7%), while the remaining 21.3% (100- 78.7%=21.3%) is determined by other variables beyond this study. This study’s results show the path coefficients and the level of significance. The path coefficients were used to test the hypothe- sis; the path coefficient test shows a significant correlation between organizational factors and SBNC (Table 6). Organizational factors and SBNC has positive, strong, and signifi- cant influence (p-value=0.000; β-value=0.786; t-value>1.96). Organizational factors and patient satisfaction have positive, mod- erate, and significant influence (p-value=0.000; β-value=0.508; t- value>1.96), and SBNC and patient satisfaction have positive, moderate and significant influence (p-value=0.000; β- value=0.430; t-value>1.96). The consolidation of organizational factors with SBNC on patient satisfaction shows that there is influ- ence and can increase patient satisfaction (p-value=0.001; β- value=0.338; t-value>1.96). These results show that patient satis- faction can be increased quickly through special methods or strate- gies, namely through consolidation or a combination of organiza- tional factors with SBNC, so consolidation becomes a special strat- egy to increase patient satisfaction. Discussion This study investigated the indicators that shape organizational factors, SBNC, and patient satisfaction. In addition, this study also examines specific strategies to increase patient satisfaction, orga- nizational factors that can influence SBNC, patient satisfaction, and the role of each organizational factor indicator, assesses SBNC that can increase patient satisfaction, and examines the role of each indicator of SBNC in increasing patient satisfaction. In-depth find- ings regard the consolidation of organizational factors with SBNC on patient satisfaction, which is the most important factor in increasing patient satisfaction. The study results indicate that organizational factors signifi- cantly influence SBNC and patient satisfaction. This study’s results also show that organizational factors are shaped by the indi- cators: leadership, culture, goal, reward, and training and develop- ment. This is in line with the research that organizational charac- teristics and nurses’ behavior influence patient’s perception of the care they receive.33 Organization is an important factor not only serving as part of the administrative process, but also a challenge to nursing services, since a nursing model is selected depending on how the organization establishes it, besides the fact that the quality of nursing care for patients reflects health service organization.34 Social and political factors affecting public health Table 5. Measurement model evaluation, coefficients of determination, and path coefficients. Measurement model evaluation Latent variable Items Convergent validity Internal consistency Discriminant validity reliability Loadings AVE Composite reliability Cronbach alpha HTMT <1 Organizational Factors OF1 0.862 0.734 0.932 0.909 Yes OF2 0.859 OF3 0.871 OF4 0.843 OF5 0.849 Sharia-Based Nursing Care SBNC 1 0.889 0.831 0.961 0.949 Yes SBNC 2 0.889 SBNC 3 0.918 SBNC 4 0.937 SBNC 5 0.912 Patient Satisfaction PS1 0.863 0.780 0.947 0.929 Yes PS2 0.908 PS3 0.904 PS4 0.856 PS5 0.884 Coefficients of determination Variable R square R square adjusted Sharia-Based Nursing Care 0.618 0.615 Patient Satisfaction 0.787 0.784 AVE, Average Variance Extracted. Table 6. Path coefficients. Hypothesis β SD t-value ρ-value Test result Organizational Factors ⇒ Sharia Based Nursing Care 0.786 0.050 4.394 0.000 Supported Organizational Factors ⇒ Patient Satisfaction 0.508 0.126 14.878 0.000 Supported Sharia Based Nursing Care ⇒ Patient Satisfaction 0.430 0.111 3.859 0.000 Supported Organizational Factors ⇒ Sharia Based Nursing Care � Patient Satisfaction 0.338 0.102 3.299 0.001 Supported SD, Standard Deviation. [page 64] [Healthcare in Low-resource Settings 2024;12(s2):12359] Non -co mmerc ial us e o nly A health service organization plays an important role in lead- ership, as stated by Specchia et al. (2021), that leadership plays a key role in effective and efficient care provision and positively influences the nursing profession, environment, and patient. Leadership is defined as the ability to influence others in achieving goals or works through good communication, motivation, leader- ship ability, and decision-making.35 Leadership greatly influences the success of SBNC; in providing nursing services, nurses must comply with the maqshid Sharia guidelines, thus a leader plays an important role in directing, creating cooperation, and evaluating nurses’ performance for them to comply with the five elements of maqshid Sharia. A nurse leader’s leadership style directly or indi- rectly determines the quality of nursing care, since good leadership determines the right steps to achieve goals, and good and compe- tent leadership will improve nursing care quality and patient satis- faction, but achieving these two things, in addition to leadership, also requires well-established organizational culture.36 Organizational culture is a set of shared mental models reflect- ing a group’s life: perspective-making, problem-solving, and emo- tional reaction to what we feel.37 Organizational culture plays an important role in creating a work environment that may support nurses in the avoidance of negative organizational attitudes, nurse job satisfaction, and patient satisfaction.38 This study result shows that organizational culture is the indicator forming organizational factors in determining SBNC and patient satisfaction in that, as stated by Bakar et al. (2022), organizational culture can shape a nurse’s professionalism in their work environment and enhance cooperation between nurses. Work culture is related to the quality of a nurse’s work, as work quality depends on the culture applied, and a hospital’s understanding of a sustainable organizational cul- ture helps improve nurse performance in the long run.40 Organizational goals are expressed in the products and services offered, the needs addressed, and the community groups served through the values obtained and through the aspirations and ideals for the future, called vision. Nurses are a hospital’s extension in translating its vision and mission, thus nurses must understand and implement the organization’s vision and mission in providing nurs- ing services.41 SBNC is a service objective implemented in Sharia hospital services, and nurses here play an important role in their performance, since, as stated by Mukisi & PPNI (2019), the nurs- ing profession has ethics aimed at patient safety as part of service quality besides knowledge and skills, and additional terms or codes of conducts for nurses from the Qur’an and Hadith are needed in Sharia-based nursing implementation, thus a health service organi- zation’s (hospital) goals or vision and mission play an important role in SBNC implementation, patient satisfaction, and nurse job satisfaction. Nurse job satisfaction is a factor influencing the quality of nursing care since a nurse’s good job satisfaction will boost the quality of nursing care, and nurse job satisfaction is influenced by salary or reward. Salary or compensation is an appreciation, as Nursalam (2020) defined as a statement explaining what the orga- nization desires in the long run in developing and expecting poli- cies, practices, and appreciation processes that may support achieving their goals and meeting their needs. Reward is also a stimulus to improve nurse performance in providing nursing care, thus reward is an organization’s important indicator, and nurse per- formance can also be improved through training and developing human resources. Training and development in this study are proven to be an indicator influencing organizational factors, in conformance to the statement by Bhatti et al. (2021) that, in aiming at developing skills and knowledge, hospitals can provide training programs. Training is a useful educational method in the short run as a coherent and systematic way of learning for nurses. Training, in Sriviboon and Jermsittiparsert (2019), shows a strong influence on improving nursing and organizational resources. Therefore, hospitals should train nurses in an effort to develop this resource for better organi- zational performance, quality of nursing care, and patient satisfac- tion. Improving patient satisfaction through SBNC requires efforts in improving organizational factors, which can be improved through improved leadership, organizational culture, improved goal setting, optimized reward, and training and development for nurses. Hospitals can hone nurse leadership, improve organization- al culture, and set goals in accordance with maqshid Shariah prin- ciples, since goal honing and setting according to Sharia principles can help optimize a nurse’s performance of SBNC. In addition, hospitals also need to optimize nurse reward, since the reward is proven capable of increasing nurse job satisfaction, increasing their loyalty to the hospital, and nurse performance, which can lead to improving nurse performance in providing SBNC and increas- ing patient satisfaction. Training is also needed to increase nurse’s knowledge, skills, and abilities with regard to SBNC. So that patient satisfaction can be increased quickly through special meth- ods or strategies, namely through consolidation or a combination of organizational factors with SBNC, consolidation becomes a spe- cial strategy to increase patient satisfaction. Strengths The results draw the novel contributions of organizational fac- tors with SBNC to increase patient satisfaction in Islamic hospi- tals; the effect of the consolidation relationship between organiza- tional factors and SBNC on increasing patient satisfaction hasn’t been published. It is important because this research provides a model to clarify how the consolidation of organizational factors with SBNC can significantly increase patient satisfaction. In addi- tion, SBNC is a new model developed by the authors themselves, so it has an important update for the world of nursing, considering that the population of Muslims is the largest in the world and the need for spiritual needs is also increasing so that when a hospital wants to expand or enlarge, it is necessary to improve the quality of service. This improvement can be seen in this model, namely by developing SBNC and applying it; the organizational factor con- solidation model with SBNC shows that it can strengthen patient satisfaction; when patient satisfaction increases, patient loyalty will also increase, which will later attract consumers or patients to continue to return to the hospital if they need a service or recom- mend others. Implications This research also has a positive impact on nursing students, nurses, student nursing practitioners, and nurse practitioners, and, because it is closely related to the service system, it also has bene- fits for nursing managers and directors. This is because it can pro- vide very adequate information to nurses to become the basis for leadership and organizational culture, and always improve their knowledge in order to provide the best nursing services for patients so as to provide satisfaction to patients. This research also had a positive impact on health facilities because it is known that nurses have it. However, by increasing the nurse factor, patient satisfac- tion can be determined; thus, when the patient is satisfied, patient loyalty can increase, which is beneficial for health services. Thus for society. In addition, this study has undergone several updates. Hospital managers and nursing managers should realize that organizational factors have a positive impact on SBNC and that the consolidation of organizational factors and SBNC can increase Social and political factors affecting public health [Healthcare in Low-resource Settings 2024;12(s2):12359] [page 65] Non -co mmerc ial us e o nly patient satisfaction; thus, SBNC can be implemented in Islamic hospitals as a key hospital expansion. Limitations and recommendations for future research It is essential to acknowledge the limitations of this study. The findings of this study are context-specific and may not be univer- sally applicable. Future research should consider broader samples and more diverse settings to enhance the generalizability of the results. Several recommendations for future research were pro- posed. Researchers should conduct longitudinal studies to explore the long-term impact of organizational factors and SBNC on patient satisfaction. Additionally, investigating the influence of contextual factors, such as nursing and specific cultural and reli- gious contexts, on nursing practice and patient satisfaction is war- ranted. Comparative studies across different healthcare settings and populations could further expand our understanding. Conclusions Nurses with good leadership and an appropriate organizational culture, and giving of appropriate rewards can shape the quality of professional nursing performance so that they are in line with hos- pital organizational goals by implementing SBNC; thus, patients feel that all their needs are met, especially the spiritual aspect, patients feel comfortable, and have patient satisfaction with the nursing services. Thus, a SBNC model is the key mediator to patient satisfaction, indicating that organizational factors have a strong influence in determining SBNC. 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