Contextual Influence of Anesthesia Nursing Care by the Anesthesia Care Team on Service Quality Among Anesthesia Patients

Authors

  • Muh Anan Wais Lahay Master’s of Public Health, Universitas Sebelas Maret, Indonesia
  • Adi Prayitno Department of Community Nutrition, Universitas Sebelas Maret, Indonesia
  • Dewi Pratiwi Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Sebelas Maret, Indonesia
  • Erindra Budi Cahyanto Department of Nursing Anesthesia, Universitas Sebelas Maret, Indonesia Doctorate Degree Program in Public Health, Universitas Sebelas Maret, Indonesia
  • Sri Mulyani Department of Nursing Anesthesia, Universitas Sebelas Maret, Indonesia

DOI:

https://doi.org/10.26911/

Abstract

Background: The quality of general anesthesia care depends on the non-technical skills of nurse anesthetists and the socio-administrative factors of patients. This study aimed to analyze the relation­ships among emergency training status, clinical competence, health financing types, and patient satisfaction.

Subjects and Method: This study used an observational analytic cross-sectional design conducted at Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. The sample consisted of 19 nurse anesthetists selected through total sampling and 80 general anesthesia patients selected through consecutive sampling. Data were collected using modified Anaesthetists' Non-Technical Skills (ANTS) observation sheet and Rater questionnaire. Data analysis included One-Way ANOVA, Linear Regression, and mediation analysis using the PROCESS macro in SPSS.

Results: There was a significant difference between trained and untrained providers in anesthesia nursing care skills (p<0.001) and patient satisfaction (p=0.004). Patient satisfaction also varied significantly by financing type (p=0.034). Linear regression indicated that training status predicted anesthesia nursing care scores (p<0.001) and patient satisfaction (p=0.004). However, anesthesia nursing care scores did not significantly predict patient satisfaction (p=0.061). There was no significant relationship between provider training status and patient financing type (p=0.089). Mediation analysis showed that financing type did not mediate the relationship between training status and patient satisfaction (b=-1.61; p=0.193).

Conclusion: Emergency training improves both the non-technical skills of nurse anesthetists and patient satisfaction. Since intraoperative clinical competence does not directly predict post-operative satisfaction, hospitals should evaluate clinical safety and service quality as separate metrics. Furthermore, the findings indicate that anesthesia care is provided equally to all patients, regardless of their health financing type.

Keywords:

anesthesia nursing care, general anesthesia, health financing, service satisfaction

Published

16-05-2026

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How to Cite

Contextual Influence of Anesthesia Nursing Care by the Anesthesia Care Team on Service Quality Among Anesthesia Patients. (2026). Journal of Health Policy and Management, 11(2), 243-253. https://doi.org/10.26911/

How to Cite

Contextual Influence of Anesthesia Nursing Care by the Anesthesia Care Team on Service Quality Among Anesthesia Patients. (2026). Journal of Health Policy and Management, 11(2), 243-253. https://doi.org/10.26911/

References

Andemeskel YA, Elsholz K, Gebreyohannes Y, Tefamariam T (2019). Patient satisfaction with perioperative anesthesia care and associated factors at a national referral hospital. BMC Anesthesiol. 19(1): 1–9. [https://doi.org/10.1186/s12871-019-0724-3](https://doi.org/10.1186/s12871-019-0724-3).

Aoyama K, Yang A, Pinto R, Ray JG, Hill A, Scales DC, Fowler RA (2024). Using multi-level regression to determine associations and estimate causes and effects in clinical anesthesia due to patient, practitioner and hospital or health system practice variability. J Anesth. 39: 134–145. [https://doi.org/10.1007/s00540-024-03408-3](https://doi.org/10.1007/s00540-024-03408-3).

Capuzzo M, Gilli G, Paparella L, Gritti G, Salcuni S, et al. (2007). Factors predictive of patient satisfaction with anesthesia. Anesth Analg. 105(2): 435–442. [https://doi.org/10.1213/01.ane.0000270207.69831.33](https://doi.org/10.1213/01.ane.0000270207.69831.33).

Donabedian A (2003). An introduction to quality assurance in health care. New York: Oxford University Press.

Field A (2017). Discovering statistics using IBM SPSS statistics. 5th ed. London: SAGE Publications.

Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R (2003). Anaesthetists' non-technical skills (ANTS): Evaluation of a behavioural marker system. Br J Anaesth. 90(5): 580–588. [https://doi.org/10.1093/bja/aeg112](https://doi.org/10.1093/bja/aeg112).

Flin R, Patey R, Glavin R, Maran N (2010). Anaesthetists' non-technical skills. Br J Anaesth. 105(1): 38–44. [https://doi.org/10.1093/bja/aeq134](https://doi.org/10.1093/bja/aeq134).

Weller J, Boyd M, Cumin D (2014). Teams, tribes and patient safety: Overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 90(1061): 149–154. [https://doi.org/10.1136/postgradmedj-2012-131168](https://doi.org/10.1136/postgradmedj-2012-131168).

Handayani R, Setyawan D, Mustofa A (2022). Analysis of central surgical service utilization among JKN patients at a referral hospital. J Manaj Kesehat Indones. 10(2): 120–128.

Hayes AF (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. 3rd ed. New York: Guilford Press.

Jarl M, Escher C, Harbut P, Conte H, Nilsson U (2025). Psychometric evaluation of a structured assessment tool for nurse anesthetists' non-technical skills. BMC Med Educ. 25(1): 72. [https://doi.org/10.1186/s12909-025-07297-2](https://doi.org/10.1186/s12909-025-07297-2).

Kang J, Hu J, Yan C, Xing X, Tu S, Zhou F (2024). Development and applications of the Anaesthetists' Non-Technical Skills behavioural marker system: A systematic review. BMJ Open. 14(3): e075019. [https://doi.org/10.1136/bmjopen-2023-075019](https://doi.org/10.1136/bmjopen-2023-075019).

Levin KA (2006). Study design III: Cross-sectional studies. Evid Based Dent. 7(1): 24–25. [https://doi.org/10.1038/sj.ebd.6400375](https://doi.org/10.1038/sj.ebd.6400375).

Lubis A (2020). Hospital policy and governance in the JKN era. Jakarta: Kencana.

Lyk-Jensen HT, Jepsen RMHG, Spanager L, Dieckmann P, Ostergaard D (2014). A Danish version of the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system: Translation, adaptation and validation. Acta Anaesthesiol Scand. 58(10): 1282–1289. [https://doi.org/10.1111/aas.12404](https://doi.org/10.1111/aas.12404).

Parasuraman A, Zeithaml VA, Berry LL (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retail. 64(1): 12–40.

Ruetzler K, Khanna AK, Sessler DI (2020). Myocardial Injury After Noncardiac Surgery: Preoperative, Intraoperative, and Postoperative Aspects, Implications, and Directions. Anesthesia & Analgesia. 131(1): 173-186. [https://doi.org/10.1213/ANE.0000000000004567](https://doi.org/10.1213/ANE.0000000000004567).

Simegn AE, Melesse DY, Bizuneh YB, Alemu WM (2021). Patient satisfaction survey on perioperative anesthesia service. Anesthesiol Res Pract. 2021: 3379850. [https://doi.org/10.1155/2021/3379850](https://doi.org/10.1155/2021/3379850).

Sodhi K, Singla MK, Shrivastava A (2011). Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med. 15(4): 209–212. [https://doi.org/10.4103/0972-5229.92070](https://doi.org/10.4103/0972-5229.92070).

World Health Organization (2019). Patient safety: Global action on patient safety. Geneva: World Health Organization.

Zeithaml VA, Bitner MJ, Gremler DD (2018). Services marketing: Integrating customer focus across the firm. 7th ed. New York: McGraw-Hill Education.