Extrinsic and Intrinsic Motivation to Improve the Quality of Public Services: A Case Study at

: This research is intended to answer the questions how the employees of RSUD Cengkareng can improve the quality of their services with extrinsic and intrinsic motivation and what are the obstacles encountered in improving the service quality of RSUD Cengkareng. Data collection methods in this qualitative research are interviews and documentation. The interviews conducted were semi-structured interviews. Researchers conducted interviews with 20 non-medical employees with the criteria of having worked for more than 5 years to obtain data on whether employees have intrinsic motivation to work and provide excellent service to patients and whether the leadership at Cengkareng Hospital provides extrinsic motivation to employees so that they can continue to work. improve services to patients. To get more objective results, the researchers also interviewed 20 Cengkareng Hospital patients, in order to obtain data related to how the services provided by the employees at Cengkareng Hospital. The results of this study indicate that extrinsic motivation given by superiors is highly expected by employees so that employees' intrinsic motivation can increase to provide better services to patient.


INTRODUCTION
In the future, it must be realized that human resources will need a model and process to acquire skills in a globalized world, work effectiveness and ability to compete (Hutomo et al., 2020;Kazakovs et al., 2015;Piwowar-Sulej, 2021). Human resources are one of the elements that determine the success of an organization in achieving its goals (Mujtaba & Senathip, 2020;Suwatno & Priansa, 2022;Tordera et al., 2020). In government organizations, the quality of the state apparatus is required for better performance by having attitudes and behaviors that identify devotion, honesty, responsibility, discipline, justice and authority so that they can provide services and protection to the community in accordance with the guidance of the people's conscience (Dye, 2017;Shinkle et al., 2021;Thoha, 2015).
Employees who have high motivation to occupy a higher position in the organization are likely to be able to increase work productivity in order to achieve organizational goals and vice versa.
By understanding the role played in motivation, a manager will be able to increase the work productivity of his subordinates and can further improve their performance (Alhashedi et al., 2021;Khalifa Elgelal & Noermijati, 2014;Varma, 2017).
Every organization (business and public) in principle always has a goal to be achieved. This goal will only be achieved through employee commitment. Having goals without commitment is futile, empowered employees make this commitment mentally, emotionally and physically (Dessler, 2007). This is because they take part in the decision-making process and also hold responsibility for their actions. Emphasizes the need for commitment by assuming that commitment encourages employee habitual choices that support the company that are vital to effective work (David & Newstrom, 1989;Dessler, 2007;Luthans, 2010;O'Reilly et al., 1991).
Motivation is a simple management task, but very complicated to implement. The reason is simple, because as a leader you only need to know what the members need. That said, this is complicated because it is not easy to find the needs of members due to differences in the personal needs of members. The fulfillment of individual needs in the organization makes the task of motivating a person complicated and important, so that organizational processes continue to run in accordance with the goals that have been set. At work, some leaders assume that members who appear to be less motivated are seen as lazy. On the other hand, members who have high motivation are considered as diligent members. Thus motivation is closely related to the quality of human resources. This can be seen, one of which is the quality of services provided both in private companies and in government agencies (Kanfer, 1990;Mašková et al., 2022;McLeod, 2020).
One of the organizations that has duties and functions in public health services is the hospital.
One of the hospitals managed by the government in the West Jakarta area is RSUD Cengkareng, This study aims to answer the question of how the employees of RSUD Cengkareng can improve the quality of their services with extrinsic and intrinsic motivation and what are the obstacles encountered in improving the service quality of RSUD Cengkareng. This research will contribute to employees who work in public service agencies in general and hospitals in particular. This research will also contribute to stakeholders in the health sector.

LITERATURE REVIEW
Motivation comes from the word "move" which means to push or move. Motivation is the whole process of giving subordinates work motives in such a way that they want to work sincerely for the achievement of organizational goals efficiently and economically (Manullang, 2017;Siagian, 2012). In talking about motivation, it is often associated with "motive" or "motive". The motive is an encouragement for someone to do something or work (Gie, 1992).
Motivation is an impulse that arises from the existence of stimuli from within and from outside so that a person wishes to make changes in certain behavior / activities better than the previous situation (Uno, 2007). Motivation is a process that gives enthusiasm, direction, and persistence of behavior, meaning that motivated behavior is behavior that is full of energy, directed and lasts a long time (Santrock, 2017). Motivation also defines as providing a driving force that creates a person's enthusiasm for work, so that they are willing to work together, effectively and integrated with all their efforts to achieve satisfaction (Hasibuan, 2014).
Basically there are two types of motivation (Brantas, 2009), namely: a. Positive motivation is an encouragement that is positive, meaning that if employees can produce above average achievements. Then the employee is given incentives in the form of gifts. b. Negative motivation, encouraging subordinates with legal threats. This means that if the performance is Extrinsic and Intrinsic Motivation to Improve the Quality of Public Services: A Case Study at the Rumah Sakit Umum Daerah (RSUD) Cengkareng Sari, Poernomo, Flores, and Premchaiporn less and the standard performance will be punished. Meanwhile, if the achievement is above the standard will be given a prize.

Instrinsic Motivation
Intrinsic motivation is the motivation that drives a person to achieve that comes from within the individual, which is better known as the motivational factor. Motivational factors was classified as include (Herzberg, 1993;Luthans, 2010): 1. Achievements. The success of an employee can be seen from the achievements he has achieved. In order for an employee to be successful in carrying out his work, the leader must study his subordinates and their work by giving him the opportunity so that subordinates can try to achieve good results. When subordinates have succeeded in doing their work, the leader must declare that success.

2.
Recognition. As a continuation of the success of the implementation, the leader must give a statement of recognition of the success of subordinates, which can be done in various ways, namely: (a) Directly stating success in the workplace, preferably when someone else is there, (b) Letter of appreciation, (c) Giving gifts in the form of cash, (d) Providing medals, letters of appreciation and cash prizes, (e) Providing promotion salary increases.
3. Work it yourself. Leaders make real and convincing efforts, so that subordinates understand the importance of the work they do and try to avoid boredom in the work of subordinates and make sure that every subordinate is right in his work.

Responsibilities.
In order for true responsibility to be a motivating factor for subordinates, leaders must avoid strict supervision, by leaving subordinates to work alone as long as the work allows and applying the principle of participation. The application of the principle of participation makes subordinates fully plan and carry out their work.

5.
Advancements. Development is one of the motivating factors for subordinates. This development factor really functions as a motivator, so the leader can start by training his subordinates for more responsible work. When this has been done, the leader then provides recommendations on subordinates who are ready for development, to raise their rank, to be sent for further education and training.
Intrinsic motivation is a driving force for work that comes from within the worker as an individual in the form of awareness of the importance or benefits or meaning of the work he does (Nawawi, 2016). Intrinsic motivation involves people doing an activity because they find it Extrinsic and Intrinsic Motivation to Improve the Quality of Public Services: A Case Study at the Rumah Sakit Umum Daerah (RSUD) Cengkareng Sari, Poernomo, Flores, and Premchaiporn interesting and derive satisfaction directly from the activity itself. Intrinsic motivation arises from within the individual himself without any coercion or encouragement from others, but on the basis of his own will (Gagné & Deci, 2005;Porter & Lawler, 1968).

Extrinsic Motivation
Extrinsic motivation is motivation that comes from outside the self which also determines a person's behavior in his life which is known as hygiene factor theory which is classified as hygiene factors (Herzberg, 1993;Luthans, 2010), include: 1. Policy and administration. The implementation of the policy is carried out by each manager concerned. In this case so that they do as fair as possible.
2. Quality supervisors. Technical supervisors who have lower technical abilities than their subordinates must try to improve themselves by participating in training and education.

Interpersonal relations. Interpersonal relations show individual relationships between
subordinates and their superiors, where the possibility of subordinates feeling unable to get along with their superiors. In order not to cause employee disappointment, there are at least three skills that every supervisor must possess, namely: a) Technical skills, including the ability to use methods and processes in general related to the ability to use tools. b) Human skills, the ability to work within or with groups, so that they can build cooperation and coordinate various activities. c) Conceptual skills, the ability to understand the complexity of the organization so that the various actions taken are always in an effort to realize the overall organizational goals.
4. Working conditions. According to Hezberg if good environmental conditions can be created, high achievement can be created, high achievement can be produced through concentration on the needs of the ego and higher self-realization.

5.
Wages. Each manager has an obligation to assess whether the positions under his supervision are compensated according to the work they do.

Public Service Quality
Public service basically involves a very broad aspect of life. The implementation of public services is an effort by the state to fulfill the basic needs and civil rights of every citizen for goods, services, and administrative services provided by public service providers. The 1945 Constitution mandates the state to fulfill the basic needs of every citizen for their welfare, so that Public service is defined as providing services (serving) the needs of people or communities who have an interest in certain organizations in accordance with the basic rules and established procedures (Sinambela, 2006). Each of these sections is influenced by several quite important factors, namely as follows: 1) Factors that affect the quality of internal services (organizational employee interactions), namely the general management pattern of the organization, providers of supporting facilities, resource development people, work climate and harmony of work relations, as well as incentive patterns. 2) Factors that affect the quality of external services (external customers), namely service patterns and service provision procedures, service distribution service patterns, service sales service patterns, and service patterns in service delivery (Barata, 2004).
There are five characteristics used to evaluate service quality, namely: 1) Tangibles, including physical facilities, equipment, employees and means of communication. 2) Reliability, namely the ability to provide the promised service immediately and satisfactorily. 3) Responsiveness, namely the desire of the staff to help customers and provide responsive service. 4) Assurance, includes the ability, courtesy, and trustworthiness of the staff: free from danger, risk, or doubt. 5) Empathy, including ease of making relationships, good communication and understanding the needs of customers (Tjiptono, 2016;Zeithaml et al., 2018).

METHOD
In this study, the researcher used a qualitative approach with the type of case study research.
Qualitative research is research that uses a natural setting, with the intention of interpreting phenomena that occur and is carried out by involving various existing methods (Denzin & Lincoln, 2017). The emphasis of case studies is to maximize understanding of the case being studied and not to generalize, cases can be complex or simple and the time to study can be short or long, depending on the time to concentrate (Johnson & Stake, 2005;Stake, 1996). Data collection is done to obtain the information needed in order to achieve the research objectives (Gulo, 2002). Data collection methods in this qualitative research are interviews and documentation. The interviews conducted were semi-structured interviews where the researcher used a framework of questions to be asked and these questions could develop so that researchers could obtain as much information as possible about the informants of this research (Creswell, 2017). Meanwhile, data collection from documents was carried out through documents related to the Cengkareng Regional General Hospital (RSUD).
Researchers conducted interviews with 20 non-medical employees with the criteria of having worked for more than 5 years to obtain data on whether employees have intrinsic motivation to work and provide excellent service to patients and whether the leadership at Cengkareng Hospital provides extrinsic motivation to employees so that they can continue to work. improve services to patients. To get more objective results, the researchers also interviewed 20 Cengkareng Hospital patients, in order to obtain data related to how the services provided by the employees at Cengkareng Hospital.
In this study, the researchers used a reliability procedure  (Creswell, 2017;Gibbs, 2008).
The steps taken in the data analysis process of this research are: (1). Make verbatim or transcripts of data from interviews. Interview transcript. This interview transcript was typed according to what was obtained from the recording device, field notes and observations. This transcript is typed in a question and answer format, (2). Then the data is compiled and categorized based on the themes that have been determined by the researcher, (3). The researcher then made a descriptive description of the data based on the categories that had been made. The description is written in detail and written in such a way as to allow the reader to visualize the observed setting, (4). The researcher then analyzes and interprets the data from the descriptive description which is related to the theory. By using descriptive as well as informative descriptions, observers minimize bias, so they can develop a more accurate analysis when interpreting all existing data, (5). The researcher then made a comparison between research subjects by looking at the similarities and differences in each category (Poerwandari, 2007).

RESULTS AND DISCUSSION
The results of interviews with 20 employees of RSUD Cengkareng are summarized in the following  From the results of interviews with non-medical officers at Cengkareng Hospital, it was found that leaders who belong to the supervisor and manager category very rarely motivate their Extrinsic and Intrinsic Motivation to Improve the Quality of Public Services: A Case Study at the Rumah Sakit Umum Daerah (RSUD) Cengkareng Sari, Poernomo, Flores, and Premchaiporn subordinates. If staff make a mistake, they generally prefer to give direct warnings and sanctions, without digging up information regarding the obstacles encountered by staff in the field. In addition, the relationship between superiors and subordinates is very rigid, causing conditions in the workplace to be less conducive.
"I have worked at this hospital for more than 5 years and have changed supervisors more than 3 times. However, what I feel is that superiors have a rigid relationship with their subordinates. If I make a mistake in my work or From the answers given by the informants, we can see that there are still many superiors or leaders who do not understand the importance of giving extrinsic motivation to their subordinates even though this extrinsic motivation plays a very important role in improving employee performance, which in this case is related to service. If staff make mistakes or delays in completing their tasks, superiors give more warnings and immediately impose sanctions without digging up information regarding obstacles or problems encountered by their subordinates.
Bosses also never give motivation to their employees even though motivation is a driving force that involves one's work enthusiasm so that they want to work together, work effectively, and be integrated with all their efforts to achieve satisfaction (Hasibuan, 2014).  From the results of interviews with employees, also obtained data related to the intrinsic motivation they have while working. The lack of leadership skills in motivating employees makes it difficult for employees to improve their performance because they do not have intrinsic motivation at work. The atmosphere is not conducive, causing employees to only work according to standards without any desire to provide satisfaction to patients or customers.
" There has never been a culture of giving awards to employees who excel or who have worked very well. This also makes employees less enthusiastic to work better because there is no difference, we work well and employees who work normally. " (RE-Employee) "There are rarely activities that provide space for employees to refresh.
Here, it seems, we are required to work, work and work without building an atmosphere that can foster togetherness and motivate employees to work and provide even better services. In fact, as employees, what we need is not only money, but also comfort at work." (SE-Employee) By giving awards to employees who excel, it will provide or cause employee work motivation because employees will feel that the leadership appreciates and recognizes the results of their work. them with the hope of obtaining the award (Hasibuan, 2014). The results of interviews with patients or hospital customers, obtained data that the patients were not satisfied with the services provided by the staff at the hospital. From the answers given by the patient, it was obtained data that the officer had not given satisfaction to the patient or customer. Officers, doctors and hospitals have not implemented the elements of service quality, namely: Tangibles, Responsiveness, Reliability, Assurance and Empathy. So, service quality is the interaction between customers and employees whose results can be directly felt by customers right away. Customer satisfaction is very important because customer satisfaction is the level of one's feelings after comparing the perceived performance or results compared to their expectations (Kotler & Keller, 2016).

CONCLUSION
The results of this study indicate that supervisors who do not provide motivation to their employees will cause a decrease in employee motivation and create a work atmosphere that is not conducive. This unfavorable relationship between superiors and subordinates will cause employees not to have the motivation to improve the quality of their work so it is difficult to improve the quality of service to patients. Bosses rarely even give praise and positive feedback for the excellent work of their subordinates. This causes employees to be less enthusiastic about improving the quality of their work. The results of this study also indicate that extrinsic motivation given by superiors is highly expected by employees so that employees' intrinsic motivation can be more motivated to provide better services to patients. For further research, the researchers recommend conducting research related to extrinsic motivation of superiors and intrinsic motivation of subordinates in community health service centers with different approaches.
Extrinsic and Intrinsic Motivation to Improve the Quality of Public Services: A Case Study at the Rumah Sakit Umum Daerah (RSUD) Cengkareng Sari, Poernomo, Flores, and Premchaiporn