THE DEVELOPMENT OF THE USE OF SOCIAL MEDIA MARKETING RS: HOW FAR HAS IT BEEN?

ABSTRACT


Introduction
Health services' culture and development are undergoing enormous and rapid changes.Patients today have become partners in health services and become very information literate because of the abundance of information through communication facilities that are fast growing through the internet and various social media platforms (Alsughayr, 2015).
Cultural changes and perspectives of both patients and health care providers have occurred since the rapid development of technology and coupled with the pandemic conditions in 2020, increasingly making technology and social media a means of communication, a means of relation, a means of marketing, a means of changing and influencing people's views on various things (both specific programs, specific issues and others).
The Internet and social media are increasingly developing through various online applications and platforms with their respective specificities and links.Information and communication can be done anytime, anywhere and with anyone as desired at a more economical cost.
The changes of the last 10 years have been cataclysmic, These changes are not just in healthcare but in all industries and individuals at all levels, all looking for and using new "tools" to communicate with family, friends, peers and potential customers.The health sector is still somewhat lagging compared to the non-health sector, but it is expected to grow to catch up with developments in other fields.
Social media is defined as a group of internet-based applications built on the ideology and technology of Web 2.0 that liberates all creation and exchange of "content" between users (Singh et al., 2016).
Social Media has several unique features (Singh et al., 2016): 1. Content can be in various formats: text, photos, images, graphics, videos and various other multimedia 2. To share information and its distribution can be on a wide scale and at high speed 3. Provide different levels of communication: one with one, one with many people, many people with many people 4. Enable "real-time" and asynchronous synchronization communication 5. Easy to access with computer, tablet, mobile phone / mobile phone and does not require special IT skills 6. Usually/ mostly free 7.The results can be tabulated and measured Various social media sites are very famous and widely used: Facebook: Social network websites allow users to create a personal profile, connect with others, exchange messages and join other users with the same interests.Facebook is one of the most popular sites, with over 1 billion active users.(al, 2019) YouTube: A platform that allows users to view and share videos with viewers that can cover the whole world, anyone who wants to be able to see them so that at the same time, all information and entertainment can be seen instantly.More than 1 billion YouTube users usually visit monthly, and 100 hours of videos are uploaded every minute.

Twitter:
A micro-blogging site that allows users to communicate with each other and share information through short 140-character messages or "tweets."The site is growing fast, with 255 million active users per month and 500 million tweets sent daily.

Linkedln:
A dynamic, business-based platform where people exchange credentials and professional skills and find suitable "workers."Growing by more than 2 new accounts per second WhatsApp Messenger: A cross-application to send messages where users can exchange messages.Users can form groups and send each other pictures, videos, and voice messages unlimitedly.Currently, users send more than 1 billion messages per day.

Instagram:
An application where users can send and view pictures, photos, short videos, and reels, interact with each other and can be "locked" to choose who can see and communicate.
There are many other applications such as marketing media and communicating media, with various purposes and varying specificities.

Research Methods The first part:
Observation and review of social media marketing by 3 private hospitals, 1 local private hospital, 1 national corporate private hospital and 1 private corporate hospital in Singapore: Adi Husada Undaan Wetan Hospital Surabaya, Siloam Hospital Surabaya, Mount Elisabeth Hospital Singapore What is compared is how many have been posted while using Instagram social media, how many posts on average each month (using data for 2 months, namely October-November 2022), how many followers, Average 2 likes and the number of "comments" that can show how engaged from followers and users and other data (content/type of post) and others with the method of observation and review only due to data and time limitations.Other data cannot be obtained because those who can see in detail are only admins, such as how many accounts were reached, accounts engaged, reached audience what age, which region, gender, content reach, post, stories, reels, live video, video, the type of post that is most viewed, shared etc.

Part Two:
RS Adi Husada Undaan conducted discussion about social media marketing; data was obtained further by interviews with marketing communication admins, although the data obtained is also limited only to social media Instagram and Youtube, while Facebook and Tiktok data is minimal.

Part One:
The following results were obtained from the results of limited observations and reviews by only looking at business accounts on Instagram and Youtube.From Table I, the highest number of posts overall is at Adi Husada Undaan Hospital, with a total of 1067.Likewise, his followers on Instagram are the most at Adi Husada Undaan Hospital Surabaya, as much as 14.5 K. Total posts per month between hospitals are almost the same, the most on the Mount Elizabeth Hospital Instagram group.However, the difference between the three hospitals compared is not significant.What is very striking is that the number of followers of Adi Husada Undaan Wetan Hospital is far more than that of the other two hospitals (Siloam et al. Group Hospital).From Table 2, the highest number of likes overall is Adi Husada Undaan Wetan Hospital Surabaya, with an average of 238 / month, followed by Mount Elizabeth Group Hospital, as much as 65 / month and at least Siloam Hospital Surabaya, as much as 12 / month.The average number of comments per month is only 1, the same result for all hospitals.The types of posts are also the same: education, posters and events organized by hospitals.Linktr.ee is not yet available at Adi Husada Undaan Wetan Hospital and is already available in 2 other hospitals.Part Two: Based on Table 3, Adi Husada Hospital has used several social media platforms but has never been evaluated and compared per platform by marketing communications.
Based on this table, the most followers are on Instagram, which seems to be the best managed.Youtube and Facebook, as the most widely used platforms in the world, have not many followers, and Tiktok has just begun to be followed because, following the trend now, young people like Tiktok which is more excited and feels more "fun".
Reviews obtained from Youtube and Facebook are quite good, namely 4.8 and 4.7 out of 5, but this assessment is only from 117 raters (only 6% of followers), the review assessment criteria are unknown, so the results of the review cannot be a benchmark / guarantee of good service quality in hospitals reviewed by social media users and require more in-depth analysis and research on this matter (Glover et al., 2015).
The amount posted for Instagram and Facebook is 25 to 2 months which means that if on average every 2 days there is content posted and because it is connected, what is posted on Instagram is automatically posted on Facebook.But the number of "likes" is much more on Instagram and this corresponds to the difference in the number of followers.
You Tube and Tiktok most of the content is videos or reels, and the amount uploaded is not much because it requires special preparation in making content to be uploaded.From creative ideas to editing takes longer than photos and other materials that can be prepared quickly for upload on Instagram and Facebook.
The following are the results of the interview about the results of the You tube and Instagram review of Adi Husada Undaan Wetan Hospital: Youtube Review of Adi Husada Undaan Hospital for November 2022 : Subscriber : 856 Watched 21,513 x Average viewer: 223x Geographical Distribution : Indonesia : 51.6% Average watch time : 5.7 hours 1.The most viewed content is: a. Overcome stroke early, disability is avoided b.Healthy Women, Happy Women c. Healthy Injection Adi Husada Undaan Wetan Hospital Based on the results of the review of You Tube as a social media marketing subscribers are not too much, the content that many like, especially about education.There is no review result about the age of the most users because the subscribers have not reached 1000 people.Based on the results of Instagram reviews as a social media used by Adi Husada Undaan Wetan Surabaya Hospital, quite a lot of followers and have been managed well, the most followers come from Surabaya, Indonesia and women as much as 70.1% and the most age is young people 18-34 years covering 64.1%.
The highest content that was liked turned out to be an event held at a special hospital for November 2022, because it involved many activities of Adi Husada Undaan Surabaya Hospital employees and some of the followers were Adi Husada Undaan Wetan Hospital employees themselves.Based on table 4, the types of materials posted vary from holidays / special days such as religious holidays, other holidays that have been determined by the Government, national doctor days etc., Events held outside hospitals, health service promotion / special promotion packages, Internal Events in hospitals and development of new systems in hospitals (e.g.payment systems, new medical record systems and others) The highest is precisely congratulations for big days / special days, followed by events outside the hospital, then promotion of health services / promotional packages, followed by educational content and internal hospital events.But the difference is not too significant because all of them reach more than 200 likes, meaning that all content is quite balanced.No particular type of content stands out from the rest.

Part One
To obtain data on Instagram is the easiest to browse.While searching for how many videos are uploaded on YouTube and other social media is difficult to get data (because it cannot be known immediately, you have to ask the admin who manages the social media) The comparison was made between private hospitals in Surabaya which are not corporations / groups, private hospitals in Surabaya which are corporations / groups and private hospitals in Singapore which are corporations.Adi Husada Undaan Wetan Hospital and Mount Elizabeth Group Hospital do not accept BPJS patients or Government insurance patients.Only accept patients with private financing and private insurance.Meanwhile, Siloam Surabaya Hospital accepts patients with private financing, private insurance and BPJS.All of them are type B hospitals with beds above 200.
Actually, it would be good if it can be compared with Government Hospitals, BUMN Hospitals as well, because it can be known whether there are differences in the management and development of social media marketing between hospitals managed by the Government, SOEs, private but due to limited time and information that can be obtained, the discussion is limited to only 3 hospitals that have been reviewed and observed as mentioned above.
RS Adi Husada Undaan Wetan has the most posts and likes, this needs to be further investigated whether it is also a strategy taken by management that every employee should be a marketer for the hospital as well, at least for his family and acquaintances / colleagues.Many events are posted so that employees also feel social media as a place to "exist" and can feel more enganged with RS.Whether this will really make promotion through social media powerful, it cannot be ascertained the connection.But all of this will build a brand / image of the hospital that involves employees as part of the hospital which is one of the core values of RS Adi Husada Undaan Wetan.Being part of a hospital is very important to make employees engaged, feel ownership and expected to serve better.Of course, with many posts also about other things such as promotional packages, education by doctors in turn, the public and also customers of Adi Husada Undaan Wetan Hospital also become more informed about educational and promotional events at Adi Husada Undaan Wetan Hospital.
Siloam Hospital Surabaya is a corporate or group private hospital.In Instagram, there are also various Instagram of Siloam Hospital in various other cities and there is a special Instagram that is managed in groups.There are corporations that manage their social media into one such as Mount Elizabeth Group Hospital, Mayapada Group and there are those who manage their RS social media marketing separately in addition to groups (Siloam group, Premier group).There are advantages and disadvantages of each, namely group management must be more efficient both in time, energy and cost; The drawback is that each hospital cannot "exist" separately and use its own creativity to develop its RS marekting social media.But it also needs to be considered that it will take special energy, time and special energy to think about the content and prepare a special admin who manages social media.
Social media can help increase the number of patients, get new prospective patients, introduce new services, increase awareness, improve customer service, and maintain the reputation of the hospital through its content.
All hospitals observed display content that is almost the same for all hospitals, namely hospital event activities, brief education and promotion of packages, certain issues, certain anniversaries such as Christmas, Eid, National Dr. Day etc.; only Mount Elizabeth Hospital group that displays employee profiles on the frontline, catering etc. as a form of appreciation and introduces its employees who are other than doctors, which also greatly supports the achievement of holistic service quality at the Hospital.
Social media content should be further developed about the content and use of social media as promotion and increase engagement between RS and its users.For example, about how the hospital is managed by various parts that support the smooth running of services at the hospital.Duties and responsibilities as patients, patients' families, the importance of developing responsible attitudes as good members of society in improving health status, can also be used to improve services in hospitals through input from "followers" or other users (De Las Heras-Pedrosa, Rando-Cueto, Jambrino-Maldonado, & Paniagua-Rojano, 2020).Providing information and education related to special issues that are currently developing and others so that the function of social media can be further developed, It's not just promotion and forming a brand.
What is also important to realize is that there are no clear measures of the effectiveness of social media use.Reviews from users or followers also cannot be said to be representative because assessments are very subjective and cannot provide a reliable measure (Glover et al., 2015).It takes a long time to get the expected results and further research is needed to develop parameters or indicators that show the performance of RS social media marketing, to assess how much influence social media marketing has in achieving the expected goals of RS. (Hoffman & Fodor, 2010) (Martínez-Millana, Fernández-Llatas, Basagoiti Bilbao, Traver Salcedo, & Traver Salcedo, 2017) (Ukoha & Stranieri, 2019).
To assess the success of certain package sales that can be linked to special bookings through linktr.eecan also be used as a measure of promotional success but the results can also be inaccurate because if not specifically designed users can use other means such as ordering if through Instagram with a special code will get a special discount.Bookings beyond that are not subject to discounts.But this can also make it difficult for other customers who don't know how to order through certain social media because they may include elderly users or stuttering technology so they end up not being able to order even if they want to.So special promotions / special packages are needed that suit users so that business flows can be established as expected.The suitability of user segments and types of promotions and types of social media needs to be studied and prepared in advance in order to achieve the expected goals and objectives.The use of linktree should be very helpful because it can be directly connected to various other social media platforms including WA, other e-commerce and looks more professional because it is connected to the website page provided which allows direct connection between platforms and can communicate privately through a more familiar / preferred platform.
The use of professional content managers to manage social media and analyze data is now an urgent need for all hospitals.In this era, especially since the pandemic, everything is done online, internet-based.People try to find a health service place that suits their wishes, expectations, looking for a suitable place of service that suits their needs, expectations and of course also their abilities.With the existence of social media, all hospital services have become more transparent and open, thus competition is also becoming tighter and all hospitals are expected to improve themselves because if there are those who are not satisfied they can also submit negative comments that can damage the image of the hospital that has been built with difficulty.
In all hospitals observed, there are negative comments, all of which have been responded well by DM users who submit complaints, to be resolved privately, not on social media.It is necessary to handle all cases in hospitals that have the potential to avoid dissatisfaction raised on social media, because it can be very damaging to the image if left to drag on and not handled properly.

Second part
RS Adi Husada Undaan Wetan Surabaya has used various social media platforms but the selection is not based on the results of existing marketing data regarding its target customers.The selection is only based on the popularity of platforms that are currently rife and are more mastered or more familiar / familiar with certain social media and have not set the intended target strategy according to the specifics of the social media platform that will be chosen to be used as a medium for marketing, whether the social media will be more helpful in forming a brand or to increase sales / sales.
It is necessary to first study customer data and strategies that have been set by RS so that the selection of platforms is more in line with the goals set by RS. (Richter, Muhlestein, & Wilks, 2014) (Smailhodzic, Hooijsma, Boonstra, & Langley, 2016) It is necessary to determine the target that will be targeted, for example, young age is very striking to be a follower and Instagram RS users, women reach 70.1%.So the target of Instagram is a young age, the majority of women, thus this data needs to be analyzed and followed up.What are the needs of these young people and women, what is suitable as content that can win the hearts of young people and women, who have been widely researched to be the main decision makers in the selection of various needs in their families / households including the selection of health services / hospitals that are used as places for family treatment.How to achieve the target users who are older / higher age groups, whether the use of other social media platforms is needed, whether the goals and objectives of the hospital will determine the selection of social media platforms, (Ukoha & Stranieri, 2019) what content is most suitable and how often posts should be done and how to manage social media, whether you are familiar with social media, whether you have sufficient ability in terms of funding and manpower to manage various social media for hospital marketing simultaneously at once or must be one by one first.
Based on existing references, the use of social media as a means to build a brand and promotion has indeed been widely used (Nayal, 2021) and the existing data only helps to measure the "success" of using social media because until now there is no indicator or measure to assess that if the post is many, the likes are many and the comments (positive) mean that the promotion has been successful and will definitely increase sales, Get customers and make them loyal.(Hoffman, 2010) (Martínez-Millana et al., 2017).
Building a brand requires a long time and supporting factors that simultaneously support the expected brand / image.(Nayal, 2021) Can't just expect from social media alone.Because social media only helps introduce our hospitals, invite users to try, and "patient experience" in the real world when visiting hospitals and starting to use the available facilities that is when "brands" are truly created, felt and accepted as perceptions by patients.That is why currently in various hospitals began to apply many promotions in the form of patient testimonials that tell their "patient experience" during treatment or using facilities in hospitals.Testimonials telling the patient's illness need to get written permission from the patient and need to think about the rules governing health promotion in hospitals and promotion of doctors as professionals.Indeed, with the existence of social media, the patient-doctor relationship has become more equal and can cause emotional closeness, the need to be listened to and communicate more intensely, but for social media marketing, regulations and policies need to be established regarding the use of social media marketing that must be known and obeyed by both internal and external parties of the hospital (Kumalasari & Sulistiadi, 2022).
From various observations and interviews, RS has actually used various social media such as Instagram, Youtube, Facebook, Tiktok, and others, which seems to be changing now depending on the development of social media with all its advantages and disadvantages.Videos are certainly uploaded more on you tube.Photos and reels are more widely used on Instagram, Tiktok and Facebook.But to prepare content and "maintain" a social media also requires readiness from the hospital.Regarding special personnel who prepare content, manage and analyze results regularly and make it as input for the right social media management strategy, the right content and the right target as well (Martínez-Millana et al., 2017).
The age of the user also affects the selection of social media, what the user likes/is interested in, and geographical location also affects the selection of the community/user in choosing social media.And the factor of funds in the form of quotas also affects the tendency of users to choose social media that they are interested in.Data has shown that in today's era, social media users (who are increasingly increasing) make decisions on choosing health care places and doctors to handle their health based on the social media they follow or the content of social media content they follow as a source of data and decision makers (De Las Heras-Pedrosa et al., 2020).
Hospital social media marketing can help increase the number of patients, get new prospective patients, introduce new services, increase awareness, improve customer service, and maintain the reputation of the hospital through its content (Richter et al., 2014).
In all the advantages and benefits of using social media, it must also be aware of the disadvantages and negative effects that may arise / occur in connection with various issues, namely (Kumalasari & Sulistiadi, 2022): 1) Control over messages, information and education disseminated.
If you are not sure about the truth, you should not say it first, and if necessary, mention the source of the information so that the official RS account becomes an account that is still trusted by users and followers of the account (Ventola, 2014).

2) Security and privacy
This is the main thing that must be considered and maintained properly when managing an account.There must also be separate content and privacy issues, security for personal matters and professional matters.Posts should be assumed to be viewable and searchable for a long period of time, as long-term consequences should also be considered when engaging sensitive content related to privacy and security 3) Ethical issues While using social media that represents certain professions, you must be careful because what is conveyed will be received with the lens of representing certain professions, in this case it is a profession in the field of Health (Wang, McKee, Torbica, & Stuckler, 2019).And in using social media that represents hospitals, it should not be a place for consulting medical practice because it must be done according to applicable rules and regulations.Only done on certain applications that are permitted and regulated for that purpose.If needed to do telemedicine, it should be connected with a special link to serve telemedicine needs.

4) Negative comment issues
All hospitals can face this problem, including the three hospitals that were reviewed and observed above.The issue of negative comments should be handled carefully as it is a sensitive issue.The risk of getting negative comments can always occur and precisely with negative comments, there is also an opportunity to find out in what ways the hospital can improve existing service deficiencies, clarify misperceptions that occur and turn complaints into opportunities to make them loyal customers and still maintain trust in the hospital 5) The Misinformation Problem The problem of misinformation can occur related to the many current issues and the abundance of information that is not clear and often occurs because there are no provisions / policies that have been set by the hospital to answer, share and disseminate information through social media used by the hospital, therefore it is necessary to regulate and establish the rules of the game, the division of authority and responsibility for using social media as a means of communication, promotion and education on behalf of RS, because fixing misinformation is relatively more difficult because information has spread widely, you should be careful before uploading data that is not clear or concerns personal opinions instead of official RS statements on social media.We recommend that some information needs to be submitted to the source of information / research if there is one (Wang et al., 2019).
Although there are disadvantages and risks that can occur in the use of social media, the benefits that can be obtained are still much greater and have become a necessity for the use of social media marketing at this time if you do not want to miss and lose a very large opportunity to achieve the potentials that can be obtained by managing social media as an extraordinary marketing "tool" other than conventional "word of mouth".
The use of Social Media besides being very promising also has several challenges that must be considered: a.The use of social media is free, but what must be realized is that social media management requires special staff or admins who must think about management strategies and respond well and quickly.Special personnel are also needed who must create content according to the type of social media application chosen and all of this costs too.(Zhang et al., 2018) But it is undeniable that good social media management will greatly attract many new patients in addition to existing loyal patients.A report indicates that 57% of consumers state that a good connection between hospitals and social media has a strong impact on their decision to seek health services (Smailhodzic et al., 2016) b.Legality issues and applicable regulations Especially for the world of health / hospitals, there are special provisions in the management of promotion and use of social media that must be obeyed.Permission from the patient in writing is required when displaying patient testimonials, must not promise absolute cure, excessive promotion (Ventola, 2014).
If there are unclear matters that need to be consulted with the Legal and Ethics department of the Hospital, as well as who has the right to allow, access and share specific content about the Hospital, it is necessary to establish its authority and responsibility (Kumalasari & Sulistiadi, 2022).
Recommendations for the Use of Social Media Marketing by RS (Alsughayr, 2015): a.Using social media that suits the goals and objectives, familiar with the social media.So beforehand it is necessary to study the characteristics of each social media platform that will be used as a tool for RS marketing (Beier, 2020) b.Creating relevant and special, well-prepared content will make users more interested in RS accounts c.Determine the purpose of using social media and create targets as well.d.Honesty, trust, tolerance, privacy and security need to be upheld in the use of social media marketing by hospitals e. Be consistent and prepare well social media that will and have been used, manage well, friendly, polite and integrity f.Hospitals always seem to be serious about Health topics and now everyone needs social media for entertainment as well, so content must be made interesting, memorable, fun and add enthusiasm and motivation.

Conclusion
The use of social media marketing in the current era is a must.To make maximum use of good Data and Analysis requires good data and analysis, creativity and commitment to preparation, management and evaluation as well as continuous development.The power of social media marketing RS is no doubt because in a short time it can reach many people anywhere, anytime without geographical restrictions anymore, and everything always has two sides, there are advantages and disadvantages, challenges that need to be considered and managed, especially ethical, legal, privacy, security and misinformation issues.The role of RS social media marketing for various things such as promotion, building the RS brand, public education and communication media between hospitals and prospective new customers and loyal customers, improving service quality and others is very large, therefore it really needs to be developed and research in this field is still very necessary.