Main Article Content
Abstract
This study aims to analyze the effect of competence on nurses’ operational performance, with process effectiveness and service reliability as mediating variables at Andi Makkasau Regional General Hospital, Parepare City. The research employed a quantitative design using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The population consisted of 380 nurses, and 195 respondents were selected using the Slovin formula. Data were collected through structured questionnaires measuring competence, process effectiveness, service reliability, and operational performance. The results indicate that competence has a positive and significant effect on process effectiveness, service reliability, and nurses’ operational performance. Furthermore, both process effectiveness and service reliability significantly improve operational performance. Mediation testing shows that competence indirectly enhances operational performance through improving work process effectiveness and service reliability. These findings suggest that strengthening professional competence contributes not only directly to performance but also indirectly through better work systems and more dependable healthcare services. The study implies that hospital management should prioritize competency-based training, workflow optimization, and service standardization to improve service quality. Future research is recommended to explore additional organizational or psychological factors influencing healthcare performance in broader institutional contexts.
Keywords
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Abrahamson, K., Hass, Z., Morgan, K., Fulton, B., & Ramanujam, R. (2016). The relationship between nurse-reported safety culture and the patient experience. Journal of Nursing Administration, 46(12), 662–668. https://doi.org/10.1097/NNA.0000000000000423
- Al-Damen, R. (2017). Health care service quality and its impact on patient satisfaction: Case of Al-Bashir Hospital. International Journal of Business and Management, 12(9), 136–146. https://doi.org/10.5539/ijbm.v12n9p136
- Alrubaiee, L., & Alkaa'ida, F. (2011). The mediating effect of patient satisfaction in the patients' perceptions of healthcare quality–patient trust relationship. International Journal of Marketing Studies, 3(1), 103–127. https://doi.org/10.5539/ijms.v3n1p103
- Cruz, J. P. (2017). Quality of life and its influence on clinical competence among nurses: A self-reported study. Journal of Clinical Nursing, 26(3–4), 388–399. https://doi.org/10.1111/jocn.13402
- Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person-centredness are associated with perceived nursing care quality. Journal of Advanced Nursing, 73(1), 217–227. https://doi.org/10.1111/jan.13105
- Fukada, M. (2018). Nursing competency: Definition, structure and development. Yonago Acta Medica, 61(1), 1–7. https://doi.org/10.33160/yam.2018.03.001
- Gu, X., & Itoh, K. (2016). Performance indicators: Healthcare professionals’ views. International Journal of Health Care Quality Assurance, 29(7), 801–815. https://doi.org/10.1108/IJHCQA-12-2015-0142
- Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
- Hu, X., Zhao, R., Gao, J., Li, J., Yan, P., Yan, X., Shao, S., Su, J., & Li, X. (2021). Relationship between proactive personality and job performance of Chinese nurses: The mediating role of competency and work engagement. Frontiers in Psychology, 12, 533293. https://doi.org/10.3389/fpsyg.2021.533293
- Ilangakoon, T. S., Weerabahu, S. K., Samaranayake, P., & Wickramarachchi, R. (2022). Adoption of Industry 4.0 and lean concepts in hospitals for healthcare operational performance improvement. International Journal of Productivity and Performance Management, 71(6), 2188–2213. https://doi.org/10.1108/IJPPM-12-2020-0654
- Jones, J. L. S., & Linderman, K. (2014). Process management, innovation and efficiency performance: The moderating effect of competitive intensity. Business Process Management Journal, 20(2), 335–358. https://doi.org/10.1108/BPMJ-03-2013-0026
- Lee, E. K., Atallah, H. Y., Wright, M. D., Post, E. T., Thomas, C., Wu, D. T., & Haley, L. L. (2015). Transforming hospital emergency department workflow and patient care. Interfaces, 45(1), 58–82. https://doi.org/10.1287/inte.2014.0788
- Lin, Y. W., Ni, C. F., Hsu, S. F., Tsay, S. L., & Tung, H. H. (2024). Effects of length of employment and head nurse leadership style on the clinical competency of staff nurses in Taiwan. Journal of Nursing Research, 32(3), e331. https://doi.org/10.1097/JNR.0000000000000617
- Liou, S. R., Liu, H. C., Tsai, S. L., Chu, T. P., & Cheng, C. Y. (2020). Performance competence of pregraduate nursing students and hospital nurses: A comparison study. Journal of Clinical Nursing, 29(13–14), 2652–2662. https://doi.org/10.1111/jocn.15287
- Memarian, R., Salsali, M., Vanaki, Z., Ahmadi, F., & Hajizadeh, E. (2007). Professional ethics as an important factor in clinical competency in nursing. Nursing Ethics, 14(2), 203–214. https://doi.org/10.1177/0969733007073715
- Mirzaei, A., Imashi, R., Saghezchi, R. Y., Jafari, M. J., & Nemati-Vakilabad, R. (2024). The relationship of perceived nurse manager competence with job satisfaction and turnover intention among clinical nurses: An analytical cross-sectional study. BMC Nursing, 23, 528. https://doi.org/10.1186/s12912-024-02203-5
- Önal, A., & Seren İntepeler, Ş. (2024). Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses. International Nursing Review, 71(4), 1015–1022. https://doi.org/10.1111/inr.12955
- Rahmah, N. M., Sri Hariyati, R. T., & Sahar, J. (2022). Nurses’ efforts to maintain competence: A qualitative study. Journal of Public Health Research, 11(2). https://doi.org/10.4081/jphr.2021.2736
- Ramadevi, D., Gunasekaran, A., Roy, M., Rai, B. K., & Senthilkumar, S. A. (2016). Human resource management in a healthcare environment: Framework and case study. Industrial and Commercial Training, 48(8), 387–393. https://doi.org/10.1108/ICT-03-2016-0014
- Riman, K. A., Harrison, J. M., Sloane, D. M., & McHugh, M. D. (2023). Work environment and operational failures associated with nurse outcomes, patient safety, and patient satisfaction. Nursing Research, 72(1), 20–29. https://doi.org/10.1097/NNR.0000000000000626
- Vogelgesang, G. R., Crossley, C., Simons, T., & Avolio, B. J. (2020). Behavioral integrity: Examining the effects of trust velocity and psychological contract breach. Journal of Business Ethics, 172(1), 175–190. https://doi.org/10.1007/s10551-020-04497-2
- Whelan, L. (2006). Competency assessment of nursing staff. Orthopedic Nursing, 25(3), 198–202. https://doi.org/10.1097/NOR.0000000000001191
- Yu, W., Liu, Q., Zhao, G., & Song, Y. (2023). Exploring the effects of data-driven hospital operations on operational performance from the resource orchestration theory perspective. IEEE Transactions on Engineering Management, 70(8), 2747–2759. https://doi.org/10.1109/TEM.2021.3098541
- Zhang, Z. X., Luk, W., Arthur, D., & Wong, T. (2001). Nursing competencies: Personal characteristics contributing to effective nursing performance. Journal of Advanced Nursing, 33(4), 467–474. https://doi.org/10.1046/j.1365-2648.2001.01688.x
References
Abrahamson, K., Hass, Z., Morgan, K., Fulton, B., & Ramanujam, R. (2016). The relationship between nurse-reported safety culture and the patient experience. Journal of Nursing Administration, 46(12), 662–668. https://doi.org/10.1097/NNA.0000000000000423
Al-Damen, R. (2017). Health care service quality and its impact on patient satisfaction: Case of Al-Bashir Hospital. International Journal of Business and Management, 12(9), 136–146. https://doi.org/10.5539/ijbm.v12n9p136
Alrubaiee, L., & Alkaa'ida, F. (2011). The mediating effect of patient satisfaction in the patients' perceptions of healthcare quality–patient trust relationship. International Journal of Marketing Studies, 3(1), 103–127. https://doi.org/10.5539/ijms.v3n1p103
Cruz, J. P. (2017). Quality of life and its influence on clinical competence among nurses: A self-reported study. Journal of Clinical Nursing, 26(3–4), 388–399. https://doi.org/10.1111/jocn.13402
Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person-centredness are associated with perceived nursing care quality. Journal of Advanced Nursing, 73(1), 217–227. https://doi.org/10.1111/jan.13105
Fukada, M. (2018). Nursing competency: Definition, structure and development. Yonago Acta Medica, 61(1), 1–7. https://doi.org/10.33160/yam.2018.03.001
Gu, X., & Itoh, K. (2016). Performance indicators: Healthcare professionals’ views. International Journal of Health Care Quality Assurance, 29(7), 801–815. https://doi.org/10.1108/IJHCQA-12-2015-0142
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Hu, X., Zhao, R., Gao, J., Li, J., Yan, P., Yan, X., Shao, S., Su, J., & Li, X. (2021). Relationship between proactive personality and job performance of Chinese nurses: The mediating role of competency and work engagement. Frontiers in Psychology, 12, 533293. https://doi.org/10.3389/fpsyg.2021.533293
Ilangakoon, T. S., Weerabahu, S. K., Samaranayake, P., & Wickramarachchi, R. (2022). Adoption of Industry 4.0 and lean concepts in hospitals for healthcare operational performance improvement. International Journal of Productivity and Performance Management, 71(6), 2188–2213. https://doi.org/10.1108/IJPPM-12-2020-0654
Jones, J. L. S., & Linderman, K. (2014). Process management, innovation and efficiency performance: The moderating effect of competitive intensity. Business Process Management Journal, 20(2), 335–358. https://doi.org/10.1108/BPMJ-03-2013-0026
Lee, E. K., Atallah, H. Y., Wright, M. D., Post, E. T., Thomas, C., Wu, D. T., & Haley, L. L. (2015). Transforming hospital emergency department workflow and patient care. Interfaces, 45(1), 58–82. https://doi.org/10.1287/inte.2014.0788
Lin, Y. W., Ni, C. F., Hsu, S. F., Tsay, S. L., & Tung, H. H. (2024). Effects of length of employment and head nurse leadership style on the clinical competency of staff nurses in Taiwan. Journal of Nursing Research, 32(3), e331. https://doi.org/10.1097/JNR.0000000000000617
Liou, S. R., Liu, H. C., Tsai, S. L., Chu, T. P., & Cheng, C. Y. (2020). Performance competence of pregraduate nursing students and hospital nurses: A comparison study. Journal of Clinical Nursing, 29(13–14), 2652–2662. https://doi.org/10.1111/jocn.15287
Memarian, R., Salsali, M., Vanaki, Z., Ahmadi, F., & Hajizadeh, E. (2007). Professional ethics as an important factor in clinical competency in nursing. Nursing Ethics, 14(2), 203–214. https://doi.org/10.1177/0969733007073715
Mirzaei, A., Imashi, R., Saghezchi, R. Y., Jafari, M. J., & Nemati-Vakilabad, R. (2024). The relationship of perceived nurse manager competence with job satisfaction and turnover intention among clinical nurses: An analytical cross-sectional study. BMC Nursing, 23, 528. https://doi.org/10.1186/s12912-024-02203-5
Önal, A., & Seren İntepeler, Ş. (2024). Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses. International Nursing Review, 71(4), 1015–1022. https://doi.org/10.1111/inr.12955
Rahmah, N. M., Sri Hariyati, R. T., & Sahar, J. (2022). Nurses’ efforts to maintain competence: A qualitative study. Journal of Public Health Research, 11(2). https://doi.org/10.4081/jphr.2021.2736
Ramadevi, D., Gunasekaran, A., Roy, M., Rai, B. K., & Senthilkumar, S. A. (2016). Human resource management in a healthcare environment: Framework and case study. Industrial and Commercial Training, 48(8), 387–393. https://doi.org/10.1108/ICT-03-2016-0014
Riman, K. A., Harrison, J. M., Sloane, D. M., & McHugh, M. D. (2023). Work environment and operational failures associated with nurse outcomes, patient safety, and patient satisfaction. Nursing Research, 72(1), 20–29. https://doi.org/10.1097/NNR.0000000000000626
Vogelgesang, G. R., Crossley, C., Simons, T., & Avolio, B. J. (2020). Behavioral integrity: Examining the effects of trust velocity and psychological contract breach. Journal of Business Ethics, 172(1), 175–190. https://doi.org/10.1007/s10551-020-04497-2
Whelan, L. (2006). Competency assessment of nursing staff. Orthopedic Nursing, 25(3), 198–202. https://doi.org/10.1097/NOR.0000000000001191
Yu, W., Liu, Q., Zhao, G., & Song, Y. (2023). Exploring the effects of data-driven hospital operations on operational performance from the resource orchestration theory perspective. IEEE Transactions on Engineering Management, 70(8), 2747–2759. https://doi.org/10.1109/TEM.2021.3098541
Zhang, Z. X., Luk, W., Arthur, D., & Wong, T. (2001). Nursing competencies: Personal characteristics contributing to effective nursing performance. Journal of Advanced Nursing, 33(4), 467–474. https://doi.org/10.1046/j.1365-2648.2001.01688.x