The Influence of Work Family Conflict, Work Environment and Job Stress on the Performance of Regional General Hospital Employees

This research aims to examine the impact of Work Family Conflict, Work Environment, and Job Stress on employee performance at RSUD Bengkulu Tengah. The research focuses on testing the extent to which work-family conflict affects performance, understanding the influence of the work environment, and analyzing the impact of job stress. The research employs a quantitative design with primary data collection through questionnaires. Random sampling from various divisions ensures population representation. Statistical analysis utilizes Structural Equation Modeling (SEM) with SmartPLS, commonly used in research. The findings indicate that job stress and work-family conflict do not significantly affect performance, while the work environment has a positive and significant impact on RSUD employees' performance. These findings underscore the crucial role of the work environment in enhancing performance and well-being at RSUD Bengkulu Tengah, offering valuable insights for the development of effective policies and management practices.

This research aims to examine the impact of Work Family Conflict, Work Environment, and Job Stress on employee performance at RSUD Bengkulu Tengah.The research focuses on testing the extent to which work-family conflict affects performance, understanding the influence of the work environment, and analyzing the impact of job stress.The research employs a quantitative design with primary data collection through questionnaires.Random sampling from various divisions ensures population representation.Statistical analysis utilizes Structural Equation Modeling (SEM) with SmartPLS, commonly used in research.The findings indicate that job stress and work-family conflict do not significantly affect performance, while the work environment has a positive and significant impact on RSUD employees' performance.These findings underscore the crucial role of the work environment in enhancing performance and well-being at RSUD Bengkulu Tengah, offering valuable insights for the development of effective policies and management practices.

INTRODUCTION
Hospitals provide complex and diverse health services, from medical examinations to intensive care.To successfully provide this service, human resources (HR) are key.HR can be defined as managers, employees, laborers, or employees who work for an organization (Cachón-Rodríguez et al., 2022).In this way, the organization's human resources can function well.Several HR management activities such as procurement, assessment, protection, employee motivation, employee empowerment, coaching and increasing discipline (Wang et al., 2022).Thus, HR is a factor that influences the quality of employee work in an agency.Thus, employee performance conveys an important message in providing good quality service to the community, safety and patient satisfaction are very important aspects.
Studyprevious (Pujiyanto & Hapsari, 2021)found that there are three factors that influence performance, namely dissatisfaction, displeasure in the work atmosphere, and excessive workload.Excessive responsibility has an impact on employee work performance in hospitals, excessive responsibility will cause work performance to increase or vice versa, the more responsible a person is for their work, the better they will be, but there are several conditions where excessive responsibility will result in neglect of responsibility.this responsibility.Other problems, such as responsibility towards the employee's family, which will give rise to work-family conflict.
Work-life conflict, a common challenge faced by employees in organizations (Baer et al., 2016), has garnered significant attention due to its prevalence and the interest in understanding its negative impact on employees.Previous research has highlighted adverse effects such as symptoms of strain (Allen et al., 2000) and fatigue (Kinnunen et al., 2003).While it seems intuitive that work-life conflict hinders job performance, empirical studies have yielded inconsistent results regarding this relationship, indicating notable findings (Obrenovic et al., 2020) These conflicting outcomes suggest the potential existence of unidentified moderators (Allen et al., 2000).To reconcile these discrepancies, researchers (Allen et al., 2000); (Kinnunen & Mauno, 2008) recommend that future studies explore potential moderators and mediators in the relationship between work-life conflict and performance.Such a focus is crucial for gaining a deeper understanding of how and when work-life conflict leads to decreased performance.
Work-family conflict can affect employee performance by creating pressure and imbalance between work demands and family needs.The ongoing shift between professional and personal life aspects leads to inequality and stress, diminishes overall health, and impedes progress in the workplace.. (Liao et al., 2019).(Liao et al., 2019)believes that work-life conflict causes a loss of human resources, whether at work or outside of work, employees will spend more resources or energy to achieve work-life balance.Employees who have problems with multiple roles may find it difficult to manage their time and attention to work.and for family.A conducive work environment can improve employee work.This includes social support, role clarity, and possible flexibility in work schedules.Employees who feel their work environment is supportive can be more focused and productive.A good work environment may provide the resources and support necessary for employees to overcome work-family conflict.On the other hand, a less conducive work environment can exacerbate multiple role conflicts and have a negative impact on performance.
Work family conflict, or conflict between work and family, refers to the role tension experienced by employees.In addition, they are faced with office demands for work, meanwhile, they have to give full attention to their family.As a result, it is difficult to separate work interference from family and vice versa.This conflict can also occur when there is conflict between work and family.The impact of conflict between work and family involves the harmony of work professionalism and workers' personal spheres, which in turn can affect their performance at work.Work-family conflict has a tendency to increase the level of stress and anxiety felt between work and family.
Another significant factor is the work environment which makes it a crucial element for employees to carry out their duties.By creating a positive and motivating work environment, this can have a good impact on employees being enthusiastic about work.In hospitals, the work environment is an important factor for performance.Research relating to the relationship between work atmosphere and work performance can provide insight into the factors that influence the efficiency and effectiveness of services in hospitals.A safe and positive environment can improve employee well-being, thereby potentially improving their performance.The work environment plays an important role and can influence employee performance, unfortunately there are still companies that are not responsive to the work environment.
The next factor that influences employee performance is work stress which can make you tense and have an impact on a person's emotions and condition, ultimately resulting in high stress levels.If it cannot be controlled, work stress can threaten employees' abilities in the work environment and interfere with the implementation of work duties.Stress can have both good and bad effects; The positive impact of work stress at a healthy level can play a role in motivating work enthusiasm, while the negative impact of excessive stress can cause a decrease in the quality of work.Researchers chose the work stress variable as a factor that influences employee work in hospitals because work stress can arise due to various conditions felt by employees, both physical and non-physical.Job stress can also be triggered by excessive workload, emergency situations, or interactions with patients and their families.
Central Bengkulu Hospital is a hospital that provides community services in Bengkulu.Based on survey results from several RSUD patients, information was obtained that the service provided by employees at the hospital was less than optimal, where criticism was obtained regarding good to poor service.Researchers obtained information that many employees at the hospital are married, so it is suspected that employees find it difficult to fulfill work demands and family responsibilities or vice versa, this will reduce employee performance, the work environment also influences employee work, where the environment is appropriate, role clarity, and Adequate facilities will influence employee performance positively.On the contrary.Incompatibility of the work environment will increase the burden on employees and create work stress on employees and ultimately have the potential to reduce employee performance.Based on the description above, the researcher intends to measure the influence of work family conflict, work environment and stress on the work of employees at the Central Bengkulu Regional Hospital.

THEORETICAL REVIEW Work Family Conflict
Work-family conflict represents a challenge where the demands of work and family life intersect and create mutual interference.This issue has captured the attention of both psychologists and business professionals, leading to extensive research.The conflict arises when an individual assumes multiple roles, such as being an employee, a partner, and often a parent (Greenhaus & Beutell, 1985).
Instances of work-family conflict manifest when experiences and commitment to the organization clash with family responsibilities (Chan & Ao, 2019).This conflict may be triggered by issues such as scheduling inflexibility, rigid working hours (Las Heras et al., 2017), excessive workload, various forms of work-related stress, workplace politics (Ekawarna & Kohar, 2019), and challenges during career transitions, including unsupportive supervisors (Maloni et al., 2019)  Various studies have been conducted to discuss matters regarding work family conflict, it is known that work family conflict has no influence on employee performance (Damayanti et al., 2021)research conducted (Agustina & Sudibya, 2018) (Karlina, 2023)The results obtained were Work Family Conflicthas a negative influence on employee performance.From the description above the researcher formulated a hypothesis H1: Conflicts in the work family have a negative impact on employee performance.

Work Environment
What needs to be paid attention to in the work environment is the physical environment, which includes room temperature, a clean place, and adequate lighting.Apart from that, there is a non-physical environment, which includes a good working atmosphere and harmony between workers (Pitafi et al., 2018).Comfortable workplace conditions for employees can attract organizations to engage employees so they can work as well as possible in the company.An inadequate environment of course has an impact on employee productivity.Workplace conditions are said to be good if the environment is healthy, comfortable, safe and friendly for workers in completing their work tasks (Yeh et al., 2022).
The work environment includes everything within the scope of work that influences the implementation of a worker's duties.Supportive environmental conditions are very important for employees to achieve job satisfaction, and thus, achieve company targets more effectively.Satisfaction in the work environment can provide comfort in completing their tasks and encourage the achievement of optimal results.Meanwhile, a mismatch in the work environment has a negative impact in reducing work performance.Therefore, it is important to pay attention to structuring the work environment.The work environment is not directly involved in company productivity, but this factor has a significant influence.Environmentwork includes various aspects such as lighting, air temperature, air circulation, work space dimensions, work space arrangement, privacy, cleanliness, noise level, color and work tools used.Work environment indicators acc (Hanaysha, 2016) a. Workplace satisfaction b.Clean work place c.A supportive work space with work partners d.A feeling of calm and comfortable working environment e. Job environment satisfaction Previous research has differences, many differences between them (Kerja et al., 2023); (Kerja et al., 2023) (Kristiana et al., 2021)The work environment has a positive and significant effect on employee performance.(Yuliya., 2019) the work environment has a significant positive influence.From the description above, the researcher formulated a hypothesis H2: The work environment variable significantly and positively influences employee performance.

Job Stress
Work stress is an unpleasant condition within the scope of work that can cause mental pressure and have an impact on the individual's psychology and behavior at work (Lu et al., 2017).Lack of vacations and high responsibilities for medical personnel are factors that trigger mental and physical fatigue.The impact of job stress can influence employee responses, with the possibility of undesirable outcomes such as job dissatisfaction.
The source of stress is indicated by three factors, namely role conflict, role overload, and role ambiguity (Zeb & Saeed, 2015).Efforts to reduce stress are made to improve the company's work performance and provide a work environment that supports the presence of the best employees.Work stress arises when individuals cannot do their work as expected (Potale & Uhing, 2001).indicators of work stress (Lambert et al., 2007) When employees feel stressed for a long period of time, their work performance can decrease because they will feel unenthusiastic and less motivated to complete their work (Smoktunowicz et al., 2019)Therefore, companies need to be careful so that their employees do not experience stress at work so that work performance does not decrease and this ultimately also has an impact on the company's overall performance.(Setyawati et al., 2018) (Karlina, 2023); (Saputra et al., 2020)obtain results: Job stress has a negative effect on employee performance, meaning that the higher the employee's level of work stress, the more negative impact it will have on employee performance.Different from research (Damayanti et al., 2021) have results Job stress has no influence on employee performance.From the description above and the results of previous research, the researcher formulated a hypothesis H3: The Job Stress variable has a negative effect on employee performance at the Central Bengkulu Regional Hospital.

Employee Performance
Employee performance is generally limited to individual success in carrying out their duties.Good employee performance can be seen from the success of carrying out tasks according to expectations.The performance of employees at the Central Bengkulu Hospital is said to be good when they provide treatment, responsibility efficiently and effectively.The performance of employees in hospitals is seen from superior patient service, the quality of services provided to patients, satisfied patients and families, the quality of medical care and high patient safety.Performance is a person's achievements and behavior for a period of time, generally 1 year.Then performance can be indicated by the quality in completing its responsibilities (Agustina & Sudibya, 2018).According to (Inuwa, 2016)

Research Type and Location
Research is classified as quantitative,The population in this study was employees of the Central Bengkulu Regional Hospital, totaling 260 employees who were health workers and non-health workers.In this study, random sampling was used to determine the sample.The sample used was 161 samples consisting of several medical and non-medical work divisions to represent the entire population.Data is collected through questionnaires, questionnaires are a technique for collecting data by presenting written questions to respondents who obtain information about the respondent and data analysis is carried out using statistical data processing applications.

Data Instrument Test and Data Analysis
This research uses a structural formula analysis model (SEM) with the smartPLS program.The dependent variable is measured through tests of validity, reliability, coefficient of determination, redundancy validity, and path

Validity Test Results
Validity testing is a valid determination test.Convergent validity test, namely a test that measures how big the correlation is between the indicator and the construct it measures.This test uses the AVE (Average Variance Extracted) value with the condition that the value that must be met is that the AVE must be greater than 0.5

Reliability Test Results
TestingReliability is a method used to evaluate how reliable or consistent a measuring instrument is used to measure objects.Cronbach's alpha is a method commonly used to measure the internal consistency of a measurement instrument, such as a test or questionnaire.The alpha value ranges from 0 to 1, and the higher the value, the more reliable the device.Below are some general rules used to evaluate reliability using Cronbach's alpha: 1. Alpha value > 0.9: Very high reliability.This instrument is considered to have excellent internal consistency.2. Alpha value between 0.8 and 0.9: High reliability.This instrument is considered to have good internal consistency.3. Alpha Value Between 0.7 and 0.8: Moderate reliability.The instrument is considered to have fairly good internal consistency, but there is still room for improvement.4. Alpha Value Between 0.6 and 0.7: Low to moderate reliability.The instrument may have some problems in internal consistency and needs to be evaluated further. 5. Alpha Value Below 0.6: Low reliability.The instrument is considered to have low internal consistency, and needs to be repaired or modified to increase its reliability.

Coefficient of Determination (R-Square) Test Results
The determination coefficient, The coefficient of determination, denoted as R-squared (R²), is a measure employed to assess how well a linear regression model aligns with the observed data.R-squared shows how much changes in the independent variables (variables used for explanation) can be accounted for by the changes in the dependent variables.From table 3, it is known that the R-square of employee performance is 0.571, which means that the variables work family conflict, work environment and work stress can influence worker performance by 57.1%, while the other 42.9% is caused by factors outside the variables studied.

F-Square Test Results
F-Square is a measuring tool that is useful in measuring whether or not an independent variable is relative to the dependent variable.The F Square value > 0.35 indicates that the independent variable has a big influence on the Dependent variable, whereas if the F Square value < 0.35 indicates that the Independent variable has a small influence on the Dependent In Table 4, it has been identified that the F Square value for the Work Environment variable exceeds 0.35, indicating a substantial impact of the Work Environment variable on employee performance.This study reveals that higher quality in the work environment corresponds to enhanced employee performance.On the other hand, the variables of Work Family Conflict and Work Stress possess values less than 0.35, suggesting a minor influence on employee performance.

T Test Results
Table 5 Original  X1) has an adverse effect on employee performance (Y).Similarly, the P Values reflecting the influence of Work Family Conflict on performance are 0.408, which is higher than 0.05, signifying its lack of significance.This implies that Work Family Conflict does not have a substantial impact on employee performance.

2) Work Environment
According to Table 5, the coefficient linked to the work environment is 0.750, suggesting a positive influence on employee performance.Additionally, the P Values associated with the influence of Work Environment (X2) on Employee Performance (Y) is 0.000, indicating it is less than 0.05 and signaling a significant and positive impact of the work environment on employee performance.Therefore, when employees find their surroundings comfortable, there is a probability of an enhancement in their work quality.

3) Job Stress
As indicated in Table 5, the coefficient for Work Stress is -0.059, implying a detrimental effect on employee performance.However, the P Values for the impact of Work Stress (X3) on Employee Performance (Y) is 1.118, surpassing 0.05, indicating insignificance in the influence of work stress on employee performance.

DISCUSSION
This research aims to analyze the impact of work family conflict, work environment and work stress on the performance of Central Bengkulu Regional Hospital workers.This research is quantitative in nature using primary data in the form of distributing questionnaires to employees of Central Bengkulu Regional Hospital, by taking samples from different divisions to represent the entire employee population, random sampling was used to take 161 respondents.Structural Equation Modeling (SEM) analysis was carried out via the SmartPLS application.
Work Family Conflict or work life conflict can be in the form of work that disturbs the family, such as working too long so that time in the family is reduced which causes problems in the family or family that interfere with work, namely family problems that affect employees, thus making employees not focus on work and reducing employee performance, the results of research conducted by researchers showed that Work Family Conflict had no influence on employee performance at the Central Bengkulu Regional Hospital.The results of this research are supported by previous research (Damayanti et al., 2021) (Khaerana & Amri, 2020) Work Environment has a positive influence on employee performance, research results show that there is a positive and significant relationship between work environment and employee performance at Central Bengkulu Hospital.This is in agreement with research from(Iqbal Chaudhry et al., 2017) (Setiyani et al., 2019) A good work environment will also improve employee performance.Next is work stress, work stress.
The next variable is work stress, According to Ekienabor (2019), work pressure arises from the relationship between the individual and his environment, thereby emphasizing emotions and having an impact on the individual's physical and psychological well-being.Based on the results of Hypothesis Testing using SmartPLS, it is proven that Central Bengkulu Regional Hospital employees can be said to have low work stress.Proven by data obtained by researchers from respondents and then processed via Smar PLS.This means that low work stress at the Central Bengkulu Hospital will not affect employee performance.From the description above, in accordance with the results of research from (Karlina, 2023) The researchers discovered comparable results, suggesting that the influence of work stress on employee performance at the Central Bengkulu Regional Hospital is minimal.The study's results confirm that work-family conflict does not impact employee performance, the work environment positively influences employee performance, and work stress lacks a notable effect on employee performance at the Central Bengkulu Hospital.

CONCLUSIONS
Based on the aim of the research, namely to examine the influence and impact of Work Family Conflict, Work Environment and Work Stress on the performance of RSUD employees.The results of data management show that 2 hypotheses have an influence and 2 hypotheses have no influence on the performance of RSUD employees.Based on the findings and discussion, the following conclusions are obtained: 1) Work Family Conflict does not have an impact on the performance of employees at the Central Bengkulu Regional Hospital, this shows that there is no significant relationship between work and family conflict on employee performance/Conflict between work and family life is not a factor that influences employee performance at the Central Bengkulu Regional Hospital.With the data processing results, the coefficient from Work Family Conflict is -0.009 and the P Values are 0.408 > 0.05, which means it is not significant.
2) The work environment has a positive effect on employee performance at the Bengkulu Central Regional Hospital, this shows that a better work environment correlates with more balanced employee performance.The positive relationship between the work environment and performance shows that factors in the work environment contribute to employee performance.With the results of data processing, the coefficient of Work Environment is 0.740, showing that there is a positive influence on employee performance with a P Value of 0.000<0.05,indicating that there is a significant and positive level between the Work Environment variable on employee performance at Central Bengkulu Regional Hospital.3) Work stress has no effect on employee performance at the Central Bengkulu Regional Hospital.with a value of -0.059 and P Values 1.118This shows that there was no significant impact of work stress on employee performance at the Central Bengkulu Regional Hospital, which means that work stress is not a factor that influences employee performance at the Central Bengkulu Regional Hospital.
From the results of the research, researchers suggest that the Central Bengkulu Regional Hospital can continue to create a comfortable work environment and continue to pay attention to employees at the Central Bengkulu Regional Hospital, so that it is hoped that Work Family Conflict and work stress will not have an influence on the performance of the Central Bengkulu Regional Hospital.

FURTHER STUDY
This research increases our knowledge about family conflict in the workplace, work environment, and work stress on employee performance.However, as with most research, there are some drawbacks to this study; The results show that family conflict at work and work stress have no influence on employee performance, which means there are other variables that influence RSUD performance.Therefore, researchers must conduct additional research.Researchers hope that future research will be better.
Employee job satisfaction and turnover intention emerge as critical factors in this context.In dual-role matters, there are three main components: a) Time-based conflict b) Pressure-based conflict c) Behavior-based conflict These components contribute to the complexity of the work-family conflict phenomenon, shedding light on the various dimensions through which the conflict can manifest in individuals' lives.The indicators contained in the variable are problems between work and family (work-family conflict), as explained by(Vieira et al., 2014)involves several aspects, namely: a) Work pressure takes up time with family b) Running out of time to complete work due to family c) Emotionally exhausted after work d) Work is interrupted by family problems.e) Actions implemented at home, have no impact in the office, , Research was conducted on 115 employees at Manggarai Station, South Jakarta.The research results indicate that stress has a significant negative effect on the work performance of nurses.Job stress indicators according to Robbins (2007 a clear and concise version of your method for conducting the research, population and sample, and how the data was analyzed.

Table 1 .
Convergent test results (Average Variance Extracted) Source: Data processed 2023Table1states that the AVE value of each variable has met the Average Variance Extracted requirements, namely above 0.5.Therefore, the results of the Convergent Validity (AVE) analysis can be concluded to meet the eligibility requirements for the convergent validity test.

Table 2 .
Reliability test results (Cronbach's Alpha) From table 2 above, it is stated that the Cronbac's Alpha value for each variable is > 0.6, which concludes that this variable has a good level of reliability.

Table 3 .
Coefficient of Determination Test Results