Jurnal Manajemen Pelayanan Kesehatan
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SKENARIO PERKEMBANGAN RUMAH SAKIT SWASTA DAN HUBUNGANNYA DENGAN DOKTER SPESIALIS
Get PDFPerkembangan Rumah Sakit (RS) swasta diIndonesia tidak terlepas dari peranan dokterspesialis. Secara historis peranan dokter spesialissangat besar, terutama pendirian RS swasta pascakemerdekaan. Dokter-dokter spesialis ternama adayang berkesempatan menjadi pemilik RS danmendirikannya. Fenomena ini menarik karena terlihatada rasa tidak puas, rasa tidak nyaman, tidakmempercayai sistem di RS induk, ataupun tidakcocok dengan RS induknya. Yang menarik walaupunmendirikan RS sendiri, para dokter spesialis pemilikRS swasta tidak keluar dari RS induknya.Salah satu motivasi lainnya adalah sebagiandokter spesialis yang mempunyai RS sendiri, tidakingin hanya sebagai “karyawan” atau lebih jauh lagisebagai “buruh” sebuah RS. Istilah “buruh” dapatdiartikan sebagai suatu keterpaksaan dokter untukbekerja di RS. Ini berarti tidak ada kesesuaian antaranilai-nilai yang dianut pribadi dokter dengan nilai-nilaiRS-nya.Pertanyaan-pertanyaan yang muncul adalah:Apakah dokter spesialis cenderung berkeinginanmempunyai RS sendiri. Lebih spesifik lagi: apakahdokter spesialis tidak mempercayai sistemmanajemen RS induknya sehingga tidak terjadisinergi. Jika memang "ya" jawabannya apakahketidakpercayaan pada sistem manajemennyamerupakan hal yang tepat? Bagaimana hubungandokter spesialis dengan RS? Apakah berposisisebagai Pemilik, Karyawan, Mitra, atau Buruh? Apamasalahnya? Bagaimana skenario di masa depanuntuk hubungan dokter spesialis dan RS swasta?Tajuk ini mencoba untuk membahas pertanyaanterakhir dalam konteks pertanyaan-pertanyaanlainnya. Ada beberapa skenario RS swasta yangmungkin terjadi.Skenario 1: Perkembangan didominasi oleh RSbertipe Boutique (layanan sempit) milik dokterspesialis. Dokter spesialis merangkap sebagaiwirausaha untuk RS dengan layanan yang tidak luas.Sistem manajemen dipegang sendiri oleh dokter.Rumah Sakit (RS) tipe ini dapat dilihat daripenampakan RSIA, RS khusus mata, atau RSkhusus bedah diberbagai kota.Skenario 2: Perkembangan didominasi oleh RSumum milik dokter spesialis dalam bentukperusahaan. Jangkauan pelayanan mengalamiperkembangan dari RS layanan sempit menjadi RSUmum layanan luas yang berasal dari kepemilikandokter spesialis dan berkembang menjadi sebuahkorporasi besar. Rumah Sakit (RS) besar milik dokterspesialis ini (bisa sendiri atau berkelompok)menggunakan filosofi dimana dokter spesialislainnya yang bukan pemilik merasa cocok denganRS-nya. Skenario ini menggambarkan situasidimana para spesialis senang bekerja di RS yangtidak dimilikinya.Skenario 3: Perkembangan ddidominasi RSswasta bukan milik dokter spesialis, layanan luasdengan mengikuti filosofi partnership dengan dokterspesialis. Pemiliknya dapat berupa lembagakeagamaan, perusahaan, ataupun perorangan.Model pelayanan klinik dan sistem manajemennyamenempatkan dokter sebagai partner.Skenario 4: Perkembangan didominasi RSswasta besar bukan milik dokter, dengan layananluas. Rumah Sakit (RS) swasta ini bukan milik paradokter. Pemiliknya dapat berupa lembagakeagamaan, perusahaan, ataupun perorangan.Model manajemennya adalah birokrasi. Dokterspesialis merasa menjadi karyawan atau buruh diRS. Akibatnya dokter spesialis bebas bekerja di RSswasta lain bahkan menjadi pemilik RS swasta lain.Skenario mana yang paling mungkin terjadi?Pengamatan saat ini menunjukkan bahwa terjadisuatu interaksi kompleks antara sistem manajemen,khususnya sistem pembayaran untuk dokter dengankeinginan pribadi dokter spesialis, kesempatanuntuk pengembangan karir, kecocokkan bekerja danberbagai hal lainnya. Faktor penting lainnya adalahaturan perijinan RS. Apabila aturan perijinan longgar,dapat terjadi suatu perkembangan yang mengarahke skenario 1 dimana banyak RS berbentuk tipebutik. Namun apabila ada peraturan bahwa dokterspesialis dilarang untuk menjadi pemilik RS agartidak terjadi conflict of interest, ada kemungkinanskenario 3 atau 4 yang akan terjadi. Faktor lain yangperlu diperhitungkan adalah kepekaan masyarakatdalam hukum. Jika terjadi semakin banyak tuntutanhukum, maka dokter spesialis yang merangkapsebagai pemilik sekaligus sebagai doktermempunyai risiko dituntut rangkap, sebagai pemilikdan sebagai operator pelayanan klinik. (LaksonoTrisnantoro, [email protected]
KEPEMIMPINAN KEPALA PUSKESMAS DENGAN TEMPAT PERAWATAN DAN PENGARUHNYA TERHADAP KINERJA PEGAWAI PUSKESMAS DENGAN TEMPAT PERAWATAN DI KABUPATEN KUNINGAN JAWA BARAT
Get PDFBackground:This research is grounded on the fact that thetarget of the health service performance of UPTD PuskesmasDTP has not been reached as shown on the result of theevaluation in 2004. Based on the study at theories, there are acouple at sub-problems which influence the effectiveleadership and the optimal staff’s performance.Methods: The objective of this research is to look for analternative solution to promote the staff’s performance throughrealizing the effective leadership.This research use descriptive analytical method with crosssectionalsurvey design. The independent variables at theresearch are the leadership style and the leadership situation,while the dependent variable is the staff’s performance. Theresearch measuring instrument use questioners disseminatedto 42 respondents in 6 UPTD Puskesmas DTP throughoutKuningan Regency. The data analysis uses the method at pathanalysis and multiple regressions.Result and conclusion: The research findings that leadershipstyle applied by Heads UPTD Puskesmas DTP are mixed one’swhich consist of directive style, supportive style, delegativestyle, and participative style (multicratic leadership style).Leadership situation covering quality dimension of leader-staff’srelationship, degree of task structure, amount of powerposition, ability of leader, and staff’s maturity is at good category.The staff’s performance of UPTD Puskesmas DTP coveringwork ability (knowledge and skills), initiative, communication,cooperation, planning and organizing, work productivity, worksatisfaction, and rewards is good category.It is suggested that in the effort to promote the staff’sperformance of UPTD Puskesmas DTP, leadership style shallto be applied by Heads of UPTD Puskesmas DTP use styleleadership of mixture among directive leadership style,supportive leadership style, delegative leadership style, andparticipative leadership style, and with interest using manyparticipative leadership style and should be adjusted with thesituation, the level at the staff’s maturity, the gaining ofinformation for problem solving, the time available, andsupported by the management resource and goodcommunication.Keywords: leadership style, leadership situation, personalcharacters of the leaders, staff’s performanc
IMPROVING ACCESS TO NARCOTIC ANALGESICS: THE INTERNATIONAL CONTROL SYSTEM AND OPTIONS FOR QUANTIFICATION METHOD
Get PDFNarkotika lebih dikenal masyarakat karena masalahpenyalahgunaannya, padahal salah satu kelompok narkotikayang digunakan dalam bidang medis adalah analgetika narkotika,utamanya tablet morfin, yang merupakan obat esensial.Penghitungan kebutuhan yang akurat untuk analgetika narkotikasangat penting untuk memastikan ketersediaannya bagipelayanan kesehatan pasien. Saat ini data global menunjukkanbahwa penggunaan morfin lebih terkonsentrasi di beberapanegara di Eropa dan Amerika Utara saja, sedangkan di negaranegaralain termasuk Indonesia, konsumsinya sangat minim.Morfin bahkan tak tersedia di 70 negara dan teritori.Penyebabnya bisa karena kurang akuratnya penghitungankebutuhan, kurang digunakan atau karena kebocoran distribusi.Di lain pihak, ketidakakuratan penghitungan juga bisamenyebabkan surplus persediaan yang bisa menyebabkankebocoran distribusi dan dapat mengarah ke penyalahgunaan.Oleh karena itu, sangatlah penting untuk memilih metodepenghitungan kebutuhan morfin yang paling tepat, agarkebutuhan medis terpenuhi secara optimal. Makalah inimenyajikan sistem pengawasan internasional untuk penyediaannarkotika bagi kebutuhan medis, dan langkah-langkah untukmeningkatkan keakuratan penghitungan kebutuhan analgetikanarkotika, dengan tetap memperhatikan langkah-langkahpengamanan distribusinya.Kata Kunci: sistem pengawasan internasional, analgetikanarcotika, morfin, estimasi, metode kuantifikas
PENGUKURAN INDEKS KEPUASAN MASYARAKAT TERHADAP PELAYANAN KESEHATAN
Get PDFBackground and Method: This research measured SocietySatisfaction Index (SSI) toward health service at AchmadMochtar Hospital West Sumatera. Society Satisfaction Index(SSI) is one of indicators for measuring public service providedby govermental institution for society. This is stipulated in thedecesion of Minister for Empowering State apporatus NumberNo. 25/2004 on General Guide for Society Satisfaction Indexat Service Unit of Goverment Institution.Result and Conclusion: The result of measuring SSI atAchmad Mochtar Hospital showed; (1) in general, service givento society has been good, except for aspects; officers disciplinein serving, the speed of service, the certanty of service costand service schedule, (2) from service side, service at inhospitalstay is better that service at out-hospital stay andemergency service, (3) the difference in service occuredaccording to service unit and three best service based on SSIwere in the unit of modwifery, sex/skin and THT. Based on thisfinding, goverment and hospital can improve health service.Keywords: society satisfaction index, helath service, publicservic
REDESIGN PELAYANAN FARMASI DENGAN METODE FAILURE MODE AND EFFECT ANALYSIS
Get PDFBackground: Pharmacy service is a high risk area in thesupport of health service quality. PKU Muhammadiyah Hospitalis a hospital that respons to systematic movement in servicesthat focus on patient safety such as minimizing the incidenceof medication error that often happens. This condition requiresnew design that can minimize risk for the incidence of medicationerrorr by implementing Failure Mode and Effect Analysis (FMEA)method as a systematic and proactive method that improvesquality of hospital service.Objective: To design new service quality at PKUMuhammadiyah Hospital Yogyakarta by identifying risk formedication error in the process of drug use, factors that caninduce the incidence of medication error in the process druguse and make new design that can minimize risk for medicationerror of PKU Muhammadiyah Hospital Yogyakarta.Method: This study used action research. This design waschosen to involve subject of the study more actively in doing theredesign of pharmacy service using FMEA method to minimizerisk for the incidence of medication error. Subject of the studywere all incidents of medication error in the process of drug useincluding related health staff involved in the process of druguse. Primary were data obtained from indepth interview, groupdiscussion, focuses group discussion, and workshop.Result: Failure Mode and Effect Analysis (FMEA) method wasexpected to minimize errors in drug use system at outpatientpharmacy service at PKU Muhammadiyah Hospital Yogyakarta.Through FMEA method it was identified that the highest RiskPriority Number (RPN) was failure in confirmation with doctors(294), failure in identifying drug name (216). In this study newdesigns proposed as pilot project were change of layout ofdrug identification color sticker according to therapy class; thedetermination of standard operating procedure ofcommunication with doctors giving prescription, confirmationwith doctors for non cito prescription and procedure ofimplementation of outpatient pharmacy service supervision.Trial of layout of drug identification color sticker was carriedbecause it did not need high cost and was relatively easy tosocialize and do. The result of evaluation after new designintervention was declining value of RPN for failure incommunication with doctors (from 294 to 196) and failure inidentifying drug name (from 216 to 144).Conclusion: The new design implemented was relativelyeffective in minimizing errors in identifying drug name andminimizing failure in communication with doctors.Keywords: medication error, failure mode and effect analysis,redesig
KAJIAN PENGEMBANGAN DESA SIAGA DI KABUPATEN OGAN ILIR
Get PDFBackground: One strategy to achieve Healthy Indonesia isalert village program as stipulated in Decree of the Minister ofHealth number 564/Menkes/SK/VIII/2006. The observationthrough document review of Ogan Ilir health profile in year2007, environment-based morbidity is still high at 7.011 casesof diarrhea, 30 cases of dengue fever, 68 cases of clinicalmalaria and 11.637 cases of upper respiratory infections and295 cases of pulmonary tuberculosis. It showed that there'restill health problems that need to be handled by both governmentand society.Objective: Objective of this research was to developrecommendations of alert village development based on localresources in Ogan Ilir district.Methods: This was an observational study with quantitativeand qualitative approaches. The data was collected in OganIlir Health Office, all Health Centers in the working area ofOgan Ilir, and 40 villages that have become the pilot of alertvillage program in Ogan Ilir.Results: Development of alert villages in Ogan Ilir still topdown, and the establishment of alert villages have not beenfully utilizing the potency of various community based healthactivities.Conclusion: The community empowerment still needs to beimproved so that local community can dig their own potentialresources. The local government and health centers only asfacilitators.Keywords: alert village, community based health activities,community empowerment
PENGEMBANGAN PROTOTIPE SISTEM INFORMASI MANAJEMEN REGULASI PRAKTIK KEDOKTERAN BERBASIS WEB DENGAN PENDEKATAN SISTEM INFORMASI GEOGRAFIS
Get PDFBackground: Every medical practitioner in Indonesia isrequired to have a medical practice lisence (Surat Izin Praktikor SIP). The medical practice lisence not only functions as alegal permision legal paper, but the information can be used tomonitor distribution of existing practitioners.Objective: The study aims at developing a web-based medicalpractice regulation with geographical information systemapproachMethod: The study employed an action research study designwith 13 respondents from Denpasar City Health Departmentand doctors in the area of Denpasar City. The study beganwith in-depth interviews to explore information needs, processflow and expected results. The programming process wascarried out by applying the results obtained from interviews.Trials and demonstrations were then carried out to allrespondents to evaluate the usability aspect of the prototypedeveloped.Result: A prototype has been developed with different featuresand information for two groups of users with different needsfor information. They are the visitors of the website of theHealth Agency of Denpasar City. The medical practices andpopulation distribution are the information necessary for thephysicians in addition to the online registration, while themanagement of the issuance of the of the medical practicelisence and the related report are necessary for the HealthAgency of Denpasar City. The detailed information may beaccessed in table presentation and the distribution may beclearly observed in map presentation.Conclusion: Ease in operating the information system andavailability of the necessary information are important for theusers. The use of map presentation facilitates the users inmaking decisions based on the information given.Keywords: medical practice lisence, medical practicedistribution, information system prototyp
ROLES OF THE STAKE HOLDER AND PROVIDER OF BATAM CITY IN AN ATTEMPT TO ENHANCE CLINICAL GOVERNANCE OF HEALTH SERVICES IN CONNECTION WITH DOCTOR PRACTICE LAWS
Get PDFBackground: Deming (1984), Crosby (1979, 1985), and Juran(1988), all found that more than 85% of errors are related to asystem; whereas, only 15% of them constitute human error,or an employee’s. According to NGO coordinator, IskandarSitorus, 2000 victims of malpractice have been recordedthroughout Kepulauan Riau. This malpractice occurs when asystem does not have a proper policy, standard procedure,and equipment needed.Objective: The purpose of this research is to find out themanagement, obstacles, and expectations with regards toclinical governance management from the point of view of thestakeholder and provider of Batam City.Method: The method used in this research was a qualitativemethod with a grounded theory. The primary data are derivedfrom in-depth interview. The respondents involved are thecommission IV chairperson of Batam City local Parliament,Kepulauan Riau, chairperson of Medical Committee of Batu AjiLocal Public Hospital Kepulauan Riau using a purposivesampling with an extreme case sampling approach.Result and conclusion: The research shows that clinicalgovernance by the stakeholder and provider still needs furtherimprovement. There are still obstacles in terms of regulationsand implementation of clinical governance. Based on theMinimum Service Standard, some indicators of Batam City in2008 did not meet the performance target and national standard.Therefore, the clinical governance system has not beenimplemented throughout health services in Batam City.Suggestions: For IV Legislative Commission for People’sWelfare and Human Resources Batam Riau Islands areexpected to lack of regulation and appropriate systems inimproving health services. And then for Hospital MedicalCommittee Batu Aji, Batam Riau Islands is expected to implementClinical Governance.It is expected that the recording and reporting systems as wellas obtaining accurate data in making the next Batam healthprofile based on the quality of evidence-based.Keywords: Clinical Governance, stakeholder, provide
