Jurnal Manajemen Pelayanan Kesehatan
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EVALUASI PERENCANAAN DAN PENGANGGARAN DINAS KESEHATAN KABUPATEN PESISIR SELATAN PROVINSI SUMATERA BARAT
Get PDFBackground: Pesisir Selatan District Health Office faces complexproblems with limited budget available. The budget is determinedin accordance to Act No. 25/2004 about the NationalDevelopment Planning System, Act No. 32/2004 about the RegionalGovernment, and Act No. 33/2004 about the balancebetween central and district government budget.Objective: This study is aimed to evaluate factors influencingthe implementation of planning and budgeting at Pesisir SelatanDistrict Health Office.Methods:This was a qualitative study adopting a case studystrategy. The unit of analysis was the district level and datawere gathered through in-depth interviews. Key persons werechosed reflecting the management capacity of district healthoffice, the executive role (Regional Government BudgetingTeam/RGBT), and the legislative role (Assembly at RegionalLevel) at Pesisir Selatan District. Triangulation was conductedby documents analysis and observation to enhance data quality.Analysis was carried out through coding and categorization.Results: The role of management was still weak in financialplanning and budgeting. This was due to lack of training onbudgeting and inaccurate data about the health problems. Coordinationin planning management was still weak becausethe health centers were not involved, causing overlaps betweenthe programs. The resulted plan and budget made bythe district health office was revised by RGBT because theywere not convinced with the budget and the regional expendituresand revenues budget was limited. The local parliamentwas also not able to increase budget for the health sector.Budget expenditure in years 2006, 2007, and 2008 were stilllow.Conclusion: planning and budgeting capacity of health officemanagement remain weak, which affect deficiency of healthbudget. In the other hand local parliament could not be able toincrease health budget.Keywords: planning and budgeting, health office, decentralizatio
THE IMPACT OF INACTIVATED POLIO VACCINE INTRODUCTION ON THE OVERALL EXPANDED PROGRAM ON IMMUNIZATION COVERAGE AND TIMELINESS IN YOGYAKARTA PROVINCE
Get PDFBackground: Implementation of the expanded program on immunization(EPI) has been excellent in Yogyakarta Province.Since September 2007 this province has piloted the introductionof inactivated polio vaccine (IPV), instead of oral polio vaccine(OPV). The shifting policy raised concern on the possibility thatthe new program would compromise the performance of theexisting EPI. This study was a part of evaluation study on IPVpilot project in this province 2.5 years after its implementation. Itwas aimed to assess the impact of IPV introduction on coverageand timeliness of immunizations within EPI.Method: We conducted a cross sectional study using WHOstandard 30-by-7 cluster sampling to evaluate the EPI programin Yogyakarta Province, both in urban and rural areas. Thesubjects included children aged 12-23 months old and theirparents. A questionnaire was used to get information fromparents/caregivers on demographic and socioeconomic characteristics.Along with data on status and date of IPV vaccination,we included those of other EPI. The impact of IPV implementationwas evaluated by determining the coverage andtimeliness of all immunizations within EPI. We compared thecurrent data with those in period before introduction of IPV.We used Epi InfoTM 2003 software for data entry and analysis.Result: Coverage of vaccinations within EPI is in overall rangedfrom 92-100%. The coverage is similar between urban andrural areas for all vaccines and doses. There is no differencein EPI coverage before and after the introduction of the IPV.Approximately 89% children have received complete immunization.Average age of immunization for each vaccine wasvery close to the recommended schedule. However, only 69%children received the immunization timely.Conclusion: The EPI coverage in Yogyakarta Province is excellentand not compromised by the introduction of IPV. Theproportion of children received timely immunization is relativelylow. We suggest including timeliness, beside the coverage,when evaluating the performance of immunization program.Key words: immunization, EPI, IPV, coverage, timelines
ANALISIS KEBUTUHAN SUMBER DAYA PROMOSI KESEHATAN DI RUMAH SAKIT UMUM DAERAH SOLOK, SUMATERA BARAT
Get PDFBackground: The Implementation of Health Promotion Programat the hospital is an effort to manpower workers andother community hospitals in maintain, enhance and protecttheir health, through increased knowledge, willingness andability to healthy life style in the hospital.Objective: This study aimed to explore information concerninghealth promotion resources in the hospital, with respect tohuman resources, fuunding and infrastructureMethod: This study was conducted to explore the implementationof health promotion programs in the hospital with a systemsapproach. This study used qualitative methods in-depthinterviews with the Director of Regional General Hospital SolokCity, Head of Section Officer, Health Promotion Coordinator atthe Hospital, Section Chief of Service, Head Room, Chief OfficerInstallation and Polyclinic to represent all programs thatintegrate health promotion in hospital, and conduct documentreview of the implementation process.Result: The results showed that the implementation of healthpromotion programs have not been gone well, the programswere not accordance with the instructions in the manual implementationof health promotion in hospitals issued by the Ministryof Health. There was a lack of infrastructure facilities requiredfor the implementation of health promotion as well aslack of guidelines and procedures. Most officers do not havethe same understanding about the human resource for conductedhealth promotion.Conclutions: The conclusion of this research is the managementand decision-makers to put the manpower in accordancewith the educational background of health promotion with aninterest and talent in health promotion in hospitals, and notleast the importance of providing training for existing staff. Forthe management of Regional General Hospital Solok City andcoordinator of Health Promotion in Hospitals (PKRS) in order tocreate an integrated health promotion planning with other programsat the hospital, so the goal of health promotion in hospitalscan be achieved.Keywords: resource requirements, health promotion, humanresource
INISIASI MENYUSU DINI PADA SEKSIO SESAREA: STUDI MIXED METHODS PADA DUA RUMAH SAKIT SWASTA SAYANG IBU DAN ANAK DI JAKARTA DAN BEKASI
Get PDFBackground: Early initiation of breastfeeding (EIB) for allbabies is recommended globally and nationally as a part ofBaby Friendly Hospital Initiatives. Caesarean section (C-section)has been identified as an obstacle to EIB implementationObjectives: (1) To measure the proportion of EIB amongbabies born by C-section, and (2) To explore the barriers ofEIB in C-section.Methods: This study used a mixed-methods study, in whichthe qualitative study embedded to the quantitative study. Across sectional design was applied to measure the proportionof EIB in all babies born by C-section in two baby friendlyhospitals during two months of observation. In-depthinterviews were conducted among two pediatricians, twoanesthesiologist, two obstetricians, two nurses and twomanagers. Qualitative data was analyzed by content analysis.Result: Of 68 babies born by C-section, none were performedfor adequate EIB. Variations of knowledge on EIB procedure,lack of cooperation among SC team, lack of infrastructure andpolicy, as well as other obstacle from patients’ side wereamong the barriers.Conclusion: EIB is not adequately implemented in the twobaby friendly hospitals. Standards of EIB practice should beestablished and disseminated to C-section team and patientsin the hospitals.Keywords: early initiation of breastfeeding, caesareansection, baby friendly hospital initiative, hospital practice
LAMA WAKTU OPERASI, LUAS DAERAH OPERASI, BANYAKNYA LARUTAN IRIGASI DAN JENIS ANESTESI DENGAN KOMPLIKASI YANG TERJADI PASCAODONTEKTOMI
Get PDFBackground: There have been changes in clinical performancemanagement paradigm. Previously, clinical managementfocused on the outcome occurred. Nowadays, the improvementof health care processes becomes the main focus. Impacted-tooth case is a frequentdental problem and a majorcause of patient complaints.Common complications duringodontectomy are oedema, trismus, paresthesia and dry socket.Objective: This research aims to measure the relations betweenoperating time, operating area, amount of irrigation andtype of anaesthesia used with post odontectomy complications,and to measure factors affecting odontectomy complications.Methods: This study applied a cross-sectional study design.Data were collected prospectively at Cipto MangunkusumoCentral Hospital, consisting of subjective and objective clinicalexaminations. Patient complaints post odontectomy, length ofsurgery, operations area, amount of irrigations and type ofanaesthesia used were collected.The data obtained wereanalyzed by using multiple logistic regression methods.Results: There were 57 patients aged 18-55 years. Co-morbiditywas significantly associated with higher odontectomycomplications (p=0.026). Oedema, trismus, and paresthesiaincreased with increasing length of surgery. However, lengthof operation, operations area, amount of irrigations and typeof anaesthesia used were not statistically associated to odontectomycomplications.Conclusions:Co-morbidity is associated with higher postoperativemorbidity. In revising and implementing clinical protocol,co-morbidity should be considered as an important factor.Keywords: clinical performance, complications, odontectomy,teaching hospita
KONTRIBUSI KOORDINASI TERHADAP PENEMUAN SUSPEK TUBERKULOSIS PARU DI KABUPATEN MADIUN
Get PDFBackground: This research aims to analyze the contributionof coordination to find tuberculosis (TB) suspects in MadiunRegency.Method: This is observational study, unit of analysis is PublicHealth Center (PHC). Number of sample was 9 PHC where arespondent of this research is Polindes Midwives, Nurse Pustu,BP Personels and TB Coordinator.Result: Spearman correlation test results showed there iscontribution between knowledge contribution about the coordinationand the type of coordination to communication andsupervision. There is a contribution on the role of supervisorycontrol to supervision, communication and work procedures.There is a coordination mechanisms contribution (supervision,communication and working procedures) to the coverage ofthe findings TB suspected.Conclusion: Coordination contributes to finding of TB suspects.Keywords: contribution, coordination, coverage of findingsTB suspec
Diperlukan Kepemimpinan Spesialis dalam Mencapai MDG4 dan MDG5: Apakah Perlu Pengajaran Kepemimpinan untuk Para Residen?
No full textData terbaru menunjukkan bahwa sebagianbesar kematian ibu dan bayi di Jawa berada di rumahsakit dan sistem rujukan. Di Nusa Tenggara Timur(NTT) sedang terjadi proses perpindahan tempatkematian dari rumah ke fasilitas, dan bergerak kerumah sakit. Keadaan ini menjadikan sebuah tantanganbaru bagi dokter SpOG dan dokter SpA untukmempercepat penurunan kematian ibu. Pada kontekspenurunan kematian ibu, mutlak diperlukan perandokter SpOG dan dokter SpA dan kepemimpinannya.Hal ini wajar karena secara teknis kesehatanibu dan kesehatan anak, dokter SpOG dan dokterSpA menjadi pemimpin di lapangan (playing-captain)untuk penurunan kematian ibu. Tim kesehatan yangdipimpin termasuk dokter spesialis lain yang terkaitKIA (misal anastesi dan penyakit dalam), dokterumum di rumah sakit, bidan di rumah sakit, danperawat rumah sakit.Salah satu tugas penting dari para spesialisadalah memimpin tim teknis pelayanan kesehatanibu dan anak di rumah sakit PONEK 24 jam dansistem rujukannya. Kepemimpinan teknis medik inisangat penting karena evidence di berbagai negaramenunjukkan tanpa mutu pelayanan klinik danrujukan yang baik, penurunan kematian ibu dan anakakan sulit tercapat. Pertanyaan penting adalahbagaimana situasi kepemimpinan spesialis untukMDG4 dan MDG5 dan apakah kepemimpinanspesialis sudah diajarkan di pendidikan residensi.Gambaran mengenai pendidikan kepemimpinandi program residensi saat ini memang masih belumditangani secara sistematis. Di dalam pendidikanresiden kebidanan dan kandungan, topik kepemimpinanmemang satu dari sekian banyak kompetensiyang harus dimiliki residen. Kepemimpinan termasuksoft competency sehingga kadang-kadang tidakdiformalkan. Topik ini diberikan saat ada penugasankeluar daerah yang merupakan cara untuk memantaukemampuan soft competency.Di dalam pendidikan kesehatan anak, topik kepemimpinansudah termasuk ke dalam modul spesialisanak. Hal ini terwujud dalam stase dari pendidikanspesialis anak, yaitu pada saat menjadi chiefdi masing-masing bangsal. Namun leadership inimasih terbatas pada peran dokter spesialis anakpada kasus yang ditangani. Kepemimpinan dokterspesialis anak dalam cakupan yang lebih luas belumdituangkan secara langsung dalam modul pendidikan.Di dalam pelatihan setelah menjadi spesialismemang belum banyak yang dikerjakan di kesehatanibu dan anak.Topik kepemimpinan belum menjadiisu penting dalam pendidikan profesi berkelanjutan.Apabila dilihat ke agenda-agenda pertemuan kesehatanibu dan anak oleh ikatan profesi, belum banyakmateri yang mengarah ke kepemimpinan dalamusaha mencapai MDG4 dan MDG5.Dapat disimpulkan bahwa pendidikan dan pelatihankepemimpinan untuk SpOG dan SpA merupakankebutuhan dan salahsatu prasyarat untukpercepatan pencapaian MDG. Beranjak dari situasiini kolegium perlu diperkenalkan lebih dulu mengenaileadership pada saat pertemuan ilmiah tahunanPOGI atau IDAI dan kongres-kongresnya. Modulpelatihan leadership untuk para spesialis perlusegera dikembangkan karena modul pendidikanspesialis baru mencakup leadership sebatas kasuskasusyang ditangani. Oleh karena itu diperlukantindakan segera untuk melaksanakan.Ada beberapa usulan untuk pengembangan modul:Pertama adalah keterlibatan ikatan profesi. Olehkarena itu, modul kepemimpinan yang disusunsebaiknya melibatkan POGI dan IDAI. Keterlibatanikatan profesi ini menunjukkan komitmen untukpencapaian MDG4 dan MDG5. Kedua, dalam pelaksanaannyasebaiknya modul pelatihan kepemimpinanperlu berbasis pada web sehingga mudahdiakses. Kemudahan ini penting untuk menjangkauhampir 500 kabupaten yang membutuhkan kepemimpinanspesialis. Sebagai catatan, sasaran jangkapendek untuk dokter SpOG dan dokter SpA yangberada di rumah sakit - rumah sakit PONEK sebaiknyadimulai tahun ini untuk mempercepat pencapaianMDG4 dan MDG5. Ketiga, diperlukan banyakinstruktur yang menguasai leadership ini sehinggaperlu training of facilitator untuk mempelajari leadership.Instruktur-instruktur ini merupakan tulangpunggung dalam usaha penyebaran kepemimpinandi dokter SpOG dan SpA. Laksono Trisnantoro([email protected]
PROSPEK PENGEMBANGAN PELAYANAN HOME CARE RUMAH SAKIT PRIMA MEDIKA DENPASAR
Get PDFoai:jurnal.ugm.ac.id:article/2473Background: Demographic and epidemiologic transitionscause population structure and changes in disease patterninto degenerative and chronic disease. Hospitals in Indonesiahave not developed chronic care service. Prima Medika hospitalhome care (HC) has not been developed, without assessingthe prospect of HC service development as a revenuecenter.Methods: Qualitative research using methods of participationobservation; in-depth interview with patients, personnelof HC unit, and management; close observation with checklist.Data were analyzed qualitatively using thematic content analysisResults: Based on concept of strategic management, thefollowing opportunities and potentials of HC exist: patient satisfaction,payment ability, and benefit perception, dependencesof cancer patients and elders. The hospital has the followingstrengths: personnel readiness, presence of personnel motivator,personnel commitment to work, facility and hospital equipment,commitment from directors. However, their weaknessesand barriers are: limited human resources, marketing, and tariffcalculation. Challenges and expectations of patients are:diversification of service types, use of tools, visit frequencies,and personnel qualification.Conclusion: The prospect of HC service development washigh. Alternatives strategy proposed are: specific administrationfor HC selection and offer to patients, HC tariff makingaccording to unit cost, provision or coordination of personnel,rental and sales of tools, and focus for cancer patients andelders.Keywords: home care, prospect, strateg
KETERLEKATAN DOKTER SPESIALIS DI EKA HOSPITAL BSD-CITY DAN PEKANBARU
Get PDFBackground: Physicians engagement to the hospital is moreimportant due to the growth and development of hospital aswell as tighter competition. Eka Hospital management attemptedto change the strategy for designing remuneration system andphysician partnership patterns so that physicians as the mainactors in medical service have high engagement to the hospital.Objective: To analyse the correlation between remunerationsystem, physician partnership patterns and physicians engagementat Eka Hospital, and to analyse other related factorinfluencing physicians engagement to the Eka Hospital.Method: This study used a cross-sectional survey, supplementedby qualitative data collection. Data were analysed usingcorrelation between remuneration system, physician partnershippatterns and physicians engagement.The instrumentsapplied in this study were questionnaires concerning perceptionsof the remuneration system that have been tested for itsvalidity and reliability, adopted from the Utrecht Work EngagementScale.Result and discussion: The study showed that only 30% ofphysicians at Eka Hospital had strong engagement. Most physicianswith positive perception toward remuneration systemhad strong engagement to Eka Hospital. While those with lowengagement also had negative perception toward the remunerationsystem. Most physicians with strong engagementwere part-time specialists. Likewise, those with weak engagementwere also part-time specialists. Engagement wasnot only related to material or income they received but alsoother non-material forms of reward and recognition. Therewas a correlation between physicians engagement with workinglocation. BSD-City physicians had stronger engagementthan Pekanbaru physicians. By specialization, non surgeryphysicians had higher engagement than surgery physicians.Another related factors to physician engagement were motivationsof working at Eka Hospital, such complete facility toenable them to develop their skill and professionalism, andsimilar vision and mission with Eka Hospitals.Conclusion: There was no correlation between remunerationsystem and part time or full time physician engagement.Physician engagement was related to hospital perception supportlike completeness of the facility and staff support, visionand mission of the hospitals and prospect for development ofskills and professionalism.Key words: physicians engagement, remuneration, privatehospita
MONTE CARLO SIMULATION FOR ANALYZING OPERATING THEATRE UTILIZATION SIMULASI MONTE CARLO DALAM MENGANALISIS UTILISASI KAMAR OPERASI
Get PDFBackground: Previous researches in different countries studiedabout operating theatre performance, but in Indonesia lessresearch has been conducted. Operating theatre performanceis measured by utilization rate, however the way utilizationmeasured in practice is different with the general terminology.We conduct research in one referral hospital. It was declaredthat although the utilization of operating theatre is not high,many patients wait for the services. Therefore, the objectivesof this research are to validate the low utilization rate and toidentify causes of unutilized capacity of operating theatre.Method: This research applied statistical description methodto analyze the utilization with general terminology, and theMonte Carlo simulation is run to identify what factors that causeunutilized capacity. Three scenarios are used in the simulation.First scenario is simulation with no cancellation occurs,the second is simulation with cancellation, and the third scenariois simulation for determining unutilized capacity due towaiting and idle time in operating theatre.Results: This study has successfully revealed factors causingunutilized capacity of operating theatre i.e. number of cancellation,waiting for facilities, and idle capacity. Our studyshows that 1% of cancellation rate will reduce utilization about1%. This study also indicates that unutilized capacity due towaiting for facilities and idle capacity in these operating theatresis fairly high.Conclusion: It had confirmed that operating theatres in thehospital are in low utilization and need for improvement. Determiningutilization rate with Monte Carlo simulation provides moreinformation to hospital manager for decision making process.Keywords: operating theatre, utilization, monte carlo simulation,healthcare service