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Lucia Ratna Kartika, Lucia Ratna
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Decision Sciences, Operations Research & Management Health Professions

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Analysis of Organizational Culture Change Processin Badan Rumah Sakit Umum Tabanan-Bali Hariyadi, Sepri; Sudiro, Sudiro; Kartika, Lucia Ratna
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki1210326

Abstract

Badan Rumah Sakit Umum (General Hospital Board= BRSU) Tabanan-Bali had changed inmany aspects of organization since 2002. These changes had a significant impact on the way togive further services, increasing the number of patients’ visit and staff welfare. These changes, ingeneral, had changed the hospital image. Objective of the study was to analyze the process ofhospital organizational culture change (basic assumption, value system, norm, and artifact) onstructure, technology, and person aspects through the transformation steps (refreezing, freezing, and unfreezing). This was an observational, qualitative study. Data were collected through in-depth interview, documentary collection, and direct observation. Study subjects consisted of fourhospital managers (top and middle) as main informants, three functional staffs (physician andnurses) as triangulation informants. Results of the study showed that, at the beginning, therewere differences on BRSU organization. The differences included basic assumptions, valuesystem, norm, and artifact. Status of the BRSU was UPTD; and this BRSU had minimaltechnology, fraudulence revenue in every unit, and low quality of staffs. These situationsmotivated hospital director (as an initiator) to change hospital organization culture.Implementation of the change was to give understanding and awareness to all hospital staffsthrough giving vision and mission of the hospital, basic trust, norms, artifacts, and motto.Changes included 1) change of hospital status by District leader and district house ofrepresentative, from UPTD to LTD. This change was conducted according to accreditationstandard, ISO, and Citra cup service; 2) change on hospital information system (SIM-RS),communication system, and conducting KSO of instruments; 3) change of the quality of hospitalhuman resource. Impact of the changes included 1) increase in 1999-2000 hospital revenue from350-400 million rupiahs to 1.6 billion rupiahs, 2) significant increase on the staffs’ wages. Supervision was conducted by the presence of an auditors, credential, and periodic refreshment of organizational culture. Impact of the whole changes was improvement of service quality. Inaddition, no service quality disruption was found after twice changes of hospital directors. Thecurrent type of organizational culture in BRSU Tabanan was an open organizational culturetype. Suggestion: changes will certainly occur, and BRSU Tabanan is expected to continuously control the changes towards the better, physically and non-physically.
Analysis on the Implementation of Iron Supplementation Program by Midwives at Primary Healthcare Center in South Minahasa District Tuju, Sjenny Olga; Nugraheni, Sri Achadi; Kartika, Lucia Ratna
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki1310328

Abstract

Implementation of iron tablets supplementation program in the primary healthcare centers of SouthMinahasa district was still below the national target (78.8%) although there was a policy regardingiron supplementation program by midwives. The national target was 90%. Preliminary surveyconducted on 7 midwives showed that there were midwives who had not implemented the programaccording to the existed standard operating procedure. The objective of this study was to analyzefactors affecting the implementation of iron tablets supplementation program by midwives in theprimary healthcare centers in the area of South Minahasa district.This was an observational analytical study with cross sectional approach. Data collection wasdone through interview guided by questionnaire and direct observation to midwives when givingiron tablets in a polindes/posyandu. The number of study samples was 98 village midwives in 17 sub districts of South Minahasa district. They were selected using simple random sampling method.Univariate analysis, bivariate analysis with chi square test, and multivariate analysis with logisticregression were applied in the data analysis.Results of the study showed that midwives had implemented the activities with good category incommunication (46.9%), resources (52%), disposition (57.1%), and structured bureaucracy (53.1%).Variable affecting the implementation of iron tablets supplementation program was bureaucracy(p= 0.24), exp â= 2.584.Suggestions for the South Minahasa district health office were to conduct socialization to midwivesregarding the benefits of using standard operating procedures of the implementation of iron tablessupplementation; to give incentive for midwives who implement the program according to thestandard and reaching the target; to provide Hb Sahli set for all midwives who work in the villageand they do not have the Hb Sahli set
Evaluation of the Implementation of Posyandu (Integrated Service Center) Development Policy by Operasional Working Group (Pokjanal) City of Banjarmasin South Kalimantan Province (Case Study in The District of East Banjarmasin) Sari, Anggrita; Kartika, Lucia Ratna; Kuntjoro, Tjahjono
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki1310339

Abstract

Since 2010, in East Banjarmasin sub-district, members of sub-district operational team work(pokjanal) had been established based on the decree no. 10/2010 regarding sub-district Pokjanalboard member. The role and function of this pokjanal was not maximal. Objective of this study wasto evaluate the implementation of posyandu supervision by pokjanal based on supervision output,input, and process aspects.This was a descriptive-qualitative study with cross sectional approach. Data collection was doneusing in-depth interview technique on four sub-district pokjanal board members as main informants.Triangulation informants consisted of ten people. Content analysis was applied in the data analysis.Results of the study showed that sub-district pokjanal was established. However, based on evaluationon output aspect, it was found that completeness of data and information were insufficient; problemanalysis and intervention were not done; annual planning and supervision activity scheduleformulation were not performed; coordination activity and report of activities results were notdone. Input aspect: human resource, facilities, and funding were not provided according to the roleand function of pokjanal in implementing the supervision. Process aspect: data collection,information, and problem analysis were not done. Annual plan formulation, monitoring and activityevaluation were not implemented according to pokjanal function. This was caused by no socializationand technical guidance that could assist the work of pokjanal; therefore, no pokjanal activity reportdocuments were found.Conclusion of this study was that Pokjanal organization did not function properly. Reasons for thiscondition could be viewed from output aspect: posyandu supervision activity was not done; inputaspect: Pokjanal did not function according to their role; process aspect was not implementedaccording to the pokjanal guideline.It is suggested that stakeholder commitment and clarity are needed; cross sectors and cross programscoordination and communication should be optimized
Factors Related to the Midwives Work Performance on the Implementation of Obstetric Care Standard in Antenatal Care (Study in Primary Healthcare Centers with in Patient Unit in Gresik District) Hamidah, Siti; Widagdo, Laksmono; Kartika, Lucia Ratna
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 1 (2014): April 2014
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki2110353

Abstract

Maternal mortality rate (AKI) in Gresik district in 2011 slightly decreased compared to 2010, from 20 maternal deaths (105.91/100.000 live births) to 19 maternal deaths (98.82/100.000 live birth). Thenumber of death infants in 2010 was 47 infants (2.48%), and it became 140 infants (7.49/1000 live birth)in 2011. Result of MP showed that besides direct cause of death, it was also resulted from indirect causesuch as delay in conducting early detection of pregnancy complication. Obstetric standard of care (SAK)for ante natal care (ANC) was a task that should be implemented by all midwives. A monitoring done byIBI of Gresik district showed that 50% of midwives had not conducted ANC according to the standard.Objective of the study was to identify factors affecting work performance of midwives in the implementationof SAK ANC in the inpatient primary healthcare centers of Gresik district.This was a quantitative study with cross sectional approach. Data were collected using structuredquestionnaire and by conducting documentation observation toward results of ANC performance.Study population was all 119 midwives in the inpatient primary healthcare centers in Gresik district.Study samples were 87 midwives who were selected using simple random sampling method. Chisquare test was applied in the bivariate analysis, and multiple logistic regressions were applied in themultivariate analysis.Results of the study showed that work performance of midwives in the implementation of SAK ANCwas inadequate (44.8%), SAK management system was inadequate (55.2%), and knowledge onSAK was insufficient (56.3%). No association was found between work performance of midwives inthe implementation of SAK ANC and leadership, creativity, knowledge. Significant association wasfound between SAK ANC management system and work performance of midwives in theimplementation of SAK ANC (p: 0.031). There was an influence of SAK management system towardwork performance of midwives in the implementation of SAK ANC (p: 0.045).District health office is suggested to review PerMenKes no. 938/SK/MenKes/VIII/2007, to adviceheads of primary healthcare centers to implement the SAK ANC, to facilitate organizationmanagement training and SAK ANC training, to do more intensive monitoring of the workperformance of midwives. Suggestions for IBI were to monitor, to evaluate, and to follow up theimplementation of SAK ANC continuously.
Analysis on the Implementation of Community Empowerment by Midwives to Support Delivery Planning and Complication Prevention Program (P4K) at Primary Healthcare Centers in Kediri Lutfiasari, Dessy; Purnami, Cahya Tri; Kartika, Lucia Ratna
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 1 (2014): April 2014
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki2110356

Abstract

Implementation of delivery planning and complication prevention program (P4K) could run if midwives could empower people to do P4K. However, implementation of P4K in Kediri city particularly in community empowerment was still below the target set by Kediri city health office. The objective of this study was to explain implementation of community empowerment by midwives to support P4K at primary healthcare centers in Kediri city, in 2011. This study was conducted in May – July 2011 in all primary healthcare centers in Kediri city. This was a qualitative study with cross sectional approach. Primary data were collected through in- depth interview technique, and secondary data were also used. Content analysis method was applied in the data analysis. Results of the study showed that tubulin was the community empowerment activity that was not implemented due to many options for health insurance in the community; basic indicator, purpose of the policy were not clear. Although human resources was appropriate, and there was a support from gerdu sehati; however, there was no funding and special facilities. Additionally, control management was not performed by primary healthcare center; supervision by midwife did not provide special forum for communication between cadres and people in the community. Although attitude of midwives was positive in doing their responsibilities but there was no support from the community, as a result the program would not run. Suggestions for district health office are to make clearly basic indicator and policy objective regarding P4K implementation; to conduct routine training for midwives and cadres regarding community empowerment. Primary healthcare center has to implement good control function; to improve communication done by midwives to implement community empowerment activities.
Implementation of Delivery Planning and Complication Prevention Program by Midwives at Primary Healthcare Center in Ambon Hasnawati, Hasnawati; Mawarni, Atik; Kartika, Lucia Ratna
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 2 (2014): Agustus 2014
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jmki2210357

Abstract

Delivery planning and complication prevention program (P4K) was established to accelerate the decrease of maternal mortality rate (AKI), Implementation of this program in Ambon was not optimal. Objective of this study was to explain the implementation and related factors of P4K by midwives in the primary health care centers of Ambon city. This was a descriptive-qualitative study with cross sectional time approach. Data collection was done using in-depth interview technique to 3 P4K executor midwives as main informants. Triangulation informants were three heads of primary healthcare centers, head of family health unit of Ambon district health office (DKK), and three mothers who gave birth in the last 0-42 days. Content analysis method was applied in the data analysis. Results of this study showed that P4K implementation in the form of giving comprehensive counseling was not done by midwives. Antenatal care (ANC) visit was not conducted according to the standard. Delivery assisted by ‘dukun’ was still found. Post delivery contraception use did not attain the target. ‘Tabulin’ (savings for giving birth time) and blood donor collection was not performed. Program socialization to the community and cross sectors was still insufficient. The number of midwives was still insufficient. Facilities were still insufficient, and no funding allocation for socialization activity was provided. Management control from Ambon city health office and head of puskesmas was inadequate. Communication forum for P4K was not performed by midwives. Commitment and attitude of P4K executor midwives were good. No standard operating procedure (SOP) for P4K implementation was provided. Implementation of P4K by midwives in Ambon city was insufficient. It was caused by no local policy that supported P4K; lack of communication to the community; insufficient number of midwives, facilities, and funding; inadequate management control by Ambon city health office; and no SOP for P4K implementation.
Co-Authors Anggrita Sari, Anggrita Atik Mawarni Cahya Tri Purnami Dessy Lutfiasari, Dessy Hasnawati Hasnawati Laksmono Widagdo Sepri Hariyadi, Sepri Siti Hamidah Sjenny Olga Tuju, Sjenny Olga Sri Achadi Nugraheni Sudiro Sudiro Tjahjono Kuntjoro