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Jurnal Manajemen Pelayanan Kesehatan
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DEVELOPING A FRAMEWORK FOR CIVIL AVIATION OCCUPATIONAL HEALTH AND SAFETY SYSTEM IN INDONESIA Wirawan, I Made Ady
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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A series of aircraft accidents in the past three years exposedserious safety problems in Indonesian civil aviation. Latestaviation accident investigations reported that flight crews weremainly responsible for two major accidents happened in 2007.This indicates that occupational health and safety (OHS) is anintegral part of civil aviation. Improvement in OHS system wouldthen contribute to the development in Indonesian civil aviationsafety in general. This paper seeks to present applicable OHSdesigns in Indonesian civil aviation by carefully consideringlocal situations, current problems and their determinants.Furthermore, ideal designs based on literature reviews andgood practices in some developed countries were examinedto show the main principles and components needed indesigning a civil aviation OHS system.Keywords: OHS system, civil aviation, IndonesiaABSTRAKSerangkaian kecelakaan pesawat udara dalam tiga tahunterakhir telah menunjukkan masalah keselamatan yang seriusdi dunia penerbangan sipil Indonesia. Dari hasil investigasiterbaru, kru penerbang dilaporkan bertanggung jawab terhadapdua kecelakaan maut yang terjadi tahun 2007. Hal inimengindikasikan bahwa kesehatan dan keselamatan kerja (K3)merupakan bagian yang sangat penting dalam penerbangansipil. Perbaikan dalam sistem K3 akan memberikan kontribusidalam peningkatan keselamatan penerbangan sipil di Indonesiasecara umum. Tulisan ini menunjukkan desain K3 yang bisaditerapkan di penerbangan sipil Indonesia denganmempertimbangkan situasi lokal, permasalahan saat ini danfaktor-faktor penentunya. Lebih jauh, desain yang idealberdasarkan studi kepustakaan dan praktik-praktik yang baikdi beberapa negara maju dianalisis untuk menunjukkan prinsipprinsipdan komponen-komponen utama yang diperlukan dalammerancang sebuah sistem K3 penerbangan sipil.Kata Kunci: sistem K3, penerbangan sipil, Indonesia
FAKTOR-FAKTOR YANG MEMPENGARUHI PERMINTAAN (DEMAND) MASYARAKAT TERHADAP PEMILIHAN KELAS PERAWATAN PADA RUMAH SAKIT Hutapea, Tahan P.
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background: Individual need for hospital services is directlyinfluenced by psychologic variables: taste, sick-healthperception, expectation, assessment of provider and individualcharacteristic such as: age, sex, education and job.Objectives: The study covered people who had hospitalization.The goal of this research is to identify and analyze factors thatinfluence the public demand to select hospital class and examinebed composition which suitable with consumer needs andconsumer characteristics. The consumer’s characteristics are:sex, education, job and ability, availability, acceptability,accessibility and willingness.Method: The samples are inpatients from Dr.Soetomo Hospital,Dr.Ramelan Hospital and Darmo Hospital. Total sample is 296,which consist of 98 from Dr.Soetomo Hospital, 98 fromDr.Ramelan Hospital and 100 from Darmo Hospital. Samplesare collected by proportional stratified random sampling.The method in this study is cross sectional study and analysiswith logistic regression analysis (significants < 0.05).Result and conclusion: Result this experiment show that 3factors (ability, availability and willingness) have correlation inchoosing the hospital class. Suitable Bed composition withconsumer need are: VIP:1st Class:2nd Class:3rd Class =6%:15,6%:28,4%:50%.Keywords: demand, consumer characteristics, hospital classselection, bed composition
KEPEMIMPINAN KEPALA PUSKESMAS DENGAN TEMPAT PERAWATAN DAN PENGARUHNYA TERHADAP KINERJA PEGAWAI PUSKESMAS DENGAN TEMPAT PERAWATAN DI KABUPATEN KUNINGAN JAWA BARAT Sulaeman, Endang Sutisna
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background: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 performance
EVALUASI HARGA OBAT DI APOTEK KOTA KENDARI TAHUN 2007 Suryawati, Sri
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background: Medicine is an integral part of health services.Several actions have been conducted by the government inorder to ensure the availability and affordability of medicines,among others is close monitoring of medicine prices so thatthey are affordable by the community. Previous studies inIndonesia in 1996 and 2002 revealed that medicine prices,both generic and branded, were quite high.Objective: To evaluate selling price of generic medicine inpharmacies in Kendari municipalities.Methods: This is a non-experimental study applying a crosssectional survey design, targeted to selling price of genericand branded medicines in 27 pharmacies in Kendari municipality.Data on prices was collected retrospectively from theprescription sheet and pharmacy price lists, and in-depthinterviews were paid to uncover underlying factors on decisionto set the medicine prices.Result: The study showed that in general, the average sellingprice of generics was 2.72 times higher (range 0.70 – 15.38)than the Ministry of Health Price Standard (HJA Menkes - HargaJual Apotek Menteri Kesehatan Tahun 2006). The averageselling price of branded medicines was approximately 14.53times higher (range 1.24 – 76.33) than HJA Menkes. The sellingprice of the most frequently prescribed generic medicines,i.e., amoxicillin tablet 500 mg, were 3 times higher than HJAMenkes 2006. Generic medicines which priced >5 times higherthan HJA Menkes 2006 included chlorfeniramine maleate,ciprofloxacine, ambroxol, glibenclamide, metoclopramide, anddexamethazone. A month treatment cost for hypertension withcaptopril and furosemide ranged from Rp 8,300 to Rp 125,680or in term of minimum daily wages (MDW) for Kendari whichwas Rp 24,500, ranged from 0.3 to 5 MDW. Treatment cost forpneumonia with amoxycillin ranged from Rp 7,972 to Rp 39,094or 0.3 to 1.6 MDW. The prices of HJA Menkes 2006 were onaverage 1.04 times (or equal) compared to the MSHInternational Price Index 2006.Conclusion: HJA Menkes 2006 equals to MSH internationalprice index 2006. The average selling prices of generics andbranded medicines in private pharmacies in Kendari municipalitywere 2.72 times and 14.53 times, respectively, as comparedto HJA Menkes 2006. However, cheaper alternatives wereavailable, and treatment costs were affordable if patientspurchased cheaper products.Keywords : medicine prices, pharmacy selling price, HJAMenkes 2006, MSH International Price Index
INTEGRATING MULTIVARIATE METHOD AND QUALITY FUNCTION DEPLOYMENT TO ANALYZE IN-PATIENT SATISFACTION Surjandari, Isti
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background : The increasing competition in healthcareindustry has caused the delivery of service quality to patientsbecome essential. Every hospital competes to deliver the bestservice to its patients. As a result, it is necessary to analyzehospitalized patient satisfaction. This study discusses servicequality improvement in healthcare industry by analyzing inpatientsatisfaction using Multivariate Analysis and QualityFunction Deployment (QFD).Objectives: The objectives of this study are to identify patients’characteristics which are significantly affect their satisfactionlevel, to identify service attributes and dimensions which arecritical to patients, and subsequently improve those attributes.Method: The identification of characteristics and servicedimensions which are significantly affect patients’ satisfactionlevel is accomplished using Multivariate Analysis. While thecritical service attributes identification is completed usingImportance-Performance Analysis. Afterward, using Houseof Quality (HOQ), as the basis of QFD, those critical serviceattributes are developed into service elements.Result: Using Discriminant Analysis, the result of this studyshows that patients’ characteristics which significantly affecttheir satisfaction level are sex and occupation. The male andunemployed patients are more satisfied than the female andemployed patients. Afterward, Factor Analysis brings aboutfive new factors (service dimensions), which are the linearcombinations of the original 42 service attributes. Based onthe Importance-Performance Analysis, there are four serviceattributes which are critical to be improved which have highimportance level, but low performance level. Then, using theQuality Function Deployment (QFD), the four critical serviceattributes are developed into service elements. The serviceelements with high priorities are training program, recruitmentof experts, standard of information flow, online administrationsystem, and computer as provider of information.Conclusion: Service quality improvement in healthcareindustry can be analyzed more comprehensive by integratingMultivariate Method and Quality Function Deployment (QFD).The result of this study may provide contributions to hospitalsin general in enhancing its service performance to achieve itspatients’ satisfaction.Keywords: customer satisfaction, healthcare industry,multivariate analysis, quality function deployment
HUBUNGAN MOTIVASI PERAWAT DENGAN KINERJA PERAWAT DI RUANG RAWAT INAP RUMAH SAKIT DAERAH PANEMBAHAN SENOPATI BANTUL TAHUN 2008 Badi’ah, Atik
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background: Hospital was an organization that is foundbecause of the society demands which are more complex andthey have realized that health is very important. It makes thehospital must gives the optimal services for the society. Nursingservices in the hospital are the main factor to decide the servicequality and the image hospital on the society, because thegreater society need of the good services the higher nurses’working motivation will be needed in order to improve theirperformance optimally. The purpose of the study is to find outthe relation between nurses’ motivation and performance inHospital Ward in Panembahan Senopati Bantul.Method: This was a survey analytical research using crosssectionalapproach to find out the relation between nurses’motivation and performance at the same time. The instrumentwas questioners that consist of the nurse characteristics andquestions on nurses’ motivation and performance.Results: The finding analysis using product moment correlationwith significance score is 5 % (p < 0.005) showing there wasa significance relation between internal motivation and externalmotivation factors (p = 0,000) with nurses’ performance. Therewas a relation between the sub-variable responsible(p=0,001), acknowledgment (p=0,000), achievement (p=0,000),development (p=0,000), task (p=0,033), supervise (p=0,001),work condition (p=0,000), organization policy (p=0,000), salary(p=0,000) and nurses’ performance. However, there is nosignificance relation between colleagues and nurses’performance. The result of double regression analysis showsthe relation between internal and external motivation factor(p=0,000) and nurses’ performance. While the sub-variableachievement (p=0,005), development (p=0,003), work condition(p=0,004), and organization policy (p=0,000) have a notsignificance relation with nurses’ performance, but the others(responsible (p=0,734), acknowledgment (p=0,320), task(p=0,145), supervise (p=0,268), colleagues (p=0,773) andsalary (p=0,118).Conclusion: This research showed that the internal andexternal motivation factors were good, so it must be maintainedto keep the effect on nurses’ motivation. According to theresearch findings, it also needs to increase the nurses’motivation so that it can increase the nurses’ performance inorder to get the hospital goal. It can be done by developing thenurses’ resource by doing workshop or getting highereducation.Keywords: motivation, performance, nurse
SKENARIO PERKEMBANGAN RUMAH SAKIT SWASTA DAN HUBUNGANNYA DENGAN DOKTER SPESIALIS Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Perkembangan 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, trisnantoro@yahoo.com)
VAKSIN ROTAVIRUS: APAKAH SUDAH WAKTUNYA DIMASUKKAN DALAM PROGRAM IMUNISASI NASIONAL DI INDONESIA? Wilopo, Siswanto Agus
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 02 (2009)
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Background: Two rotavirus vaccines have been availablefor use. The objectives of the study to examine disease burdenof diare rotavirus and the cost and effectiveness of a rotavirusvaccination program in Indonesia.Material and Methods:  Data on direct and indirect costs ofchildren with rotavirus diarrhea were established in PurworejoDistrict and Yogyakarta city. It was extrapolated to nationalestimates on the basis of the projected birth cohort in 2007and diarrhea morbiditity rate at national level. The main outcomemeasures were economic burden and cost-effectiveness ratio(Rupiah per DALY averted).Results: The disease burden is equivalent to an economicburden of an estimated Rp390.4 billion in medical direct costs,Rp 67.3 bilion in nonmedical direct costs, and 70.4 billion rupiahin indirect costs. From the health care system and communityperspectives, universal vaccination of infants at a cost of lessthan US $12,7 for a vaccine dose would be a cost-effective ofpublic health intervention.Conclusions and Recommendation: In Indonesia, rotavirusvaccination would reduce the morbidity burden of rotavirusinfection, but would not be cost-effective unless the price ofvaccine decreased considerably. At the current price ofvaccine, universal vaccination program for rotavirus wouldnot be recommended.Keywords: burden of disease, rotavirus diarrhea vaccine,cost-effectiveness

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