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Jurnal Manajemen Pelayanan Kesehatan
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PROSPEK PENGEMBANGAN PELAYANAN HOME CARE RUMAH SAKIT PRIMA MEDIKA DENPASAR Suarjana, Ketut
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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, strategy
PENGALAMAN PASIEN DIRAWAT INAP SEBAGAI UPAYA PERENCANAAN BAURAN PEMASARAN (STUDI FENOMENOLOGI DI RUMAH SAKIT X KABUPATEN MALANG, JAWA TIMUR) Juhariah, Siti
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: A good exploration of patient’s behavior inchoosing hospital and patient’s experience will build anopportunity for hospital, especially on how hospital could makea customer oriented product. Suitability of hospital product andpatient’s need can assure that the marketing process is drivenby the patients. Hospital mixed marketing as a marketing toolcan be used by hospital in order to get a right positioning attarget market, it was influenced the patients to chose hospitalas well.Methods:It is a qualitative study with phenomenology approachto descriptively know about patient’s experience duringhospitalization at Hospital X, District Malang. The baselinephenomenon was consistently high visiting patients at HospitalX among hospital competition in District Malang. We purposivelytake six patients to include this study.Results: We got some assessment regarding patient’s services,hospital environment, and patient’s reason in choosingHospital X. Patient feel comfort during hospitalized, They reportedas: they were served by ‘friendly doctors’, ‘caring andefficient nurses’ and ‘diligent cleaning services’. They enjoyhospital environment such as: fresh air, no unpleasant odor,clean room and toilet, a good clean maintenance, even at aquite a big building hospital. A fast response time also was feltby patients, with no class differentiation. Patient and relativescan know well about hospital rule and direction, they feel wellinformed. Patient feel happy with hospital payment, because itwas charged after all service finished. The reasons on howpatients chose this hospital X were components of: distance(place), price, doctors (people), fast response time (process),hospital environment (physical evidence). All these reasonscalled mixed marketing components. Other reason out of mixedmarketing component is prestige.Conclusion: By phenomenological approach, a good exploringpatient’s experience can use as marketing planning byHospital. A good marketing planning and strategy made hospitalbe better during massive competition era.Key words: patient’s behavior, experience, phenomenology,mixed marketing
INISIASI MENYUSU DINI PADA SEKSIO SESAREA: STUDI MIXED METHODS PADA DUA RUMAH SAKIT SWASTA SAYANG IBU DAN ANAK DI JAKARTA DAN BEKASI Izwar, Dian
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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 practices
MONTE CARLO SIMULATION FOR ANALYZING OPERATING THEATRE UTILIZATION SIMULASI MONTE CARLO DALAM MENGANALISIS UTILISASI KAMAR OPERASI Hasan Basri, Mursyid
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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 services
KETERLEKATAN DOKTER SPESIALIS DI EKA HOSPITAL BSD-CITY DAN PEKANBARU Tjung, Lipin
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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, privatehospital
EVALUASI PERENCANAAN DAN PENGANGGARAN DINAS KESEHATAN KABUPATEN PESISIR SELATAN PROVINSI SUMATERA BARAT Kani, Abdul
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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, decentralization
PERSIAPAN RUMAH SAKIT SWASTA DALAM MENERAPKAN TARIF PELAYANAN JAMINAN PERSALINAN: STUDI KASUS DI RUMAH SAKIT KHUSUS IBU DAN ANAK DI KOTAMADIA MALANG Maharani, Asri Maharani
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: High maternal death is mainly caused by limitedaccess to maternity services due to unaffordable cost of services.Therefore, a special insurance scheme named JaminanPersalinan (Jampersal) was launched and it is expected to beable to solve this problem.The Muhammadiyah Maternal andChild Hospital in Malang is a private hospital that offers obstetricand neonatal emergency service for those with Jampersal.The Jampersal fee was already set similar to that of JaminanKesehatan (Jamkesmas)scheme, using INA-CBG. Therefore,it is important to elicit the possibility of Jampersal fees beingaccomodated by private hospital.Objective:This research aimed to compare between Jampersaland hospital fees and analyse efforts of a private hospital inaccomodating the INA-CBG’s pricing scheme.Methods:This study was carried out at Muhammadiyah MalangMaternal and Child Hospital. Unit cost calculation and hospitalpricing were collected using the secondary data available fromthe department of finance in the hospital, while Focus GroupDiscussion (FGD) was held with the management level to understandwillingness and opportunity of hospital managersto collaboratewith the government in providing Jampersal services.Results: The results showed that INA-CBG’s tariff was lowerthan both unit cost and hospital pricing for normal delivery anddelivery with cesarean section.The unit costand tariff of normaldelivery were Rp1.633.704,00 and Rp2.070.275,00, respectively.Both of them were higher than the INA-CBG’s tariff(i.e., Rp1.487.770,00).The INA-CBG’s tariff for cesarean section(i.e. Rp2.712.943,00) was lower than both the unit costand hospital tariff of similar service (i.e. Rp4.782.072,00 andRp 5.110.500,-, respectively). From the FGD, it was found thatunlike for cesarean section, efforts to accommodate the Jampersalpricing for patients with normal delivery are possible.Conclusions: The findings indicate that Jampersal feesarelower than both the Muhammadiyah Malang Maternal and ChildHospital’s pricing and unit cost.Development of clinicalpathwaymay become a solution for the hospital to apply theINA-CBG’s tariff.Keywords: fees, Jampersal, private hospital
LAMA WAKTU OPERASI, LUAS DAERAH OPERASI, BANYAKNYA LARUTAN IRIGASI DAN JENIS ANESTESI DENGAN KOMPLIKASI YANG TERJADI PASCAODONTEKTOMI Heryono, Andi
Jurnal Manajemen Pelayanan Kesehatan Vol 15, No 03 (2012)
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Background: 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 hospital

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