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Jurnal Manajemen Pelayanan Kesehatan
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IMPLEMENTASI TATA KELOLA KLINIS OLEH KOMITE MEDIK DI RUMAH SAKIT UMUM DAERAH DI PROVINSI JAWA TENGAH Adi Utarini, Kasyfi Hartati Hanevi Djasri
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Background: Clinical governance aims to deliver the bestclinical care for patient as stipulated in Law No. 44 of 2009about Hospital and the Minister of Health Decree No. 755/Menkes/Per/IV/2011 about Implementation of Medical Committee.Medical committee is in charge of implementing clinicalgovernance so that the medical staff at the hospital maintainedtheir professionalism.Objective:To measure implementation of clinical governanceby the medical committee at district general hospitals in CentralJava province.Methods: This was a cross-sectional survey study. The subjectswere 48 District General Hospitals in Central Java consistingof 1 class A,17 class B, 26 class Cand 4 class D. Dataobtained using questionnaire which measurestructure andprocess of clinical governance implementation. There are 8variables on structures and 13 variables on processes. Questionnaireswere sent to respondents through a courier serviceand answers were given by interviews or written responsesand analyzed descriptively.Results: Data obtained from 30 hospitals (1 class A, 12 classB,14 classC and 3 class D). The average level of clinical governanceimplementation is 67%.The average fulfillment level ofthe structure is 75 and 58% forthe processes. Implementationof the medical committee assignments is a medical audit 3.3%,credentialing 3.3%, sustainable professional development 50%and medical professional development 70%. There is severalconstraints in implementation the Minister of Health Decree No.755/Menkes/Per/IV/2011 because of the uneven spread ofspecialist and lack of support from hospital management.Conclusions: Implementation of clinical governance by themedical committee in district’s hospitals in Central Java has notbeen in accordance with existing regulations. There is a needto strengthened the medical committee. It would need to manufactureclinical governance guidelines by the authorities andmonitoring its implementation.Keywords: clinical governance, medical committee, districtgeneral hospital
EVALUASI IMPLEMENTASI REKAM MEDIS TERINTEGRASI DI INSTALASI RAWAT INAP RSUP DR. SARDJITO YOGYAKARTA Lutfan Lazuardi, Patricia Suti Lasmani Fitri Haryanti
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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ABSTRACTBackground: There was an interview with medical forensicsub-committee at Dr. Sardjito Hospital that stated no medicalrecord was complete. Separated patient-monitoring reflectedpoor colaboration among medical staffs. Hence, Dr. SardjitoHospital had implemented integrated medical records forinpatients and there should be an evaluation f or theimplementation.Objective: This study aimed to evaluate documentation processof integrated medcal records for inpatients at Dr. SardjitoHospital through completeness, patient-centered care, interprofesionalcollaboration and confidentiality aspects. Second,it aimed to explore barriers and enablers of implementation ofintegrated medical records.Methods: T his study is a case study with descriptiveexplanatorydesign. Main data source was documentation onmedical records of three to six days inpatients. T hedocumentation proess was aimed for obtaining quantitativedata of medical records-completeness. Triangulation ofobservation and focus group discussion was done f orobtaining qualitative data.Results: Implementation of integrated medical records waspoor. None of medical records had standard abbreviation.Medical records which had no signed correction were 29.7%and only 41.6% of medical records had date and time written,while those with non-clear and simplified notes were 61.5%.However, most medical records had complete progress note(85.4%) and equipped with clear name and signed by thecaregivers (81.3%). Focus group discussion resulted thatintegrated medical records was giving benefit. Integrated medicalrecords provided better service to patients.Conclusion: Dr. Sardjito Hospital has to obliged its medicalstaffs to implement integrated medical records for betterservices to patients.Keywords: evaluation, integrated notes, medical records
PENGARUH INTERVENSI DISKUSI KELOMPOK KECIL DISERTAI UMPAN BALIK TERHADAP PERENCANAAN KEBUTUHAN OBAT DI RUMAH SAKIT UMUM DAERAH TIDAR KOTA MAGELANG Sulanto Saleh Danu, Nunung Priyatni, Octariana Sofyan Chairun Wiedyaningsih
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Background: In order to increase health service to people toobtain healing and restore health, very influencing factor issufficient drug need planning, either for its type and amount.Problem faced in Magelang Tidar Hospital is excessive drugand low appropriate drug requirement plan (<100%). Thisresearch to increase appropriate drug need planning inMagelang Tidar Hospital in 2013.Method: This research used quasi experiment research designwith pretest-posttest design. It used indicator of drug needplanning as output before and after FGD intervention.Results: 1) Average drug suitability with formulary for regularin before and after FGD intervention are 82.2% and 84.1%, forASKES in before and after intervention are 95.1% and 97.5%,and for Jamkesmas in before and after FGD intervention are64.7% and 81.8%. 2) Average drug appropriateness withDOEN 2011 for regular in before and after FGD interventionare 65.6% and 72.8%, for ASKES in before and af terintervention are 66.6% and 69.1% and for Jamkesmas beforeand after FGD intervention are 68.7% and 71.1%. 3) Drug fundallocation has reached 100% of available fund. (4) Percentageof drug item amount in planning and real drug item in usage forregular drug before and after FGD intervention are 124.6%and 241.7%, for ASKES in before and after intervention are185.5% and 265.2%, and for Jamkesmas in before and afterFGD intervention are 220.5% and 399.8%. (5) Percentage ofplanning appropriateness for regular drug before and afterFGD intervention are 40.1% and 10.4%, for ASKES in beforeand after intervention are 13.5% and 4.9%, and for Jamkesmasin before and after FGD intervention are 13.8% and 4.5%.Conclusion: FGD intervention with feedback can increasesome appropriateness indicator of drug need planning inMagelang Tidar Hospital such as drug suitability with formularyindicator and drug suitability to DOEN indicator. Fund allocationindicted that required fund have accorded to available fund.Percentage of drug item amount in planning and in real usageis increase and percentage of planning appropriateness isdecreased due to excessive drug budget.Keywords: FGD intervention, drug need planning, MagelangTidar Hospital
PERAN RESEP ELEKTRONIK DALAM MENINGKATKAN MEDICATION SAFETY PADA PROSES PERESEPAN Iwan Dwiprahasto, Margareta Susi Widiastuti
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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ABSTRACTBackground: Many health organizations pay high attention tomedication safety, because medication errors lead to harmand financial loss. Prescribing error as part of medicationerror could have been prevented. Many interventions are developedto prevent prescribing errors, one of which is theelectronic prescribing system. Since 2007 this hospital alreadyimplemented the electronic prescribing system but not all physicianshave used the system yet.Objective: To describe the use of electronic prescribing systemto improve medication safety through reducing prescribingerror, to analyse other factors causing prescribing errors,and to evaluate physicians acceptance of the electronic prescribingsystem.Methods: Prescriptions were collected from ambulatory patientsreceiving two drug jeniss or more. Prescribing errorsfrom electronic and non electronic prescriptions were identifiedand compared, and Odds ratio were calculated. Acceptanceof the electronic prescribing system was obtained fromin-depth interview and questionnaire.Result: Incomplete prescription was significantly higher in thenon-electronic than the electronic prescribing (OR 1.30; 95%CI1.06-1.58), while illegible prescription was sigficantly found in91 among the the non-electronic prescription. Drug interactionsand other errors such as improper drug selection, polipharmacyand unusual dosage resulted from clinical decisionmakingerrors could not be reduced by electronic prescription.Other factors influencing prescribing errors were professionalbackground, age group of the patients, compounding drug andpolipharmacy. More than 50% physicians agreed and stronglyperceived ease of use and benefits of electronic prescribing.Conclusion: The electronic prescription reduced prescribingerrors due to the writing process, while additional supportsystems and clinical pharmacy interventions are needed toreduce prescribing errors due clinical decision making to improvemedication safety. Perceived benefits influenced utilizationof electronic prescribing greater than perceived ease ofuse.Keywords: medication error, prescribing error, electronic prescribing
PENGEMBANGAN MANAJEMEN PELAYANAN PALIATIF Effendy, Christantie
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Editorial
UPAYA MANAJEMEN RUMAH SAKIT DALAM MENDUKUNG KOLABORASI ANTARA DOKTER UMUM DAN SPESIALIS DI INSTALASI GAWAT DARURAT Gustantini, Lussy Messiana; Hasanbasri, Mubasysyir
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Background: General practitioners play a major role in runningthe service in the emergency department. As members ofthe team, general practitioners often disagree with specialistdoctors. Problems in communication and coordination oftenhave an impact on the poor service. They even have legalconsequences for the hospital.Objective: This study identified problems of collaboration betweengeneral practitioners and specialists in the managementof patients in the emergency unit, factors that impede thecollaborative process and evaluated efforts of hospital managementin supporting the collaborative process.Methods: This descriptive and exploratory study obtaineddata from in-depth interviews, official documents and routing,as well as participant observation and field observations.Results: General practitioners and specialists have a poorworking relationship that can be coined the legal consequencesin the management of patients in the emergency unit. Individualfactors such as a lack of confidence in the competence ofspecialist physicians, social closeness, the arrogance of specialiststo general practitioners, incomplete standards of carein the emergency unit, and physician adherence to hospitalpolicies and regulations are all obstacles in implementing cooperationteamwork in the emergency unit. The hospital management,on the other hand, takes a losing position in thepresence of doctors. Hospital management failed to prioritizethe development and the implementation of hospital bylawsthat control poor professional coordination and communication.The hospital management still has problems in contractsystem with the doctor, the procedures in the recruitment process,debriefing doctor, and the standard of care in the emergencyunit. This situation becomes more complicated with theexistence of blaming culture, no informal meetings betweendoctors, tacit practices in the supervision and guidance of themedical staff, as well as management’s lack of assertivenessoffenses committed by doctors on hospital policies and regulations.Conclusion: This study shows that general practitioners andmedical specialists fail to understand the legal consequencesof poor cooperation in emergency services. If a hospital managerdevelop and enforce the hospital bylaws relevant to situationalproblems in emergency care, reluctance and barrierscollaboration between physicians, personal issues, and professionalbias in medical practice would no longer a source ofpoor team performance. Hospital managers should enforcetheir hospital bylaws to control personal and professional arrogance.Keywords: Collaboration between GP and specialists, hospitalmanagement, emergency unit.
ANALISIS BESARAN BIAYA KAPITASI DAN PREMI BERDASARKAN BIAYA KLAIM DAN UTILISASI JPK PT JAMSOSTEK DIY Firdaus Hafidz As Shidieq, Dian Safriantini Julita Hendrartini
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Introduction: Debate on the issue of contributory SocialSecurity Agency (BPJS) for health have yielded disappointingresults. The majority of workers wanting health insurancedues BPJS as lowHowever, the premium that is too lowresulting in payments to health care provider also low. Theamount of the payment of low will affect the quality of servicesand satisf action participants over a health care benefitprogram.Methods: This study is a descriptive research design with acase study involving two data sources, primary and secondarydata. Primary data obtained through interviews and secondarydata obtained from reports the DIY branch office PT.Jamsostek.Results: Based on data of claim costs and utilization of service:In 2008, capitation Rp1.876,00 PMPM and premium Rp11.070,00;in 2009, capitation Rp1.973,00 PMPM and premium Rp11.085,00;in 2010, capitation Rp2.398,00 PMPM and premium Rp13.425,00;in 2011, capitation Rp2.403,00 PMPM and premium Rp14.921,00;in 2012, capitation Rp3.416,00 PMPM and premium Rp15.923,00.Perceptions of the family physician capitation date suggeststhat capitation received lower with the services they have toprovided.Conclusion: The capitation and premium is calculated usingdata cost of claims and the utilization of its value lower thanstandard the capitation and premiums set on PT Jamtsostekbranch DIY and PT Askes. The results of calculation of cost acapitation is also lower than the amount of capitation andpremium on the implementation of the National Health Insurance(JKN) in 2014 who sets capitation Rp8.000,00 to Rp10,000,00PMPM. Need of further studies concerning the benefit serviceclinic 24 hours in effect in jamsostek; an absence of adjustmentbetween magnitudes payment the capitation with the openservice and performance the doctors family.Keywords: capitation, premium, family physician perceptions
ANALISIS BIAYA RAWAT JALAN HEMODIALISIS DAN PERITONEAL DIALISIS MANDIRI BERKESINAMBUNGAN PADA PESERTA ASKES DI PT ASKES (PERSERO) DIVISI REGIONAL VI Bambang Djarwoto, Ika Eri Haryani Ari Probandari
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Background: End Stage Renal Diseases (ESRD) becomes aserious healthcare problem because of the increasingprevalence of RRT andhealthcare costs. ESRD patients needRenal Replacement Therapy (RRT). There are two types ofRRT: Hemodialysis (HD) and Continuous Ambulatory PeritonealDialysis (CAPD). Several previous studies showed that CAPDhas more advantage than HD, but it was stilldebated.Thebackground of the country and the healthcare cost systeminfluenced the treatment results CAPD and HD.Aims: The aim of the study wasto comparebetween HD costsand CAPD cost covered by PT Askes (Persero) or known asthe insurance medical cost and out of pocket cost from thepatients.Methods: This study was an observational comparative studywith descriptive analytical design. The data of insurance costwas obtained from Askes database, whereas the patient costwas taken by questionnaires. The subjects were 59 patientsundergoing HD and 50 patients undergoing CAPD in the centerof HD provided by PT Askes (Persero) Regional Division VI.Random sampling was conducted with consecutive samplingsystem.Results: The medianof HD insurance medical cost was Rp5.949.234,00/person/month, while CAPD was Rp5.023.792,00/person/month. There were also medical and non-medicalcostspaid by the patients. these median were Rp287.208,00/person/month for HD patients and Rp323.000,00/person/monthfor CAPD patients.30,5% of HD patients and 22% of CAPDpatients got their income decreased, whereasthe patient familythat got decreased their income were 10% of HD patient familyand 6% of CAPD patient family. The median of the incomereduction among HD patients and HD patient family wasRp2.250.000,00/person/month, whereas CAPD patients andCAPD patient family was Rp2.125.000,00/person/month.Conclusion: The HD insurance medical expenseswere higherthan that of CAPD. Compared to CAPD, thepatientexpenses(medical and non-medical) werelower in HD. Theincome deduction among HD patients and HD patient familywas bigger than the one in CAPD patient andCAPD patientfamily.Keywords: hemodialysis, continuous ambulatory perytonealdialysis, healthcare costs, cost-minimization analyses.
EFEKTIVITAS PELAYANAN SELAMA PENERAPAN CLINICAL PATHWAY SKIZOFRENIA RAWAT INAP DI RSUP DR. SARDJITO YOGYAKARTA Mahar Agusno, Ika Nurfarida Bambang Hastha Yoga
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Background Clinical pathway is a requirement for quality andcost control, especially on cases potentially exhausting onavailable resources. Schizophrenia is a mental disorder with apotency to exhaust available resources, therefore requiresevaluation for its service effectiveness.Method and Aims This study was a quasi experimentalstudy with qualitative approach. The aims of this study wereto assess the effectiveness of clinical pathway applicationand patient service during three months application of clinicalpathway for schizophrenia in the inpatient service in SardjitoHospital, Yogyakarta. The data for this study was obtainedfrom both primary and secondary sources.Result: Our results showed that the preparation phase forthe clinical pathway was appropriate with guideline providefor clinical pathway development in Sardjito Hospital.Nevertheless the application was still ineffective. T hecompleteness of the clinical pathway forms was only 33.11%.This was because the information about the clinical pathwayapplication was not properly disseminated to the informant.The design of the forms was difficult to read due to its smallfonts. The planning concepts for the inpatient service forschizophrenia according to the clinical pathway had not wellapplied. The verification and validation of the service providedby the residents in training by home psychiatrist were notconsisted and were not well documented.Conclusion: To solve this, dissemination of the clinical pathwaywith personal approach is required. The design of the clinicalpathway needs also to be improved. Commitment of eachmembers of the multidisciplinary team needs to be improved sothat the application of the planning concept and patient servicefor schizophrenia can fulfill the clinical pathway and theminimum service requirement.Keywords: effectiveness, clinical pathway, schizophrenia
UPAYA MANAJEMEN RUMAH SAKIT DALAM MENDUKUNG KOLABORASI ANTARA DOKTER UMUM DAN SPESIALIS DI INSTALASI GAWAT DARURAT Gustantini, Lussy Messiana; Hasanbasri, Mubasysyir
Jurnal Manajemen Pelayanan Kesehatan Vol 17, No 1 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (228.249 KB)

Abstract

Background: General practitioners play a major role in runningthe service in the emergency department. As members ofthe team, general practitioners often disagree with specialistdoctors. Problems in communication and coordination oftenhave an impact on the poor service. They even have legalconsequences for the hospital.Objective: This study identified problems of collaboration betweengeneral practitioners and specialists in the managementof patients in the emergency unit, factors that impede thecollaborative process and evaluated efforts of hospital managementin supporting the collaborative process.Methods: This descriptive and exploratory study obtaineddata from in-depth interviews, official documents and routing,as well as participant observation and field observations.Results: General practitioners and specialists have a poorworking relationship that can be coined the legal consequencesin the management of patients in the emergency unit. Individualfactors such as a lack of confidence in the competence ofspecialist physicians, social closeness, the arrogance of specialiststo general practitioners, incomplete standards of carein the emergency unit, and physician adherence to hospitalpolicies and regulations are all obstacles in implementing cooperationteamwork in the emergency unit. The hospital management,on the other hand, takes a losing position in thepresence of doctors. Hospital management failed to prioritizethe development and the implementation of hospital bylawsthat control poor professional coordination and communication.The hospital management still has problems in contractsystem with the doctor, the procedures in the recruitment process,debriefing doctor, and the standard of care in the emergencyunit. This situation becomes more complicated with theexistence of blaming culture, no informal meetings betweendoctors, tacit practices in the supervision and guidance of themedical staff, as well as management’s lack of assertivenessoffenses committed by doctors on hospital policies and regulations.Conclusion: This study shows that general practitioners andmedical specialists fail to understand the legal consequencesof poor cooperation in emergency services. If a hospital managerdevelop and enforce the hospital bylaws relevant to situationalproblems in emergency care, reluctance and barrierscollaboration between physicians, personal issues, and professionalbias in medical practice would no longer a source ofpoor team performance. Hospital managers should enforcetheir hospital bylaws to control personal and professional arrogance.Keywords: Collaboration between GP and specialists, hospitalmanagement, emergency unit.

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