UPAYA MANAJEMEN RUMAH SAKIT DALAM MENDUKUNG KOLABORASI ANTARA DOKTER UMUM DAN SPESIALIS DI INSTALASI GAWAT DARURAT

Abstract

Background: General practitioners play a major role in running
the service in the emergency department. As members of
the team, general practitioners often disagree with specialist
doctors. Problems in communication and coordination often
have an impact on the poor service. They even have legal
consequences for the hospital.
Objective: This study identified problems of collaboration between
general practitioners and specialists in the management
of patients in the emergency unit, factors that impede the
collaborative process and evaluated efforts of hospital management
in supporting the collaborative process.
Methods: This descriptive and exploratory study obtained
data from in-depth interviews, official documents and routing,
as well as participant observation and field observations.
Results: General practitioners and specialists have a poor
working relationship that can be coined the legal consequences
in the management of patients in the emergency unit. Individual
factors such as a lack of confidence in the competence of
specialist physicians, social closeness, the arrogance of specialists
to general practitioners, incomplete standards of care
in the emergency unit, and physician adherence to hospital
policies and regulations are all obstacles in implementing cooperation
teamwork in the emergency unit. The hospital management,
on the other hand, takes a losing position in the
presence of doctors. Hospital management failed to prioritize
the development and the implementation of hospital bylaws
that control poor professional coordination and communication.
The hospital management still has problems in contract
system with the doctor, the procedures in the recruitment process,
debriefing doctor, and the standard of care in the emergency
unit. This situation becomes more complicated with the
existence of blaming culture, no informal meetings between
doctors, tacit practices in the supervision and guidance of the
medical staff, as well as management’s lack of assertiveness
offenses committed by doctors on hospital policies and regulations.
Conclusion: This study shows that general practitioners and
medical specialists fail to understand the legal consequences
of poor cooperation in emergency services. If a hospital manager
develop and enforce the hospital bylaws relevant to situational
problems in emergency care, reluctance and barriers
collaboration between physicians, personal issues, and professional
bias in medical practice would no longer a source of
poor team performance. Hospital managers should enforce
their hospital bylaws to control personal and professional arrogance.
Keywords: Collaboration between GP and specialists, hospital
management, emergency unit.