Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management)

PENGALAMAN PASIEN RAWAT JALAN DI RSIA MARDI WALOEJA RAMPAL, MALANG

Dipa Elyana, Adi Utarini, Betha Candra Sari — Mon, 05 Feb 2024 14:58:20 +0700

Background: In recent years, there has been a trend away from global satisfaction measures to a more detailed measurement of the patient experience. While the measurement of service quality through patient experience is still rarely done in Indonesia. The number of hospitals in Malang city increase every year that creates fairly tough competition in hospital business. To answer that challenge, RSIA Mawar has measured the patient satisfaction index with an achievement of 82-89% with the lowest satisfaction score in outpatient services. Even so, hospital still received several negative comments written by patients in the 'suggestions and input' column on the patient satisfaction form. This indicates that the patient satisfaction survey has not described the real experience that patients receive.

Objectives: To describe the outpatient experience and formulate recommendations for improving the outpatient experience at RSIA Mardi Waloeja Rampal, Malang.

Methods: The design of this study is a retrospective case study. The research subjects were patients in outpatient services, doctors and nurses in outpatient services, and related hospital management. Quantitative data were collected by translated and modified outpatient experience questionnaire (OPEQ). Quantitative data will be processed and presented descriptively. Qualitative data were obtained by in-depth interviews with outpatients, doctors, and nurses as well as discussions with groups of hospital management. Qualitative data was analyzed thematically.

Results: Quantitative studies show that the majority of respondents agree with the statements in the outpatient experience questionnaire. Qualitative studies dig deeper informations into quantitative results and also generate recommendations for improvement. In addition to the seven dimensions of outpatient experience, it was found that the number of human resources in the hospital was also considered to influence the patient experience.

Conclusions: The dimension that has provided a good experience in outpatient services is the dimension of nurse-patient communication. The dimensions that still need improvement are the dimensions of health information and medical costs. There are several recommendations that have been formulated to improve the outpatient experience. RSIA Mawar is expected to be able to measure patient experiences and discuss it regularly.

STRATEGI PENINGKATAN PENERIMAAN PENGGUNA REKAM MEDIS ELEKTRONIK

Izzatul Muna, Guardian Yoki Sanjaya — Mon, 05 Feb 2024 00:00:00 +0700

Background: The benefits of using electronic medical records have encouraged the government and hospitals in Indonesia to continue developing them. Many factors support and hinder the successful implementation of electronic medical records. User acceptance is a key variable in the mandatory use of electronic medical records. The Unified Theory of Acceptance and Use of Technology is the theory used to evaluate EMR and factors that influence user acceptance, namely intention to use RME.

Objective: This study aims to identify the influence of UTAUT indicators on the behavior intention to use outpatient electronic medical records.

Methods : This research used a descriptive case study approach with a location at PKU Muhammadiyah Wonosobo Hospital with a sample of all users of outpatient electronic medical records. The research was conducted with in-depth interviews with 10 informants and distributing questionnaires to 95 respondents who were analyzed using SmartPLS.

Results: Outpatient RME users at PKU Muhammadiyah Wonosobo Hospital accept to use and utilize the system now and in the future due to positive perceptions of performance expectations, effort expectations, and facility conditions. Obstacles are still found that hamper the acceptance of outpatient RME users including RME not yet integrated with all services in the hospital, RME feature dysfunction, interoperability interference, data access is not automatic, availability of inappropriate infrastructure, lack of availability of skilled IT human resources, lack of regulation. Performance expectation has a positive and significant effect on usage intention (t=2.381; p=0.018). Expectation of effort has a positive and significant effect on intention to use (t=2.004; p=0.046). Facility conditions have a positive and significant effect on usage intention (t=2.245; p=0.025). Social influence has an insignificant positive effect on intention to use (t=1.179; p=0.239).

Conclusion : Increasing user acceptance of EMR is done by increasing performance expectations, business expectations, and facility conditions that support implementation. User expectations for the use of RME in the future are system improvements, all user needs accommodated, and interoperability so that the system can be fully integrated.

HUBUNGAN KEPUASAN KOMPENSASI, MOTIVASI KERJA, DAN KINERJA PERAWAT DI RS AKADEMIK UGM

Rosyida Avicennianing Tyas, Andreasta Meliala — Mon, 05 Feb 2024 00:00:00 +0700

Background: Nurses are the largest human resource that has a big impact on the quality of health services to patients. Good nurse performance will result in good quality health services as well. Employee performance will increase if employees are satisfied with the compesation they receive and have high work motivation. UGM Academic Hospital began implementing a remuneration system in October 2021, but there are still pros and cons to its implementation. After the remuneration system was implemented, there was no significant improvement in nurse’s performance. Various problems that occur in terms of employment status and work environment can also affect nurse’s work motivation.

Objective: To measure the relationship between remuneration system satisfaction, work motivation and nurse performance at UGM Academic Hospital.

Method: Case study research with an explanatory design. Quantitative data was obtained from the results of filling out questionnaires and documentation studies. Qualitative data was obtained from in-depth interviews with representatives of nurses, other professions (doctors), representatives of room heads, heads of nursing, HR directors, and the remuneration team.

Results: The level of work motivation of UGM Academic Hospital nurses was classified as medium and tended to be high, as many as 86.5% were in the medium category, while the other 13.5% were in the high category. The level of compensation satisfaction classified as medium tends to be low, as much as 60.1% is in the medium category, while the other 39.9% is in the low category. The results of the Spearman's Rank Correlation test on work motivation and performance show a p-value of 0.814 with a correlation coefficient of 0.018, while test on compensation satisfaction and performance show a p-value of 0.484 with a correlation coefficient of 0.053.

Conclusion: There is no relationship between work motivation and compensation satisfaction on the performance of UGM Academic Hospital nurses.

IMPLEMENTASI LEAN SIX SIGMA UNTUK MENURUNKAN VARIASI DAN WAKTU PROSES PENGADAAN OBAT DI INSTALASI FARMASI RUMAH SAKIT ISLAM AMAL SEHAT SRAGEN

Meyta Radhila Gwen, Erna Kristin, Firman — Mon, 05 Feb 2024 15:42:01 +0700

Background: Drug management needs to be done to prevent stock out, over stock, and drug purchases due to emergency conditions. Reports of drug management problems at Amal Sehat Sragen Hospital are stock outs resulting in immediate drug purchases and patients do not get the drug as they should. Lean Six Sigma combines two methodologies to help speed up certain processes so they can solve problems faster while creating more value for customers. When combined, these create a powerful methodology for managing a business and completing tasks on time, on budget, saving money, adding value and increasing productivity.

Objectives: Assessing the implementation of Lean Six Sigma to reduce variation and processing time for drug procurement at the Pharmacy Installation of Amal Sehat Sragen Hospital.

Methods: The method used in this study is a mixed methods with a Participatory Action Research (PAR) approach.

Results: The results of the sample data that has variations and processing time are correlated with criticality, cost, and performance values to obtain Importance Index (II) values. Calculation of Importance Index (II), before implementation, 3 items with high Importance Index (II) values were obtained, namely "Gabapentin 300mg" (8.7), "Metformin 500mg (11.8), and "Lisinopril 5mg" (10.7) which decreased after implementation to “Gabapentin 300mg” (4.5), “Metformin 500mg (3.2), and “Lisinopril 5mg” (5.3). Assessment of the effectiveness and efficiency of drug procurement by measuring the lead time in cycle I was 9 days 23 hours 25 minutes, decreasing to 4 days 7 hours 50 minutes in cycle III. The efficiency measure based on the Value-added ratio (VAR) in cycle I was 14% and increased to 34% in cycle III.

Conclusions: The implementation of Lean Six Sigma with DMAIC (Define, Measure, Analyze, Improve, Control) and Participatory Action Research approaches (three cycles) was able to reduce variations in the drug procurement process (critical criteria, performance, and cost) and overall lead time in the drug procurement process at Amal Sehat Sragen Hospital.

ANALISIS FAKTOR YANG MEMENGARUHI MORTALITAS PASIEN RAWAT INAP DI RUMAH SAKIT AKADEMIK UGM

Diasa Ayu Raharni, Hanevi Djasri, Dewi Ratmasari — Tue, 06 Feb 2024 00:00:00 +0700

Background: Hospital mortality indicators are important element of a hospital patient safety monitoring program. In 2022, the record of inpatient performance at RS Akademik UGM (RSA UGM) shows that the NDR value has not yet reached the ideal standard, namely 34.1‰.
Objective: Identifying factors that influence the mortality rate of adult patients ≥48 hours in inpatient care and developing a program plan to reduce hospital mortality at RSA UGM.
Methods: An explanatory sequential design of mixed methods research was used. The medical records of adult patients admitted to RSA UGM from October 2022 to December 2022. Quantitative data analysis used chi-square, Fisher’s exact tests and multivariate logistic regression. Qualitative data was obtained from focus group discussions with three separate groups, namely the managerial group, the doctor team and the nurse team., while qualitative data used thematic analysis.
Results: 388 subjects were obtained with 18 (4.64% or 46.4‰) patients died during treatment ≥48 hours. Independently, ward type (OR 10,799, CI 95 % 3,990 – 29,233), EWS score (OR 15,644, CI 95 % 5,511 – 44,412) and number of comorbidities (OR 8,603, CI 95 % 2,769 – 26,730) associated with with ≥48 hours in-hospital mortality (<0.001). Multivariate analysis showed that ward type (p=0.018, aOR 4,122, CI 95 % 1,279 – 13,284) and early warning system (EWS) score (p=0.016, aOR 4,531, CI 95 % 1,327 – 15,469) had a strong association with ≥48 hours in-hospital mortality. Qualitative results show that the problems faced daily related to the increasing death rate are the high complexity of patients, inadequate ICU facilities and inadequate human resource competency; the proposed program to reduce inpatient mortality by improving clinical management in intensive care, improving the competency and skills of doctors and nurses, and increasing the effectiveness of the early warning system.
Conclusion: The EWS score >5 and the intensive care are significantly related to in-hospital mortality ≥48 hours after hospitalization so it is important for management to improve the quality of services at the RSA UGM by carry out a strategy to reduce hospital mortality rates in order to decrease the net mortality rate in accordance with the Ministry of Health’s national standards.