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Waiting time is one indicator of health services. The increase in waiting time in the Emergency Department (ED) has an impact on longer treatment days, increased mortality and reduced patient satisfaction. The purpose of this study was to determine the length of stay for services at the emergency department of the Tangerang General Hospital using lean method to determine waste at each stage of activity. This research method is operational research with qualitative and quantitative approaches, primary data sources taken from direct observation using time motion study techniques and in-depth interviews. The waiting time at the ER at the Tangerang Regency General Hospital is 852.92 minutes for inpatients and 564.24 minutes for outpatients. The length of time for each service is as follows: triage is 11.83 minutes, waiting time for an emergency room doctor examination is 32.25 minutes, drug administration time and action is 22.33 minutes, waiting time for laboratory examination is 106.07 minutes, waiting time for examination radiology 140.15 minutes, waiting time for specialist doctor consultation 146.54 minutes, waiting time for inpatient registration 164.8 minutes, waiting time for inpatient admission 58.5 minutes, patient administration time going home 89.6 minutes. The largest nonvalued added activity is waiting for specialist consultations. Found 2 types of waste, namely waiting (93.3%) and motion (6.7%). After conducting an analysis using the 5 why method, the root of the problem was found in the number of nurses, not yet maximally carrying out tupoksi, hospital information system applications that are less user friendly, specialist doctors are not standby and consultation SOPs are not optimally run, lack of clinical experience of doctors ER, as well as the unavailability of the ward. The conclusion, t the waiting time in the ER at the Tangerang General Hospital exceeds the standard time (4 hours). The lean approach is appropriate to look for waste in health service activities so that problem solving efforts can be obtained to improve service waiting times in the IGD RSU Tangerang Gneral Hospital
Instalasi Gawat Darurat (IGD) merupakan salah satu bagian yang strategis dari Rumah Sakit, kegiatannya yang terus menerus selama 24 jam mempakan cermin kinerja Rumah Sakit sehingga kesan pertama pelanggan Rumah sakit dapat terlihat dari penampilan dan kemampuan kerja. Tujuan Penelitian ini adalah menghasilkan rumusan perencanaan strategis untuk pengembangan IGD BPK-RSUD Datu Iieru Takengon dengan menggunakan pendekatan Balanced scorecard penclitian ini menggunakan pendekatan kualitatif dimana data sekundef' diperoleh dari BPS (Badan Pusat Statistik) Aceh Tengah Pemda Aceh Tengah, Dlnas Kesehatan Aceh Tengah dan profil BPK-RSUDB Aceh Tengah. Pengumpulan informasi dilakukan dengan wawancara menclalam dan CDMG (Consensus Decision Making Group). Teknik penyusunan strategi dilakukan melalui tiga tahapan, yaitu: Tahap I (Input Stage) meliputi analisis Iingkungan ekstemal dan lingkungan internal dengan menggunakan Mafriks Elrsremal Factor Evaiuatfon ( EFE ) dan Matrilcs Internal Factor Evalualfan ( IFE ). Dari hasil analisis input srage diperoleh hasil skor total faktor EFE adalah 2,30 sedangkan untuk total faktor IF E yaitu 2,65 Tahap II (Matching Stage), pada mhap ini dilakul-can pencocokan atau penyesuaian dengan menggunakan matriks SWOT dan matriks IE, berdasarkan analisis kedua matriks tersebut diketahui bahwa posisi IGD BPK-RSUD Datu Beru Takengon berada pada sel V yaitu hold and maintain dengan strategi yang dianjurkan adalah Product Development dan market Peneration. Berdasarkan altcmatif strategi terseiaut, strategi yang terpilih menjadi prioritas utama adalah Product Development. Tahap IH ( Decision Stage ) meliputi penetapan strategi terpilih IGD BPK-RSUD Dam Beru Takengon tahun 2008 - 2012. Berdasarkan basil scoring matriks QSPM (Quantitatg' Straregic Planning Matrix), diperoleh 4 strategi terpilih yang dijabarkan menjadi 6 tujuan strategi, dimana perspektif keuangan 2 tujuan straiegi, perspektif pelanggan 2 tujuan strategi, perspektif proses bisnis intemal 3 tujuan strategi serta perpektif pertumbuhan dan pembelajaran 3 tujuan suategi, Sedangkan pengadaan alat-alat kesehatan dan diagnostik IGD menjadi prioritas utama untuk diimplementasikan, dalam melaksariakan strategi terpilih, IGD BPK-RSUD Datu Bern Takengon mendapat duklmgan scpenuhnya dari Pemda Aceh Tengah melalni anggaran APBD dan APBN. Selain dilakukan Penetapan ukuran (Key Performance Indicator) dari masing-masing tujuan strategi bescrln penanggungiawabnya juga dilakul-Lan pendeiinisian dan penetapan target dari masing- masing KPI untuk jangka waktu lima tahun mendatang. Kesimpulan secara umum dengan memperhatikan beberapa komponen yang sesuai dengan kondisi IGD BPK-RSUD Dam Benn Takengon saat ini maka pengembangan gedung IGD aan pengaaam smug dan fasilitas IGD mmm 2008~20l'2 dapat direalisasikan. Saran kepada Pemda Aceh tcngah, selain anggaran untuk invcstasi juga dialokasikan anggaran khusus untuk operasional IGD. Unruk BPK RSUD-Datu Beru Takengon, perencanaan strategik yang telah disusun sebaiknya disosialisasikan, Sedangkan untuk implementasi Balanced Scorecard disarankan KPI yang sudah ditetapkan untuk masing-masing penanggung jawab sebaiknya di distribusikan ke struktur dibawahnya sehingga musing-musing bagian yang tcrkait mempunyai KPI. IGD BPK-RSUDB hams mempunyai standar kinegia yangjelas dan terukur, pemberian bobot pada sctiap KPI dapat dirancang ulang alan direvisi oleh masing- masing pemilik KPI, perlunya dukungan clan komitmen dari Stake Holder untuk mensosialisasikan Balanced Scorecard di seluruh jajaran BPK RSUD dalam mendukung kemajuan IGD BPK-RSUD Dam Beru Takengon dimasa mendatang.
Emergency Installation (IGD) is a strategic part of hospital. Its continuous 24 hours activity is a reflection of hospital perfonnance and hence tirst impression of hospital is resulted from performance of IGD. This study objective was to develop a strategic planning on the development of Emergency msallarisn in Dam Bern liospital (BPK-RsUnB),Takengon, cena-at Aceh using Balance Scorecard. The study was a qualitative study with secondary data liom Statistics Bureau Oiiicc Central Aceh, Central Aceh Government Office, Central Aceh Heqalth Oflice, and profile of BPK-RSUDB. Data was collected through in-depth interview and Consensus Decision Making Group. Strategic planning was developed through three stages, namely Input Stage including extemal and intemal environment analyses using Extemal Factor Evaluation (EFE) and Intemal Factor Evaluation (IF E). The analyses show that total scores for EFB was 2.30 and IFE was 2.65. The second stage was Matching Stage where matching or adjustment was done using SWOT matrix and IE matrix. Based on those matrices, it was known that position of IGD BPK-RSUDB was in cell V, namely ?hold and maintain? with advised strategy of ?Product Development? and ?Market Penetration". Between those two strategies, the chosen priority strategy was ?Product Development". 'Third stage was Decision Stage including determination of strategy. Based on Quantitative Strategic Planning Matrix, four strategies was expanded to 6 strategic objectives consisting of 2 strategic objective in finance, 2 strategic objectives in customer, 3 strategic objectives internal business process, and 3 in growth and teaming. The procurement of health and IGD diagnostics equipments was prioritized to be implemented. The hospital was supported by Aceh Tengah Govemment Office through APBN and APBD funding schemes. Beside the determination of Key Perfomance Indicator fiom each strategic objective and the persons incbarge, delining and targeting were also conducted for the next tive years. It could be concluded that considering the components of IGD BPK-RSUDB at the present time, the development of IGD and procurement of equipment and facilities year 2008-2012 could be implemented. It is suggested to Central Aceh Govemment to allocate speciiic funding for IGD operationalization beside investment allocation. Strategic planning that had been develop should be informed and balance scorecard should be distributed until the lower level including the KPI. Performance standard should be clear and measurable, weighing of KPI could be re-designed or be revised by each KPI owner, there is need of support and commitment 'from all stakeholders to socialize Balance Scorecard among all management of BPK-RSUDB to improve the performance in the future.
Implementation of ISO 9001:2008 Quality Management Standards have beenimplemented in BRSU Tabanan since 2009 in an effort to improve the quality ofcare , but there are still complaints against the ministry in BRSU Tabanan . Untilnow, this has never been done in the Emergency Room service performanceanalysis on the application of ISO 9001:2008 Quality Management StandardBRSU Tabanan . This study was conducted aimed to determine and analyze theperformance of services in the emergency department on the application of ISO9001:2008 QMS in Emergency Room BRSU Tabanan.Do months from August toOctober , 2013, with a qualitative research method that comes with thequantitative data is secondary data quality objectives in the Emergency Room asindicator performance .. Respondents service satisfaction in the emergencydepartment for patients or their families were coming month of August to October2013, which are willing to fill out a questionnaire , as many as 150 people .Emergency Room staff and staff working in the field of service of at least 3 yearsas respondents in the application of ISO 9001:2008 QMS Emergency Room are71 . In-depth interviews to the Board of Directors as an informant were 3 peoplein the achievement of performance information in the Emergency Room and theapplication of ISO 9001:2008 QMS . Data were analyzed using content analysis .The results show the performance of services in the Emergency Room alreadywell on target mutul 9 of 12 quality objectives in the Emergency Room . Qualityobjectives is not good customer complaints , customer dissatisfaction with theservices of doctors and patient mortality in Emergency Room ≤ 24 hours .Required an increase in the budget aimed at improving the quality of humanresources in the emergency department with increasing hospital revenue ,completing facilities for intensive care and resocialization of the application ofQMSKeyword : Performance Emergency Room Services, ISO 9001:2008 QMS
Dewasa ini pola penyakit cenderung mengalami perubahan. Penyakit-penyakit yang disebabkan oleh perubahan gaya hidup misalnya trauma semakin meningkat. Sedangkan di Indonesia trauma merupakan penyebab kematian tertinggi pada usia 15-45 tahun dan kematian yang disebabkan kecelakaan menempati urutan keempat tertinggi. Propinsi Lampung, terletak pada daerah yang merupakan perlintasan arus transportasi darat dari dan menuju Pulau Jawa dan Sumatera, daerah ini memiliki tingkat resiko kecelakaan lalu lintas yang tinggi, dan ini terlihat dan banyaknya kasus trauma yang ditangani di IGD RSAM lebih dan 4000 kasus pertahun. Sebagai rumah sakit rujukan tertinggi di propinsi ini maka RSAM berkeinginan untuk mengembangkan IGD nya menjadi pusat pelayanan trauma di Propinsi Lampung. Tujuan penelitian ini adalah mendapatkan gambaran situasi Instalasi Gawat Darurat RSUD Dr. H. Abdul Moeloek untuk menjadi pusat pelayanan trauma di Propinsi Lampung. Penelitian ini menggunakan pendekatan kualitatif informasi yang didapat berupa data primer melalui observasi dan wawancara mendalam dan data sekunder melalui telaah dokumen. Hasil penelitian menunjukkan bahwa Pemda Propinsi Lampung memberikan dukungan sepenuhnya baik (dari segi anggaran maupun politis guna mewujudkan pusat pelayanan trauma ini, dengan jumlah total penderita trauma yang dilayani di IGD RSAM mencapai diatas 4100 pertahun, sekitar 1500(37%) penderita pertahun merupakan kasus trauma yang membutuhkan perawatan dari suatu pusat pelayanan trauma, dan dan jumlah tersebut I044 (69%) adalah penderita trauma serius/trauma parah. Dengan jumlah seperti ini menurut informan maka RSUD Dr. H. Abdul Moeloek sudah memerlukan tersebut 1044 (69%) adalah penderita trauma serius/ trauma parah. Dengan jumlah seperti ini menurut informan maka RSUD Dr. H. Abdul Moeloek sudah memerlukan penanganan oleh Tim Trauma dan dengan 460 tempat tidur dan BOR 85% memenuhi kriteria pusat pelayanan trauma tingkat dua. Sumber Daya Manusia yang dimiliki dari kompetensi dokter spesialis sudah memenuhi standar jumlah dan tenaga pendukung nonmedis masih kurang. Untuk dokter umum dan tenaga paramedik jumlahnya sudah memenuhi standar tetapi kompetensi yang dimiliki belum memenuhi standar. Untuk fasilitas fisik sudah memenuhi standar, kecuali kemiringan ramp lebih dari 20°, tidak memiliki pintu khusus untuk pasien dengan alat pengangkut, untuk fasilitas alat medik sudah memenuhi standar pusat pelayanan trauma, hanya belum memiliki alat torakosintesis, dan pada ruang resusistasi belum memiliki kotak pemanas cairan infus, gantungan infus dari langit-langit serta alat komunikasi khusus, sedangkan fasilitas layanan intensif belum memenuhi standar karena belum memiliki HCU, depo penyediaan darah dan untuk layanan CT Scan pada radiologi belum memenuhi standar karena hanya melayani pada pagi hari. Kesimpulan secara umum dengan memperhatikan komponen penderita dan komponen umum berdasarkan kondisi saat ini maka pusat pelayanan trauma RSUD Dr. H. Abdul Moeloek berada pada tingkat tiga menuju dua, dan pada tahun 2006 ini dapat di realisasikan. Saran kepada Pemda Propinsi Lampung, selain anggaran untuk investasi juga dialokasikan anggaran khusus untuk operasional pusat pelayanan trauma tersebut. Dinas Kesehatan Propinsi harus melakukan sosialisasi kepada rumah sakit-rumah sakit kabupaten/ kota tentang penanganan penderita trauma dan kriteria kasus trauma yang perlu dirujuk ke Pusat PeIayanan Trauma RSUD Dr. H. Abdul Moeloek. Kepada RSUD Dr. H. Abdul Moeloek, dilakukan penambahan dokter spesialis dan penambahan tenaga non medik, pelatihan khusus trauma untuk dokter umum dan paramedik, memperbaiki kekurangan pada fasilitas fisik dan melengkapi fasilitas alat medik serta untuk fasilitas layanan pendukung layanan CT Scan diberikan dalam 24 jam, melengkapi sarana prasarana HCU dan menyiapkan depo penyediaan darah.
In recent days, the pattern of the disease or illness is tending to change. Diseases caused by the changing of lifestyle, such as trauma, are likely to increase. in Indonesia, trauma has been a highest leading cause of death among people age 15 to 45, and death cause by accident is the forth highest. Province of Lampung is located on the area of cross-land transportation from and to the island of Java and Sumatera, and having a very high risk of road accident. It can be seen from the high number of trauma cases handled in the Emergency Room (ER) of District General Hospital of Dr. H. Abdoel Moeloek (DGHAM), which are as high as 4,000 cases per-year. Therefore, as the highest referral hospital in the province, DGHAM need to develop its ER and shifted to be a Trauma Service Center (TSC) for the province of Lampung. The aim of the study is to find out the description of situation on the ER of DGHAM that will shift to be a TSC. The study using a qualitative approach, and the information obtained are a primary data from observation and in-depth interview, and secondary data from documents review. The study found that District Authority (Pemda) of Lampuitg Province is giving fully supports both on budgeting and politically, in order to develop the TSC to become a reality. With the total cases handled at the ER of DGHAM are more than 4,100, about 1,500 (37%) of those are patients of trauma that need advance and intensive care form a trauma service center, and from those numbers, about 1,044 (69%) are having serious and severe trauma_ Informant from the DGHAM stated, with a figure as explained above the DGHAM is suppose to be have its own Trauma Team, and with 460 beds and BOR as high as 85% that makes DGHAM have a criterion for the level two of TSC. Regarding to the human resources, DGHAM has reach the standard of competency for its specialist doctors, but still have a lack on number of non-medic supporting staffs. It also has an adequate number on GPs and paramedic personnel, but they have not yet reach their standard of competency. DGHAM also has reached the standard for facilities, physically, but still have some exception, such as: the slope of the building is more than 20°, and there is no special entrance for patient that carried by cart. The facility on medical instruments and utensils has fulfilled the standard for TSC, but there is no instruments for thoracosinthesys, and at the resuscitation room, there is not yet have a warmer box for warming liquid infuse, infuse hanger at the ceiling, and a communication device. However, facilities for the intensive service has not fulfill the standard for an intensive services because there is no HCU instrument, blood reserve depot, and CT Scan services at the radiology department is only gave services in the morning. In general conclusion, with regard to the components on the situation of patients and condition of ER at DGHAM, it can be said that DGHAM have status for being a TSC level three to become a TSC level two, and it is hoped that in this year of 2006 can be brought into reality. Suggestion for Pemda of Lampung Province, beside the budget for investment, it is also needed to have special budget for the operational of the TSC. For DGHAM, there is a need to increase the number of specialist doctors and non medic supporting staffs, special trauma training for the GP and paramedic personnel, to improve the facilities on the building, and to complete the medical instruments, to provide 24 hours service for CT Scan, and also to supply the HCL' instrument and to have the blood reserve depot.
RSUD Kota Bekasi sebagai Badan Layanan Umum (BLU) harus meningkatkan daya saing RS di era globalisasi dengan melakukan refonnasi manajemen yang diharapkan dapat menyelesaikan berbagai masalah manajemen dalam efisiensi. produktivitas, kualitas dan patient responsiveness. BLU mempakan suatu badan kuasi Pemerintah yang tidak bertujuan mencari laba, meningkatkan kualitas dan memberikan fleksihilitas manajemen RS. RSUD Kota Bekasi merupakan satu dari beberapa RS yang beberapa RS yang berada di perbatasan dengan DKI Jakarta, sehingga tingkat persaingan sangat tinggi, dengan demikian diperlukan pengembangan strategi yang jelas dan penjabarannya sampai ke tingkat operasional. Untuk itu peneliti berusaha untuk membantu penerapan strategi dengan menggunakan Balanced Scorecard di IGD scbagai he frontliner RSUD Kota Bekasi. Balanced Scorecard (BSC) merupakan a1at manajemen untuk menttansfonnasikan strategi menjadi aksi. BSC mampu menje1askan dan rnenerjemahkan strategi secara komprehensif dan dapat dijatankan dalam kegiatan operasional sehari-bari. Kinetja ditetjemahkan ke dalam sasaran dan tolok ukur yang jelas dan spesifik melalui keempat perspektif : keuangan, pelangganproses bisnis internal. serta pembelajaran dan pertumbuhan sehingga kinelja dapat dimonitor dan dievaluasi secara berkafa untuk mengetahui kemajuannya dalam pencapaian strategi. (Kaplan dan Norton, 1996). Penelitian yang dilakukan merupakan pcnclhian operasional (Riset Operasional), yaitu penelitian yang berhubungan dengan penernpan suatu metode yang sesuai dengan somber daya yang tersedia. Dalam tahap pengembangan BSC, dibagi kinerja yang didasarkan pada uraian jabalan belum pemah dilakukan, tidak ada evaluasi terhadap kinerja setiap individu yang bertugas di IGD, yang ada hanya mengukur jumlah kunjunganjumiah pendapatan, dan survei kepuasan pelanggan. 4) Penilaian kinerja di Instalasi Gawat Darurat beJum memiiiki aJat ukur dan basil akur. Penilaian kine!ja yang ada hanya berdasarkan indikator (SPM) IGD yang dltetapkan DepKes. 5) Media komunikasi dilakukan sebulan sekali, namun jika ada pennasaiaban mendadak seperti keluhan pasien atau keluban dokter spesiatis, maka rapat bisa dilakukan sewaktu-waktu. namun belum dioptimatkan sebagai media monitoring: dan evaluasL Fase II Proses Cascading Strategi RS yaitu : 1) strategi IGD yang sesuai visi dan misi didapatkan melalui wawancam dan FGD rnengbasilkan pengembangan strategi yang disepakati bersarna. 2} Pengembangan strategi juga dituronkan dari renstra RSUD, 3) Pela Strategi IGD dibuat melalui dua iterasi, melalui FGD dan CDMG, 4) Membangun BSC dengan empat perspektif di dapat perspektif pelanggan 25%, proses bisnis internal 35o/o, pembelajaran dan pertumbuhan 25%, keuangan 15%. Berdasarkan penelitian ini, dapat diketahui bahwa sangat diperlukan suaut penjabaran KPI yang jelas untuk masing-masing pemegang jabatan dan individu yang disesuaikan dengan tugas dan tanggung jawab. Sistem Pelapon:rn dan review KPI perlu dijalankan secara berkala agar dapat diketahui kemajuan dalam pencapaian strategi melalui pencapaian KPJ. Eva1uasi kinerja hendaknya didasrakan pada pencapaian KPI pada masing-masing individu.
RSUD Kota Bekasi as a Public Service Board have to well-develop to face hospital competition as global by reforming management to manage all those management's complexity in such efficient. productivity, quality and patient responsiveness. Public Service Board becoming a government institution which is a Non-Profitable entity, up grading the quality and giving hospital's management to more flexible way. RSUD Kota Bekasi is one from those hospitals which is located at the border from DKI Jakarta. This means the degree of competition is very high, therefore need a clear strategy development in all sectors, especially at operational sector. Research and Development people has to help out to implement all strategies by using Balanced Scorecard at Emergency Department as the front/iner RSUD Kota Bekasi. Balanced Scorecard (BSC) is a management tool in transforming all strategy into action. BSC can explain and translating in such comprehensive way and can be implemented as a daily operational. Productiveness can be translated and can became a clear specific measurement through 4 perspective such as financial, customer, internal business and learning procedure and growth which all these can be monitored and being evaluated into several steps to know whether the growth still in corridor of strategy achievement. (Kaplan dan Norton, 1996). Any research taken is an Operational Research which is related in implementation a method with all provided internal resources. There are 2 phases in BSC's development step. Phase I is Analyzing Current Performance system to review the system that already implemented, then Phase II is Cascading Process of satisfaction survey.4) The productivity measurement at Emergency Department of performance appraisal is not clear. 5) Regular meeting is taken monthly. however if there is an urgent incident such complaints the meeting an optimized as media monitoring dan evaluation. Phase II Cascading Process of Hospital's Strategy are : 1) AU Emergency Department's strategy relating with hospital's vision and mission which obtained through interview and FGD resulting strategy development to all members 2) planning also giving several feedback for strategy development.3) Emergency Department Strategy Map is made through two iteration, which are through FGD and CDMG, 4) Developing BSC with four perspectives are consists of 25% of Customers perspective, 35% of Internal Business. 25% of learning and growing then J 5% of financial. Through this research, we can make a conclusion that a very clear of KPl s cascading is really a crucial part to aU hospitat?s members and to every person to aU their duties and responsible. System report and review of KPI need to be done step by step so can be noticed on the strategic achievement Productivity evaluation must base on the achievement to each person individu.