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Kartika Malahayati; Pembimbing: Jaslis Ilyas; Penguji: Atik Nurwahyuni, Vetty Yulianty Permanasari, Muhamad Nur Ihwan,
Purwa Kurnia Sucahya
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Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit di bawah sistem pembayaran INA-CBGs. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INA-CBGs dan global budget yang mulai diujicobakan. Penelitian ini dilakukan dengan tujuan untuk menganalisis capaian dan determinan indikator casemix, casemix index dan hospital baserate RSPG Cisarua Bogor selama tahun 2017 – 2022. Penelitian akan dilakukan selama bulan Mei – Juni 2023 oleh peneliti langsung di RSPG Cisarua Bogor. Analisis capaian indikator casemix, casemix index dan hospital baserate rumah sakit menggunakan data sekunder yang didapatkan dari rekapitulasi data pada elektronik klaim (e-klaim) Kementerian Kesehatan. Determinan yang berpengaruh terhadap ketiga indikator yang dihitung dalam penelitian ini akan dianalisis secara crossectional melalui pendekatan analitik kuantitatif dari data sekunder berupa e-klaim dan laporan rumah sakit. Uji statistik berupa uji korelasi dan regresi linier sederhana digunakan untuk melihat determinan yang berkaitan dengan indikator casemix, casemix index dan hospital baserate. Hasil penelitian menunjukkan tren casemix rawat jalan dan rawat inap tahunan RSPG mengalami penurunan dari 2017 hingga 2021 seiring dengan penurunan jumlah kasus. Penurunan pada tahun 2020 dan 2021 diakibatkan adanya penurunan jumlah kasus yang signifikan selama pandemi Covid-19. Nilai casemix di tahun 2022 kembali naik seiring membaiknya kondisi pandemi di Indonesia. Capaian casemix index rawat jalan dan rawat inap RSPG Cisarua lebih rendah bila dibandingkan dengan rata-rata capaian casemix index RS Pemerintah Kelas A di regional I. Terjadi kenaikan casemix index saat pandemi Covid-19 dikarenakan masyarakat berobat dalam keadaan lebih parah di saat pandemi. Hospital baserate rawat jalan RSPG tahun 2017 dan 2021 masih berada di bawah tarif nasional, sedangkan tahun 2018, 2019, 2020, dan 2022 hospital baserate lebih tinggi dibandingkan tarif nasional. Hospital baserate rawat inap RSPG secara konasisten lebih tinggi dibandingkan tarif nasional. Artinya biaya yang dikeluarkan rumah sakit lebih tinggi dibandingkan tarif yang dibayarkan oleh BPJS dalam menangani kasus dengan nilai cost weight=1. Terdapat 5 variabel yang bernilai signifikan dengan p<0,05 terhadap casemix rawat jalan, yakni jumlah kasus, jumlah klinik rawat jalan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Variabel yang berkorelasi secara statistik terhadap casemix rawat inap adalah jumlah kasus, severity level II dan III, lama hari perawatan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Jumlah klinik rawat jalan dan proporsi beban pegawai memiliki hubungan dengan capaian casemix index rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, serta jumlah dokter spesialis yang praktek di rumah sakit secara statistik berpengaruh terhadap capaian casemix index rawat inap. Hospital baserate di rumah sakit dihitung dengan membagi total biaya dengan casemix. Jumlah klinik rawat jalan, jumlah dokter spesialis, dan proporsi beban pegawai memiliki hubungan (p<0,05) terhadap hospital baserate rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, dan proporsi beban pegawai merupakan determinan yang teridentifikasi terhadap hospital baserate rawat inap.
Casemix, casemix index and hospital baserate are important indicators to evaluate hospital performance under the INA-CBGs payment system. These indicators are the basis for the INA-CBGs tariff rates, the instrument for assessing the performance of BPJS Kesehatan partner hospitals and the constructing instrument of mixed method global budget claim payments for INA-CBGs which has begun to be trialled. This research was conducted to analyze the achievements and determinants of casemix, casemix index and hospital baserate RSPG Cisarua Bogor from 2017 to 2022. The research conducted on May - June 2023 at RSPG Cisarua Bogor. Analysis of the achievement indicators for casemix, casemix index and hospital base rate uses secondary data obtained from Ministry of Health's electronic claims (e-claims). The determinants that affect the indicators will be analyzed cross-sectionally through a quantitative analytical approach from secondary data form e-claims and hospital reports. Correlation and simple linear regression were used to see whether the determinants related to the casemix, casemix index and hospital baserate indicators. The results showed that the casemix trend for outpatient and inpatient at RSPG had decreased from 2017 to 2021 along with the number of visits. The decline in 2020 and 2021 was due to a significant decrease in the number of visits during the Covid-19 pandemic. The casemix in 2022 increased as the pandemic conditions improved in Indonesia. The casemix index for outpatient and inpatient care at RSPG Cisarua were lower than the average casemix index for Class A Government Hospitals in regional I. RSPG outpatient hospital baserate in 2017 and 2021 is still below the national rate, while the other years are higher. RSPG's hospital base rate of inpatient care is consistently higher than the national rate. This means that the costs incurred by the hospital are higher than the rates paid by BPJS in handling cases with cost weight = 1. There are 5 variables that have significant value with p
B-2348
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Tomy Oeky Prasiska; Pembimbing: Pujiyanto; Penguji: Mardiati Nadjib, Atik Nurwahyuni, Sholihul Absor, Benjamin Saut
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Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit dengan pembayaran DRG. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INA-CBGs dan global budget yang mulai diujicobakan. Cakupan pelayanan rawat inap dan rawat jalan rumah sakit Muhammadiyah Jawa Timur didominasi pasien JKN, rumah sakit harus mempunyai keunggulan kompetitif dan dapat berkembang di era JKN. Penelitian bertujuan menganalisis capaian casemix, casemix index dan hospital baserate Rumah Sakit Muhammadiyah Jawa Timur tahun 2017-2020. Studi observasional dengan pengamatan selama empat tahun dilakukan pada 27 rumah sakit. Penelitian menggunakan data sekunder yang didapatkan dari elektronik klaim (E-klaim) Kementerian Kesehatan. Hasil penelitian menunjukkan klasifikasi rumah sakit, jenis rumah sakit, kelas perawatan, dan lama hari rawat inap mempengaruhi capaian casemix, casemix index dan hospital baserate. Casemix, casemix index dan hospital baserate rumah sakit kelas B lebih besar dibandingkan rumah sakit kelas C dan kelas D, capaian indikator rumah sakit umum kelas C lebih besar dibandingkan rumah sakit khusus kelas C. Capaian indikator antar rumah sakit pada kelas yang sama dapat berbeda signifikan tergantung variasi dan derajat keparahan kasus. Rumah sakit yang menangani kasus derajat berat mempunyai nilai casemix, casemix index dan hospital baserate lebih besar. Hasil uji statistik menunjukkan lama rawat inap berpengaruh signifikan terhadap kenaikan hospital baserate rawat inap, semakin lama hari perawatan maka peluang peningkatan hospital baserate semakin besar (p<0,05). Rumah sakit yang menangani kasus hemodialisis dan operasi katarak mempunyai casemix, casemix index dan hospital baserate rawat jalan lebih besar. Pandemi COVID-19 pada tahun 2020 berdampak pada capaian casemix, casemix index dan hospital baserate rumah sakit. Sebanyak 19 rumah sakit (70,4%) mengalami penurunan capaian casemix rawat inap dan 20 rumah sakit (74,1%) mengalami penurunan casemix rawat jalan. Sebanyak 21 rumah sakit (77,4%) mengalami peningkatan hospital baserate rawat inap dan 23 rumah sakit (85,2%) mengalami peningkatan hospital baserate rawat jalan pada tahun 2020. Kesimpulan: capaian indikator casemix, casemix index dan hospital baserate dipengaruhi oleh klasifikasi, jenis rumah sakit, jumlah kasus, variasi dan derajat keparahan kasus serta lama rawat inap. Pandemi COVID-19 berdampak pada penurunan nilai casemix dan peningkatan hospital baserate rawat inap dan rawat jalan. Rumah sakit harus meningkatkan cakupan pelayanan, mengendalikan biaya pelayanan dan menjamin kualitas pengkodean diagnosis dan prosedur secara optimal. Rumah sakit harus memonitor capaian casemix, casemix index dan hospital baserate rawat inap dan rawat jalan secara berkala dan membandingkan dengan rumah sakit lain yang mempunyai kelas dan kapasitas yang sama
Casemix, casemix index and hospital baserate are important indicators to see the hospital performance with DRG payments. These indicators are the compilers of the INA-CBGs tariff rate, the performance assessment instrument for Healthcare and Social Security Agency partner hospitals and the instrument for compiling claims for the mixed method INA-CBGs and global budget which are being piloted. The coverage of inpatient and outpatient services at Muhammadiyah Hospitals in East Java is dominated by the National Health Insurance patients, therefore the hospitals must have a competitive advantages and be able to develop well in the JKN era. This study aims to analyze the achievement of casemix, casemix index and hospital baserate at Muhammadiyah Hospitals in East Java in year 2017-2020. An observational study within four years of observation was conducted in 27 hospitals. The study used secondary data obtained from the Ministry of Health's electronic claims (E-claims). The results showed that hospital classification, type of hospital, treatment class, and length of stay affected the achievement of casemix, casemix index and hospital base-rate. The casemix, casemix index and hospital base-rate of class B hospitals are higher than those of class C and class D hospitals, the indicator achievement of class C general hospitals is greater than those of special class C hospitals. The achievement of indicators between similar class hospitals can differ significantly. depending on the variety and severity level. Hospitals that handle severe cases have higher casemix, casemix index and hospital baserate values. The results of statistical tests showed that the length of stay had a significant effect on the increase of inpatient hospital baserate, the longer the days of stay, the greater the chance of increasing the hospital baserate (p <0.05). Hospitals that handle cases of hemodialysis and cataract surgery have a higher casemix, casemix index and outpatient hospital base-rate. The COVID-19 pandemic in 2020 had an impact on the achievement of casemix, casemix index and hospital base-rates. A total of 19 hospitals (70.4%) experienced a decrease in inpatient casemix achievement and 20 hospitals (74.1%) experienced a decrease in outpatient casemix. A total of 21 hospitals (77.4%) experienced an increase in inpatient hospital baserate and 23 hospitals (85.2%) experienced an outpatient hospital baserate increase in 2020. Conclusion: the achievement of the casemix, casemix index and hospital baserate indicators are influenced by classification, type of hospital, number of cases, variation and severity level and length of stay. The COVID-19 pandemic has resulted a decrease in casemix values and an increase in inpatient and outpatient hospital baserates. Hospitals must increase healthcare coverage, control costs and ensure optimal quality of diagnostic coding and procedures. Hospitals must monitor the achievement of casemix, casemix index and hospital baserates of inpatient and outpatient regularly and compare to other hospitals of the same class and capacity. Keyword : casemix, casemix index, hospital baserate, the National Health Insurance, outpatient, inpatient
B-2255
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ida Bagus Yudistira Nugraha Yustama; Pembimbing: Atik Nurwahyuni; Penguji: Masyitoh, Prastuti Soewondo, Kalsum Komaryani, Ni Putu Ayu Prima Dewi
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Pemanfaatan ketiga indikator (casemix, CMI, dan HBR) secara berkala untuk mempertahankan mutu sembari menjaga efisiensi pelayanan RS di era JKN. Penelitian ini bertujuan untuk menganalisis dan strategi peningkatan capaian indikator casemix, casemix index dan hospital baserate RSU Bali Royal tahun 2019 - 2024.
Penelitian dilakukan di RSU Bali Royal selama bulan Mei - Juni 2025, menggunakan data primer wawancara mendalam dan focus group discussion dan sekunder yang didapatkan dari rekapitulasi elektronik klaim (e-klaim) Kemenkes, laporan keuangan, dan laporan rumah sakit. Penelitian ini menggunakan studi observasional pendekatan kualitatif untuk menganalisis capaian indikator Casemix, CMI dan HBR rawat inap dan rawat jalan.
Hasil penelitian menunjukkan bahwa terdapat unsur struktur (sumber daya manusia, material, mesin, anggaran, dan metode) dan unsur proses (manajemen pasien, manajemen koding, dan manajemen klaim) membuahkan unsur output (indikator casemix, casemix index, dan hospital baserate) Dinamika penambahan unsur struktur berdampak pada proses pelayanan pasien, efisiensi koding hingga 50%, dan keberhasilan klaim. Casemix rawat jalan tahun 2019 – 2024 diperoleh 11.393; 16.037; 32.763; 59.520; 111.193; dan 129.423. Casemix rawat inap kelas 1 tahun 2019 – 2024 diperoleh 907; 1.321; 2.657; 3.165; 3.829; dan 4.014. Casemix rawat inap kelas 2 tahun 2019-2024 diperoleh 818; 1.013; 1.800; 2.511; 3.052; dan 3.309. Casemix rawat inap keas 3 tahun 2019 – 2024 diperoleh 205; 539; 1.557; 2.023; 2.646; dan 3.038. Nilai CMI rawat jalan tahun 2019 – 2024 diperoleh 0,98; 1,11;1,16; 1,21; 1,35;dan 1,24. CMI rawat inap kelas 1 tahun 2019 – 2024 diperoleh 1,32; 1,60; 1,84; 1,57; 1,45; dan 1,37. CMI rawat inap kelas 2 tahun 2019 – 2024 diperoleh 1,17; 1,36; 1,58; 1,41; 1,33; dam 1,33. CMI rawat inap kelas 3 tahun 2019 – 2024 diperoleh 1,46; 1,82; 1,67; 1,54; 1,53; dan 1,45. HBR rawat jalan tahun 2019 – 2024 diperoleh 354.393; 333.231; 257.536; 243.675; 226.650; dan 238.494. HBR rawat inap kelas 1 tahun 2019 – 2024 diperoleh 5.257.416; 6.028.120; 5.477.120; 5.970.918; 6.542.667; dan 7.082.825. HBR rawat inap kelas 2 tahun 2019 – 2024 diperoleh 4.449.693; 5.628.665; 4.817.066; 4.993.043; 5.156.750; dan 5.563.012. HBR rawat inap kelas 3 tahun 2019 – 2024 diperoleh 3.616.138; 4.594.204; 3.746.071; 4.325.317; 4.584.260; dan 4.789.356. Nilai casemix dan casemix index mengalami peningkatan setiap tahunnya dengan capaian CMI di atas standar rumah sakit swasta kelas C regional 2. HBR rawat jalan pada tahun 2021-2024 dibawah HBR nasional, namun HBR rawat inap kelas 1, 2, dan 3 selalu berada di atas HBR nasional. Strategi yang dapat ditempuh untuk peningkatan casemix, casemix index, dan penurunan HBR adalah optimalisasi unsur struktur dengan perbaikan sumber daya manusia dan pengkajian metode, efisiensi mesin, material, dan anggaran, dan evaluasi pada unsur proses (manajemen pasien, koding, dan klaim).
The periodic utilization of three key indicators—casemix, Casemix Index (CMI), and Hospital Base Rate (HBR)—is crucial for maintaining service quality while ensuring operational efficiency in hospitals, particularly within Indonesia's National Health Insurance (JKN) system. This study aimed to analyze factors influencing, and develop strategies for enhancing the performance of, casemix indicators, the Casemix Index, and the Hospital Base Rate at Bali Royal General Hospital over the period 2019–2024. The research was conducted at Bali Royal General Hospital from May to June 2025. Primary data were collected through in-depth interviews and focus group discussions, while secondary data were obtained from the Ministry of Health's electronic claim (e-claim) database, hospital financial reports, and institutional records. This study employed an observational design with a qualitative approach to analyze the performance of casemix indicators, CMI, and HBR for both inpatient and outpatient services. The findings revealed that structural elements (i.e., human resources, materials, machinery, budget, and methods) and process elements (i.e., patient management, coding management, and claims management) collectively determine output elements, identified as casemix indicators, the Casemix Index, and the Hospital Base Rate. Strategic enhancements to these structural elements were found to positively impact patient service processes, improve coding efficiency by up to 50%, and increase claim success rates. Results for the 2019–2024 period were as follows: Outpatient casemix counts were 11,393; 16,037; 32,763; 59,520; 111,193; and 129,423 for the years 2019 to 2024, respectively. Inpatient casemix counts for the years 2019 to 2024 were, respectively: Class 1: 907; 1,321; 2,657; 3,165; 3,829; and 4,014. Class 2: 818; 1,013; 1,800; 2,511; 3,052; and 3,309. Class 3: 205; 539; 1,557; 2,023; 2,646; and 3,038. Casemix Index (CMI) values for the years 2019 to 2024 were, respectively: Outpatient CMI: 0.98, 1.11, 1.16, 1.21, 1.35, and 1.24. Inpatient CMI: Class 1: 1.32, 1.60, 1.84, 1.57, 1.45, and 1.37. Class 2: 1.17, 1.36, 1.58, 1.41, 1.33, and 1.33. Class 3: 1.46, 1.82, 1.67, 1.54, 1.53, and 1.45. Hospital Base Rate (HBR) values for the years 2019 to 2024 were, respectively (currency unit not specified in the original text): Outpatient HBR: 354,393; 333,231; 257,536; 243,675; 226,650; and 238,494. Inpatient HBR: Class 1: 5,257,416; 6,028,120; 5,477,120; 5,970,918; 6,542,667; and 7,082,825. Class 2: 4,449,693; 5,628,665; 4,817,066; 4,993,043; 5,156,750; and 5,563,012. Class 3: 3,616,138; 4,594,204; 3,746,071; 4,325,317; 4,584,260; and 4,789,356. Overall, casemix counts and the Casemix Index exhibited an upward trend annually, with CMI performance exceeding the established standard for Class C private hospitals in Regional Area 2. While the outpatient HBR from 2021 to 2024 fell below the national HBR, the inpatient HBR for Classes 1, 2, and 3 consistently surpassed the national benchmark. Recommended strategies to enhance casemix performance, improve the Casemix Index, and reduce the Hospital Base Rate center on optimizing structural elements. This includes improving human resource competencies, refining methodologies, and increasing the efficiency of machinery, materials, and budget allocation. Furthermore, a rigorous evaluation of process elements—such as patient management, clinical coding accuracy, and claims management procedures—is deemed essential.
T-7325
Depok : FKM UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Yofen Dhamigus; Pembimbing: Atik Nurwahyuni; Penguji: Pujiyanto, Taufik Santoso, Melanie Husna
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Penelitian ini mengkaji analisis capaian casemix dan casemix index rawat inap di Rumah Sakit Kelas B Grup Primaya Hospital. Data dikumpulkan dari lima rumah sakit (PH1-PH5) dalam kelompok Primaya Hospital. Penelitian mengevaluasi sumber daya manusia, anggaran, material, metode, dan proses terkait capaian casemix dan casemix index. Hasil penelitian menunjukkan bahwa implementasi clinical pathways (PPK-CP) di PH1, PH2, PH3, dan PH5 efektif dalam meningkatkan standar klinis dan efisiensi operasional. Kelengkapan rekam medis di PH1 tertinggi (93.3%) dibandingkan dengan PH lainnya. Meskipun demikian, tingkat klaim tertunda masih menjadi tantangan, terutama di PH4. Ketepatan koding di PH5 terbaik dengan hanya 14.6% data klaim yang tertunda. Verifikasi klaim di PH1 mencapai 98.2%, menunjukkan kualitas pengajuan klaim yang baik. Hasil penelitian ini memberikan wawasan tentang hubungan antara input, proses, dan output dalam manajemen capaian casemix dan casemix index di rumah sakit tersebut. Implikasi dari temuan ini berpotensi untuk merumuskan strategi korporasi yang efektif dalam meningkatkan kualitas layanan dan efisiensi operasional di rumah sakit kelompok Primaya Hospital.
This research examines the analysis of casemix achievement and casemix index inpatient care at Primaya Hospital Class B. Data were collected from five hospitals (PH1-PH5) within the Primaya Hospital group. The study evaluates human resources, budgets, materials, methods, and processes related to casemix achievement and casemix index. The results show that the implementation of clinical pathways (PPK-CP) in PH1, PH2, PH3, and PH5 is effective in improving clinical standards and operational efficiency. The completeness of medical records in PH1 is the highest (93.3%) compared to other hospitals. However, the level of delayed claims remains a challenge, especially in PH4. Coding accuracy in PH5 is the best with only 14.6% of delayed claim data. Claim verification in PH1 reaches 98.2%, indicating good quality of claim submission. The findings provide insights into the relationship between inputs, processes, and outputs in managing casemix achievement and casemix index at these hospitals. The implications of these findings have the potential to formulate effective corporate strategies to improve service quality and operational efficiency in Primaya Hospital group.
B-2483
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Ulfia Mutiara Supatmanto; Pembimbing: Amal Chalik Sjaaf; Penguji: Helen Andriani, Purnawan Junadi, Wellya Hartati, Endang Adriyani
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Proses bisnis yang penting dalam organisasi rumah sakit salah satunya adalah manajemen pengelolaan perbekalan farmasi. Manajemen pengelolaan perbekalan farmasi di RSPG Cisarua Bogor melibatkan tim dimulai dari tahapan perencanaan, pengadaan, penyimpanan dan distribusi. Hambatan internal dalam proses perencanaan dan pengadaan perbekalan farmasi merupakan hambatan yang bisa dikendalikan dengan intervensi secara internal dalam proses bisnis di dalam rumah sakit. Penelitian ini fokus pada usulan perubahan sistem manajemen pengelolaan perbekalan farmasi khususnya perencanaan dan pengadaan di internal RSPG Cisarua Bogor. Intervensi dalam proses pengadaan menggunakan lean six sigma sebagai alat bantu evaluasi untuk menentukan titik-titik lemah dalam penelitian ini hanya sampai pada tahap improve. Pengumpulan data menggunakan wawancara mendalam dengan informan yang terkait proses perencanaan dan pengadaan perbekalan farmasi, observasi dan penelusuran dokumen kemudian diakhiri dengan diskusi kelompok untuk menentukan kesepakatan bersama. Hasil penelitian menunjukkan bahwa ketiadaan prosedur tetap dalam proses pengadaan perbekalan farmasi membuat lamanya prosedur berjalan dan tidak ada tolak ukur efisiensi dalam sistem. Alat bantu dalam proses pengadaan perbekalan farmasi juga tidak ada sehingga komunikasi internal antar bagian walaupun dalam satu tim yang sama menjadi rendah. Pada tahapan improve dari lean six sigma menghasilkan usulan perubahan standar operasional prosedur untuk proses pengadaan perbekalan farmasi rutin, penggunaan indikator efisiensi pengadaan dan pemanfaatan ABC VEN sebagai alat bantu dalam proses pengadaan perbekalan farmasi. Usulan perbaikan penggunaan ABC VEN dan indikator efisiensi perencanaan untuk mengatasi waste over production yang teridentifikasi selama proses perencanaan perbekalan farmasi. Usulan penetapan standar operasional prosedur baru yang memuat timeline, alat bantu pengelompokan perbekalan farmasi berdasarkan ABC VEN dan indikator efisiensi pengadaan untuk mengatasi waste waiting dalam proses pengadaan perbekalan farmasi.
One of the important business processes in hospital organizations is the management of pharmaceutical supplies. The management of pharmaceutical supplies management at RSPG Cisarua Bogor involves teams starting from the stages of planning, procurement, storage and distribution. Internal obstacles in the process of planning and procuring pharmaceutical supplies are obstacles that can be controlled by internal intervention in business processes within the hospital. This research focuses on proposed changes in the management system of pharmaceutical supply management, especially planning and procurement within RSPG Cisarua Bogor. Intervention in the procurement process using lean six sigma as an evaluation tool to determine weak points in this study only reached the improvement stage. Data collection used in-depth interviews with informants related to the process of planning and procuring pharmaceutical supplies, observation and document tracing then ended with group discussions to determine mutual agreement. The results showed that the absence of fixed procedures in the process of procuring pharmaceutical supplies made the procedure run longer and there was no benchmark of efficiency in the system. Tools in the process of procuring pharmaceutical supplies are also absent so that internal communication between departments even in the same team is low. At the improve stage of lean six sigma produced proposals for changes to standard operating procedures for routine pharmaceutical supply procurement processes, the use of procurement efficiency indicators and the use of ABC VEN as a tool in the pharmaceutical supply procurement process. Proposed improvements in the use of ABC VEN and planning efficiency indicators to address waste over production identified during the pharmaceutical supply planning process. Proposed establishment of new standard operating procedures containing timelines, tools for grouping pharmaceutical supplies based on ABC VEN and procurement efficiency indicators to overcome waste waiting in the pharmaceutical supply procurement process.
One of the important business processes in hospital organizations is the management of pharmaceutical supplies. The management of pharmaceutical supplies management at RSPG Cisarua Bogor involves teams starting from the stages of planning, procurement, storage and distribution. Internal obstacles in the process of planning and procuring pharmaceutical supplies are obstacles that can be controlled by internal intervention in business processes within the hospital. This research focuses on proposed changes in the management system of pharmaceutical supply management, especially planning and procurement within RSPG Cisarua Bogor. Intervention in the procurement process using lean six sigma as an evaluation tool to determine weak points in this study only reached the improvement stage. Data collection used in-depth interviews with informants related to the process of planning and procuring pharmaceutical supplies, observation and document tracing then ended with group discussions to determine mutual agreement. The results showed that the absence of fixed procedures in the process of procuring pharmaceutical supplies made the procedure run longer and there was no benchmark of efficiency in the system. Tools in the process of procuring pharmaceutical supplies are also absent so that internal communication between departments even in the same team is low. At the improve stage of lean six sigma produced proposals for changes to standard operating procedures for routine pharmaceutical supply procurement processes, the use of procurement efficiency indicators and the use of ABC VEN as a tool in the pharmaceutical supply procurement process. Proposed improvements in the use of ABC VEN and planning efficiency indicators to address waste over production identified during the pharmaceutical supply planning process. Proposed establishment of new standard operating procedures containing timelines, tools for grouping pharmaceutical supplies based on ABC VEN and procurement efficiency indicators to overcome waste waiting in the pharmaceutical supply procurement process.
B-2339
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Zubaedah; Pembimbing: Hasbullah Thabrany; Penguji: Atik Nurwahyuni, Amal C. Sjaaf, Poppy Mariani Yuliati
B-1248
Depok : FKM UI, 2010
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Mila Fitriana; Pembimbing: Anhari Achadi; Penguji: Ede Surya Darmawan, Masyitoh Bashabih, Ida Bagus Sila Wiweka, Chairulsjah Sjahruddin
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Latar Belakang: Rumah Sakit (RS) harus menyelenggarakan perlindungan pasien dari risiko Healthcare-Associated Infections (HAIs). Program Pencegahan dan Pengendalian Infeksi harus diselenggarakan dengan baik untuk menurunkan risiko HAIs, termasuk kepatuhan hand hygiene pada seluruh staf RS. Rendahnya kepatuhan diantara petugas kesehatan menjadi masalah di fasilitas pelayanan kesehatan. World Health Organization (WHO) mengeluarkan Multimodal Hand Hygiene Improvement Strategy sebagai salah satu strategi untuk mengatasi permasalahan kepatuhan hand hygiene. Rumah Sakit Paru Dr. M. Goenawan Partowidigdo (RSPG) Cisarua Bogor telah memiliki regulasi hand hygiene yang mengacu pada kebijakan yang berlaku, namun kepatuhan hand hygiene tidak mencapai target selama tiga tahun. Analisis kepatuhan implementasi kebijakan, dalam hal ini regulasi, perlu dilakukan untuk memetakan faktor-faktor yang mempengaruhi implementasi. Oleh karena itu penelitian ini ingin menganalisis lebih lanjut bagaimana kepatuhan implementasi regulasi hand hygiene di RSPG Cisarua Bogor berdasarkan WHO Multimodal Hand Hygiene Improvement Strategy. Metode: Penelitian ini menggunakan pendekatan penelitian kualitatif deskriptif analitik dengan metode studi kasus. Peneliti melakukan analisis kepatuhan implementasi regulasi hand hygiene dengan mengembangkan teori George Edward III yang dikolaborasikan dengan WHO Multimodal Hand Hygiene Improvement Strategy. Penilaian WHO Multimodal Hand Hygiene Improvement Strategy dilakukan dengan skoring Hand Hygiene Self-Assessment Framework (HHSAF). Lokasi penelitian di Rumah Sakit Paru Dr. M. Goenawan Partowidigdo (RSPG) Cisarua Bogor yang merupakan Rumah Sakit Khusus Pusat Tipe III. Hasil: Berdasarkan analisis terhadap variabel komunikasi, masih perlu peningkatan konsistensi komunikasi. Persentase perolehan skor HHSAF pada variabel komunikasi 80,4%. Berdasarkan analisis terhadap variabel sumber daya, diperoleh persentase skor 73,9%. Pada SDM peneliti mendapatkan temuan selain kuantitas dan kualitas SDM, yaitu isu keaktifan dan perilaku. Berdasarkan analisis terhadap variabel disposisi didapatkan pada pengangkatan birokrasi masih kurangnya bentuk komitmen yang jelas dari kepala keperawatan. Bentuk apresiasi non materi dianggap akan lebih berdampak positif, dan masih kurangnya komitmen implementor. Persentase perolehan skor HHSAF pada variabel disposisi adalah 65%. Berdasarkan analisis terhadap variabel struktur birokrasi, diketahui perlu perbaikan pada SPO keperawatan mengenai momen cuci tangan sesuai SPO dan panduan PPI. Pada fragmentasi diketahui koordinasi penyebaran tanggung jawab untuk implementasi regulasi hand hygiene masih kurang baik, namun tidak terjadi bureaucratic fragmentation. Persentase perolehan skor HHSAF pada variabel struktur birokrasi adalah 23%. RSPG berada pada hand hygiene level Intermediate dengan skor total 312,5. Kesimpulan: Diantara keempat variabel, persentase perolehan skor HHSAF terendah adalah pada variabel struktur birokrasi, namun hal ini bukan menjadi variabel yang paling berpengaruh pada implementasi regulasi hand hygiene di RSPG. Variabel yang paling berpengaruh terhadap implementasi regulasi hand hygiene di RSPG adalah variabel sumber daya, yaitu sumber daya manusia, terkait isu keaktifan dan perilaku.
Background: Hospitals must organize patient safety from the risk of Healthcare-Associated Infections (HAIs). Infection Prevention and Control programs must be well organized to reduce the risk of HAIs, including hand hygiene compliance among all hospital staff. Low compliance among healthcare workers is a problem in healthcare facilities. WHO issued the Multimodal Hand Hygiene Improvement Strategy as one of the strategies to overcome the problem of hand hygiene compliance. Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) Cisarua Bogor has hand hygiene regulations that refer to applicable policies, but hand hygiene compliance has not reached the target for three years. Compliance analysis of policy implementation, in this case regulation, needs to be done to map the factors that influence implementation. Therefore, this study aims to further analyze how the implementation compliance of hand hygiene regulation in RSPG Cisarua Bogor is based on WHO Multimodal Hand Hygiene Improvement Strategy. Methods: This study used a qualitative analytic descriptive research approach, with a case study method. Researcher analyzed the implementation compliance of hand hygiene regulations by developing the George Edward III theory collaborated with the WHO Multimodal Hand Hygiene Improvement Strategy. The WHO Multimodal Hand Hygiene Improvement Strategy assessment was carried out by scoring the Hand Hygiene Self-Assessment Framework (HHSAF). The research location was at the Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) Cisarua Bogor which is a Type III Central Specialty Hospital. Results: Based on the analysis of communication variables, there is still a need to improve communication consistency. The percentage of HHSAF scores on communication variables is 80.4%. Based on the analysis of the resource variable, a percentage score of 73.9% was obtained. In human resources, researchers found findings other than the quantity and quality of human resources, namely the issue of activeness and behavior. Based on the analysis of the disposition variable, it was found that the bureaucratic appointment still lacked a clear form of commitment from the head of nursing. Non-material forms of appreciation are considered to have a more positive impact, and there is still a lack of implementor commitment. The percentage of the HHSAF score on the disposition variable is 65%. Based on the analysis of bureaucratic structure variables, it is known that improvements need to be made to the nursing SPO regarding hand washing moments according to SPO and PPI guidelines. In fragmentation, it is known that the coordination of the distribution of responsibilities for implementing hand hygiene regulations is still not good, but there is no bureaucratic fragmentation. The percentage of the HHSAF score on the bureaucratic structure variable was 23%. RSPG is at the Intermediate level of hand hygiene with a total score of 312.5. Conclusion: Among the four variables, the lowest percentage of the HHSAF score was on the bureaucratic structure variable, but this was not the most influential variable on the implementation of hand hygiene regulations in RSPG. The variable that has the most influence on the implementation of hand hygiene regulations in RSPG is the resource variable, namely human resources, related to the issue of activeness and behavior.
Background: Hospitals must organize patient safety from the risk of Healthcare-Associated Infections (HAIs). Infection Prevention and Control programs must be well organized to reduce the risk of HAIs, including hand hygiene compliance among all hospital staff. Low compliance among healthcare workers is a problem in healthcare facilities. WHO issued the Multimodal Hand Hygiene Improvement Strategy as one of the strategies to overcome the problem of hand hygiene compliance. Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) Cisarua Bogor has hand hygiene regulations that refer to applicable policies, but hand hygiene compliance has not reached the target for three years. Compliance analysis of policy implementation, in this case regulation, needs to be done to map the factors that influence implementation. Therefore, this study aims to further analyze how the implementation compliance of hand hygiene regulation in RSPG Cisarua Bogor is based on WHO Multimodal Hand Hygiene Improvement Strategy. Methods: This study used a qualitative analytic descriptive research approach, with a case study method. Researcher analyzed the implementation compliance of hand hygiene regulations by developing the George Edward III theory collaborated with the WHO Multimodal Hand Hygiene Improvement Strategy. The WHO Multimodal Hand Hygiene Improvement Strategy assessment was carried out by scoring the Hand Hygiene Self-Assessment Framework (HHSAF). The research location was at the Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) Cisarua Bogor which is a Type III Central Specialty Hospital. Results: Based on the analysis of communication variables, there is still a need to improve communication consistency. The percentage of HHSAF scores on communication variables is 80.4%. Based on the analysis of the resource variable, a percentage score of 73.9% was obtained. In human resources, researchers found findings other than the quantity and quality of human resources, namely the issue of activeness and behavior. Based on the analysis of the disposition variable, it was found that the bureaucratic appointment still lacked a clear form of commitment from the head of nursing. Non-material forms of appreciation are considered to have a more positive impact, and there is still a lack of implementor commitment. The percentage of the HHSAF score on the disposition variable is 65%. Based on the analysis of bureaucratic structure variables, it is known that improvements need to be made to the nursing SPO regarding hand washing moments according to SPO and PPI guidelines. In fragmentation, it is known that the coordination of the distribution of responsibilities for implementing hand hygiene regulations is still not good, but there is no bureaucratic fragmentation. The percentage of the HHSAF score on the bureaucratic structure variable was 23%. RSPG is at the Intermediate level of hand hygiene with a total score of 312.5. Conclusion: Among the four variables, the lowest percentage of the HHSAF score was on the bureaucratic structure variable, but this was not the most influential variable on the implementation of hand hygiene regulations in RSPG. The variable that has the most influence on the implementation of hand hygiene regulations in RSPG is the resource variable, namely human resources, related to the issue of activeness and behavior.
B-2337
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ratu zahra Azqia Nur; Pembimbing: Puput Oktamianti; Penguji: Ede Surya Darmawan, R. Heru Aryadi, Martina Yulianti
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Komunikasi dan edukasi merupakan komponen fundamental pelayanan rumah sakit yang berhubungan langsung dengan keselamatan pasien. WHO melalui Global Patient Safety Action Plan 2021–2030 menegaskan bahwa 10–18% pasien rawat inap global mengalami insiden yang merugikan akibat kegagalan transfer informasi. Di Indonesia, meskipun 92% dari 3.178 rumah sakit telah terakreditasi pada April 2024, kepatuhan pelaporan Indikator Nasional Mutu (INM) hanya mencapai 69% pada tahun 2023, mencerminkan kesenjangan antara status akreditasi dan konsistensi mutu di lapangan. LARS DHP, yang telah mengakreditasi 563 rumah sakit sejak 2021, belum pernah dijadikan subjek penelitian khusus terkait capaian standar Komunikasi dan Edukasi (KE), sehingga terdapat kesenjangan informasi yang perlu diisi. Penelitian ini bertujuan menganalisis capaian pelaksanaan 7 standar komunikasi dan edukasi pada rumah sakit terakreditasi mitra LARS DHP serta mengidentifikasi faktor-faktor yang berhubungan dengan capaian tersebut, meliputi karakteristik rumah sakit (jenis, kelas, kepemilikan, letak geografis), kebijakan organisasi, sistem informasi rekam medis, serta pendidikan dan pelatihan SDM. Penelitian menggunakan desain kuantitatif cross-sectional berbasis data sekunder. Sampel berjumlah 34 rumah sakit yang dipilih dengan teknik total sampling. Data bersumber dari dokumen survei akreditasi LARS DHP menggunakan instrumen STARKES 2024. Analisis dilakukan secara deskriptif dan uji Chi-Square untuk menguji hubungan antar variabel. Hasil penelitian menunjukkan Standar KE 6 (Komunikasi Berkelanjutan) memiliki capaian terendah, dengan hanya 35,29% rumah sakit berstatus Terpenuhi Lengkap (TL), mengindikasikan kelemahan koordinasi edukasi antara rumah sakit dan FKTP. Dari seluruh variabel yang diuji, hanya kepemilikan rumah sakit yang menunjukkan hubungan signifikan (p < 0,05), di mana rumah sakit swasta berpeluang 10,31 kali lebih tinggi mencapai TL dibandingkan rumah sakit pemerintah. Variabel lainnya tidak bermakna secara statistik. Capaian Komunikasi dan edukasi secara umum baik pada standar struktural dan regulatif, namun lemah pada standar yang memerlukan implementasi aktif dan koordinasi lintas institusi. Diperlukan intervensi terarah pada RS pemerintah dan kelas D, akselerasi digitalisasi rekam medis, penguatan jejaring komunitas, serta pelatihan komunikasi efektif bagi seluruh PPA
Communication and education constitute fundamental components of hospital services that are directly linked to patient safety. Through the Global Patient Safety Action Plan 2021–2030, the World Health Organization (WHO) affirms that 10–18% of inpatients worldwide experience adverse incidents resulting from failures in information transfer. In Indonesia, despite 92% of 3,178 hospitals having achieved accreditation as of April 2024, compliance with reporting the National Quality Indicators (Indikator Nasional Mutu/INM) reached only 69% in 2023, reflecting a gap between accreditation status and actual quality consistency in the field. LARS DHP (Lembaga Akreditasi Rumah Sakit Damar Husada Paripurna), which has accredited 563 hospitals since 2021, has never been the subject of dedicated research concerning the attainment of Communication and Education (CE) standards, leaving an information gap that warrants further investigation. This study aims to analyze the level of compliance with seven communication and education standards among LARS DHP-accredited partner hospitals, and to identify factors associated with such compliance, including hospital characteristics (type, class, ownership, and geographic location), organizational policies, medical record information systems, and human resource education and training. The study employed a quantitative cross-sectional design based on secondary data. The sample comprised 34 hospitals selected through total sampling. Data were sourced from LARS DHP accreditation survey documents using the STARKES 2024 (Standar Akreditasi Rumah Sakit/Hospital Accreditation Standards 2024) instrument. Analysis was conducted descriptively, with Chi-Square tests applied to examine associations between variables. The findings indicate that CE Standard 6 (Continuous Communication) recorded the lowest level of compliance, with only 35.29% of hospitals achieving Fully Met (Terpenuhi Lengkap/TL) status, signaling weaknesses in educational coordination between hospitals and Primary Health Care Facilities (Fasilitas Kesehatan Tingkat Pertama/FKTP). Among all variables examined, only hospital ownership demonstrated a statistically significant association (p < 0.05), with private hospitals being 10.31 times more likely to achieve Fully Met status compared to government-owned hospitals. All other variables were not statistically significant. Overall, communication and education compliance was satisfactory with respect to structural and regulatory standards but remained weak in standards requiring active implementation and cross-institutional coordination. Targeted interventions are needed for government hospitals and Class D facilities, alongside accelerated digitalization of medical records, strengthening of community networks, and effective communication training for all Authorized Healthcare Professionals (Profesional Pemberi Asuhan/PPA).
B-2625
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Wellya Hartati; Pembimbing: Sandi Iljanto; Penguji: Suprijanto Rijadi, Hendrik Johanenes, Iing Irat Setiamasa
B-1316
Depok : FKM-UI, 2011
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Putri Ganesha Asturini; Pembimnbing: Kurnia Sari; Penguji: Atik Nurwahyuni, Rahmi Handayani
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ABSTRAK Keberhasilan universal health coverage di Indonesia sangat ditentukan oleh utilisasi sumber daya yang efisien di rumah sakit. Variasi biaya yang tinggi untuk perawatan tertentu menunjukkan indikasi bahwa rumah sakit belum cukup efisien dalam memanfaatkan sumber dayanya untuk menyediakan pelayanan. Length of stay (LOS) adalah salah satu faktor penting penentu biaya yang banyak digunakan sebagai indikator efisiensi rumah sakit dalam penggunaan sumber daya. LOS dan biaya perawatan dipengaruhi oleh banyak faktor, baik yang merupakan karakteristik pasien maupun faktor terkait manajemen di rumah sakit. Penelitian ini bertujuan untuk mengidentifikasi seberapa besar hubungan antara karakteristik pasien dengan variasi LOS dan biaya perawatan,dan mengetahui gambaran penerapan clinical pathway sebagai upaya kendali mutu dan biaya pada pasien JKN rawat inap di RSUP Fatmawati dari tahun 2015 – September 2017. Hasil penelitian menunjukkan bahwa variasi usia, jumlah diagnosis, jumlah prosedur dan kelas rawat hanya dapat menjelaskan sedikit variasi LOS dan biaya perawatan (R 2 <34%). Sementara itu clinical pathway sebagai salah satu pendekatan manajemen untuk kendali mutu dan biaya belum diterapkan secara optimal. Berbagai upaya kreatif perlu dilakukan manajemen antara lain implementasi care plan, difungsikannya kembali case manager, pengisian CP secara elektronik dan identifikasi inefisiensi dalam pelayanan menggunakan data unit cost rumah sakit. Kata kunci: Length of stay (LOS), biaya (costs), efisiensi, clinical pathway, CMG
ABSTRACT Efficient use of resources in hospitals will contribute to successful implementation of universal health coverage in Indonesia. Substantial variation in hospital costs for certain diagnosis or procedure is an indication of resource use inefficiency. Length of stay is a well-accepted measure of resource utilization and a key driver to hospital costs. Variation in LOS and costs can be influenced by patient demographic and clinical factors that are outside a hospital’s control, in the meanwhile there are also factors within the control of a hospital. This research focuses on five Casemix Main Groups and aims to identify how patient characteristic factors contribute to variation in LOS and costs, and to investigate qualitatively the implementation of Clinical Pathway as a management approach to control LOS as well as hospital costs for JKN patients at RSUP Fatmawati, a class-A teaching hospital in Jakarta, from 2015 to September 2017. The result indicates that the variance in LOS and cost is not significantly correlated to patient’s age, number of diagnoses, number of procedures and room types as independent variables. The hospital has numerous clinical pathways that have not been optimally implemented yet for LOS and cost control. This research provides information for hospital management team to improve LOS performance by implementing care planning, intensive case management and to use cost data for identification of inefficiency of certain types of care. Keywords: Length of stay (LOS), costs, efficiency, clinical pathway, CMG
B-1945
Depok : FKM-UI, 2018
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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