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Made Ratna Saraswati; Pembimbing: Dumilah Ayuningtyas; Penguji: Purnawan Junadi, Sukamto Koesnoe, Ni Made Ayu Lestari, Amal Chalik Sjaaf
Abstrak:
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Diabetes melitus tipe 2 (DMT2) dengan komplikasi merupakan salah satu tantangan utama pelayanan kesehatan di rumah sakit rujukan tersier karena bersifat kronis, kompleks, dan membutuhkan pelayanan berkesinambungan lintas disiplin. Rumah Sakit Prof. dr. I G.N.G. Ngoerah, Bali (RS Ngoerah) sebagai rumah sakit rujukan nasional menghadapi tuntutan untuk tidak hanya menyediakan layanan klinis lanjutan, tetapi juga memastikan mutu, efisiensi, dan kesinambungan pelayanan melalui tata kelola yang kuat dan terintegrasi. Penelitian ini bertujuan mengembangkan governansi klinis pelayanan kronis terintegrasi bagi pasien DMT2 dengan komplikasi di Poliklinik RS Ngoerah, agar pelayanan berkesinambungan dan berkualitas. Penelitian menggunakan pendekatan mixed methods dengan kerangka analisis Teori Donabedian (struktur/input–proses–outcome/output) serta prinsip governansi klinis dan pelayanan penyakit kronis. Data diperoleh melalui analisis dokumen, survei, dan wawancara mendalam dengan berbagai pemangku kepentingan layanan. Hasil penelitian menunjukkan bahwa secara struktural RS Ngoerah telah memiliki sumber daya manusia, fasilitas, dan layanan subspesialistik yang memadai. Namun, keunggulan struktur tersebut belum sepenuhnya diikuti oleh proses pelayanan yang terintegrasi dan berkesinambungan. Pelayanan pasien DMT2 dengan komplikasi masih didominasi pendekatan episodik, terfragmentasi antar unit, serta belum didukung oleh alur pelayanan kronis terintegrasi, sistem rujuk balik yang efektif, dan pemanfaatan data klinis longitudinal secara optimal. Ketidakselarasan antara struktur/input, proses, dan outcome/output ini berdampak pada belum optimalnya efektivitas layanan, efisiensi biaya, dan pengalaman pasien. Analisis tata kelola menunjukkan bahwa interaksi unsur man, machine, dan method belum berjalan secara sinergis. Kompetensi tenaga kesehatan yang tinggi belum sepenuhnya didukung oleh sistem informasi terintegrasi dan metode pelayanan kronis yang baku. Dari perspektif availability, affordability, dan accessibility, layanan komprehensif tersedia secara klinis, namun masih terdapat hambatan dalam akses berkelanjutan dan kesesuaian pembiayaan dengan kebutuhan pelayanan kronis jangka panjang. Berdasarkan temuan tersebut, penelitian ini merekomendasikan pengembangan model governansi klinis pelayanan kronis terintegrasi yang menekankan integrasi struktur/input–proses–outcome/output, penguatan kepemimpinan klinis, standarisasi alur pelayanan kronis lintas unit, pemanfaatan sistem informasi klinis terintegrasi, serta mekanisme evaluasi berbasis outcome klinis dan pengalaman pasien dalam bentuk unit pelayanan diabetes terpadu (diabetes integrated care unit). Model ini diharapkan mampu meningkatkan efektivitas, efisiensi, dan kesinambungan pelayanan pasien DMT2 dengan komplikasi di RS Ngoerah Bali, sekaligus menjadi rujukan penguatan tata kelola pelayanan penyakit kronis di rumah sakit rujukan lainnya.
Type 2 diabetes mellitus (T2DM) with complications represents one of the major challenges in healthcare delivery at tertiary referral hospitals due to its chronic nature, clinical complexity, and the need for continuous, multidisciplinary care. Prof. dr. I G.N.G. Ngoerah Hospital, Bali (Ngoerah Hospital), as a national referral hospital, is therefore required not only to provide advanced clinical services but also to ensure the quality, efficiency, and continuity of care through a robust and integrated governance framework. This study aimed to develop an integrated chronic care governance model for patients with T2DM and complications attending the outpatient clinics of Ngoerah Hospital, Bali, in order to support high-quality and continuous care delivery. A mixed-methods approach was employed, guided by the Donabedian framework (structure/input–process–outcome/output) and informed by principles of clinical governance and chronic disease management. Data were collected through document review, surveys, and in-depth interviews with key healthcare stakeholders. The findings indicate that, from a structural perspective, Ngoerah Hospital has adequate human resources, facilities, and subspecialty services to support comprehensive diabetes care. However, these structural strengths have not been fully translated into integrated and continuous care processes. Care for patients with T2DM and complications remains predominantly episodic, fragmented across service units, and insufficiently supported by integrated chronic care pathways, effective referral-back mechanisms, and optimal use of longitudinal clinical data. This misalignment between structure/input, process, and outcomes/output has contributed to suboptimal service effectiveness, cost efficiency, and patient experience. Governance analysis further reveals that the interaction among the elements of manpower, machinery, and methods has not yet functioned synergistically. While healthcare professionals demonstrate a high level of clinical competence, this capacity is not adequately supported by integrated health information systems and standardized chronic care methods. From the perspectives of availability, affordability, and accessibility, comprehensive services are clinically available; however, barriers persist in ensuring sustained access and alignment between financing mechanisms and the long-term needs of chronic care. Based on these findings, this study recommends the development of an integrated chronic care governance model that emphasizes alignment across structure, process, and outcomes; strengthens clinical leadership; standardizes multidisciplinary chronic care pathways; optimizes the use of integrated clinical information systems; and implements evaluation mechanisms based on clinical outcomes and patient experience, as in diabetes integrated care unit. Such a model is expected to enhance the effectiveness, efficiency, and continuity of care for patients with T2DM and complications at Ngoerah Hospital, while also serving as a reference for strengthening chronic disease care governance in other tertiary referral hospitals.
B-2560
Depok : FKM-UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Irma Yudi Febrianti; Pembimbing: Mardiati Nadjib; Penguji: Anhari Achadi, Amila Megraini, indah Rosana Djadiredja
Abstrak:
Atas rekomendasi dokter spesialis pelayanan Rujuk Balik ke puskesmas dianjurkan bagi pasien di RS yang menderita penyakit kronis termasuk diabetes melitius. Penelitian ini bertujuan untuk melihat faktor-faktor yang berhubungan dengan kesediaan pasien diabetes mellitus Tipe 2 peserta JKN di RSU Jagakarsa untuk dirujuk balik ke FKTP. Desain potong lintang dan pendekatan kualitatif melalui wawancara mendalam digunakan dalam studi ini.. Hasil penelitian menunjukkan bahwa kepercayaan pasien terhadap dokter layanan primer, persepsi pasien mengenai ketersediaan obat di fasilitas kesehatan primer, jarak tempuh terhadap fasilitas kesehatan primer dan dukungan keluarga dan teman berhubungan dengan kesediaan pasien untuk dirujuk balik. Disarankan untuk mengembangkan SOP rujuk balik di RS dan mengembangkan pojok rujuk balik. Kata Kunci: rujuk balik, peserta Jaminan Kesehatan Nasional, Dibetes Melitus Tipe 2 Back referral service to primary care is provided for JKN patients including diabetes mellitus type 2 patients as recommended by the internal medicine specialist. This study aim is to analyse the factors that related to willingness of the patients to be referred to primary care after receiving care at the hospital in Jagakarsa Hospital. This study is using quantitative method with cross sectional design, followed by qualitative method with in-depth interview. The study revealed that trust to the primary health care physician, perception on medicine availability in primary health care facility, accessiibility and support from family and friend affect patient willingness to agree with back referral service. The study suggested to develop standard procedure for back referral and initiate back referral corner in hospital Key word: Back referral, National Health Insurance members, Diabetes Mellitus Type 2
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B-1900
Depok : FKM-UI, 2017
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Handi Wirawan; Pembimbing: Prastuti Soewondo; Penguji: Pujiyanto, Atik Nurwahyuni, Ari Purwohandoyo, Slamet Tjahjono
Abstrak:
Penelitian ini bertujuan untuk mengetahui posisi biaya satuan layanan rawat jalan Diabetes Melitus Tipe II agar Manajemen Rumah Sakit dapat menentukan upaya efisiensi kedepannya dalam rangka menutup kesenjangan antara tarif Rumah Sakit dengan tarif INA CBG's. Menggunakan metode penelitian kualitatif dengan wawancara mendalam, observasi serta telaah dokumen terkait penelitian. Informan dalam penelitian adalah Kepala Bagian Keuangan, Dokter Spesialis Penyakit Dalam, Kepala Unit Rawat Jalan serta Petugas Bagian Farmasi. Total biaya Rajal DM sebesar Rp 369.573.586,- Hasil perhitungan menunjukkan bahwa besar unit cost untuk Rajal DM Tipe II adalah sebesar Rp 251.069,- dimana tarif INA CBGs untuk Rajal DM Tipe II hanya sebesar Rp 192.100,- yang berarti terdapat kesenjangan sebesar Rp 58.969,- . Efisiensi untuk menekan biaya tidak tetap dan mengurangi variasi pemberian obat serta pemeriksaan laboratorium Diabetes Melitus Tipe II dengan membuat clinical pathway Diabetes Melitus Tipe II. Untuk mengurangi beban biaya tetap, tindakan efisiensi yang dapat dilakukan adalah menaikkan angka kunjungan pasien Diabetes Melitus Tipe II dengan menyediakan dokter spesialis tetap untuk penyakit dalam agar pelayanan untuk pasien dapat maksimal serta kunjungan dapat meningkat
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B-2122
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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I Wayan Surya Sedana; Pembimbing: Masyitoh; Penguji: Kurnia Sari, I Gusti Ngurah Ketut Sukadarma, Anak Agung Ngurah Jaya Kusuma
Abstrak:
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Instalasi Gawat Darurat (IGD) RSUP Prof. Dr. I.G.N.G. Ngoerah menghadapi tantangan volume kunjungan yang tinggi sebagai pusat rujukan tersier di wilayah Bali dan Nusa Tenggara. Meskipun standar ketepatan waktu pelayanan kurang dari empat jam telah ditetapkan, capaian rata-rata pada tahun 2025 masih berfluktuasi di angka 53,28%. Fenomena memanjangnya Length of Stay (LOS) berisiko menurunkan efisiensi layanan, meningkatkan biaya operasional, serta memperburuk luaran klinis pasien. Penelitian ini bertujuan menganalisis berbagai faktor yang memengaruhi pemanjangan waktu pelayanan IGD (LOS ≥ 4 jam) menggunakan pendekatan sistem aliran pasien Input-Throughput-Output. Studi observasional analitik dengan desain cross-sectional dilakukan terhadap data sekunder rekam medis elektronik periode Januari hingga Desember 2025. Teknik stratified random sampling digunakan untuk menarik sampel minimal yang proporsional. Analisis data menggunakan uji bivariat Chi-Square sebagai seleksi awal prediktor, dilanjutkan dengan uji multivariat regresi logistik berganda untuk menghitung nilai Odds Ratio (OR). Analisis multivariat mengkonfirmasi bahwa faktor yang memiliki hubungan independen paling dominan terhadap pemanjangan LOS IGD berturut-turut adalah jumlah pemeriksaan diagnostik kombinasi laboratorium dan radiologi (OR = 46.887; p < 0.001), pemeriksaan laboratorium saja (OR = 20.220; p < 0.001), pemeriksaan radiologi saja (OR = 6.873; p = 0.0096), keputusan disposisi rawat inap (OR = 4.728; p < 0.001), adanya konsultasi dokter spesialis (OR = 2.627; p < 0.001) dan cara bayar JKN PBI (OR = 2.149; p = 0.0175). Sebagai kesimpulan, terdapat kecenderungan hambatan utama yang menyebabkan pemanjangan LOS IGD terjadi pada fase throughput dan output dengan proses diagnostik dan konsultasi dokter spesialis serta keputusan rawat inap yang diperparah dengan tingginya kebutuhan ruang perawatan untuk cara bayar JKN PBI.
The Emergency Department (ED) of Prof. Dr. I.G.N.G. Ngoerah General Hospital encounters a high volume of patient visits as a tertiary referral center in the Bali and Nusa Tenggara regions. Despite the established service timeliness standard of less than four hours, the average compliance rate in 2025 fluctuated at 53.28%. Prolonged Length of Stay (LOS) poses a risk of reducing service efficiency, increasing operational costs, and worsening patient clinical outcomes. This study aims to analyze various factors influencing prolonged ED service time (LOS ≥ 4 hours) utilizing the Input-Throughput-Output patient flow model framework. An analytical observational study with a cross-sectional design was conducted using secondary electronic medical record data from January to December 2025. A stratified random sampling technique was applied to obtain a proportional minimum sample size. Data analysis was performed using the bivariate Chi-Square test for initial predictor screening, followed by a multivariate multiple logistic regression model to determine the Odds Ratio (OR) values. The multivariate analysis confirmed that the independent factors significantly contributing to prolonged ED LOS were the combination of laboratory and radiology diagnostic tests (OR = 46.887; p < 0.001), laboratory tests alone (OR = 20.220; p < 0.001), radiology tests alone (OR = 6.873; p = 0.0096), inpatient disposition decisions (OR = 4.728; p < 0.001), the need for specialist physician consultations (OR = 2.627; p < 0.001), and the JKN PBI payment method (OR = 2.149; p = 0.0175). In conclusion, the primary bottlenecks causing prolonged ED LOS predominantly occur during the throughput and output phases, driven by diagnostic processes, specialist consultations, and inpatient admission decisions, which are further compounded by the high demand for JKN PBI inpatients.
B-2613
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Christina Prilia Damaranti; Pembimbing: Dumilah Ayuningtyas; Penguji: Anhari Achadi, Masyitoh, Ramaniya Kirana, Eka Ginanjar
Abstrak:
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PPOK merupakan penyakit pernapasan kronis penyebab morbiditas dan mortalitas terbanyak dengan dampak pembiayaan yang cukup tinggi di Indonesia. Clinical Pathway (CP) adalah bagian dari pelaksanaan tata kelola klinis rumah sakit dan salah satu tools dalam mewujudkan sistem kendali mutu dan kendali biaya di era JKN. Efektivitas kepatuhan penerapan clinical pathway (CP) terhadap luaran klinis pasien pada beberapa penelitian menunjukkan hasil yang positif. RS Paru Respira Yogyakarta telah menetapkan CP PPOK sebagai CP prioritas, namun dalam proses evaluasi kepatuhan CP belum menggunakan seluruh komponen PPA seperti yang diatur dalam Permenkes Nomor 30 Tahun 2022. Paradigma pelayanan kesehatan saat ini adalah value-based healthcare sehingga perlu dilakukan evaluasi dampak kepatuhan CP terhadap luaran klinis pasien. Penelitian ini bertujuan untuk mengetahui hubungan kepatuhan CP terhadap luaran klinis pasien PPOK dan proses penerapan kepatuhan CP PPOK di RS Pusat Paru Respira Yogyakarta tahun 2022. Desain penelitian adalah observasional (cross sectional) dengan pendekatan mix method. Pengambilan data metode kuantitatif menggunakan rekam medis pasien rawat inap dengan diagnosis utama PPOK tahun 2022 (n=57) dan metode kualitatif dengan wawancara mendalam, observasi dan telaah dokumen. Hasil penelitian kuantitatif didapatkan tingkat kepatuhan CP PPOK sebesar 87,7%, ada hubungan yang signifikan antara DPJP dengan kejadian komplikasi (p value=0,003) dan antara kepatuhan CP dengan luaran klinis yaitu komplikasi (p value=0,05 dan OR=6,75), faktor yang paling berpengaruh pada luaran klinis pasien adalah kepatuhan terhadap CP. Metode kualitatif, berdasarkan perspektif 10 variabel dalam teori Gibson dan Mathis-Jackson, didapatkan hasil yang baik pada variabel sikap. Untuk variabel pengetahuan, supervisi, komunikasi, pelatihan, SDM, standar kinerja, sarana prasarana, insentif dan struktur organisasi masih perlu peningkatan. Untuk meningkatkan kepatuhan CP diperlukan komunikasi yang efektif antara pembuat dan pelaksana CP, pemahaman dan komitmen penuh para PPA, dukungan manajemen untuk rutin meninjau ulang tata laksana CP, meningkatkan sosialisasi, pelatihan, sarana prasarana, kebutuhan SDM, fasilitas IT penunjang serta regulasi terkait pelaksanaan CP.
COPD is a chronic respiratory disease that causes the most morbidity and mortality with a high cost impact in Indonesia. Clinical Pathway (CP) is part of the implementation of hospital clinical governance and one of the tools in quality and cost control system in JKN era. The effectiveness of clinical pathway (CP) compliance to patient clinical outcomes in several studies has shown positive results. Respira Lung Hospital Yogyakarta has designated CP COPD as a priority CP, but in the process of evaluating CP compliance, it has not used all Profesional Caregiver components as stipulated in Health Ministerial Regulation No. 30 of 2022. The current paradigm of health services is value-based healthcare, so it is necessary to evaluate the impact of CP compliance on the patient's clinical outcome. This study aims to determine the association of CP compliance to the clinical outcome of COPD patients and the process of implementing COPD CP compliance at the Respira Lung Hospital Yogyakarta in 2022. The research design is observational (cross sectional) with mix method approach. Quantitative method data collection using inpatient medical records with a primary diagnosis of COPD in 2022 (n=57) and qualitative method using with in-depth interviews, observation and document review. The results of quantitative study showed that COPD CP compliance rate is 87.7%, there is a significant relationship between doctor in charge of services with the incidence of complications (p value=0.003) and between CP compliance with clinical outcomes of complications (p value=0.05 and OR=6.75), factor that most influenced the patient's clinical outcome was CP compliance. Qualitative methods, based on the perspective of 10 variables in the theory of Gibson and Mathis-Jackson, showed good results on attitude variables. Knowledge, supervision, communication, training, human resources, performance standards, infrastructure, incentives and organizational structure variables still need improvement. To improve CP compliance, an effective communication between CP makers and implementer are required, full understanding and commitment of Profesional Caregivers, management support to regularly review CP governance, improve socialization, training, infrastructure, human resource needs, supporting IT facilities and regulations related to the implementation of CP are required.
B-2383
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Sukma Marthia Rahani; Pembimbing: Amal Chalik Sjaaf; Penguji: Anhari Achadi, Mardiati Nadjib, Erike A. Suwarsono, Dede Sri Mulyana
Abstrak:
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Penggunaan antibiotik yang tepat dan rasional dipercaya dapat mencegah terjadinya resistensi terhadap antibiotik juga berpengaruh terhadap keberhasilan pengobatan pasien pneumonia. Penggunaan antibiotik yang tidak rasional diduga juga dapat menyebabkan pemanjangan lama hari rawat di rumah sakit sehingga mempengaruhi biaya perawatan pasien pneumonia. Data Riskesdas tahun 2018 menunjukkan terjadi peningkatan prevalensi pneumonia berdasarkan diagnosis tenaga kesehatan sebesar 2%, sedangkan tahun 2013 sebesar 1.8%. Tujuan penelitian ini adalah untuk mengetahui hubungan antara kerasionalan penggunan antibiotik dengan outcome klinis pasien pneumonia di Rumah Sakit Haji Jakarta. Penelitian ini merupakan penelitian deskriptif-analitik (cross-sectional) kuantitatif yang pengambilan datanya dilakukan secara retrospektif menggunakan data rekam medik pasien di Rumah Sakit Haji Jakarta periode 1 Januari 2019 sampai dengan 31 Desember 2019. Dari 77 sampel yang didapat, sebanyak 37,7% pasien mendapatkan antibiotik secara tepat, 93.5% pasien mendapat dosis antibiotik secara tepat, 85.7% pasien yang mendapat antibiotik dengan durasi yang tepat, dan 98.7% pasien mendapat antibiotik dengan frekuensi yang tepat. Perbaikan klinis yang terjadi ≤ hari kelima sebanyak 88.3% dan lama hari rawat (length of stay) ≤ 5 hari sebanyak 67.5%. Kerasionalan penggunaan antibiotik tidak menunjukkan hubungan yang bermakna terhadap outcome klinis (p value > 0.05) dan lama hari rawat (p value > 0.05).
Appropriate and rational use of antibiotic is believed to prevent the occurrence of resistance to antibiotic also affect the success of the treatment of pneumonia patients. The irrational use of antibiotic is thought to also be able to cause lengthening of the length of stay in the hospital, thereby affecting the cost of treating pneumonia patients. Riskesdas data for 2018 showed an increase in the prevalence of pneumonia based on diagnosis by health professionals by 2%, while in 2013 it was 1.8%. The purpose of this study was to determine the relationship between the rational use of antibiotic with the clinical outcome of pneumonia patients at the Jakarta Hajj Hospital. This research is a quantitative descriptive-analytic (cross-sectional) study whose data was collected retrospectively using medical records of patients at the Jakarta Hajj Hospital for the period of January 1 2019 to 31 December 2019. Of the 77 samples obtained, 37.7% patients get the right antibiotik, 93.5% of patients get the right dose of antibiotic, 85.7% of patients get antibiotic with the right duration, and 98.7% of patients get antibiotic with the right frequency. Clinical improvement that occurred ≤ fifth day was 88.3% and length of stay ≤ 5 days was 67.5%. The rationality of antibiotik use did not show a significant relationship to clinical outcome (p value > 0.05) and length of stay (p value > 0.05).
Appropriate and rational use of antibiotic is believed to prevent the occurrence of resistance to antibiotic also affect the success of the treatment of pneumonia patients. The irrational use of antibiotic is thought to also be able to cause lengthening of the length of stay in the hospital, thereby affecting the cost of treating pneumonia patients. Riskesdas data for 2018 showed an increase in the prevalence of pneumonia based on diagnosis by health professionals by 2%, while in 2013 it was 1.8%. The purpose of this study was to determine the relationship between the rational use of antibiotic with the clinical outcome of pneumonia patients at the Jakarta Hajj Hospital. This research is a quantitative descriptive-analytic (cross-sectional) study whose data was collected retrospectively using medical records of patients at the Jakarta Hajj Hospital for the period of January 1 2019 to 31 December 2019. Of the 77 samples obtained, 37.7% patients get the right antibiotik, 93.5% of patients get the right dose of antibiotic, 85.7% of patients get antibiotic with the right duration, and 98.7% of patients get antibiotic with the right frequency. Clinical improvement that occurred ≤ fifth day was 88.3% and length of stay ≤ 5 days was 67.5%. The rationality of antibiotik use did not show a significant relationship to clinical outcome (p value > 0.05) and length of stay (p value > 0.05).
B-2151
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Fahrul Rahman; pEMBIMBINBG: Sandi Iljanto; Penguji: Mardiati Nadjib, Pujiyanto, Amila Megraini, Emi Lidia Arlini
Abstrak:
Mulai 1 januari 2014 diberlakukannya JKN di rumah sakit maka terjadi perubahan
sistem pembayaran dari pembayaran secara retrospektif (fee for service) menjadi
sistem pembayaran prospektif (INA-CBG‟s).Direncananakn pada 2019 Indonesia
seluruh penduduk Indonesia terdaftar di BPJS (Universal Heath Coverage).Sebagai
salah satu fasilitas pelayanan kesehatan milik pemerintah RSUD Banyuasin
mempunyai peranan untuk memberikan pelayanan yang berkualitas namun tetap
memperhatikan efisiensi karena makin berkurangnya subsidi pemerintah.Penelitian
ini bertujuan untuk menganalisis biaya dan mengidentifikasi faktor-faktor penentu
inefisiensi layanan Diabetes Melitus Komplikasi sehingga bisa dijadikan pedoman
pengendalian biaya dalam melayani pasien.Jenis penelitian ini bersifat analisis
deskriptif dengan menggunakan data primer (pengamatan dan wawancara) dan data
sekunder berupa data dari RSUD Banyuasin tahun 2015.Analisis biaya menggunakan
pendekatan Activity Based Costing (ABC).Metode ABC untuk mengalokasikan biaya
dengan mengidentifikasi pemicu biaya (cost driver) penyebab terjadinya biaya
layanan Diabetes Melitus Komplikasi.Hasil penelitian menunjukkan komponen obat
pada pelayanan Diabetes Melitus Komplikasi merupakan faktor penentu inefisiensi.
Usaha yang dapat dilakukan oleh rumah sakit untuk mengatasi inefisiensi dengan
pembuatan Panduan Praktek Klinik, Revisi Formularium RS, Klinisi secara konsisten
menggunakan obat e-cataloq
Kata kunci: Analisis biaya, metode ABC, inefisiensi
Since JKN was offiacially administered in general hospital on January 1st, 2014, there
has been changing in hospital administration payment from the restrospective system
(free for services) to the prospective system (INA-CBG‟s). It is planned in 2019 that
all the people in Indonesia is registered in BPJS (Universal Heath Coverage) as one
of the facilities for public healt services provided by Banyuasin general hospital
(RSUD Banyuasin) which ains to provide qualified services, yet still considering
effiencies due to the lach of the government subsidies. This study aimed to analyze
the cost and identify determinant factor in handling Diabetes Melitus with
complications, so that it can be a reference to handle the cost in taking care of patients
with Diabetes Melitus. This study applied descriptif analysis which using primary
data (observation and interview) and secondary data from Banyuasin general hospital
(RSUD Banyuasin) in 2015 meanwhile. The cost analysis was appliyng Activity
Based Costing (ABC) method. The ABC method was applied to allocated the cost by
identifying the cost driver which was the major cause for cost for financing services
for Diabetes Melitus with complication. The result of this study showed that medical
component was the determinant factor of the inefficiencies for Diabetes Melitus with
complication services. There are many efforts that can be done by the hospital to
overcome the ineficiencies, for instance, making quidance for clinical practies,
making revision for hospital formulation, and using e-cataloq medicine consistently
Keywords : the cost analysis, ABC method, ineficiency
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B-1872
Depok : FKM-UI, 2017
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
I Nyoman Satria Wijaya; Pembimbing: Mieke Savitri; Penguji: Vetty Yulianty Permanasari, Dumilah Ayuningtyas, Sumijatun, Budiman Widjaja
Abstrak:
Proses pemulangan pasien rawat inap merupakan proses kompleks yang melibatkan banyak unit dalam pelaksanaannya. Pendekatan lean merupakan pendekatan terhadap proses yang menembus sekat antar unit dan dapat memberikan gambaran jelas pelaksanaan proses dari awal sampai akhir serta dapat memberikan pembenahan. Penelitian ini dilakukan untuk menganalisis proses pemulangan pasien rawat inap BPJS Kesehatan naik kelas perawatan di Rumah Sakit BaliMed Karangasem dengan pendekatan lean. Hasil penelitian kualitatif yang menggunakan metode pengumpulan data observasi, telaah dokumen dan wawancara mendalam ini mendapatkan lama proses pemulangan pasien BPJS Kesehatan naik kelas perawatan mencapai 192,9 menit dengan kegiatan value added sebesar 29,6 % dan non value added sebesar 70,4% dengan 15 kegiatan yang merupakan waste. Usulan perbaikan yang dilakukan dengan pendekatan lean mampu meningkatkan persentase kegiatan value added menjadi 70,2 % dan menekan kegiatan non value added menjadi 29,8% serta merampingkan kegiatan proses pemulangan dari 21 kegiatan menjadi 15 kegiatan.
Kata kunci : proses pemulangan pasien, lean,value added, non value added
The discharge process of inpatients is a complex process that involves many units in its implementation. The lean approach is an approach to production processes that penetrate the boundaries between units and can provide a clear picture of the process from the beginning to the end and can provide improvements. This study was conducted to analyze the discharge process of inpatients BPJS Kesehatan upgrade class patients at BaliMed Hospital Karangasem with a lean approach. The results of the qualitative research using observational data collection methods, document review and in-depth interviews received a long process of discharge process reaching 192.9 minutes with 29.6% value added activities and 70.4% non value added activity with 15 activities which are waste. The proposed improvements made with a lean approach were able to increase the percentage of value added activities to 70.2% and suppress non value added activities to 29.8% and streamline the return process activities from 21 activities to 15 activities.
Key Word : Discharge process, lean, value added, non value added
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Kata kunci : proses pemulangan pasien, lean,value added, non value added
The discharge process of inpatients is a complex process that involves many units in its implementation. The lean approach is an approach to production processes that penetrate the boundaries between units and can provide a clear picture of the process from the beginning to the end and can provide improvements. This study was conducted to analyze the discharge process of inpatients BPJS Kesehatan upgrade class patients at BaliMed Hospital Karangasem with a lean approach. The results of the qualitative research using observational data collection methods, document review and in-depth interviews received a long process of discharge process reaching 192.9 minutes with 29.6% value added activities and 70.4% non value added activity with 15 activities which are waste. The proposed improvements made with a lean approach were able to increase the percentage of value added activities to 70.2% and suppress non value added activities to 29.8% and streamline the return process activities from 21 activities to 15 activities.
Key Word : Discharge process, lean, value added, non value added
B-2058
Depok : FKM UI, 2019
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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I Nyoman Ari Wijaya; Pembimbing: Dumilah Ayuningtyas; Penguji: Ede Surya Darmawan, Pujiyanto, Heri Iswanto, Muhammad Baharuddin
Abstrak:
Pelayanan Farmasi merupakan pelayanan yang tidak dapat dipisahkan dari pelayanan rumah sakit. Lamanya waktu tunggu di farmasi akan memengaruhi mutu layanan di rumah sakit secara menyeluruh. Demikian juga di RSU Bali Royal, didapatkan waktu tunggu diatas dari standar pelayanan minimal rumah sakit. Lamanya waktu tunggu di farmasi rawat jalan disebabkan belum berjalannya manajemen mutu yang baik di RSU Bali Royal. Peneitian ini akan melihat bagaimana proses pelayanan farmasi rawat jalan dengan menggunakan metode lean, di tahun 2017 dengan observational action process research, dengan melakukan observasi terhadap 15 pasien dari bulan oktober 2017 sampai dengan Januari 2018 di farmasi rawat jalan RSU Bali Royal, dengan melihat waste yang ada. Ditemukan kegiatan yang bersifat value added sebesar 45,65% dan kegiatan non value added (waste) sebesar 54,28%. Waste yang banyak ditemukan adalah waste waiting dan waste defect. Eliminasi waste yang sudah ditemukan dengan implementasi intervensi antara lain: memindahkan konter kasir, merubah lay out farmasi, membuat loket antara konter farmasi dengan ruang pengerjaan obat mengunci pintu ruang farmasi dan merubah alur layanan farmasi rawat jalan, sehingga kegiatan non value added dapat di eliminasi menjadi 18,28% dan kegiatan value added menjadi 81,72%. Dari segi outcome dapat dilihat adanya perbaikan waktu tunggu, perbaikan kepuasan pelanggan, peningkatan kunjungan dan peningkatan omset di farmasi. Peneitian ini menyimpulkan adanya peningkatan mutu layanan setelah dilakukan perbaikan proses pelayanan farmasi rawat jalan dengan menggunakan metode lean.
Kata kunci : Mutu; Lean; Farmasi
Pharmaceutical Services is a service that cannot be separated from hospital services. The length of waiting time in the pharmacy will satisfy the overall quality of hospital services. Currently the waiting time in Bali Royal Hospital pharmacy for out patient is still above the standard waiting time, which is not in accordance with the hospital guidelines. The standard waiting time for outpatient pharmacy cannot be achieved due to lack of quality management at RSU Bali Royal. This study will look at how the process of outpatient pharmacy service using lean method, in 2017 with observational action process research, by observing 15 patients from October 2017 to January 2018 at outpatient pharmaceutical RSU Bali Royal, by looking at the waste. It is founded that there are 45.65% value added activities and non-value added activities (vaste) of 54.28%. Most of the wastes that are found are waste waiting and waste defect. Elimination of waste that has been done by the implementation of intervention, among others: moving cashier counters, changing the lay out of pharmacy, making counter between the pharmaceutical counter with space lock pharmaceutical door lock and change in outpatient pharmacy service, so that non value added activities can be eliminated to 18.28% and value added activities to 81.72%. In terms of outcome can be seen the improvement of waiting time, improvement of customer satisfaction, increased visits and increased turnover in pharmacy. This study concludes that there is a significant improvement of service quality after the refinement of outpatient pharmacy service process using lean method.
Keyword : Quality; Lean; Pharmacy
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Kata kunci : Mutu; Lean; Farmasi
Pharmaceutical Services is a service that cannot be separated from hospital services. The length of waiting time in the pharmacy will satisfy the overall quality of hospital services. Currently the waiting time in Bali Royal Hospital pharmacy for out patient is still above the standard waiting time, which is not in accordance with the hospital guidelines. The standard waiting time for outpatient pharmacy cannot be achieved due to lack of quality management at RSU Bali Royal. This study will look at how the process of outpatient pharmacy service using lean method, in 2017 with observational action process research, by observing 15 patients from October 2017 to January 2018 at outpatient pharmaceutical RSU Bali Royal, by looking at the waste. It is founded that there are 45.65% value added activities and non-value added activities (vaste) of 54.28%. Most of the wastes that are found are waste waiting and waste defect. Elimination of waste that has been done by the implementation of intervention, among others: moving cashier counters, changing the lay out of pharmacy, making counter between the pharmaceutical counter with space lock pharmaceutical door lock and change in outpatient pharmacy service, so that non value added activities can be eliminated to 18.28% and value added activities to 81.72%. In terms of outcome can be seen the improvement of waiting time, improvement of customer satisfaction, increased visits and increased turnover in pharmacy. This study concludes that there is a significant improvement of service quality after the refinement of outpatient pharmacy service process using lean method.
Keyword : Quality; Lean; Pharmacy
B-2003
Depok : FKM UI, 2018
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ngakan Putu Daksa Ganapati; Pembimbing: Wachyu Sulistiadi; Penguji: Rico Kurniawan, Panca Hadi Putra, Benedict Sulaiman, Ni Made Ayu Lestari
Abstrak:
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Terapi radioterapi rawat jalan bersifat multidisiplin dan berlangsung lama melalui kunjungan berulang, sehingga kerap menimbulkan kebingungan pasien, menurunkan pemahaman dan kepatuhan terapi, serta mengganggu kesinambungan pelayanan; sementara itu sistem navigasi pasien yang terstruktur, berkelanjutan, dan terintegrasi dengan edukasi serta kecerdasan buatan belum tersedia di RSUP Prof. Dr. I.G.N.G. Ngoerah. Penelitian ini bertujuan mengembangkan model sistem navigasi pasien rawat jalan radioterapi berbasis edukasi dan AI recording (NAVIRA) serta mengukur penerimaannya menggunakan Technology Acceptance Model (TAM). Penelitian menggunakan desain mixed methods dua tahap: tahap kualitatif melalui wawancara mendalam terhadap lima pasien dan lima tenaga kesehatan dengan teknik purposive sampling hingga tercapai saturasi data untuk menggali kebutuhan dan merancang model, dilanjutkan tahap kuantitatif untuk menguji penerimaan model pada 80 responden melalui kuesioner daring yang dianalisis dengan statistik deskriptif dan regresi linear sederhana serta berganda. Model NAVIRA dikembangkan sebagai chatbot berbasis WhatsApp dengan arsitektur WAHA, n8n, basis data Supabase, dan Gemini API dengan pendekatan Retrieval-Augmented Generation, yang menyediakan informasi terpusat, edukasi terstruktur per fase terapi, pengingat jadwal, triase keluhan, serta dokumentasi layanan. Hasil menunjukkan penerimaan yang tinggi pada ketiga dimensi TAM, yakni Perceived Usefulness (rerata 4,16), Behavioral Intention (4,14), dan Perceived Ease of Use (3,98), dengan instrumen yang valid dan reliabel. Uji hipotesis membuktikan bahwa Perceived Ease of Use berpengaruh signifikan terhadap niat penggunaan (p=0,020), sedangkan Perceived Usefulness tidak signifikan baik secara parsial maupun simultan (p=0,614; p=0,630), dengan koefisien determinasi sebesar 6,9 persen. Penerimaan model relatif stabil lintas jenis kelamin, fase terapi, dan lama pemakaian. Penelitian menyimpulkan bahwa kemudahan penggunaan merupakan determinan utama penerimaan NAVIRA oleh pasien radioterapi, sehingga pengembangan selanjutnya perlu memprioritaskan penyederhanaan antarmuka dan pendampingan adopsi, memperluas model dengan variabel kepercayaan dan kondisi fasilitasi, serta mempersiapkan tata kelola sumber daya manusia, pengalaman pasien, dan kepatuhan regulasi data sebelum implementasi institusional.
Radiotherapy is multidisciplinary and prolonged, requiring repeated visits that often leave patients confused, reduce their understanding and treatment adherence, and disrupt continuity of care; meanwhile, a structured, continuous patient navigation system integrated with education and Artificial Intelligence is not yet available at RSUP Prof. Dr. I.G.N.G. Ngoerah. This study aimed to develop a radiotherapy patient navigation model based on education and AI recording (NAVIRA) and to measure its acceptance using the Technology Acceptance Model (TAM). A two-stage mixed methods design was applied: a qualitative stage involving in-depth interviews with five patients and five health workers selected through purposive sampling until data saturation to explore needs and design the model, followed by a quantitative stage assessing acceptance among 80 respondents through an online questionnaire analysed using descriptive statistics and simple and multiple linear regression. NAVIRA was developed as a WhatsApp-based chatbot with a WAHA, n8n, Supabase, and Gemini API architecture using a Retrieval-Augmented Generation approach, providing centralized information, structured phase-based education, schedule reminders, complaint triage, and service documentation. The results showed high acceptance across all three TAM dimensions, namely Perceived Usefulness (mean 4.16), Behavioural Intention (4.14), and Perceived Ease of Use (3.98), with a valid and reliable instrument. Hypothesis testing demonstrated that Perceived Ease of Use significantly influenced behavioural intention (p=0.020), whereas Perceived Usefulness was not significant either partially or simultaneously (p=0.614; p=0.630), with a coefficient of determination of 6.9 percent. Acceptance was relatively stable across sex, treatment phase, and duration of use. The study concludes that ease of use is the primary determinant of NAVIRA acceptance among radiotherapy patients, so future development should prioritize interface simplification and adoption assistance, expand the model with trust and facilitating-condition variables, and prepare human resource governance, patient experience, and data regulatory compliance prior to institutional implementation.
B-2595
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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