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This Research aims to determine patient satisfaction on service of ambulatory care Installation at Drug Dependence Hospital Jakarta in year 2010 and the factors associated with patient satisfaction, ie, patient characteristics and service in ambulatory care installation. The method of this thesis is cross sectional analytic study on 110 patients that used univariate analysis, bivariate and multivariate analysis. Chi square and logistic regression is used as statistic test.
The research results that 64% respondents who expressed satisfaction. There are three dominant variables of patient characteristics that are related to occupation, income and education. There are three dominant variables of ambulatory services related with satisfaction, that are environmental infrastructure in the waiting room, nursing services, and physician services. By patients characteristics this research informed that requiring community services more customer-oriented, communicative, fast, responsive, and competence and quality of the service implementation.
Analysis of Outpatient Installation Pharmacy Waiting Time at Special Hospital of Drug Addiction Jakarta in 2023 Abstract Prescription services waiting time in outpatient installations is one of the indicators for evaluating the performance of pharmaceutical installations that affects the quality of hospital services. Hospitals need to effort that prescription services waiting time meet the Minimum Service Standards (SPM). Through the Lean method with the Value Stream Mapping approach, this study aims to determine the prescription service procedures at the outpatient installation of RSKO Jakarta, identify value added and non-value added and waste that occurs so that factors that cause waste can be analyzed which can be prevented through the strategy recommendations obtained. This is a qualitative research with data collection obtained through observing and recording the e-prescriptions services waiting time at the RSKO outpatient installation, extracting in-depth information from informants and reviewing documents. Observations were made on 20 concoction medicine recipes and 10 concoction medicine recipes. The selection of informants was carried out using a purposive sampling technique and interviews were conducted with patients to obtain value from the customer's perspective according to the principles of the Lean method. The data obtained is then analyzed to obtain the factors affecting the prescription services waiting time duration using a fishbone diagram then a scoring system is carried out by assessing the urgency, severity and growth aspects of the cause problem so that priority recommendations can be formulated. The results of research conducted in April-May 2023 found that the average waiting time for prescription drug services was 49.25 minutes (VAR 17.5%) and for concoction drugs 80.2 minutes (VAR 33%), which means that it still exceeds the SPM set by KMK No. 128 of 2009 (no concoction drug recipe < 30 minutes, concoction drug recipe < 60 minutes). Some of the factors that cause waste are inefficiency in human resources, pharmaceutical inventory systems that have not been automated, inadequate evaluation/monitoring of drug use, the absence of a separate system for emergency prescription services, prescription service SPO that has not been adjusted with the establishment of prescription response time quality standardsfor each process, networks information system that frequently down/loads repeatedly and patient’s interruption for asking information. It is hoped that in the future an improvement strategy can be carried out to improve the waiting time for prescription services; increasing HR efficiency through arrangements so that during peak hours pharmaceutical HR focuses on working on the duties and functions of prescription services, facilitating a pharmaceutical inventory system with an automated system, implementing an evaluation system for monitoring drug use more effectively so that procurement planning becomes more accurate, regulation separates prescription services from the emergency room, providing SPO in accordance with prescription service implementation, separate the information system network between patient services and office and providing reachable information for pastient (visual management).
Kata kunci: lean thinking, , medication error, swiss chesse model waktu tunggupelayanan
Quality improvement and patient safety are two things that cannot separated and mustbe continuous. Effort to improve quality and patient safety at Outpatient PharmacyPusat Otak Nasional Prof. DR.dr. Mahar Mardjono Hospital is described through theachievement of service indicators according to the hospital minimum service standardsthet have not resched the standard. This study was conducted to analyze the waitingtime for JKN patient medication services and risk activities of medication errors usingprinciples of lean thinking and the swiss cheese model. This type of research isoperational research with qualitative and quantitative approaches. Qualitative data isobtained through the process of observation and document review, while quantitativedata is based on waiting time data from electronic health records and waiting time forobservations. The result showed that the waiting time was 1 hour 3 minutes 11 seconds,with the longest waiting time was in the process of receiving the recipe (30 minutes 42seconds). Value_added activity (79%) was 13 minutes 13 seconds, non value addedactivity (21%) for 49 minutes 21 second. Most of waste is in waiting activities with apresentation time of 92% of the time for non value added. The bottleneck in this studywas taken from the longest waiting time process and the result of the swiss cheesemodel analysis at the assessment and examination stage of drug preparations.Reviewing the waiting time indicator profile for the finished medicine according to theSPM of the hospital. There is a need for workload analysis, and monitoring of thereview of prescription services. Proposed improvements are described in a future statemap by reducing non value added activity which can be directly eliminated withoutintervention.
Key words: lean thinking, medication error, swiss chesse model, medication error,service waiting time.
Krisis moneter yang tidak kunjung selesai bahkan diikuti dengan krisis yang lainnya, memicu timbulnya dampak yang tidak diinginkan. Salah satunya adalah peningkatan biaya kesehatan, sehingga menimbulkan beban ekonomi bagi orang yang membutuhkan. Begitu pula bagi perusahaan yang menjamin kesehatan para pegawainya seperti PT Pelindo II. RS Pelabuhan Jakarta yang merupakan penyelenggara pelayanan kesehatan bagi pegawai dan pensiunan berserta keluarganya dari PT Pelindo R juga merupakan salah satu anak perusahaan dari PT Pelindo II ikut bertanggung jawab untuk mengendalikan besarnya biaya yang timbul akibat kenaikan biaya pelayanan kesehatan.Sebelum diterapkan sistem kapitasi, PT Pelindo II melakukan cara pembayaran atas jasa pelayanan yang diberikan rumah sakit berdasarkan jasa per-pelayanan (fee-for-service). Sehingga anggaran setiap tabus untuk jaminan kesehatan parapegawai dan pensiunan berserta keluarganya meningkat terus tanpa dapat diprediksi.Sejak bulan April, PT Pelindo II yang merupakan salah satu pelanggan utama dari RS Pelabuhan Jakarta menjadi peserta JPKM sehingga berkewajiban membayar premi kepada Badan Penyelenggara (Bapel) RS Pelabuhan, dirnana Bapel merupakan badan penyelenggara asuransi kesehatan/lembaga pembayar kepada provider (RS Pelabuahn Jakarta). Sementara itu RS Pelabuhan Jakarta menerima pembayaran kapitasi dari Bapel RS Pelabuhan.Agar sistem pembayaran kapitasi berjalan sesuai seperti yang diharapkan, maka manajemen rumah sakit mengeluarkan beberapa kebijakan untuk membantu pelaksanaan kapitasi sehingga dapat membantu rumah sakit merencanakan pelayanan kesehatan yang akan diberikan tanpa menanggung kerugian dan tidak mengurangi. kualitas pelayanan kepada pasien.Perubahan pembayaran dari fee-for-service menjadi kapitasi, diharapkan dapat menunutkan biaya pemeliharaan kesehatan. Disini peneliti menyoroti biaya resep obat yang ditulis oleh dokter baik full timer maupun part-tinter dalam menangani kasus 10 penyakit terbanyak kunjungannya di rawat jalan RS Pelabuhan Jakarta untuk pelanggan dari JPKM (pegawai dari pensiunan berserta keluarga dari PT Pelindo II). Penurunan biaya resep obat rawat jalan diharapkan dapat ikut mengendalikan biaya pemeliharaan kesehatan bagi peserta JPKM tersebut karena biaya obat rawat jalan untuk pasien kelompok ini menyerap 75% lebih dari keseluruhan biaya untuk pemeliharaan kesehatan selama 5 tahun terakhir, bahkan sampai 80% untuk tahun 2001.Penelitian ini merupakan penelitian evaluasi berbentuk "pre post test evaluation" yang bersifat kuantitatif. Data yang digunakan adalah data sekunder yang diambil dari base data komputer Sistem Informasi RS Pelabuhan JakartaHasil yang diperoleh dari penelitian ini adalah angka pemanfaatan di rawat jalan sesudah kapitasi mengalami penurunan sedikit dibandingkan sebelum kapitasi, yakni hanya 0,5%. Terjadi kenaikan penulisan obat generik baik oleh dokter full-timer maupun part-timer, masing-masing sebesar 4% dan 8%. Biaya rata-rata obat/resep yang ditulis dokter full-timer menurun secara bermakna terutama untuk penyakit hipertensi (p=0), gastritis (p=0)dan influenza (p=0,01).Jumlah resep yang bernilai lebih dan Rp. 200.000,- mengalami penurunan, dokter full timer sebesar ±6%, dokter part-timer 21,87%. Jumlah resep bernilai kurang atau sama dengan Rp. 200.000; meningkat untuk dakter 54,54%, perubahan ini dibuktikan bermakna terutama untuk penyakit hipertensi dan gastritis dan dokter part-timer sebesar 50,82%, yang bermakna pada 8 penyakit kecuali pharyngitis dan asthma bronchiale.Kesimpulan utama adalah tingkat pemanfaatan rawat jalan menurun kurang berarti sesudah diterapkan kapitasi dengan kebijakan pembatasan biaya resep terutama untuk penyakit kronis. Kenaikan penulisan obat generik terutama oleh dokter part-timer (8%), penurunan biaya rata-rata obat per-resep baik oleh dokter full-timer maupun part-timer serta terjadi penurunan jumlah resep obat yang mempunyai nilai biaya rata-rata obat per-resep lebih dari Rp. 200.000; untuk kedua jenis dokter. Peran dokter pengendali sangat besar dalam penurunan biaya resep obat rawat jalan.Saran peneliti, perlu dilakukan penelitian lanjutan dan peninjauan kembali kebijakan pembatasan obat terutama untuk pasien yang mempunyai penyakit kronikDaftar bacaan :23 (1985-2001)
The unfinished problem of the monetary crisis has triggered the development of other crisis where all together have brought about some unexpected impacts to the society_ One of the impacts is an increase in the health cost which creates a significant financial burden for those in need as well as for those companies which provide health insurance service for their employees. Pelabuhan Hospital, Jakarta, as an institution which provides health services for its employees and pensioners together with their families from PT Pelindo II, it also having a responsibility to manage its total cost as a consequence of the increase in the health cost.Prior to the application of the capitation system, PT Pelindo II had used the fee for service payment system. As the result, the management was not able to forecast the total health insurance cost for its employees and their families per year.Since the beginning of April 2002, PT Pelindo II, as one of the main customers of Pelabuhan Hospital, Jakarta, has become a JPKM member. As the consequence, PT Pelindo II is obliged to pay the premium to the organizing committee of Pelabuhan Hospital, Jakarta whereas, the organizing committee itself is a committee that manages the payment of the insurance to the Pelabuhan Hospital, JakartaEn order for the capitation system to work as expected, the hospital management has released a number of policies to support the implementation of this particular system as well as in planning the type of health service to be provided without affecting the quality of the services.The transformation of the fee for service type payment into the capitation system is expected to reduce the health cost. In the thesis, the writer highlights the prescription cost written by both fish-timer and part-timer doctors in handling 10 (ten) most common cases reported by the Out- patient Department of Pelabuhan Hospital, Jakarta for its customers from JPKM (employees, pensioners and theirs families from PT Pelindo II). The management expects that decline in the prescription costs at the out-patient department could provide a .contribution in controlling the health cost for JPKM members as the prescription cost for this particular group absorps more than 75% of the total health cost for the last five years period and the number once reached 80% in the year 2001.The study in thesis can be classified as a quantitative pre-post evaluation study where the data used are the secondary data taken from the database of the Information system department in Pelabuhan Hospital, JakartaThe result of this study shows that there is a minor change in the rate- utilization after the implementation of the capitation system (0,5%). There is also an increase in the generic type of medicine in the prescription for both full-time and part-time doctors, 4% for the full-timer and 8% for the part-timer. However, the average prescription written by full-time doctors has decrease significantly in particular for hypertensi (p=0), gastritis (p=0) and influenza (p=0,0l). In addition to that, there is also a decrease in the prescription with value of the Rp 200,000,- or more as prescribed by full-timer ( approximately 6%) and part-timer (21.87%). Meanwhile, there is an increase for the prescription with values less or equal to Rp 200,000, - for full-time doctor (64,34%) in cases like hypertension and gastritis, and this also happens for part-time doctor (50.82%) in 8 (eight) cases except for pharyngitis and asthma bronchiale.The main conclusion that can be drawn from this study is that the usage level of the capitation system in the out-patient department would only have a small impact to the rate-utilization. This small impact is mainly due to the management policy that restrict the prescription cost particularly for chronic cases, the increase in the prescription of the generic type medicine by the part-time doctor (8%), the decrease in the average medicine cost in prescription written by both full-time and part-time doctors, and the decrease in the prescription cost with average cost of more than Ap. 200,000,- for both full-timer and part-timer. In addition to that, it is also clear that the doctors, both full-timer and part-timer, play a significant role in reducing the prescription costs.Last but not least, the writer suggests that there is still a need for an advanced study in this system together with the review in the policy for the medicine restriction especially for those patients with chronical diseases.Bibliography :23 (1985-2001)