Keselamatan pasien merupakan kewajiban rumah sakit dan bagian integral dari akreditasi sejak 2008. Namun, berbagai permasalahan masih sering ditemukan, sehingga keberlanjutan perbaikan menjadi tantangan. Penelitian ini bertujuan merumuskan model konseptual strategi peningkatan keselamatan pasien. Penelitian menggunakan pendekatan mixed method dengan desain convergent parallel. Data kuantitatif berasal dari Riset Fasilitas Kesehatan 2019 (523 rumah sakit) dan data akreditasi (917 rumah sakit), dianalisis menggunakan uji chi-square, regresi logistik, dan analisis jalur. Data kualitatif dikumpulkan melalui wawancara mendalam dan telaah dokumen dari enam rumah sakit, dinas kesehatan provinsi, dan Perhimpunan Rumah Sakit Seluruh Indonesia (PERSI) wilayah di Sumatera Utara dan Bali, dengan total 95 informan. Analisis tematik menggunakan perangkat NVivo, dengan kerangka Malcolm Baldrige dan model implementasi Van Meter-Van Horn, meliputi ukuran dan tujuan kebijakan, sumber daya, kepemimpinan, perencanaan strategis, fokus tenaga kerja, fokus operasi, fokus pelanggan, pengukuran, analisis, dan manajemen pengetahuan, komunikasi antar organisasi, serta peran akreditasi. Hasil kuantitatif menunjukkan bahwa pelaporan insiden keselamatan pasien berhubungan signifikan dengan lokasi (Jawa-Bali), status akreditasi, jumlah tempat tidur (> 200), kelas rumah sakit (A dan B), evaluasi pelayanan, audit internal, serta keaktifan komite keselamatan pasien dan pengendalian infeksi. Hasil kualitatif menunjukkan bahwa implementasi kebijakan keselamatan pasien sudah berjalan, namun bervariasi tergantung kepemilikan dan ketersediaan sumber daya. Semua dimensi yang diteliti berpotensi menjadi faktor pendukung maupun penghambat tergantung pengelolaannya. Kepemimpinan yang kuat, fasilitas yang memadai, serta budaya keselamatan yang ditanamkan secara konsisten memperkuat implementasi, sedangkan lemahnya komitmen dan keterbatasan dana menjadi kendala. Hambatan juga muncul dalam pelaporan insiden, baik dari sisi organisasi maupun individu. Penelitian ini menghasilkan model konseptual strategi peningkatan keselamatan pasien yang mencakup integrasi keselamatan pasien dalam perencanaan strategis, penguatan kepemimpinan, peningkatan kapasitas staf, alokasi anggaran memadai, monitoring dan evaluasi berkelanjutan, serta pelibatan pasien. Model ini diharapkan dapat mendorong peningkatan keselamatan pasien secara menyeluruh dan berkelanjutan di rumah sakit.

Patient safety is a mandatory obligation for hospitals and has been an integral part of hospital accreditation since 2008. However, various patient safety issues are still frequently found, making the sustainability of improvements a major challenge. This study aims to formulate a conceptual model of patient safety improvement strategies. A mixed-methods approach with a convergent parallel design was employed. Quantitative data were obtained from the 2019 Rifaskes (523 hospitals) and accreditation records (917 hospitals), and analyzed using chi-square tests, logistic regression, and path analysis. Qualitative data were collected through in-depth interviews and document reviews from six hospitals, provincial health offices, and the Indonesian Hospital Association (PERSI) in North Sumatra and Bali Provinces, involving a total of 95 informants. Thematic analysis was conducted using NVivo software, guided by the Malcolm Baldrige framework and the Van Meter–Van Horn policy implementation model. Quantitative findings showed that the reporting of patient safety incidents was significantly associated with location (Java–Bali), accreditation status, bed capacity (>200 beds), hospital class (A and B), presence of service evaluations, internal audits, and the activity of patient safety and infection control committees. Qualitative results indicated that while policy implementation was underway, it varied depending on hospital ownership and available resources. All dimensions could act as either enablers or barriers depending on how they were managed. Strong leadership and adequate facilities enhanced implementation, while weak commitment and limited funding were key constraints. Incident reporting also faced challenges at both organizational and individual levels. This study produced a conceptual model for improving patient safety through the integration of safety into strategic planning, strengthened leadership, staff capacity building, sufficient budget allocation, continuous monitoring and evaluation, and enhanced patient engagement. The model is expected to support comprehensive and sustainable patient safety improvements in hospitals

Ketersediaan obat esensial menjadi tantangan saat menghadapi Pandemi COVID-19 di Indonesia. Evaluasi JEE (Joint External Evaluation) 2023 menunjukkan koordinasi lintas sektor masih lemah dalam mencegah, mendeteksi dan menanggapi keadaan darurat kesehatan. Tahun 2021 sebanyak 30% kabupaten/kota belum memenuhi target 85% obat esensial tersedia. Tingkat ketersediaan ini dipengaruhi oleh implementasi kebijakan nya. Penelitian ini bertujuan menganalisis kesiapsiagaan pemerintah daerah dalam menjamin ketersediaan obat esensial pada masa pandemi dan membangun model konseptual resiliensinya.

Penelitian ini dilakukan dengan pendekatan kualitatif di Provinsi Jawa Barat, Kota Depok dan Kabupaten Bogor, serta di Provinsi Bali, Kota Denpasar dan Kabupaten Badung. Pengumpulan data wawancara mendalam, observasi dan data laporan dari instansi. Instrumen wawancara telah divalidasi dengan nilai I-CVI >0,83. Implementasi kebijakan dan penyusunan model resiliensi pemerintah daerah di analisis menggunakan model Van Meter Van Horn.

Kesiapsiagaan pemerintah daerah saat Pandemi COVID-19 pada awalnya belum siap namun dengan adaptasi dan peningkatan kapasitas telah lebih siap. Semua aktor telah menjalankan perannya sehingga tingkat ketersediaan obat esensial indikator selama pandemi COVID-19 memenuhi target capaian indikator di puskesmas maupun kabupaten/kota tahun 2020-2022. Faktor-faktor yang mendukung tingkat ketersediaan obat esensial indikator adalah adanya dukungan pemerintah daerah, dukungan kebijakan, kepemimpinan, ketersediaan anggaran BTT, kolaborasi lintas sektor dan ketepatan perencanaan obat. Faktor-faktor penghambat antara lain terbatas anggaran daerah, SDM, sarana prasarana, ketergantungan industri terhadap bahan baku impor, SIM belum terintegrasi dan ego-sektoral. Terdapat 37 indikator yang terbagi 22 indikator utama dan 15 pendukung pada dimensi ukuran dan tujuan kebijakan, sumber daya, komunikasi antar organisasi, karakteristik badan pelaksana, lingkungan sosial, ekonomi dan politik serta disposisi pelaksana yang dapat membangun resiliensi pemerintah daerah dalam mejamin ketersediaan obat esensial. Pemerintah daerah perlu meningkatkan kapabilitas SDM, penguatan surveillance obat, pemastian buffer stock, kolaborasi lintas sektor, SIM terintegrasi, serta penerapan kebijakan BLUD puskesmas dapat meningkatkan implementasi kebijakan pemerintah daerah dalam menjamin ketersediaan obat esensial.

The availability of essential medicines has been a challenge during the COVID-19 pandemic in Indonesia. The 2023 Joint External Evaluation (JEE) showed that inter-sectoral coordination remains weak in preventing, detecting, and responding to health emergencies. In 2021, 30% of districts/cities had not met the target of 85% availability of essential medicines. This availability rate is influenced by the implementation of policies. This study aims to analyze the preparedness of regional governments to ensure the availability of essential medicines during the pandemic and to develop a conceptual model of their resilience. This study used a qualitative approach in West Java Province, Depok City, Bogor District, Bali Province, Denpasar City, and Badung District. Data collection involved in-depth interviews, observations, and reports from relevant agencies. The interview instrument was validated with an I-CVI value >0.83. The Van Meter Van Horn model analyzed policy implementation and the development of regional government resilience models. Regional government preparedness during the COVID-19 pandemic was initially inadequate, but through adaptation and capacity building, it has improved. All actors have fulfilled their roles, ensuring that the availability of essential medicines during the COVID-19 pandemic met the target indicators at health centers and districts/cities from 2020 to 2022. Factors supporting the availability of essential medicines include regional government support, policy support, leadership, availability of Unexpected Costs Unexpected Costs budget, cross-sectoral collaboration, and accurate medicine planning. Hindering factors include limited local budgets, human resources, infrastructure, industry dependence on imported raw materials, unintegrated SIM, and sectoral egoism. There are 37 indicators divided into 22 main indicators and 15 supporting indicators in the dimensions of policy size and objectives, resources, inter-organizational communication, characteristics of implementing agencies, social, economic, and political environment, and the disposition of implementers that can build the resilience of regional governments in ensuring the availability of essential medicines. Regional governments need to enhance human resource capabilities, strengthen drug surveillance, ensure buffer stock, promote cross-sectoral collaboration, integrate SIM, and implement Regional Public Service Agency policies for community health centers to improve the implementation of regional government policies in ensuring the availability of essential medicines.