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

Keselamatan kerja pada jalur hauling di industri pertambangan batubara merupakan aspek penting yang memerlukan perhatian serius, mengingat tingginya risiko kecelakaan kerja pada aktivitas pengangkutan material. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang memengaruhi kecelakaan kerja dan menyusun model pencegahan berbasis Human Factor Analysis and Classification System for Mining Industry (HFACS-MI) serta metode investigasi Australian Transport Safety Bureau (ATSB). Pendekatan campuran digunakan dalam penelitian ini, dengan data kuantitatif diperoleh melalui survei terhadap 420 operator dump truck di tiga perusahaan tambang terbuka di Kalimantan, serta data kualitatif dari wawancara mendalam, Focus Group Discussion (FGD), dan observasi langsung di lapangan. Analisis regresi linier berganda digunakan untuk menguji pengaruh enam variabel independen faktor eksternal, pengaruh organisasi, kepemimpinan tidak berkeselamatan, pengendalian risiko, kondisi lingkungan, dan tindakan individu terhadap kecelakaan. Hasil penelitian menunjukkan bahwa seluruh variabel memiliki pengaruh signifikan, dengan kepemimpinan tidak berkeselamatan dan kondisi lingkungan sebagai faktor dominan penyebab kecelakaan. Temuan ini mengindikasikan perlunya penguatan pengawasan, perbaikan perilaku kerja operator, serta peningkatan kualitas jalur hauling. Model pencegahan yang diusulkan menitikberatkan pada penguatan kepemimpinan, pengendalian risiko, dan perawatan infrastruktur hauling secara berkelanjutan untuk menurunkan angka kecelakaan kerja di sektor pertambangan.

Occupational safety in hauling roads within the coal mining industry is a critical aspect that requires serious attention, considering the high risk of work accidents during material transportation activities. This study aims to analyze the factors influencing occupational accidents and to develop a preventive model based on the Human Factor Analysis and Classification System for Mining Industry (HFACS-MI) and the Australian Transport Safety Bureau (ATSB) investigation method. A mixed-method approach was used, with quantitative data collected through a survey of 420 dump truck operators across three open-pit mining companies in Kalimantan, and qualitative data gathered from in-depth interviews, focus group discussions (FGDs), and direct field observations. Multiple linear regression analysis was employed to assess the influence of six independent variables external factors, organizational influence, unsafe leadership, risk control, environmental conditions, and individual actions on work accidents. The results indicated that all variables had a significant effect, with unsafe leadership and environmental conditions emerging as the dominant contributing factors. These findings highlight the need to strengthen supervision, improve operator behavior, and enhance the quality of hauling road infrastructure. The proposed accident prevention model emphasizes the reinforcement of leadership roles, risk control management, and continuous improvement of hauling infrastructure to reduce the incidence of occupational accidents in the mining sector.

Di Indonesia kanker payudara merupakan kanker tertinggi yang banyak datang pada stadium lanjut sehingga berdampak terhadap mortalitas dan tingginya pembiayaan. Mammografi merupakan alat skrining dan diagnosis yang sudah terbukti efektifitasnya menghasilkan “down staging” pada negara maju, Indonesia sebagai negara berkembang belum menjadikan skrining mammografi sebagai program nasional. Dilakukan studi parsial evaluasi ekonomi biaya dan luaran dengan membandingkan mammografi untuk skrining berbasis populasi terhadap oportunistik skrining di RS. Dilakukan uji coba skrining berbasis populasi terhadap 683 wanita dengan menggunakan mobil mammografi hingga didapatkan case detected serta diambil data retrospektif pasien deteksi dini dengan mammografi hingga penegakan diagnosis di RS dalam periode satu tahun. Dilakukan analisis biaya berdasarkan perspektif program dengan analisis luaran case detected. Didapatkan unit cost pemeriksaan skrining adalah Rp871,045. dengan case detected 0,4% dan cost per case detected Rp Rp290,348,509. Pada deteksi dini di RS didapakan unit cost Rp1,137,881 dan 3% kasus positif kanker. Terhadap skrining berbasis populasi, untuk mendapatkan satu kasus positif kanker diperlukan biaya sebesar Rp 262.342.333. Dengan sumber daya yang dimiliki perlu dilakukan inovasi dalam deteksi dini mammografi melalui penguatan pelaksanaan skrining CBE sebagai program nasional didukung pendekatan akses melalui diagnosis dini dengan mobil mammografi terutama di daerah rentan sehingga dihasilkan diagnosis secara cepat dan tepat dan biaya yang murah. Diperlukan peran pemerintah melalui pembiayaan yang berkelanjutan terhadap deteksi dini mammografi untuk dapat menurunkan angka mortalitas dan pembiyaan dalam pengobatan kanker. Kata kunci: Kanker payudara, mammografi, cost and outcome.

Breast cancer is the highest cancer in Indonesia that come at late stage so have impact on mortality and high funding. Mammography is a screening and diagnosis that has proven its effectiveness in producing "down staging" in developed countries, Indonesia as a developing country has not made mammography screening a national program. A partial study of economic evaluation of costs and outcomes was conducted by comparing mammography for population-based screening to opportunistic screening in hospitals. A population-based screening was conducted on 683 women using a mobile mammography until a case was detected and retrospective data taken from early detection patients with mammography to diagnose the hospital in a period of one year. A cost analysis is carried out based on the program perspective with a case detected output analysis. The unit cost of screening is Rp.871,045. with case detected 0.4% and cost per case detected Rp.290,348,509. At early detection in the hospital unit unit costs are obtained Rp1,137,881 and 3% of positive cases of cancer. For population-based screening, to get one positive case of cancer costs Rp 262,342,333. With the available resources, innovation in the early detection of mammography needs to be done through strengthening the implementation of CBE screening as a national program supported by an access approach through early diagnosis by mammography cars, especially in vulnerable areas so that diagnosis is produced quickly and accurately and at a low cost. The role of government is needed through ongoing financing of early detection of mammography to be able to reduce mortality and financing in the treatment of cancer. Keywords: Breast cancer, mammography, cost and outcome