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Rumah sakit merupakan organisasi yang padat modal, padat karya, padat sumber daya dan sarat akan resiko-resiko. Bagi rumah sakit yang tidak mempersiapkan diri untuk mencegah kejadian-kejadian yang berpotensi teJjadinya resiko medis akan mengalami tuntutan hukum dan mengalami kerugian-kerugian secara finasial. Pengelolaan dan antisipasi resiko medis harus ditunjang oleh pengetahuan, sikap dan hubungan sosial tenaga kesehatan mengenai kesalahan medis untuk menghlndari dampak yang mcrugikan pasien tenaga kesehatan dan rumah sakit. Penelitian ini bertujuan untuk mengetahui pengetahuan, sikap dan hubungan sosial tenaga kesehatan terhadap kesalahan medis serta mengetahui keadaan sarana dan prasarana di unit gawat darurat. Penelitian dilakukan di rumah sakit Bhakti Husada dengan 10 informan yang terdiri dari para Kepala Ruang unit gawat darurat, Ketua Tim Perawat unit gawat darurat, dokter pelaksana dan perawat pelaksana. Metode penelitian yang digunakan adalah metode kualitatif dan metode kuantitatif yang kemudian dilakukan wawancara mendalam, telaah dokumen dan pengisian kuesioner. Analisis data dilakukan dengan membandingkan basil penelitian dengan teori-teori kepustakaan(Content analysis). Hasil penelitian didapatkan bahwa sebagian besar informan untuk pengetahuan mengenai defenisi, macam tipe dan proses serta sumber-sumber kesalahan medis medis secara umum pengetahuan tenaga kesehatan telah satu pendapat atau satu persepsi terhadap kesalahan medis. Untuk sikap informan mengenai dampak dan upaya-upaya pencegahan kesalahan medis mempunyai respon yang positip dengan mendukung program keselamatan pasien yang telah dilakukan rumah sakit Bhakti Husada. Hubungan sosial tenaga kesehatan secara umum mereka sudah terbentuk dalam hal komunikasi antar tenaga kesehatan sudah terjalin baik dan berkelanjutan dengan adanya forum diskusi sebagai upaya membentuk kebersarnaan dan satu pendapat dalam melakukan tindakan medis dan menunjukkan adanya hubungan yang timbal balik dengan saling memberi dan mengawasi dalam setiap melaksanakan tugasnya. Dari hasil penelitian ini disaraukan untuk manajemen rumah sakit lebih memperhatikan unit gawat darurat dalam memenuhi standar yang telah ditetapkan oleh Departemen Kesehatan dalam dalam hal fasilitas dan peralatan medis, meningkatkan pengetahuan tenaga kesehatan dengan memberikan pelatihan-pelatihan keselamatan pasien secara periodik. Peran kepala ruang unit gawat darurat diharapkan lebih meningkatkan pengawasan pelaksanaan (Standard operating procedure) SOP sebagai upaya mengetahui hal-hal apa saja yang selama ini dilakukannya yang dapat berpotensi menimbulkan kesalahan medis.
Hospital is an organization with full of complexity of things and high risk. For several hospitals with un-preparation them selves to avoiding some incidents which has potential high risks probably will get law problem and also will get financial losses. Managerial and anticipating of medical risks, must be completed with good attitude, good knowledge, and good social relationship of medical employees to avoiding incident or action which dangerous for patient, medical employees and also for the hospital it self. This research is aimed to understand the knowledge, attitude and social relationship of medical employees. Research done in the hospital Bhakti Husada involving 10 (ten) information sources consist from head of emergency room, team leader of nurse, doctors and nurse implementer. Research method used are both qualitative and quantitative method and later make in-depth interview, filling in questioners and document analysis. Data analysis was performed using comparing results of research to literature theory (Content analysis). It was found of the research that the knowledge of the information about definition, type of medical error and source of medical error were good general. Attitude from information about impact of medical error and prevention of medical error has positive response with supporting patient safety program which has done by the hospital Bhakti Husada. While social relationship of medical employees in general already has good communication and good team work. From this research, it is advisable for the hospital management more pay attention to emergency room to get standard from health of department about facilities and medical equipment, arrange routine schedule training about patient safety and emergency program. Head of emergency room always supervise the implementation of standard operating procedure to avoid and prevent of medical action which can be occurred as medical error. File Digital: 1
Rumah Sakit Bhineka Bakti Husada memiliki lokasi yang cukup strategis yaitu dipersimpangan perbatasan Jakarta, Bogor, Tangerang dan Depok dengan jumlah kunjungan pasien unit gawat darurat dan poli umum dari tahun ke tahun meningkat. Untuk mengetahui kualitas pelayanan unit gawat darurat maka perIu dilakukan survei analis mutu pelayanan kesehatan unit gawat darurat rumah sakit. Hal ini disebabkan karena masih bergabungnya unit gawat darurat dan poli umum. Jenis penelitian yang digunakan dalam penelitian adalah metode survei dan penelitian kuantitatif. Metode survei bertujuan untuk mengetahui faktor internal (kuantitas SDM, kompetensi SDM. kelengkapan sarana dan prasarana, keterSediaan sarana dan prasarana, kematian di UGD, rata-rata pasien UGD perhari, rata-rata pasien UGD yang dirujuk keluar perhari) yang mempengaruhi mutu pelayanan kesehatan UGD RS Bhineka Bakti Husada. Sedangkan penelitian kuantitatif yang bertujuan untuk mengetahui hubungan antara faktor eksternal (jenis kelamin, pendidikan, pekerjaan) dengan mutu pelayanan kesehatan UGD Rumah Sakit Bakti Husada. Data yang diperlukan adalah data primer dan data sekunder. Data primer diperoleh dari kuesioner yang telah diisi oleh pasien unit gawat darurat dan wawancara mendalam kepada informan. Sedangkan data sekunder diperoleh dari Rumah Sakit Bhineka Bakti Husada Tangerang. Data primer berupa kuesioner berasal dari 150 pasien unit gawat darurat, dan di analisa menggunakan univariat, bivariat, dan diagram kartesius. Untuk analisis bivariat digunakan uji chi square parametrik. Dilakukan pada bulan April dan Mei 2008. Hasil penelitian menunjukkan bahwa : Jumlah SDM yang tersedia di UGD R8 BBH sudah memenuhi standar, kompetensi SDM yang tersedia di UGD RS BBH sudah memiliki sertifikat UGD (ACLS, EKG dan PPGD). Ketersediaan sarana dan prasarana masih belum memadai dimana unit radiologi belum beroperasi selama 24 jam, kapasitas tempat tidur rnasih belum memenuhi standar nasional yaitu 12 tempat tidur, jumlah kunjungan pasien UGD mengalami peningkatan selama 4 tahun terakhir. Jumlah pasien UGD yang dirujuk ke tempat lain mengalami peningkatan khususnya pada bulan Desember 2007, angka kematian pasien di UGD tergolong tinggi, ada hubungan yang signifikan antara pendidikan dengan kepuasan pasien, tidak ada hubungan yang signifikan antara jenis kelamin kepuasan pasien tidak ada hubungan yang signifikan antara pekerjaan dengan kepuasan pasien. Variabel yang menurut pasien paling memberikan rasa puas dalam pelayanan yaitu dimensi kehandalan (penguasaan keterampilan dokter pada tugasnya) pasien menyatakan puas sebesar 97.3 %, kurang puas sebesar 2,7%, dirnensi ketanggapan (kernampuan dokter daIam berkomunikasi dengan pasien) yang menyatakan puas sebesar 90,0 %, kurang puas 10,0 %, dimensi kehandalan (kesediaan dokter ketika dibutuhkan) yang menyatakan puas sebesar 86,7 %, kurang puas sebesar 13,3 %, dimensi jaminan (perhatian dan keramahan dokter kepada pasien) yang menyatakan puas 84,7%, kurang puas 15,3 %, dimensi empati (kemampuan petugas UGD dalam mengatasi masalah tanpa membedakan pasien) yang menyatakan puas 78,7 %, kurang puas 21,3 %. Pada diagram kartesius yang termasuk di dalam kuadran 1 artinya variabel yang memiliki performance di bawah rata-rata tetapi tingkat kepentingannya cukup tinggi. Variabel yang masuk dalam kuadran 1 yaitu kemampuan petugas melayani pasien, kecepatan petugas dalam menangani pasien, pendaftaran dilaksanakan dengnn cepat, perhatian dan keramahan dokter kepada pasien. Disarankan kepada rumah sakit terutama manajemen untuk memperbaiki faktor-faktor yang berada pada kuadran 1. Selain itu mutu pelayanan unit gawat darurat RS Bhineka Bakti Husada perlu diperbaiki dengan cara melihat berbagai aspek, seperti ketersediaan sarana dan prasarana antara lain seperti pemisahan UGD dengan poli umum. unit radiologi agar beroperasi selama 24 jam, penambahan kapasitas tempat tidur minima! menjadi yaitu 12 tempat tidur sehingga rnemenuhi standar nasional.
Rumah Sakit Bhineka Bakti Husada is a hospital which has strategic location enough that is around Jakarta, Bogor, Tangerang and Depok which has significant of member patient of emergency department and general poly each year. In order to determine the quality of service of this hospital, survey of health service quality of emergency department needs to be applied to this hospital. It is because still united between emergency department and general poly The research divided into two group, there are survey method and quantitative research. The aim of survey method is to known internal factor (human resOurces quantity, human resources competence, completion tool and infrastructure, availability of tool and infrastructure, death at emergency department, amount average emergency department patient each day,amount average patient emergency department that referred out each day) which has influenced health service quality of emergency department of Bhineka Bakti Husada Hospital. While the aim of quantitative research is to known relationship between external factor (sex, education, job) with health service quality of emergency department of Bhineka Bakti Husada Hospital. The research used two kinds Qf data, there are primary data and secondary data. Primary data which collected from kuesioner that loaded by emergency department patient and interview deepens to informant. While secondary data is collected from Bhineka Bakti Husada Hospital in Tangerang. Primary data was collected from kuesioner that comes from 150 patients of emergency departmen4 and has been analised using univariat, bivariat and cartesius diagram. Bivariat analysis has used test chi square parametrik. This research was conducted in April - May 2008. The result shows that: human resources quantity that available at emergency department of Bhineka Bakti Husada Hospital is fulfil standard, human resources competence that available at emergency department of Bhineka Bakti Husada Hospital has certificate emergency department (ACLS, EKG and PPGD), completion tool and infrastructure stills not yet. give good service which the radiology unit does not operate during 24 clocks, bed capacity does not fulfil standard national that is 12 bed, totals of patient visit in emergency department have been enhanced during 4 the last year, totals patient of emergency department that referred to other place have been enhanced especially in december 2007, the rate of patient mortality at emergency department is stiil high. Relationship between education with patient satisfaction is significant. Relationship between sex of patient with patient satisfaction, relationship between job with patient satisfaction are no significant. Based on patient, we can conclude the variables which give satisfaction in service are: reliability dimension satisfaction (doctor know-how mastery in the task) patient declare satisfied as big as 97,3 %) less satisfied as big as 2,7%, dimension responsiveness (the ability of doctor in communicate with respondent) that declare satisfied as big as 90,0 %, less satisfied 10,0 %, reliability dimension (doctor always already when needed) that declare satisfied as big as 86,7 %, less satisfied as big as 13,3 %, guarantee dimension (attention and affability of doctor to respondent) that declare satisfied 84,7%, less satisfied 15,3 %. empathy dimension (operator emergency unit ability in overcome problem without distinguish patient) that declare satisfied 78,7 %, less satisfied 21,3 %. The cartesius diagram that belong in first quadrant mean variable with under average but have high importance level. Variables that enter in first quadrant are the ability operator in serves patient, operator speed in handle patient, enrollment is carried out swiftly, attention and affability of doctor to patient. Regarding t0 the result the Bhineka Bakti Husada Hospital management shall improve all factors tbat stay in first quadrant. Besides of that, service quality of emergency department of Bhineka Bakti Husada Hospital necessary repaired by see various aspect, like tool availability and infrastructure among others like separation between emergency department with general poly, radiology unit can operate during 24 clocks, increase bed capacity to become 12 beds so that fulfil standard nationa1.
The increasing number of patients visit in the Emergency Unit of Bali RoyalHospital is not followed by a change in the number of nurses. The purpose of thisstudy was to determine the workload of nurses and nurses needs in the EmergencyUnit of Bali Royal Hospital. This research was a descriptive quantitative research.Observations were made by the researcher to determine the time spent by nurses inserving patients by using the Time Motion Study. The results shown the workloadfor critically emergency patients at 63.4 minutes per day (1.1 hours per day),critically non emergency patients 1,585.5 minutes per day (26.4 hours per day), and2,187 minutes per day (36.5 hours per day) for non critical-but emergency patientsand the need for nurses in the Emergency Unit of Bali Royal Hospital was 17 people.Nurses needed additional power as much as 3 people.Keywords : emergency unit, a nurse, time motion study, workload, the need fornurses
The Emergency Department (ED) has already known as the gateway and the reflection of services given by the hospital which is suppose to be fast accurate and qualified without neglecting the pntient's safety. As the problem is more and more complicated regarding to services at the ED, therefore, a study is needed in order to explore how the quality of the service management is, as well as the input and process factors influenced at the ED of RK Charitas Hospital of Palembang. The research is a qualitative study with the Problem Solving Approach as the strategy of the study. The study is carried out at the ED of RK Charitas Hospital from March to April 2008 with an in-depth interview, direct observation and documents assessment (secondary data exploration), as the method of infonnation eolleetion. The study is using the Problem Priority Matrix in order to find the problem solving prioritizing base on the magnitude of benefit yielded from effort required. There are five problems in the three first order, namely ; time for picking-up inpatient care at the ED still too long, inadequate quality of doctor and nurse at the ED, in adequate amount of nurses, and inadequancy on triase implementation at the ED of RK Charitas Hospital of Palembang. It was suggested the existence of coordination between medical directorates and nursing to minimize time of patient?s transfer from ED to inpatient care unit, giving education and training for doctor and nurse at ED, adding nurse worker at ED, assuring triase implementation and opening an incidental unit near ED at the time of outpatient unit is closed.
The complexity of medical services in a hospital creates a change for an error, particularly on an invasive action in surgery unit. This study is aimed to analyse events and contributing factors to medical error in the inpatient unit regarding patient safety in a district hospital.
Implementation of ISO 9001:2008 Quality Management Standards have beenimplemented in BRSU Tabanan since 2009 in an effort to improve the quality ofcare , but there are still complaints against the ministry in BRSU Tabanan . Untilnow, this has never been done in the Emergency Room service performanceanalysis on the application of ISO 9001:2008 Quality Management StandardBRSU Tabanan . This study was conducted aimed to determine and analyze theperformance of services in the emergency department on the application of ISO9001:2008 QMS in Emergency Room BRSU Tabanan.Do months from August toOctober , 2013, with a qualitative research method that comes with thequantitative data is secondary data quality objectives in the Emergency Room asindicator performance .. Respondents service satisfaction in the emergencydepartment for patients or their families were coming month of August to October2013, which are willing to fill out a questionnaire , as many as 150 people .Emergency Room staff and staff working in the field of service of at least 3 yearsas respondents in the application of ISO 9001:2008 QMS Emergency Room are71 . In-depth interviews to the Board of Directors as an informant were 3 peoplein the achievement of performance information in the Emergency Room and theapplication of ISO 9001:2008 QMS . Data were analyzed using content analysis .The results show the performance of services in the Emergency Room alreadywell on target mutul 9 of 12 quality objectives in the Emergency Room . Qualityobjectives is not good customer complaints , customer dissatisfaction with theservices of doctors and patient mortality in Emergency Room ≤ 24 hours .Required an increase in the budget aimed at improving the quality of humanresources in the emergency department with increasing hospital revenue ,completing facilities for intensive care and resocialization of the application ofQMSKeyword : Performance Emergency Room Services, ISO 9001:2008 QMS
Rumah Sakit Umum Daerah Tarakan merupakan salah satu RSUD yang mempunyai potensi untuk berkembang dalam menghadapi era globalisasi, lnstalasi Gawat Darurat sebagi pintu masuk pasien yang paling besar di Rumah Sakit Daerah Tarakan. Oleh sebab itu perlu adanya pengukuran kinerja secara komprehensif IGD di RSUD Tarakan Tahun 2008. Untuk mengukur kinerja secara komprehensif dapat menggunakan pendekatan Balanced Scorecard. Mengukur kinerja dengan menggunakan Balanced Scorecard dapat memberikan informasi secara menyeluruh terhadap kinerja program yang dijalankan., baik itu keberhasilan program maupun kendala-kendala yang dihadapi dalam kegiatan. Dimana terdapat empat perspektif Balanced Scorecard yang dikaitkan dengan visi dan misi organisasiyaitu perspektif fmansial, perspektif pelanggan, perspektif proses bisnis internal dan perspektif pembelajaran dan pertumbuhan karyawan, manajemen dan organisasi. Penelitian ini dilakukan di Instalasi Gawat Darurat Rumah Sakit Umum Daerah Tarakan pada bulan April sampai Juni 2008. Penelitian ini menggunakan metode studi kasus dengan pendekatan kualitatif dan kuantitatif untuk mengetahui gambaran kinerja IGD RSUD Tarakan berdasarkan empat perspektif dalam Balanced Scorecard yaitu perspektif keuangan, perpektif pelanggan, perspektif proses bisnis internal dan perspektif pembelajaran dan pertumbuhan. Populasi adalah seluruh pasien yang berkunjung ke RSUD Tarakan pada bulan April dan Juni 2008, sampel diambil decara random sampling terhadap pasien yang berkunjung ke IGD RSUD Tarakan dengan menggunakan alat ukur kuesioner. Pendekatan kualitatif dilakukan dengan metode In-depth interview, telaah dokumen dan observasi.In-depth interview dilakukan dengan Kepala IGD, Kepala Perawat IGD, Dokter jaga IGd dan perawat IGD sebagai infonnannya, telaah dokumen terbadap data keuangan IGD sedangkan metode observasi terbadap respon time pelayanan oleh petugas IGD. Dari hasil penelitian diperoleh gambaran bahwa perspektif pernbelajaran dan pertumbuban masih kurang baik karena masih kurangnya komitmen petugas IGD terhadap pelayanan yang dilakukan di IGD di sebabkan kurangnya sosialisasi Standar Pelayanan Minimal di IGD, masih ada ketidak puasan karyawan IGD terhadap reward gaji yang diterima dan ketidak puasan terhadap sistem pengembangan karier di IGD, perspektif proses bisnis internal tentang respon time belum memenuhi standar Depkes, perspektif pelanggan tentang kepuasan pelanggan masih dibawah standar Depkes yaitu < 70 % sedangkan perspektif keuangan tingkat pertumbuhan pendapatan seeara keseluruhan terjadi peningkatan sebesar 9,43 % dari tahun 2006 ke tahun 2007. Untuk itu diharapkan kepada pihak manajer RSUD Tarakan serta Kepala IGD untuk melakukan sosialisasi Standar Pelayanan Minimal (SPM) kepada seluruh tenaga yang bertugas di IGD serta meningkatkan komitmen tenaga di IGD dalam memberikan pelayanan yang bermutu terhadap pasien dengan menjalankan SPM yang telah ditetapkan oleh Depkes Rl, dan menggunakan hasil penelitian yang didapat sebagai dasar untuk melakukan evaluasi kinerja selanjutnya di lnstalasi Gawat Darurat dan menerapkannya ke dalam manajemen rumah sakit demi tercapai Visi dan Misi rumah sakit yang baru.
Tarakan District General Hospital (TDGH) is one of a district general hospital which has a potency to expand and develop in order to deal with the globalization era. It has widely known that the ER is the main entrance of receiving patients at the hospital. Therefore, there is a need for a comprehensive measurement on the perfonnance of the ER at TDGH in 2008, using the Balanced Scoreboani approach. This approach will give the entire intbnnation of the perfonnance of program conducting at the ER, whether its successful or problems found as the program has applied. There are four perspectives that included at the Balanced Scorecard related to the vision and mission of the organization, they are perspective of finance, perspective of client, perspective of internal business process, and perspective of employee, management and organization experience and development. The study is conducted at the ER of TDGH in the period of April to June 2008, using a study case design with a qualitative and quantitative approach, in order to know the description of performance at the ER of Tarakan DGH, based on four perspecti ves of Balanced Scorecard. The population is all patients who visit to the Tarakan DGH in the month of April to June 2008. Sample is taken by a simple random sampling and interviwed with a structured questionnaire. For qualitative approach, an in-depth interview is condocted, as well as a documents exploration and observation toward the ER. The in-depth interview is carried out toward informants, i.e. the Head of the ER, Head of nurse of the ER. doctor in charge of the ER and the nurse of the ER. Finance data is obtained from the documents explonttion, and observation is taken toward service response time by the ER providers. The study found that the perspective on the experience and development is poor, as the commitment of the ER providers in giving the services is still low. This because of the socialization of the Minimum Service Standard at the ER is not so good. Some employee still dissatisfy with the reward they have and also with the development career system at the ER. The perspective of the internal business process on the response time is not fulfilling the MoH criteria of standards. Perspective of client on service satisfuction is still below MoH standard, less than 70%. Of the perspective of finance, the income growth rate in overall is increase 9.43% from the year 2006 to 2007. Therefore, it is expected that the management of the Tarakan DGH and the Head of the ER will carried out the socialization of the Minimum Service Standard (MSS/ SPM) to all health providers of the ER, and increasing the commitment among providers at the ER to address a good services by applying SPM determined by the MoH. !t is also expected that the resuit of the study will be using fur the base of the advance performance eva1uation at the ER and implemented in to the hospital management board, and hoped that the new visions and missions of the hospital are reached.