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Pasien-pasien di unit-unit perawatan intensif {ICU) lebih banyak mengalami cedera akibat adverse events hila dibandingkan dengan pasien-pasien yang bukan dirawat di ICU. Banyaknya prosedur yang dilakukan pada pasien-pasien dalam kondisi yang kritis serta banyaknya jumlah dan jenis obat yang digunakan dalam pelayanannya juga meningkntkan resiko yang lebih tinggi hilngga dibandingkan dengan pasien lainnya. Tingginya data mortalitas dan insiden di beberapa ICU rumah saklt umum pusat bantuan regional Departemen Kesehatan menunjukkan belum ada suatu analisis yang mendalam terhadap faklor-faktor penyebab yang berkaitan dengan adverse events di unit perawatan intensif (ICU) pada rumah sakit tersebut. Hasil penelitian didapatkan bahwa adverse events di unit perawatan intensif (ICU) pada !8 (delapan belas) rumah sakit umum di Indonesia yaitu sebesar 42,7 %. Faktor faktor tidak baik, prosedur tidak lengkap, kurangnya kelengkapan dan pemeliharaan alat, berkontribusi dalarn terjarlinya adverse events di ICU pada 18 nrumah sakit. Pemahaman staf dan perawat ICU terhadap patient safety di unit perawatan intensif (ICU) sangat kurang. Penyebab dari beban kerja perawat tidak sesuai yaitu sumber daya manusia yang terbatas, uraian tugas yang tidak jelas, rasio antara petugas dengan pasien tidak sesuai, mengetjakan pekexjaan yang bukan wewenangnya dan kurangnya pelatthan. Behan kelja perawat yang tinggi berdampak stress kerja perawat. Penyebab komunikasi yang karang baik yaitu masib adanya gap antara perawat senior dan perawat yunior dalam berkomunikasi, kepala unit tidak mengikuti morning briefingkomunikasi yang kurang antara tim klinis. MiskomuÂnikasi juga menyebabkan terjadinya medication error di lCU. Peralatan kesehatan tidak lengkap dan tidak sesuai standar lCU, scrta tidak adanya prosedur tertulis tentang pemakaian alat. Pimpinan unit dan supervisi klinis belum menjalankan tugrumya dengan baik. Dari hasil penelitian ini disarankan kepada pihak rumah sakit untuk meningkatkan pengetahuan dan pemahaman perawat tentang patient safety, meningkatkan peranan kepala unit, kepala ruangan, komite keperawatan dan supervisi klinis, menetapkan standar prosedur asuhan keperawatan, prosedur pemakaian dan pemeliharaan alat serta prosedur komunikasi bagi perawat di ICU, menambab surnber daya manusia kesehatan {SDMK), meningkatkan pelatihan bagi perawat, menfasilitasi sistem infOnnasi kesehatan melalui Information Technology.
Patients in intensive care units (lCUs) may be more likely than non-ICU patients to be injured by adverse events. The procedures performed on critically ill patients and the quantity and type of drugs used in their care may also increase their risk relative to non-ICU patients. The height data incident and mortality in some ICU aids centers publics hospitals regional Department of Public Healths show there is no an circumstantial analyses to factors cause of related to adverse events intensive care units ( ICU) at the hospital. It was found from the research that adverse events in intensive care unit (!CU) at 18 (eighteen) public hospitals in Indonesia that is 42,7 %. Factors like: inappropriate nurse work load poor communications, incomplete procedure Jack of equipment and conservancy of appliance, contribution in the happening of adverse events in ICU at 18 hospitals. Understanding of nurse and staff!CU to patient safety in intensive care unit ( ICU) hardly less. The cause of inappropriate nurse work load that is limited resource, breakdown of ill defined duty, ratio between officers with inappropriate patients, do work which not the authority and lack of training, High nurse work load affect stress working nurse. The cause of unfavourable communications that is still existence of gap between senior and junior nurses in communicating, lead unit don't follow morning briefing, communications which less between teams. Miscommunication also cause medication errors in ICU. Incomplete equipments and also procedure inexistence. Leader of unit and clinical supervise not yet implement the duty. From this research result suggested to the side of hospital for increasing knowledge and understanding of nurse concerning patient safety increase role of unit director, room director, treatment committee and clinical supervise, specify treatment upbringing procedure standard, usage procedure and conservancy of appliance and also communications procedure for nurse in ICU add health human resource, increase training for nurse, health information system facility through Information Technology {IT) in the form of white line as decision support system.
Penelitian ini bertujuan untuk mengetahui kepuasan keluarga pelanggan terhadap keperawatan unit perawatan intensi pada 18 Rumah Sakit di Indonesia. Dalam penyusunan kerangka konsep penelitian ini sebagai variabel dependen adalah variabel kepuasan total yang meliputi harapan dan persepsi responden dimana tingkat kepuasan dihitung berdasarkan kesenjangan nilai antara keduanya sedangkan sebagai variabel independen adalah mencari diantara lima dimensi servual yaitu tangible, reiiability, responsiveness, assurance dan emphary yang memiliki pengaruh paling dominan dalam kepuasan keluarga peianggan serta penilaian dalam pelaksanaan asuhan keperawatan yang tercakup dalam lima prosw, yaitu pengkajian, diagnosa, rencana, tindakan dan evaluasi keperawatan. Metode penelitian yang dilaksanakan adalah gabungan penelitian kuantitatif dan kualitatih dimana menggunakan suwey kepada 246 responden perawat dan |22 reponden keluarga pelanggan dalam upaya mengumpulkan data kuantitatifi Sedangkan untuk mengumpulkan data kualitatif digunakan metode cross-sectional terhadap rosponden infoman Kemudian data yang diperoleh dari hasil penelitian ini kemudian dilakukan analisis dengan menggunakan metode reliabilitas, korelasi, dan regresi yang kesemuanya menggunakan program perangkat lunak komputer. Dari hasil peneiitian terlihat bahwa 62,3 % dari responden merasa puas dengan keperawatan unit perawatan intensif pada I8 rumah sakit di Indonesia Penggunaan metode servqual sebagai alat ukur kepuasan keluarga. pelanggan, memperlihatkan adanya hubungan bemakna antam kepuasan total responden dengan lima aspek dimensi metode servqual tersebut. Juga metode servqual memperlihatkan adanya kesenjangan antara jasa yang dipersepsikan dengan jasa yang diharapkan keluarga pelanggan. Juga di dalam penelitian ini terlihat adanya hubungan tidak langsung antara pelaksanaan asuhan keperawatan dan kepuasan keluarga pelanggan, dikatakan telah terlaksana dengan baik oleh 93,9% responden dan hal ini memiliki keterkaitan tidak langsung dengan kepuasan total keluarga pelanggan unit perawatan intensif. Dalam hal ini, proses rencana keperawatan merupakan proses yang paling baik diiaksanakan dan proses tindakan keperawatan merupakan proses yang dinyatakan paling tidak baik dilaksanakan oleh para perawat pelaksana di unit perawatan intensif. Sebagai kesimpulan dari penelitian ini bahwa penilaian asuhan keperawatan dan alat ukur metode servqual dapat mengidentifikasikan unsur-unsur pelayanan yang menyebabkan ketidak-puasan keluarga pelanggan terhadap mutu pelayanan serta unsur-unsur pelayanan mana yang memberikan pengaruh besar secara signifikan terhadap kepuasan total keluarga pelanggan. Oleh karena itu disarankan kepada pihak manajemen mmah sakit untuk menggunakan metode servqual dalam melakukan survei pengukuran kepuasan keluarga pelanggan. Karena penelitian ini membuktikan bahwa metode servqual dapat digunakan dan efektif untuk diterapkan di rumah sakit dalam mengukur kepuasan keluarga pelanggan di unit perawatan intensiti Dari hasil penelitian, saran untuk semua pihak yang terkait untuk memperhazikan keluarga pelanggan yang mempunyai harapan tinggi namun berpersepsi rendah, dimana hal tersebut menggambarkan tingginya tingkat ketidakpuasan keluarga pelanggan.
This research's goal is to assess the level of the customer's family satisfaction on intensive Nursing unit at I8 Hospitals all over indonesia in compiling the frame of this research concept, the dependent variable is: total satisfaction variable that encompassed hope and perception of the respondents, where the level of satisfaction is calculated based on the different value between the two, while the independent variable is finding between consists of 5 dimensions: service quality, tangible, reliability, responsiveness, assistance and empathy that has most dominant effect in family's customer satisfaction and in executing nursing guidelines that consists of 5 process: review, diagnosis, planning, action and nursing evaluation. Research method that is implemented is a combination of quantitative and qualitative research, where it surveyed 246 nurse respondents and 122 family customer respondents, in an effort to collect quantitative data. While in the process of gathering qualitative data, cross-sectional method was used against informant respondents. Then data obtained ii-om this research will be analyzed using reliability, correlation and regression method that is all available in the computer software. From the results of the research, we can see that 62,3 % of thc respondents felt satisfied with the intensive nursing unit at I8 Hospitals all over Indonesia. The use of servqual method as a gauge for the level of customer's family satisfaction shows a meaningful correlation between total respondent satisfactions with the 5 aspect dimension of the servqual method. Also the sen/qual method shows there was a gap between the service that is perceived and the service that is hoped for by the customer's family. The research also shows an indirect correlation between the executions of the nursing guidelines and customer's family satisfaction, it is stated that it was well executed by 93,9% respondents and this also have indirect correlation with the total satisfaction of the customer's family with regards to the intensive care unit ln this point, planning process of nursing guidelines is the best process they've been doing and the action process of nursing guidelines is the worst process in their statement. In conclusion from this research, executing nursing guidelines and the servqual method could identify the service aspects that caused dissatisfaction for the customer's family against the quality of service and all aspect of service where it significantly influenced the customer's family total satisfaction. lt is recommended to the hospital management to use the servqual method in surveys, to gauge the level of the customer's family satisfaction. Due to the proof this research has shown, the servqual method could be used effectively in hospitals in order to gauge the level of the customer's family satisfaction in the intensive care unit.
Kinerja rumah sakit menxpakan suatu dimensi utama dari mutu pelayanan rumah sakit. Peningkatkan rnutu pelayanan rumah sakit merupakan hal yang sangat penting oleh karena rumah sakit memberikan pelayanan yang paling kxitis dan berbahaya dalam sistem pelayanan. Hal tersebut dikarenakan yang menjadi sasaran kegiatan adalah jiwa manusia, Balanced Scorecard (BSC) merupakan metode yang dapat digunakan untuk menilai kinexja rumah sakit dan rnengukur strategi secara komprehensif dengan pola manajemen strategis. Tujuan penelitian ini adalah untuk memperoleh garnbaran pengukuran kinerja rumah sakit secara komprehensitl akurat dan obyektif sesuai pendekatan Balanced Scorecard Penelilian ini menxpakan penelitian dcskriptif anaiitik yang menggunakan pendekatan kualitatif dan kuantitatif. Penclitian dilakukan di Rumah Sakit Harapan Kita. Hasil penclitian ini mcnunjukkan bahwa pengembangan Rumah Sakit Harapan Kita sudah diarahkan menuju pencapaian visi dan misi. Dalam Perspektif Keuangan, beberapa pencapaian indikator keuangan seperti Relurn on lnvesrrnenr (Roi) dan cash ratio menunjukkan adanya peningkatan dibanding dengan keadaan sebelum menjadi PPK-BLU. Dari sisi perspektif pelanggan, telah texjadi kecenderungan peningkatan kunjungan pasien. Beberapa indikator yang mcwakili proses bisnis intemal juga menunjukkan hasil yang positifi Terdapat peningkatan jumlah tindaknn bedah. Disamping itu, beberapa indikator pelayanan, sepeni BOR dan TOI berada di daerah ideal. Texkait dengan perspektif pertumbuhan dan pembelajaran, rumah sakit telah mengirimkan beberapa staf ke luar negeri. Rumah Sakit juga mengadakan pertemuan rutin antara komite medis, tenaga dokter, dan paramedis untuk memantau penampilan pelayanan yang dibexikan. Dilakukan pula evaluasi terhadap pelaksanaan kegiatan. Penelitian ini menghasilkan saran perlunya pelatihan/supegvisi khusus dari Departemen Kesehatan untuk pelaporan dengan penekanan terhadap analisa rasio keuangan untuk mengetahui nilai pertumbuhan ekonomis, penguatan stratcgi pemulihan layanan, kesamaan persepsi mengenai defmisi beberapa indikator kinexja rumah sakit, pembenahan sarana dan prasarana, penguatan sistem infommasi ketenagaan di rumah sakit.
Hospital performance is the main dimension of hospital service quality. The Improvement of hospital services quality is very important, because hospital provides most critical and dangerous services in health services system since it targeted human life as the object of services. Balanced Scorecard (BSC) can be used to assess hospital performance and examined the stratc gy comprehensively in strategic management framework. The objective of this study is to get the description of hospital performance assessment eomprehensiveiy, accurately, and objectively according to Balanced Scorecard. This study is descriptive-analytical study which using qualitative and quantitative technique. The study located at I-Iarapan Kita Hospital in Jakarta. The results of this study show that the Harapan Kita Hospital activities have been directed to the achievement of its vision and mission. In financial perspective, some of financial indicators, such as Retum on Investment (Rol) and cash ratio have been improved. In customer perspective side, there is an increasing trend of patient visit. Some of indicators which representing of intemal business process, also shown positive results, such as increasing of the number of operative activities. Hospital’s bed occupancy rate and tum over interval are in ideal position. In learn and growth perspective, hospital has sent some ol' its staff to study abroad. Hospital also conducting regular meeting between medical committee, doctors, and paramedics to evaluate the services which have been given. This study recommend that there should be special training or supervision from Ministry of Health for reporting purpose especially in analyzing financial ratio to observe economical growth value, strengthening of services recovery, equalizing perception regarding of some hospital performance indicators definition, improving hospital facilities, Strenghening of human resource infomation system, and comprehensive evaluation including input, process and output components by Ministry of Health as the owner.
The inpatient indicator at Bintang General Hospital is known to be below the established standard. One of the indicators is BOR and TOI. Indicators that are under average show the effectiveness and efficiency of the service. The difference in the number of patient visits in the inpatient unit and the policlinic of the obstetric and gynecological parts is significant. It needs performance measurement to find out what perspectives cause performance in inpatient unit and polyclinic not maximal yet. The purpose of this study was to assess service performance by using balanced scorecard approach in inpatient unit and polyclinic of children, obstetric and gynecology section at Bintang Hospital. This research is a quantitative and qualitative research using primary data (in-depth interview and questionnaire) and secondary data (data from public relations and finance department). The results of financial performance research is quite good, but the cost effectiveness is still less on the inpatient unit of children, customer perspective is quite satisfactory, internal business perspective is quite well aimed at the implementation of SOP, and has had patient referral procedures, but on outgoing referrals and hospital facilities are lacking in all service units. The performance of the learning growth perspective is well aimed at decreasing employee turnover, better access to training and education but needs to be evaluated for effectiveness, as well as information systems that have been good but need to support the accuracy of information. The performance of inpatient obstetric care unit is relatively better compared to the performance of the inpatient because the effectiveness level of the in-patient unit's financial unit is still not good. While the policlinic content and children have a performance that is equally good. The advice given is that management should be more careful in making budget planning and appropriately determine a good strategy with quality control of cost control and clinical pathways (CPW). Hospitals should develop quality of information system for service efficiency. Management coordinates with the head of the room to implement transformational leadership, as well as conducting ongoing monitoring and evaluation.
Nurses, as human resources for health also contribute greatly to the health servicesin hospitals and to provide services directly to patients. Nursing services atIntensive Care Unit has to be developed along with the technology development.Therefore, there is a need to concern the effieciency of nurses in term of quantityand competencies. This research discussed about the needs analysis nursing staffin the Intensive Care Unit of dr. Oen Solo Baru Hospital based on workload (usingtime and motion technique to 7 nurses then processed by Ilyas Methods) and workcompetencies based on Aditama 2007 and Ilyas (depth interview to threeinformants with a focus on job knowledge, skills and attitudes). Results of thisresearch show that productive time amounted to 81.56%, the lack of standards andcompetencies, and it need 51 nursesKey Words :Workloads , work competency , nurses, intensive care unit
Latar belakang: Kementerian Kesehatan memperkenalkan Kelas Rawat Inap Standar (KRIS) untuk meningkatkan kualitas layanan kesehatan di rumah sakit. Untuk implementasi dan pengelolaan KRIS yang efektif, diperlukan pendekatan yang komprehensif seperti Balanced Scorecard (BSC). BSC menyediakan kerangka kerja holistik untuk mengukur dan mengelola kinerja rumah sakit dari perspektif keuangan, pelanggan, proses bisnis internal, serta pembelajaran dan pertumbuhan. Tujuan penelitian: Penelitian ini bertujuan untuk mengetahui strategi untuk meningkatkan pendapatan RS dalam penerapan KRIS- JKN di Rumah Sakit Budi Kemuliaan Batam. Metodologi penelitian: Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus dengan tujuan memperoleh gambaran tentang strategi peningkatan pendapatan RS Budi Kemuliaan Batam dalam penerapan kebijakan KRIS-JKN dengan Metode Balanced Scorecard. Penelitian ini dilaksanakan dari bulan April 2024 hingga bulan Juni 2024. Hasil penelitian: Pada perspektif keuangan strategi yang diterapkan adalah pengelolaan biaya dan optimisasi pendapatan dari layanan JKN. Perspektif pelanggan menekankan pada peningkatan kualitas layanan dan kepuasan pasien, yang secara langsung berdampak pada peningkatan kunjungan serta memberikan pelatihan komunikasi efektif. Perspektif proses bisnis internal strateginya melakukan diversifikasi pelayanan dari pelayan yang sudah ada salah satunya adalah membuka poli eksekutif dan poli tumbuh kembang anak. Perspektif pembelajaran dan pertumbuhan melakukan pelatihan dan pengembangan kompetensi staf Kesimpulan: Penerapan Balanced Scorecard di rumah sakit Budi Kemuliaan Batam memberikan kerangka kerja yang komprehensif dan terukur untuk meningkatkan pendapatan rumah sakit. Ini melibatkan empat perspektif utama: keuangan, pelanggan, proses bisnis internal, serta pembelajaran dan pertumbuhan. Fokus utama adalah pengelolaan biaya dan optimisasi pendapatan, peningkatan kualitas layanan dan kepuasan pasien, efisiensi operasional dan peningkatan teknologi informasi, serta pelatihan dan pengembangan kompetensi staf. Diversifikasi layanan dan peningkatan pelayanan juga merupakan bagian penting dari strategi ini. Kata kunci: Balanced Scorecard, KRIS JKN, Keuangan, Pelanggan, Proses Bisnis Internal
Background: The Ministry of Health has introduced the Standard Inpatient Class (KRIS) to improve the quality of healthcare services in hospitals. For effective implementation and management of KRIS, a comprehensive approach such as the Balanced Scorecard (BSC) is needed. BSC provides a holistic framework for measuring and managing hospital performance from the perspectives of finance, customer, internal business processes, and learning and growth. Objective:. This study aims to identify strategies to increase hospital revenue in the implementation of KRIS-JKN at Budi Kemuliaan Hospital Batam. Methode: This research uses a qualitative approach with a case study design to obtain an overview of the revenue enhancement strategies at Budi Kemuliaan Hospital Batam in the implementation of the KRIS-JKN policy using the Balanced Scorecard Method. The study was conducted from April 2024 to June 2024 Results: In the financial perspective, the strategies implemented are cost management and revenue optimization from JKN services. The customer perspective emphasizes improving service quality and patient satisfaction, which directly impacts increased visits and includes providing effective communication training. The internal business processes perspective involves diversifying services from existing ones, such as opening an executive clinic and a child development clinic. The learning and growth perspective focuses on training and developing staff competencies Conclusion: The implementation of the Balanced Scorecard at Budi Kemuliaan Hospital Batam provides a comprehensive and measurable framework to increase hospital revenue. It involves four main perspectives: financial, customer, internal business processes, and learning and growth. The primary focus is on cost management and revenue optimization, improving service quality and patient satisfaction, operational efficiency and information technology enhancement, as well as staff training and competency development. Service diversification and enhancement are also crucial parts of this strategy Keyword: Balanced Scorecard, KRIS JKN, Financial, Customer, Internal Business Processes
Perkembangan dan pergeseran paradigma bisnis di dunia usaha sebagai akibat globalisasi dan perdagangan bebas telah membentuk kompetisi bisnis yang semakin ketat. Hal ini mendorong perusahaan berupaya mempertahankan kepuasan pelanggan dengan membuat perencanaan yang terintegrasi, penilaian kinerja pada perspektif keuangan dan non keuangan. Salah satu alat yang dapat dipergunakan untuk mengukur kinerja adalah Balanced Scorecard. RSU QRS Karawang belum pemah melakukan evaluasi terhadap kinerja dengan pendekatan empat perspektif dari Balanced Scorecard. Penelitian ini menggunakan metode deskriptif kualitatif. Penelitian ini dibatasi pada penerapan secara sederhana keempat perspektif Balanced Scorecard pada objek penelitian di RSU QRS Karawang. Hasil evaluasi kinerja tahun 2006 dan 2007 RSU QRS Karawang adalah sebagai berikut: - Perspektif keuangan: Keuntungan kotor turun dari 27,6% menjadi 26,6%, keuntungan bersih naik dari 2,3% menjadi 2,6%, tingkat pengembalian aset naik dari 9,7% menjadi 12,8%, tingkat pengembalian modal sendiri turun dari 44,3% menjadi 38,2% , efektifitas biaya turun dari 94,7% menjadi 94,6% , dan peningkatan utilsasi aset naik dari 4,1 x menjadi 4,9 x. - Perspektif pelanggan: Kepuasan pelanggan rata-rata 70%, tingkat akuisisi total turun dari 25,9% menjadi 20,4%, tingkat retensi total naik dari 74,1% menjadi 79,6%. - Perspektif bisnis intemal: Jumlah kunjungan rawat jalan turun dari 45.41 I menjadi 40.661, jumlah kunjungan rawat inap naik dari 3.619 menjadi 3715, BOR turun dari 63,S% menjadi 61,3% , LOS naik dari 3 hari menjadi 3,4 hari , T0I naik dari 3 hari menjadi 3,4 hari , sedangkan BTO tetap 63 kali (2006 & 2007). Jumlah pihak ketiga yang menjalin kerjasama naik dari 101 menjadi 110. Kecepatan pelayanan pada bagian pendafiaran tidak ada perbedaan pada pasien umum maupun pasien kontrak. - Perspektif pertumbuhan dan pembelajaran: Tingkat kepuasan karyawan 54,04% (rata-rata). Tingkat kepatuhan karyawan naik dari turunnya tingkal ketidakpatuhan karyawan dari 11 menjadi 7 pelanggaran. Fokus kinerja RSU QRS Karawang saat ini masih terpaku pada perspektif keuangan sedangkan perspektif non keuangan belum dikelola secara maksimal.
Growth and fuction of business paradigm in corporate world as effect of free trade and globalization have formed business competition which progressively tighten. This matter push company cope to maintain satisfaction of customers by making integrated planning, assessment of performance at is in perspective of finance and non finance. One of the tools able to be utilized to measure performance is Balanced Scorecard. QRS Hospital in Karawang has never evaluated to performance with approach four is in perspective the than balanced scorecard. This research use descriptive method qualitative. This research is limited by at in perspective fourth applying simply balanced scorecard at research object in QRS Hospital Karawang result of evaluation performance of year activity 2006 and 2007 QRS Hospital Karawang as following: - In perspective of finance : Gross margin alight from 27,6 % becoming 26,6%, net profit margin go up from 2,3% becoming 2,6%, rate of return on asset go up from 9,7% becoming 12,8%, rate of return on equity alight from 44,3% becoming 38,2, cost effectiveness improvement of alighting from 94,7% becoming 94,6, and asset turnover go up from 4.1 x become 4,9 x. - In perspective of customer: Satisfaction of customer of mean 70%, level of acquisition total alight from 25,9% becoming 20,4%, level retention total go up from 74,1% becoming 79,6%. - In perspective of internal business: Amount of outer patient department visiting alight from 45.411 becoming 40.661, amount of outer patient department visiting to go up from 3.619 becoming 3.715, BOR to alight from 63,5% becoming 61,3, LOS go up from 3 day become 3,4 day, TOI go up from 3 day become 3,4 day, while BTO remain to 63 times (2006 & 2007). Amount of third party brading cooperation go up from 101 becoming 110. Speed of service at part of registration there no difference at public patient and also contract patient. - In perspective of learning and growth: employee satisfaction 54,04% (mean). employee compliance index go up from going down of collision level of employees from 11 becoming 7 collision. Performance focus of QRS Hospital in Karawang in this time still fetch up all standing at is in perspective of finance while is in perspective is non finance not yet been managed maximally