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Instalasi Farmasi RSUD Pasar Rebo merupakan pusat pendapatan RS, Namun, realisasi anggaran Instalasi Farmasi selalu lebih tinggi dari perencanaannya selama lima tahun terakhir sejak 2007 sampai 2011 yang mungkin dipengaruhi oleh cost awareness, cost management, cost monitoring, dan cost incentive sebagai faktor-faktor dari cost containment. Tujuan penelitian ini untuk menganalisis cost containment di Instalasi Farmasi RSUD Pasar Rebo dengan mengetahui cost awareness, cost management, cost monitoring, dan cost incentive dan juga upaya cost containment yang dilaksanakan secara keseluruhan. Penelitian ini merupakan penelitian kualitatif dengan memanfaatkan dua teknik pengumpulan data yaitu data sekunder dan wawancara mendalam kepada pegawai level manajemen RS yang terkait erat dengan Instalasi Farmasi RSUD Pasar Rebo. Penelitian ini dilaksanakan selama Juli 2011 sampai Juli 2012. Hasil penelitian menunjukkan variabel cost awareness yaitu pelatihan belum mengarah pada efisiensi, serta pengkomunikasian harga melalui spanduk dengan slogan yang memotivasi pegawai ataupun acara khusus untuk pengenalan harga sediaan farmasi bagi pegawai pun belum ada. Variabel cost management yaitu budget dengan realisasi budget lebih tinggi dari perencanaan, pengkonsolidasian dokter melalui forum ?reboan? dihadiri sekitar 30 persen dokter, e-prescribing belum diaplikasikan, penyediaan obat dihitung dengan stok minimum dan maksimum tetapi belum ada pegawai yang ditunjuk untuk bertanggung jawab menghindari obat expired, pengurangan biaya operasional diterapkan dengan mematikan AC dan lampu yang tidak digunakan, pemanfaatan ulang kertas bekas, serta penyiapan obat dengan tepat, sementara dukungan eksekutif masih dipandang sebagai supervisi. Variabel cost monitoring yaitu pemonitoran keuangan berkelanjutan dalam hal ini cash flow masih belum mampu dimanfaatkan sebagai alat untuk memberi peringatan kepada Instalasi Farmasi untuk sejalan dengan perencanaan budget, selain belum kuatnya bargaining position RS walaupun margin obat generik dan obat non generik di atas 30 persen, dan masih terjadi selisih saat stock opname, pelayanan terintegrasi masih birokratis serta belum dapat meraih sense of belonging pegawai karena tidak sampainya informasi yang cukup, pengamanan obat penting dilakukan dengan pembedaan lemari serta adanya kartu stok. Variabel cost incentive yaitu pemberian insentif belum ditentukan oleh output kinerja melainkan kompetensi. Hal tersebut di atas menunjukkan upaya pengendalian biaya yang masih memprihatinkan di RSUD Pasar Rebo khususnya di Instalasi Farmasi. Kesimpulannya bahwa Instalasi Farmasi RSUD Pasar Rebo belum mengimplementasikan cost containment (cost awareness, cost management, cost monitoring, cost incentive) secara tepat.
The Pharmacy Installation of RSUD Pasar Rebo is a revenue centre for the hospital. Therefore, the Realisation of Budget of Pharmacy Installation had been higher than its planning for five years since 2007 until 2011 that might be influenced by cost awareness, cost management, cost monitoring and cost incentive as factors of cost containment. The objective of this research was to analyze the cost containment at The Pharmacy Installation of RSUD Pasar Rebo by knowing cost awareness, cost management, cost monitoring, and cost incentive and also the cost containment efforts for overall. This research was a qualitative research, conducted by utilizing two data collection techniques which were secondary data and in-depth interview on the entire management level of hospital which was related directly to The Pharmacy Installation of RSUD Pasar Rebo. This research conducted throughout the months of July 2011 ? July 2012. The result of the study revealed variables of cost awareness were the training program had not directed to efficiency and there were not the price communication by putting motivation statement on working area nor special event for making pharmacy staff knowing about price of pharmacy things. Variables of cost management were the budget which was realization higher than it plan, the doctor consolidation through "reboan" had admitted around 30 percent, the e-prescribing had not applied, the medicine reservation calculated by minimum and maximum stock but there was not a responsible staff to avoid expired medicine, the reducing operational cost was applied by turning off AC and lamp when unused, reuse paper, and preparation medicine correctly, the executive support was adjusted like a supervision not a support. Variables of cost monitoring were the monitoring financial continuely by cash flow was disable to warn The Pharmacy Installation strict to the budget planning nor had bargaining position in medicine principal even the generic and non generic margins upper 30 percent, moreover stock opname still had dismatch, the integrated service was birocratic and staff`s sense of belonging can?t be reached cause not enough information can be achieved, the security of important medicine through differentiating cupboard and stock card. Variable of cost incentive was the Insentive given had not determined by output of work but competences. It was revealed that cost containment efforts were still poorly implemented at RSUD Pasar Rebo especially at The Pharmacy Installation. The conclution was The Pharmacy Installation of RSUD Pasar Rebo had not yet properly implemented cost containment (cost awareness, cost management, cost monitoring, and cost incentive).
This study examines about the satisfaction of medical support affairs of non-civil servants of the remunerations based Competency Based Human Resource Management (CBHRM) in Pasar Rebo Hospital in 2011. This research is a cross sectional research using quantitative methods. The data was collected by filling questionnaires. A total of 134 questionnaires distributed but only 107 complete questionnaires are returned to the researcher. Respondents in this research are 107 medical support affairs of non-civil servants in Pasar Rebo Hospital which is divided into 6 installations. The result showed that there are 53.3 % officers who stated that they are not satisfied with the remuneration received. By this research, known that amount of time working, knowledge about remuneration system, leadership, supervision, remuneration policy, dissemination of remuneration system associated with satisfaction of medical support affairs of non-civil servants of the remunerations based CBHRM. The hospital needs to follow up these findings by evaluating remuneration and improve dissemination of the remuneration system in Pasar Rebo Hospital, involving relevant management and employees of related installation.
Tahun 1998 ketika RSUD Pasar Rebo berubah status menjadi kelas B, jumlah pejabat struktural bertambah yaitu menjadi 21 orang, kemudian Direktur/Pimpinan Rumah Sakit menetapkan Pejabat Struktural sesuai dengan kompetensi. Sejak itu pula terjadi kecaman-kecaman atau hujatam-hujatan pada pejabal struktural/manajemen.Penelitian ini bcrtujuan untuk memperoleh gambaran secara mendalam dan mengidentifikasi konflik yang berkaitan dengan kebijakan jabatan struktural di RSUD Pasar Rebo. Jenis penelilian ini adalah deskripsi analitik yang dilakukan dengan pendekatan cross-sectional secara kuantitatif dan kualitatif. Alat pengukur data kuantitatif yang disusun berdasarkan penskalaan Likert. Pengumpulan data kualitatif dilakukan dengan metode Fokus Group Diskusi (FGD). Variabel-valiabel yang diteliti adalah Z indikator konflik yang terdiri dari adu argumentasi, masalah komunikasi, kompetisi yang destruktif, sikap yang tidak fleksibel dan tidak sensitif, saling menyimpan informasi, kecaman yang tidak fair, dan hubungan menjadi sangat formal. Sampel dalam penelitian ini sejumlah 114 orang yang terdid dari : kelompok Medis 9 orang, kelompok Perawat 35 orang, Kelompok Non Medik 51 Orang dan Kelompok Struktural 19 orang.Hasil penelitian ini disimpulkan bahwa: variabel adu argumentasi, yang menyatakan ada konflik dari kelompok Non Medik 62,5% dan kelompok perawat 64,3% , pada variabel masalah komunikasi, yang menyatakan ada konflik dari kelompok non medik 39,2% dan kelompok perawat 34,2%, pada pada variabel kompetisi yang destruktif, yang menyatakan ada konflik dari kelompok non medik 33,3% dan kelompok perawat 37,l%, pada variabel sikap yang tidak fleksibel yang menyatakan ada konflik dari kelompok non medik 39,2% dan dari kelompok perawat 34,2%. Pada variabel menyimpan informasi yang menyatakan ada konflik pada kelompok non medik 29,4% dan pada kelompok pelawat 31,4%. Pada variabel kecaman yang tidak fair yang menyalakan ada konflik pada kelompok non medik l9,6% dan pada kelompok perawat 31,4%. Pada variabel hubungan yang sangat formal, yang menyatakan ada konflik pada kelompok non mcdik 30,2% dan pada kelompok Perawat 42,8%. Berdasarkan persepsi kelompok Non Medik dan Kelompgk Perawat, faktor penyebab konflik adalah adanya perbedaan pendapat lemahnya komunikasi dan gaya kepemimpinan. Posisi konflik yang paling tinggi terjadi pada kelompok Non Medik dan kelompok Perawat, Dampak konflik kearah negatif yaitu konflik yang merusak (disfungsional/destruktif). Hal ini berpengaruh terhadap motivasi kerja dan suasana kerja yang tidak kondusif.Saran dalam penelitian ini, adalah Direktur RSUD Pasar Rebo segera untuk merespon masalah ini secara cepat dan tepat, dengan melakukan persamaan persepsi dan memberikan informasi tentang kebijakan yang berkaitan dengan jabatan struktural. Selain itu guna meningkatkan ketrampilan terhadap pejabat struktural/manajemen perlu diberikan peladhan-pelatihan tentang manajemen.
In the year 1998 Pasar Rebo Hospital changed the status to class B hospital, the numbers of structtual staff becomes 21 staftf furthermore Directore of the Hospital decided the structural stat? selected according to the related competition rank and copability. From this assignment time, has rised a protest or slander destireci to management/or structural staff ofthe Pasar Rebo Hospital.This research purposed to achieve to get a clear pictures and to identifying thc conflict related with the role of function ofoocupation in Pasar Reho Hospital. The type of this research is descriptive-analytical which is conducted by means of quatitative and qualitative Cross-Sectional approach. The instrument for measureing the quantitative data structured questionnaire which is compiled based on Likert Scale. The qualitative data collection is conducted by means of Focus Group Discussion method. The variables which are researched are : unwarranted arguments among employees, communication problems, destructive competition, employees exhibiting inflexible and insensitive attitudes, colleagues withholding information, unfair criticims of certain individuals, excessively fomial interpersonal relationships between employees. The sample were ll4 persorw, which are : 9 persons hom medical group, 55 prsons from nurses, 51 persons from non medical and I9 persons hom structural.The result of this research was summarized that the variables unwarranted argument who has stated conflicts from non medik group is 62,5% and from nurses group is 64,3%. In the alterhand the variable commtmication problem who has stated cinflicts from non medik group is 39,2% and Hom nurses group is 34,2%. The variable destructive competition who has stated conflicts from non medik group is 33,3% and from nurses group is 37,1%. For the variable employees exhibiting inflekxible and inssitive attitudes who has stated conflicts from non medik group 39,2% and 34,2% for nurses group. For the variable colleagues withholding information who has stated conflicts is 29,-4% for non medik and 31,4% for nurses group. For the variable unfair criticims of certain individuals who has conflicts is l9,6% for non medik group and 3l,4% for nurses group. For the variable excessively formal interpersonal who has stated conflicts is 30,2% for non medik and 42,8% for nurses group. A factor of conflict due to diiiient ideas, cornmtuiication problems and style of leadeshipness In these kind of conflicts called disfungsiorial/destructive. Eventually the excess oh these conflicts influenced to motivation of working an uncondusively ol' comfortable working ethic.The recommendations should forward to : Directore of Pasar Rebo Hospital to response these conflicts problems seriously in order to react by uniforming of perceptions by giving them the correct information, regarding to the role of fimction which related with thc structural occupation in Pasar Rebo Hospital. ln other hands this efforts is to achieve or to improve the skilfull of the structural stall' or management staff whose needs to give them a change like a management training etc.
Padapenelitian ditemukan 45,8% perawat mengalami stres yang tinggi. Perbedaanproporsi terbesar ditemukan pada faktor individu (kepercayaan diri) dan dukungan(dukungan atasan). Hasil merekomendasikan perbaikan deskripsi kerja yang lebihjelas dan akurat serta pelatihan komunikasi terkait upaya manajemendalammengelola stres kerja.
This study discusses work stress and the factors that affect work stress amongnurses In Emergency Room in RSUD Pasar Rebo 2014. National Institute forOccupational Safety and Health (NIOSH)categorizes the factors that influencework stress, which are as job stressor, non-work, individual, and support factors.This study was conducted among 24 emergency room nurses at RSUD PasarRebo. Descriptive observational cross-sectional method was used in this study.
The results found that 45.8% of nurses experienced high stress. The largestproportionswere found in individual factor (self-esteem) and support (supervisorsupport). This study recommend improvements on clearer job descriptions andaccurate communication and training related to management efforts in managingwork stress.
Penelitian ini menggunakan metode penelitian kualitatif (analitik observasional) untuk melihat alur pelayanan resep obat dan mengidentifikasi pemborosan pelayanan resep obat. Dan didukung oleh penelitian kuantitatif (analisis deskriptif) untuk memperoleh data perhitungan waktu setiap tahapan proses pelayanan resep obat.
Berdasarkan hasil penelitian diketahui rata-rata waktu tunggu pelayanan resep obat non racikan selama 89.6 menit (88.17% kegiatan menunggu) dan 124.70 menit (82.10% kegiatan menunggu) pada pelayanan resep obat racikan.
Hasil penelitian mengidentifikasi bahwa terdapat 8 jenis pemborosan (DOWNTIME) pada pelayanan resep obat. Usulan perbaikan dengan metode lean diharapkan dapat menurunkan waktu tunggu menjadi 66.67% pada pelayanan resep obat non racikan dan 56.67% pada pelayanan resep obat racikan.
Kata kunci : farmasi; metode lean; pemborosan; waktu tunggu
Long waiting times on prescription services will reduce patient satisfaction and lead to inefficient services. Lean is one of the methodologies that can be used to deal with inefficiencies in health services. This study aims to analyze the application of lean method in reducing waiting time of outpatient prescription services at Pasar Minggu public hospital in 2017.
This study used qualitative research methods (observational analytics) to examine the flow and identify waste of prescription drug services. And also supported by quantitative research (descriptive analysis) to get the exact calculation of every step of prescription drug services.
Based on the result of the research, it is known that the average waiting time of medicine prescription services is 89.6 minutes (88.17% waiting activity) and 124.70 minutes (82.10% waiting activity) of personalized medicine prescription services.
The study identified that there were 8 types of waste (DOWNTIME) in prescription services. The future improvement by lean method is expected to reduce waiting time to 66.67% on medicine prescription services and 56.67% on personalized medicine prescription services.
Keywords : pharmacy; lean methode; waste; waiting times
RSUD Tarakan merupakan rumah sakit umum daerah milik Pemerintah Provinsi Daerah Khusus Jakarta yang ditetapkan sebagai rumah sakit pengampu layanan stroke baik untuk kasus stroke infark maupun kasus stroke hemoragik. Dalam memberikan pelayanan kasus stroke hemoragik baik severity I, II maupun III, RSUD Tarakan mengalami selisih negatif antara rata-rata tarif INA CBG’s terhadap rata-rata tarif rumah sakit. Penelitian ini bertujuan untuk mengetahui besaran biaya satuan perawatan stroke hemoragik sebagai langkah awal untuk menganalisis biaya. Dengan diketahuinya besaran biaya satuan antara layanan aktual dan clinical pathway maka dapat diketahui faktor-faktor apa saja yang dapat menyebabkan inefisiensi di dalam perawatan stroke hemoragik. Dari faktor-faktor inefisiensi yang telah diketahui maka dapat diketahui pula nilai cost recovery rate untuk menentukan upaya efisiensi dan penerapan cost containment sebagai rekomendasi bagi manajemen RSUD Tarakan. Penelitian ini menggunakan metode deskriptif dengan pendekatan kualitatif yang mengolah data primer dari hasil wawancara mendalam dan data sekunder melalui telaah dokumen dengan menggunakan metode Activity Based Costing. Hasil penelitian ini menunjukkan bahwa biaya satuan rata-rata perawatan stroke hemoragik kelas 1 sebesar Rp. 18.296.787,-, kelas 2 sebesar Rp. 32.496.824,- dan kelas 3 sebesar Rp. 15.595.005. Nilai cost recovery rate mencapai lebih dari 100% pada perawatan stroke hemoragik baik severity I, II maupun III dengan LOS 1-7 hari. Dari hasil upaya efisiensi berdasarkan layanan dan biaya disimpulkan bahwa faktor-faktor yang menyebabkan terjadinya inefisiensi pada perawatan stroke hemoragik adalah keterpakaian tempat tidur yang rendah khususnya kelas 2, utilitas alat yang rendah, biaya pemakaian obat yang tinggi serta LOS yang memanjang. Dari faktor-faktor tersebut dilakukan pemetaan terhadap 4 tahap cost containment. Cost Awareness dilakukan dengan pemantapan sosialisasi kepada dokter dan seluruh pegawai mengenai pentingnya kesadaran biaya di rumah sakit, cost management dilakukan dengan melakukan strategi optimalisasi sumber daya manusia dan pemakaian obat-obatan, optimalisasi proses layanan perawatan stroke hemoragik dan sarana-prasarana yang diberikan seperti penggabungan kelas 2 ke dalam ruang rawat kelas 3 yang sudah sesuai standar KRIS serta otomatisasi sistem informasi rumah sakit. Cost monitoring dilakukan dengan memperkuat fungsi pengawasan pihak-pihak pengendali biaya dan cost incentive dilakukan dengan memberikan reward kepada dokter maupun pegawai rumah sakit yang berkontribusi dalam melakukan efisiensi biaya rumah sakit.
RSUD Tarakan is a regional public hospital owned by the Provincial Government of the Special Region of Jakarta which is designated as the hospital in charge of stroke services for both infarct stroke cases and hemorrhagic stroke cases. In providing services for hemorrhagic stroke cases of severity I, II and III, RSUD Tarakan experiences a negative difference between the average INA CBG's tariff and the average hospital tariff. This study aims to determine the unit cost of hemorrhagic stroke care as a first step to analyzing costs. By knowing the amount of unit costs between actual services and clinical pathway, it can be known what factors can cause inefficiencies in hemorrhagic stroke treatment. From the inefficiency factors that have been known, the value of cost recovery rate can also be known to determine efficiency efforts and the application of cost containment as a recommendation for the management of RSUD Tarakan. This study uses a descriptive method with a qualitative approach that processes primary data from in-depth interviews and secondary data through document review using the Activity Based Costing method. The results of this study indicate that the average unit cost of class 1 hemorrhagic stroke treatment is Rp. 18,296,787, class 2 is Rp. 32,496,824, and class 3 is Rp. 15,595,005. The cost recovery rate value reached more than 100% in hemorrhagic stroke treatment both severity I, II and III with LOS 1-7 days. From the results of efficiency efforts based on services and costs, it is concluded that the factors that cause inefficiency in hemorrhagic stroke treatment are low bed utilization, especially class 2, low equipment utility, high drug usage costs and prolonged LOS. From these factors, a mapping of the 4 stages of cost containment was carried out. Cost Awareness is carried out by strengthening socialization to doctors and all employees regarding the importance of cost awareness in hospitals, cost management is carried out by carrying out strategies to optimize human resources and the use of drugs, optimizing the hemorrhagic stroke treatment service process and facilities provided such as the incorporation of class 2 into class 3 treatment rooms that are in accordance with KRIS standards and automation of hospital information systems. Cost monitoring is carried out by strengthening the supervisory function of cost control parties and cost incentives are carried out by providing rewards to doctors and hospital employees who contribute to hospital cost efficiency.