Pendidikan : Dokter, 1970, FK.

UKI, Jakarta Konsultan Nefrologi (Ginjal(Ginjal-Hipertensi) 1982, Pernefri (Perhimpunan Nefrologi Indonesia) Magister Manajemen, 1994, Sekolah Tinggi Manajemen PPM, Jkt. Jabatan RS : RS Mediros : Ketua Komite Medis Medis, , Koordinator KSM PD.Ginjal PD.Ginjal-Hipertensi Organisasi: Organisasi : Ketua KKPKKP-RS (Komite Keselamatan Pasien Rumah Sakit)Sakit)-PERSI 05 KARS (Komisi Akreditasi Rumah Sakit) Dep Kes RI : Ketua Bidang Akreditasi 2011 2011-2014, Surveior / Pembimbing Akreditasi Pengurus PERSI Pusat, Ketua Kompartemen Khusus, 20092009-2012 Member Advisory Council Asia Pacific, Joint Commission International, 2009, 2009, 2010 PJ SubPokja Model Akreditasi Baru, Pokja Penyempurnaan Akreditasi RS, DitJen Bina Yan Med, 2010 2010-2011 Penghargaan: Penghargaan : Kadarman Award 2007 (untuk Patient Safety), Sekolah Tinggi Manajemen PPM LainLain -lain : Sekretaris Jendral PERSI Pusat 19881990, 19901993, 19931996 Direktur Ketua RS.PGI.Cikini, Jakarta, 1983 1993 Dekan Fakultas Kedokteran UKI, 1988 1991 Kepala Bagian Ilmu Penyakit Dalam FKFK-UKI, Jakarta, 1992 - 1995 Kepala Renal Unit (Unit Ginjal) RS.PGI Cikini, 1973 1981

Nama Lahir Status Alamat

CURRICULUM VITAE : Dr. Nico A. Lumenta, K.Nefro, MM : Magelang, 5 Nov 1943 : Menikah, 1 anak : Jl. Kayu Mas I/4, Pulo Mas,Jkt Timur

Workshop Keselamatan Pasien & Manajemen Risiko Klinis

Dr.Nico A.Lumenta, K.Nefro, MM Ketua Komite Keselamatan Pasien Rumah Sakit PERSI

 Frost and Sullivan : Malaysia : Indonesian medical tourists going to Malaysia comprise around 70 percent of its total Singapore are only around 65 percent. Malaysian hospitals 2008 : 288,000 Indonesian patients, 2007 : 221,538, 2006 : 170,414 Singapore hospitals 2007 : 226,200 Indonesian patients, 2006 : 266,500

Source: International Medical Travel Journal

 Penduduk Indonesia berobat keluar negeri

2005 : 600.000

2008 : 1000.000 Sumatera Utara : 2008 : 180.00 ke Malaysia & Singapore Rp 1,8 triliun

 The patient experience is one of the top 3 priorities of hospital leaders over the next 3 years. Refocus on the person at the center of care. Hospitals : struggling to understand what patient-centered care truly means Everyone has a role in the patient journey: from the arrivals parking attendant, to the CEO and clinical staff, including environmental services and the check-out receptionist. Successful hospitals provide an exceptional patient experience. Culture that focuses on patients are rewarded with higher clinical quality and efficiency, a safer patient environment, greater employee engagement, and improved financial results. (Institute for Healthcare Improvement, 2012)

(Konsep Marketing: # Produk Barang # Produk Jasa)

Standar Akreditasi RS pd badan Internasional Patient Centered Care Fokus Pasien

Quality & Safety of Patient Care

NB. Mulai digunakan juga istilah : Patient Family Centered Care

 Balint and colleagues introduced the term patient-centered medicine in 1969. The term patient-centered care was coined by Harvey Picker (Picker Institute, 1988)

1915-2008
7

HOSPITAL RISK MANAGEMENT

PATIENT CENTRED CARE

(PELAYANAN FOKUS PASIEN)

3 Fondasi Asuhan pasien

Asuhan Asuhan Asuhan Asuhan Medis Keperawatan Gizi Obat

MUTU PATIENT SAFETY ETIK EBM VBM

Safety is a fundamental principle of patient care and a critical component of Quality Management.
(World Alliance for Patient Safety, Forward Programme, Programme, WHO, 2004)

Evidence Based Medicine Value Based Medicine

(Nico A Lumenta & Adib A Yahya, 2012) 81

 Patient centredness is becoming a widely used, but poorly understood, concept in medical practice. It may be most commonly understood for what it is nottechnology centred, doctor centred, hospital centred, disease centred.

Konsep Patient centredness dalam praktek medis makin luas digunakan, Tapi masih sangat kurang dipahami. Umumnya dipahami sebagai : o berpusat pada teknologi, o berpusat pada dokter, o berpusat pada RS atau o berpusat pada penyakit, padahal bukan demikian.
(Stewart, M. : Towads a global definition 9 of patient centred care, Editorial BMJ 322 : 444, 2001)

 For well over a decade, there has been growing recognition of the enormous benefits patient- and family-centered care offers to health care providers, patients, and families in all areas of health care. As hospitals, ........ struggle with issues related to quality, safety, HIPAA compliance, workforce capacity, the use of technology, the need to renovate or build new facilities, and cost control, ....... they are recognizing that patient- and family-centered approaches and the perspectives of patients and families are essential to their efforts.

Selama lebih dari satu dekade, pertumbuhan pengakuan thd besarnya manfaat asuhan patient- and-family-centered care bagi para PPK, pasien, dan keluarga dalam semua sarana pelayanan kesehatan Saat RS, .... berjuang dengan isu2 yang berhubungan dengan mutu, safety /keselamatan, memenuhi persyaratan HIPAA*, kapasitas tenaga kerja, penggunaan teknologi, kebutuhan untuk merenovasi atau membangun fasilitas baru, dan kendali biaya, ... RS mengakui bahwa pendekatan patient- and family-centered dan perspektif ttg pasien & keluarga adalah penting dlm upaya mereka
Advancing the Practice of Patient-and Family- Centered Care, Institute for Family-Centered Care, 2008 *(Health Insurance Portability and Accountability Act)
10

 Bringing the perspectives of patients and families directly into the planning, delivery, and evaluation of health care, and thereby improving its quality and safety is what patient- and family-centered care is all about. Studies increasingly show that when health care administrators / providers, and patients & families work in partnership, the quality and safety of health care rise, costs decrease, and provider and patient satisfaction increase.

Memasukkan perspektif ttg pasien & keluarga langsung ke dalam perencanaan, pemberian dan evaluasi dari yan kes/RS, sehingga meningkatkan mutu dan keselamatan, itulah patient- and family-centered care. Penelitian menunjukkan bahwa bila para administrator / PPK, bermitra dengan pasien & keluarga, maka mutu dan safety dari pelayanan kesehatan akan meningkat, biaya menurun, dan kepuasan provider maupun pasien akan (Advancing the Practice of Patient-and Family- Centered Care, meningkat.
Institute for Family-Centered Care, 2008 )

Dari mana PCC lahir ?

Patient Safety

11

Laporan Institute of Medicine - IOM

TO ERR IS HUMAN Building a Safer Health System
(Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, D.C.: National Academy Press, 2000.)

RS - RS

AE
(>50% krn ME)

Mati

Pasien RS di US
: Admisi /year

Pasien tsb
:Mati sb AE
(Extrapolasi)

Mati sb lain

Di Colorado & Utah(1992) Di New York(1984)

2.9 %

6.6 % 33.6 juta

44,000 - KLL :
43,458 98,000 -Cancer : 42,297 !!! Estimasi -AIDS : biaya: $17 - 16,516 $50 milyar

3.7 %

13.6 %

JUMBO JET UNITS

(98.000 pasien mati / tahun)

D A L A M 1 TAHUN SETIAP HARI 1 PESAWAT JUMBO JET BERPENUMPANG 268 ORANG (Pasien !!) J A T U H !!!

(.....and die .....!!)

Definisi
IOM Institute of Medicine : patient-centered care as care that is
respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.

Patient-centered care sebagai asuhan yang menghormati dan responsif terhadap pilihan, kebutuhan dan nilai-nilai pribadi pasien. Serta memastikan bahwa nilai-nilai pasien menjadi panduan bagi semua keputusan klinis Picker Institute :
1.Respect for patients values, preferences and expressed needs, 2. Coordination and integration of care, 3. Information communication and education, 4. Physical comfort, 5. Emotional support and alleviation of fear and anxiety, 6. Involvement of family and friends, 7. Continuity of care and smooth transition, 8. Access to Care

1.Hormati nilai2, pilihan dan kebutuhan yg diutarakan oleh pasien; 2. Koordinasi dan integrasi asuhan; 3.Informasi, komunikasi dan edukasi; 4. Kenyamanan fisik; 5. Dukungan emosional dan penurunan rasa takut & kecemasan; 6. Keterlibatan keluarga & teman2; 7. Asuhan yg berkelanjutan dan transisi yg lancar; 8. Akses thd pelayanan. 14

 NHC National Health Council :

Patients and their famities manage their heatth care in partnership with a coordinated health care team that recognizes, respects and acts upon their goals, needs, values, preferences, cultural wishes, and/or other factors identified by patients and their famities. Patients and their famities receive evidenced-based, cost-effective quality care that maximizes health, alleviates discomfort and is safe and free from avoidable errors. Patients and their families have the ability to obtain and understand health information and services, and make appropriate heatth decisions. (NHC, 2004)

Pasien & keluarga mengatur asuhan kes mereka bermitra dgn suatu tim yan kes yg diakui, yg menghormati dan bertindak utk tujuan, kebutuhan, nilai2, pilihan serta harapan budaya mereka, dan/atau faktor-faktor lain yg diidentifikasi oleh pasien & keluarga. Pasien & keluarga menerima asuhan berbasis-bukti dan dgn mutu yg efektif-biaya yg memaksimalkan kesehatan, menurunkan rasa tidak nyaman dan aman serta bebas dari error yg bisa dicegah Pasien & keluarga mempunyai kemampuan utk memperoleh dan memahami informasi maupun yan kes, dan mbuat kebutusan kesehatan yg tepat (NHC, 2004)
15

 Australian Commission on Safety and Quality in Health Care (ACSQHC) :

Patient-centred care is: is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting.

Patient-centred care (PCC) adalah suatu pendekatan inovatif terhadap perencanaan, pemberian, dan evaluasi atas pelayanan kes yg didasarkan pada kemitraan yg saling menguntungkan antar PPK, pasien & keluarga. PCC diterapkan kepada pasien dari segala kelompok usia, dan bisa dipraktekkan dalam setiap bentuk pelayanan kesehatan
16

 IAPO International Alliance of Patients Organizations :

1. A collaborative effort consisting of patients, patients' families, friends, the doctors and other health professionals...achieved through a comprehensive system of patient education where patients and the health care professionals collaborate as a team, share knowledge and work toward the common goals of optimum healing and recovery.(Grin, 1994) 2. A construct that advocates simplifying the care at the bedside in the acute care setting by focusing on the expected outcomes for the patient rather than the multiplicity of tasks of each department. (Johnston & Cooper, 1997). 3. Health care that is closely congruent with and responsive to patients' wants, needs, and preferences. (Laine & Davidoff, 1996). 4. Placing patients at the center of the system af care and developing good services that revolve around them (Mallett, 1996).

17

1. Suatu upaya kolaboratif yg terdiri dari pasien, keluarga, teman2, para dokter dan profesional kesehatan lain ... tercapai melalui suatu sistem edukasi pasien yg komprehensif dimana para pasien dan profesional yan kes yg bekerjasama sbg suatu tim, saling berbagi pengetahuan dan pekerjaan kearah tujuan yg sama yaitu penyembuhan dan pemulihan yg optimum (Grin, 1994) 2. Suatu bentuk yg menyokong penyederhanaan yan bedside pada saat pelayanan akut dgn cara memusatkan thd hasil yg diharapkan bagi pasien daripada thd kemajemukan tugas dari setiap bagian (Johnston & Cooper, 1997) 3. Yan kes yg sangat erat dan responsif thd keinginan, kebutuhan dan pilihan pasien (Laine & Davidoff, 1996) 4. Menempatkan pasien pada pusat dari sistem asuhan dan mengembangkan yan yg baik disekitar pasien (Mallett, 1996)
18

What is Patient-Centered Care?

the essential theme is the importance of delivering healthcare in a manner that works best for patients. providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences. Hospital recognize that :

A patient is an individual to be cared for, not a medical condition to be treated. Personalization of Care
tema esensialnya adalah pentingnya memberikan pelayanan kes dgn cara yg terbaik bagi para pasien para PPK bermitra dgn pasien dan anggota keluarga mereka uk mengetahui dan sedapat mungkin memenuhi kebutuhan dan pilihan pasien Rumah sakit mengakui bahwa : (tsb diatas)
19

1. 2. 3. 4. 5. 6.

7.

What is Patient-Centered Care? Each patient is a unique person, with diverse needs. Patients are partners and have knowledge and expertise that is essential to their care. Patients family and friends are also partners. Access to understandable health information is essential to empower patients to participate in their care The opportunity to make decisions is essential to the well-being of patients. Each staff member is a caregiver, whose role is to meet the needs of each patient, and staff members can meet those needs more effectively if the organization supports staff members in achieving their highest professional aspirations, as well as their personal goals. Patient-centered care is the core of a high quality health care system and a necessary foundation for safe, effective, efficient, timely, and equitable care. 20

1. 2. 3. 4. 5. 6.

7.

What is Patient-Centered Care? Setiap pasien adalah manusia yg unik, dgn berbagai kebutuhan yg berbeda Pasien adalah mitra dan mempunyai pengetahuan serta keahlian yg penting bagi asuhan mereka Keluarga dan teman pasien juga merupakan mitra Akses thd informasi kes yg bisa dimengerti adalah penting dlm memberdayakan pasien utk berpartisipasi dlm asuhan mereka. Kesempatan utk membuat keputusan adalah penting bagi keadaan sehat pasien Setiap anggota staf adalah pemberi layanan, yg perannya adalah utk memenuhi kebutuhan setiap pasien, dan anggota staf dapat memenuhi kebutuhan tsb secara lebih efektif bila RS mendukung mereka dlm mencapai aspirasi profesional, maupun tujuan pibadi mereka yg tertinggi. Patient-centered care adalah inti dari sistem Yan Kes yg bermutu tinggi dan suatu dasar yang penting bagi pelayanan yg aman, efektif, 21 efisien, tepat waktu, dan equitable.

What are the Core Concepts of Patient- and Family-Centered Care?

1. Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. 2. Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making. 3. Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose. 4. Collaboration. Patients and families are also included on an institutionwide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 200822

What are the Core Concepts of Patient- and Family-Centered Care?

1. Martabat dan Rasa hormat. Praktisi yan kes mendengarkan dan menghormati pandangan dan pilihan pasien & keluarga. Pengetahuan, nilai-nilai, kepercayaan dan latar belakang kultural pasien & keluarga dimasukkan dlm perencanaan dan pemberian yan kes 2. Berbagi informasi. Praktisi yan kes mengkomunikasikan dan berbagi informasi secara lengkap dan tdk menyimpang/bias dgn pasien & keluarga dgn cara menguatkan (affirming) dan berguna. Pasien & keluarga menerima informasi secara tepat waktu, lengkap, dan akurat agar berpartisipasi secara efektif dlm asuhan dan pembuatan keputusan. 3. Partisipasi. Pasien & keluarga didorong dan didukung utk berpartisipasi dlm asuhan dan pengambilan keputusan pada tingkat yg mereka pilih 4. Kolaborasi / kerjasama. Pasien & keluarga juga dimasukkan dlm institusi secara luas. Pimpinan yan kes bekerjasama dgn pasien & keluarga dlm pengembangan, implementasi dan evaluasi kebijakan dan program; dlm rancangan fasilitas yan kes; dan dlm edukasi profesional, serta dalam pemberian pelayanan.
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 200823

WHO General Principles of Good Chronic Care (2003)

1. 2. 3. 4. 5. 6. 7. 8. Develop a treatment partnership with your patient Focus on your patient's concerns and priorities Use the 5 A's: Assess, Advise, Agree, Assist, Arrange Educate patient on disease and support patient selfmanagement Organize proactive follow-up Involve "expert patients," peer educators and support staff in your health facility Link the patient to community-based resources and support Use written information - registers, Treatment Plan, treatment cards and written information for patients - to document, monitor, and remind Work as a clinical team Assure continuity of care

9. 10.

24

WHO General Principles of Good Chronic Care (2003)

1. Kembangkan suatu kemitraan pengobatan dgn pasien Anda 2. Fokus pada masalah dan prioritas pasien Anda 3. Gunakan 5 As : Assess (periksa), Advise (nasehat), Agree (setuju), Assist (bantu), Arrange (atur) 4. Didik pasien ttg penyakit dan dukung pengelolaan mandiri pasien 5. Atur tindak-lanjut yg proaktif 6. Libatkan pasien yg ahli, peer pendidik dan dukung staf Anda 7. Hubungkan pasien dgn sumber-sumber dan dukungan berbasis komunitas 8. Gunakan informasi tertulis pendaftaran, Rencana Pengobatan, kartu berobat dan informasi tertulis bagi pasien sbg dokumen, monitor/pemantau, dan pengingat 9. Bekerja sebagai tim klinis 10. Pastikan kontinuitas asuhan
25

 Traditional model in health care, the physician has been the central unit in the health care model.

A more modern approach to health care is now being quickly implemented in many hospitals around the world: the interdisciplinary team model. This model has shifted all of the health care providers AROUND the PATIENT focusing on PATIENTCENTERED CARE. In addition, they are all of equal importance when it comes to each health care professionals contribution to the patient and the team.

26

 Pada Model tradisional dalam yan kes, dokter merupakan unit sentral/pusat dalam model yan kes

Pedekatan yg lebih modern dlm yan kes sekarang, diterapkan dgn cepat di banyak RS di seluruh dunia, model tim interdisiplin : model ini telah menggeser semua PPK menjadi disekitar pasien berfokus pada PCC Sbg tambahan, mereka semua sama pentingnya bila tiba pada kontribusi setiap profesional yan kes tthd pasien dan tim

27

1. The traditional model calls for patients and families to give blind obedience to the expertise of paternalistic health care professionals. The patient- and family-centered model calls for an equal partnership. 2. What is difficult for many to appreciate is that for the most part todays health systems do not foster collaboration among patients, families and caregivers 3. The hard part is understanding that the shift to patient- and family-centered care is a fundamental change in how you manage your hospital. The concepts of patient- and familycentered care are woven into the infrastructure of your organizationin strategic plans, vision and values, facility design, patterns of care, information-sharing processes, family support, charting and documentation, human resources management, professional education, and quality and safety improvement processes. The key is to partner with patients and families who are trained as formal advisers.
Sodomka, P : Engaging Patients & Fam: A High Leverage Tool for Healthcare Leaders, 28 AHA Quality Update, 2006

1. Pada Model tradisional pasien & keluarga (dibangun) patuh tanpa syarat kpd expertise dari para pofesional yan kes yg paternalistik. Sedangkan pada model patient- and family-centered diberlakukan kemitraan yg setara. 2. Dalam sistem yan kes masa kini, masih sulit bagi banyak orang utk menghargai dan mengembangkan kolaborasi antar PPK dan pasien keluarga. 3. Bgn yg sulit adalah memahami bhw pergeseran ke patient- and family-centered care (PFCC) merupakan perubahan mendasar dlm cara mengelola RS. Konsep PFCC terjalin ke dalam infrastruktur organisasi RS, dalam rencana stratejik, visi dan nilai-nilai, rancang bangun fasilitas, pola yan, proses berbagi-informasi, dukungan keluarga, pemetaan dan dokumentasi, pengelolaan SDM, edukasi profesional, dan proses peningkatan mutu serta keselamatan. Yg penting adalah bermitra dgn pasien & keluarga yg terlatih sbg penasehat formal.
Sodomka, P : Engaging Patients & Fam: A High Leverage Tool for Healthcare Leaders, 29 AHA Quality Update, 2006

Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 2008
30

"Medical Excellence Model" merupakan pengembangan dari interdisciplinary team model. The clinical team of expert physicians and nurses who work together in an integrated manner, assessing patient needs, ordering tests, planning treatments, scheduling surgeries, monitoring progress and planning for early discharge to home. The pillars of this model include 1. Clinical governance 2. Credentialing and clinical privileging of physicians & nurses 3. Use of standardized, evidenced based protocols 4. Patient and Staff Safety 5. Infection control 6. A culture of audit and continuous professional development
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 2008
31

"Medical Excellence Model" / Model keunggulan medis Merupakan pengembangan dari model tim interdisiplin Tim klinis dari para dokter dan perawat ahli yg bekerja bersama dgn cara yg terintegrasi, memeriksa kebutuhan pasien, memerintahkan pemeriksaan, merencanakan pengobatan, menjadwalkan operasi / pembedahan, memonitor kemajuan dan merencanakan pasien pulang cepat ke rumah Pilar dari model ini termask Clinical governance / Tata kelola klinis Kredensialing dan pemberikan kewenangan klinis kpd para dokter dan perawat Penggunaan protokol yg terstandar dan berbasis bukti Keselamatan Pasien dan Staf Pengendalian infeksi Suatu budaya yg dewasa dan pengembangan profesional secara berkesinambungan
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 2008
32

Patient's Responsibilities

SHOULD : 1. provide accurate and complete information concerning present complaints, past medical history, hospitalizations, medications and other matters relating to the patient's health. 2. Follow the treatment plan advised by the Physician including the instructions of nurses and other health professionals as they carry out the Physician's orders. 3. Treat hospital staff and other patients with dignity & respect and not to conduct any activity that will disrupt the work of the hospital. 4. Respect the privacy of others and the property of the hospital
5. not bring alcohol, unauthorized drugs or weapons into the hosp. 6. respect that the hospital is a non smoking zone 7. follow visiting hours of the hospital 8. leave valuables at home and bring only those items necessary during hospital stay 9. assure that the financial obligations of Patient's care are fulfilled as per the hospital policy 10. be responsible for their own actions if they refuse treatment or their physician's advice
33

(Pasien tidak diatas segalanya)

Patient's Responsibilities/Tanggung Jawab Pasien (Pasien tidak diatas segalanya) WAJIB : 1. memberikan informasi yg akurat dan lengkap ttg keluhan sakit sekarang, riwayat medis yg lalu, hospitalisasi, medikasi/pengobatan dan hal-hal lain yg berkaitan dgn kes pasien. 2. Mengikuti rencana pengobatan yg diadviskan oleh Dr termasuk instruksi para perawat dan profesional kes yg lain sesuai perintah Dr 3. Memperlakukan staf RS dan pasien lain dgn bermartabat dan hormat serta tidak melakukan tindakan yg akan mengganggu pekerjaan RS 4. Menghormati privasi orang lain dan barang milik RS 5. Tidak mbawa alkohol, obat2 yg tdk mendpt persetujuan / senjata, ke dlm RS 6. Menghormati bahwa RS adalah area bebas rokok 7. Mematuhi jam kunjungan dari RS 8. Meninggalkan barang berharga di rumah dan membawa hanya barangbarang yg penting selama tinggal di RS 9. Memastikan bahwa kewajiban finansial atas asuhan pasien dipenuhi sebagaimana kebijakan RS 10. Bertangg-jwb atas tindakan2nya sendiri bila mereka menolak pengobatan atau advis Dr nya 34

Declaration on Patient-Centred Healthcare

Patient-centred healthcare is the way to a fair and costeffective healthcare system
IAPO, International Alliance of Patients Organizations, 2006

1. Health systems in all world regions are under pressure and cannot cope if they continue to focus on diseases rather than patients; 2. they require the involvement of individual patients who adhere to their treatments, make behavioural changes and self-manage. 3. Patient-centred healthcare may be the most cost-effective way to improve health outcomes for patients. 4. Patients, families and carers priorities are different in every country and in every disease area, but from this diversity we have some common priorities. To achieve patient-centred healthcare we believe that healthcare must be based on the following Five Principles:
35

a. Respect respects their unique needs, preferences and values, as well as their autonomy and independence. b. Choice and empowerment Patients have a right and responsibility to participate, as a partner in making healthcare decisions that affect their lives. . c. Patient involvement in health policy Patients and patients organizations deserve to share the responsibility of healthcare policy-making. d. Access and support Patients must have access to the healthcare services warranted by their condition. This includes access to safe, quality and appropriate services, treatments, preventive care and health promotion activities. e. Information Accurate, relevant and comprehensive information is essential to enable patients and carers to make informed decisions about healthcare treatment and living with their condition.
36

Declaration on Patient-Centred Healthcare

Patient-centred healthcare is the way to a fair and costeffective healthcare system
IAPO, International Alliance of Patients Organizations, 2006

1. Sistem kes di semua bagian dunia ada dibawah tekanan dan tdk dpt mengatasinya bila mereka terus memusatkan perhatian pd penyakit dan bukannya kepada pasien; 2. Mereka membutuhkan keterlibatan dari pasien secara individual yg melekat thd pengobatan mereka, membuat perubahan perilaku dan keloladiri 3. Yan kes yg patient-centered bisa jadi merupakan cara yg paling efektifbiaya utk meningkatkan hasil kes bagi pasien 4. Prioritas Pasien, keluarga dan PPK berbeda dlm setiap negara dan dalam setiap area penyakit, tetapi dari keberagaman ini kita mempunyai kesamaan prioritas. Untuk mencapai yan kes yg patient centered, kita harus mendasarkan pada Lima Prinsip berikut ini :
37

a) Hormat. Menghormati kebutuhan, pilihan dan nilai-nilai mereka yg unik, Juga otonomi dan kebebasan mereka b) Pilihan dan pemberdayaan. Pasien mempunyai hak & tangg jwb utk berpartisipasi, sbg mitra, dlm membuat keputusan yan kes yg mempengaruhi hidup mereka c) Keterlibatan pasien dalam kebijakan kesehatan. Pasien dan organisasi pasien layak utk mengambil tangg- jwb pembuatan-kebijakan yan kes d) Akses dan dukungan. Pasien harus mempunyai akses ke yan kes dgn jaminan kondisi mereka. Ini termasuk akses ke yan, pengobatan, yan pencegahan dan kegiatan promosi kes yg aman, bermutu serta tepat e) Informasi. Informasi yg akurat, relevan & komprehensif adalah penting utk memampukan pasien dan PPK utk membuat keputusan yg diberitahukan ttg pengobatan yan RS dan hidup dgn kondisi mereka
38

Patient Centred Care in Patient Safety

PCC dipopulerkan oleh gerakan Patient Safety (PS) Induk PS adalah Hospital Risk Management. Melalui proses manajemen risiko perlu diterapkan : Patient Centredness Patient Safety Salah satu hasil analisis penting, sewaktu pasien dirawat maka terjadi Isolasi Sosial, suatu kondisi sosiopatologis PCC Pada PS konsep2 PCC dijalankan pada : Tujuh Langkah menuju Keselamatan Pasien Tujuh Standar Keselamatan Pasien Sasaran Keselamatan Pasien Program WHO Patient Safety : Patients for Patient Safety Standar Akreditasi Baru Rumah Sakit : Pelayanan berfokus pd Pasien
39

Beberapa Publikasi Artikel ttg PFCC : PARTNERING WITH PATIENTS AND FAMILIES TO DESIGN A PATIENT- AND FAMILY-CENTERED HEALTH CARE DELIVERY SYSTEM: A ROADMAP FOR THE FUTURE PATIENT-CENTRED CARE: IMPROVING QUALITY AND SAFETY BY FOCUSING CARE ON PATIENTS AND CONSUMERS PATIENTS AND FAMILIES AS ADVISORS IN ENHANCING SAFETY AND QUALITY : BROADENING OUR VISION ENGAGING PATIENTS & FAMILIES: A HIGH LEVERAGE TOOL FOR HEALTH CARE LEADERS PATIENTS AND FAMILIES : POWERFUL NEW PARTNERS FOR HEALTHCARE AND FOR CAREGIVERS.

28 Febr 2012

Moving Forward with Patient-and Family- Centered Care: One Step at a Time The following steps can help set a hospital or health system on its journey toward patient and family-centered care. 1. Implement a process for all senior leaders to learn about patientand family-centered care. Include patients, families, and staff from all disciplines in this process. 2. Appoint a patient- and family-centered steering committee comprised of patients and families and formal and informal leaders of the organization. 3. Assess the extent to which the concepts and principles of patientand family-centered care are currently implemented within your hospital or health system. 4. On the basis of the assessment, set priorities and develop an action plan for establishing patient- and family-centered care at your institution. ......

5. Using the action plan as a guide, begin to incorporate patient- and family-centered concepts and strategies into the hospitals strategic priorities. Make sure that these concepts are integrated into your organizations mission, philosophy of care, and definition of quality. 6. Invite patients and families to serve as advisors in a variety of ways. Appoint some of these individuals to key committees and task forces. 7. Provide education and support to patients, families, and staff on patient- and family centered care and on how to collaborate effectively in quality improvement and health care redesign. For example, provide opportunities for administrators and clinical staff to hear patients and family members share stories of their health care experiences during orientation and continuing education programs. 8. Monitor changes made, evaluate processes, measure the impact, continue to advance practice, and celebrate and recognize success.
Advancing the Practice of Patient-and Family- Centered Care, Institute for Family-Centered Care, 2008

Moving Forward with Patient-and Family- Centered Care: One Step at a Time Berikut ini adalah langkah-langkah yg dapat membantu RS / sistem kes dalam perjalanannya menuju Patient-and Family- Centered Care (PFCC) 1. Terapkan suatu proses bagi seluruh pimpinan senior utk mempelajari ttg PFCC. Termasuk pasien, keluarga, dan staf dari semua disiplin dalam proses ini 2. Angkat suatu Panitia Pengarah PFCC, terdiri dari pasien & keluarga serta pimpinan formal maupun informal RS 3. Buat penilaian ttg sampai berapa jauh konsep & prinsip PFCC saat ini diterapkan di RS 4. Berdasarkan asesmen, tetapkan prioritas dan kembangkan suatu rencana aksi utk membentuk PFCC di RS anda 5. Gunakan rencana aksi sbg panduan, masukkan konsep & strategi PFCC ke dalam prioritas strategi RS. Pastikan bhw konsep2 ini terintegrasi ke dlm misi organisasi, falsafah yan, dan definisi mutu

Moving Forward with Patient-and Family- Centered Care: One Step at a Time .....(2) 6. Undang pasien dan keluarga utk berperan sbg panasehat dlm berbagai cara. Tetapkan bbrp dari inividu ini masuk ke dlm panitia kunci dan pokja. 7. Berikan edukasi dan dukungan kpd pasien, keluarga, dan staf mengenai PFCC dan ttg bagaimana berkolaborasi secara efektif dlm peningkatan mutu dan rancang ulang yan kes. Misalnya, berikan kesempatan bagi para administrator dan staf klinis utk mendengarkan pasien & keluarga membagikan cerita ttg pengalaman yan kes mereka selama orientasi maupun program pendidikan berkelanjutan 8. Monitor perubahan yg terjadi, evaluasi proses, ukur dampak, teruskan utk praktek lanjutan, dan rayakan serta buat pengakuan atas keberhasilan.
Advancing the Practice of Patient-and Family- Centered Care, Institute for Family-Centered Care, 2008

WHO South East Asia Region - Patient Safety Workshop on Patients for Patient Safety

Jakarta Declaration
Jakarta, Hotel Four Seasons, 19 July 2007

Patient For PS : Jakarta Declaration 27 July 2007 1. Tdk boleh ada pasien yg menderita cedera yg dpt dicegah; 2. Pasien adalah pusat dari semua upaya KP (Keselamatan Pasien); 3. Menyatakan bhw rasa takut disalahkan & hukuman seharusnya tdk menghalangi komunikasi terbuka dan jujur antara pasien & PPK; 4. Mengakui bhw kami harus bekerja dlm pola kemitraan utk mencapai perubahan perilaku utama & sistem yg dibutuhkan utk penerapan KP di regional kami; 5. Percaya bhw : transparansi, tangg-jwb & pendekatan manusiawi adalah yg utama pd suatu sistem yan kes yg aman; dasar hub adalah saling percaya & saling menghormati antara para profesional kesehatan & pasien; pasien & pendampingnya perlu mengetahui mengapa st pengobatan diberikan & diberitahu semua risiko, kecil / besar, shg mereka dpt mengambil bgn dlm keputusan terkait dgn asuhan kpd mereka; pasien perlu mempunyai akses kpd rekam medisnya;

6. Mengakui bhw ketika cedera terjadi : hrs ada suatu sistem dimana kejadian itu dpt dilaporkan & diselidiki secara rahasia; pasien & keluarganya harus memperoleh informasi dan dukungan; PPK yg terlibat pd cedera yg tak disengaja juga menerima dukungan; tindakan korektif harus diambil utk mencegah cedera di masa depan & pelajaran yg didapat perlu disebarkan secara luas; harus ada mekanisme kompensasi yg wajar atas kerugian pasien dan keluarga nya; 7. Komit terhadap: pemberdayaan konsumen melalui pendidikan yg jujur & tulus; bekerjasama dgn media utk mendorong pelaporan yg bertangg-jwb & utk berkesempatan mendidik masyarakat; partisipasi aktif konsumen di dalam pelaporan KTD; komunikasi 2 arah antar pasien & pemberi yan kes utk mendorong adanya tanya jawab; wakil pasien di komite keselamatan pasien dan forum-forum;

8. Berikrar melalui upaya yg berkesinambungan untuk mencapai sasaran sbb: berfungsinya sistem mutu & KP pd setiap sarana yan kes, baik publik & swasta, mulai dgn pembentukan suatu komite KP & dalam suatu sistem pelaporan KTD serta sistem tanggapannya; taat pd pedoman berbasis bukti & etik, dan hindari pengobatan yg irrasional spt pemberian obat , pemeriksaan & operasi yg tidak perlu; pendidikan kedokteran berkelanjutan utk para profesional kes; konsep KP yg terintegrasi ke dlm pelatihan professional kes; indikasi yg rasional utk admisi pasien pd setiap sarana yan kes; sumber daya yg adekuat utk KP; professional kesehatan yg termotivasi & kompeten; pasien & PPK yg puas. WHO, South-East Asia Regional Office 2007

Implementasi Patient Centred Care di Rumah Sakit

A. Organisasi : Visi, Misi, Nilai PCC B. Manajemen : Rencana Strategis, RKA Tahunan Tingkatkan cakupan Komite/Tim KPRS Komite PCC (kaji kemungkinan ada
anggota dari pasien)

Asesmen Budaya, Sosialisasi, Monev penerapan Kredensial, Pelatihan Forum pertemuan dgn pasien/keluarga C. Pelayanan & Asuhan Pasien : Personalization of care Kemitraan Hak pasien & keluarga : martabat, hormat, pilihan, informasi, partisipasi Edukasi Pasien Atasi hambatan / kendala : bahasa, budaya, pasien cacad Kebutuhan klinis pasien : mulai dari admisi, asuhan se-hari2, kondisi khusus : manajemen nyeri, pelayanan akhir kehidupan. Kontinuitas pelayanan, Asesmen terintegrasi / Integrated note Semua staf terlibat : dari pintu gerbang di tempat tidur pulang

Implementasi Patient Centred Care di Rumah Sakit

D. Praktek sehari-hari, beberapa contoh : Ketika Px mendaftar di poli, (terutama bila harus antri) kpdnya dijelaskan mengapa harus menunggu dan kira-kira berapa lama perlu menunggu. Pasien (Px) kontrol RJ dianjurkan membuat catatan, susun pertanyaan, untuk ditanyakan kepada Dokter, agar jangan sampai sudah pulang dari Poli masih ada hal yang belum dipahami Pada yan di IGD, Px perlu menunggu hasil pem Lab : maka kpd Px dijelaskan ttg mengapa perlu menungu dsb Saat mau periksa laboratorium, Px diberi informasi tentang gambaran proses pemerikssaan yang akan dialami di lab, atau bila pemeriksaan khusus terhadap spesimen. Dmk pula pd pem Radiologi, Yan Obat, Yan Gizi, Yan rehab medis dsb Pd proses pembedahan hal ini sdh lbh rinci krn keharusan Informed consent

PCC Semua staf terlibat dari pintu gerbang di tempat tidur pulang

PCC

Mulai dari CEO s/d semua staf terlibat dari pintu gerbang di tempat tidur pulang

The MCG Health System in Augusta, Georgia. Member University HealthSystem Consortium

Partnering with Patients and Families to Design a Patient 53 and Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 2008

Kesimpulan
1. 2. Pada model asuhan pasien yang tradisional, Dokter merupakan pusat dari asuhan pasien, patient safety belum terjamin. Pada model Patient Centered Care (PCC), pasien adalah pusat, para pemberi pelayanan kesehatan mengelilingi / melayani pasien, dan PPK tsb dalam fungsi yg setara dan berkolaborasi, sehingga disebut interdisciplinary team model PPC dalam pelaksanaan asuhan pasien, masih belum dipahami sepenuhnya, belum sepenuhnya dihargai PCC merupakan Mainstream model, sdh menjadi Trend global pelayanan kesehatan di Rumah Sakit PCC di Indonesia dipopularkan melalui Keselamatan Pasien Rumah Sakit PCC dilaksanakan dalam KPRS pada 7 Langkah, 7 Standar, 6 Sasaran Keselamatan Pasien, Program WHO P4PS, Standar Akreditasi Baru Rumah Sakit 54 Terapkan PCC one step at a time

3. 4. 5. 6. 7.

LET THE MIRACLE BEGIN Robert Shaw, creator of the 200-voice Atlanta Symphony Orchestra Chorus, is internationally known for his ability to blend hundreds of voices into unforgettable music. Once Shaw was asked how he was able to do this, often with very short rehearsal times. His answer says a lot about what it takes to bring about winning combinations of people and organizations. Once we find each other, he said simply, the miracle begins. The same is true of patients and families and health care providers. Once we find each other, the miracle begins. It is time to get started !!
Sodomka, P : Engaging Patients & Fam: A High Leverage Tool for Healthcare Leaders, AHA Quality Update, 2006

LET THE MIRACLE BEGIN Robert Shaw, pencipta dari 200-voice Atlanta Symphony Orchestra Chorus, terkenal secara internasional krn kemampuannya utk memadukan ratusan suara ke dlm musik yg tak terlupakan. Suatu saat Shaw ditanya bagaimana dia bisa melakukan semua ini, bahkan seringkali dengan waktu latihan yg sangat singkat. Jawabannya adalah mencakup memenangkan kombinasi orang dan organisasi. Begitu kita bertemu satu sama lain katanya dengan sederhana, mujizat itu mulai terjadi. Begitu pula halnya dengan pasien & keluarga serta pemberi pelayanan kesehatan. Begitu kita bertemu satu sama lain, maka mujizat itu mulai terjadi. Saatnya kita memulai !! - It is time to get started !!
Sodomka, P : Engaging Patients & Fam: A High Leverage Tool for Healthcare Leaders, AHA Quality Update, 2006

Terimakasih
Atas perhatiannya

Dr. Nico A. Lumenta, K.Nefro, MM