Workshop Keselamatan Pasien &

Manajemen Risiko Klinis

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

Ketua Komite Keselamatan Pasien Rumah Sakit
PERSI

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

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
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:: Kadarman Award 2007 (untuk Patient Safety), Sekolah Tinggi Manajemen PPM
Penghargaan
Lain--lain :
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

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
4

 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 : berpusat pada teknologi, berpusat pada dokter, berpusat
pada RS atau berpusat pada penyakit, padahal bukan demikian.
(Stewart, M. : Towads a global definition
of patient centred care, Editorial BMJ 322 : 444, 2001)
5

 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, terjadi pertumbuhan atas pengakuan thd
begitu besarnya manfaat asuhan patient- and-family-centered care yg
ditawarkan kepada 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, ...
mereka 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

 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 familycentered 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 meningkat.
(Advancing the Practice of Patient-and Family- Centered Care,
Institute for Family-Centered Care, 2008 )

Dari mana PCC lahir ?

Patient Safety
7

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

Mati

(>50% krn
ME)

Pasien
RS di US

Pasien
tsb

: Admisi
/year

:Mati sb
AE

Mati sb
lain

(Extrapolasi)

Di
Colorado
&
Utah(1992)

2.9 %

Di New
York(1984)

3.7 %

6.6 %

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

33.6 juta
13.6 %

$50 milyar

JUMBO JET UNITS

(98.000 pasien mati / tahun)

D A L A M 1 TAHUN
SETIAP HARI
1 PESAWAT JUMBO JET
BERPENUMPANG 268 ORANG
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 dan teman2; 7. Asuhan yang
10
berkelanjutan dan transisi yang lancar; 8. Akses thd pelayanan.

 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 efektifbiaya 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)
11

 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 yan 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 playanan
kesehatan
12

 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).

1. Suatu upaya kolaboratif yg terdiri dari pasien, keluarga, teman2,

para dokter dan profesional kesehatan lain .............
13

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 yan 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)
14

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 esensial adalah pentingnya memberikan yan 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)
15

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.
16

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 berpartisipadi 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,
17
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 200818

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 200819

WHO General Principles of Good Chronic Care (2003)

1.
2.
3.
4.
5.
6.
7.
8.

9.
10.

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

20

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
21

 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.

22

 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
23

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,
24
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,
25
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
26

"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
27

"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
28

The MCG Health System in Augusta, Georgia.

Member University HealthSystem Consortium

Partnering with Patients and Families to Design a Patient

29 and
Family-Centered Health Care System. Johnson, B et al. Institute for Family-Centered Care 2008

Patient's Responsibilities

(Pasien tidak
diatas segalanya)

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

30

Patient's Responsibilities / Tanggung Jawab Pasien

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 atau 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
31
atau advis Dr nya

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:
32

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.
33

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 :
34

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
35

Patient & Family Centerd Care in Patient Safety

PFCC dipopulerkan oleh gerakan Patient Safety (PS)
Induk PS adalah Hospital Risk Management. Melalui proses manajemen risiko perlu
diterapkan :
Patient Centeredness
Patient Safety
Salah satu hasil analisis penting, sewaktu pasien dirawat maka terjadi Isolasi Sosial,
suatu kondisi sosiopatologis PFCC
Pada PS konsep2 PFCC 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
36

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.

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 SEAR 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

Integrasi Patient Centred Care di Rumah Sakit

Organisasi : Visi, Misi, Nilai
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
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

Kesimpulan
1.
2.

3.
4.
5.
6.

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
PCC merupakan mainstream model dalam pelaksanaan asuhan
pasien, namun masih belum dipahami sepenuhnya, belum
sepenuhnya dihargai
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
Terapkan PCC one step at a time
47

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