MANAJEMEN KINERJA RUMAH SAKIT

Pradnya Paramita
Program Studi Doktor –IKM FKM-UI
 Agenda
1 Pengantar Kinerja Rumah Sakit

2 Pengukuran Praktek Manajemen di bidang Kesehatan

dan Rumah Sakit

3 Membawa sebuah Keadaan Yang Terbaik

4 “Membangun Hubungan Efektif Bagi Kinerja Rumah Sakit

5 Kesimpulan – Implikasi bagi Pemangku Rumah Sakit

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Tujuan Pelatihan
Setelah Pelatihan, peserta diharapkan mampu untuk:

1. Mengerti Model Kinerja Rumah Sakit yang dapat

diterapkan di rumah sakit
2. Mengisi Formulir Kinerja Rumah Sakit
3. Mampu Memimpin diskusi Kinerja di Rumah
Sakit
4. Membangun tujuan kinerja efektif bagi karyawan
dan rumah sakit
Mengapa Harus Mengatur
& Menyusun Kinerja

 Untuk Mencapai Misi dan Tujuan dari

Organisasi
• Meranngsang dan memberikan penghargaan
yang sejalan dengan periaku organisasi dalam
mencapai misi dan tujuannya.
• Menggali secara tidak langsung kegiatan yang
tidak produktif.
 Definisi 'kinerja
 Kinerja adalah pencapaian tujuan yang diinginkan atau yang diharapkan.
 Kinerja rumah sakit yang tinggi harus berdasarkan kompetensi profesional
dalam hal penerapan pengetahuan, tersedia teknologi dan sumber daya,
efisiensi dalam penggunaan sumber daya; risiko minimal yang terjadi pada
pasien, kepuasan pasien, hasil perawatan terhadap pasien.
 Dalam lingkungan pelayanan kesehatan kinerja rumah sakit yang tertinggi
harus lebih ditunjukkan pada ketanggapan terhadap kebutuhan dari
masyarakat dan tuntutan, integrasi layanan dalam sistem pemberian layanan
secara keseluruhan, dan komitmen untuk promosi kesehatan.
 Kinerja rumah sakit yang tinggi harus dinilai dalam kaitannya dengan
ketersediaan layanan rumah sakit 'untuk semua pasien terlepas dari fisik,
budaya, sosial, demografi dan hambatan ekonomi.
 Kanji & Sá (2003)

CONTEXT

REGULATORS AND
OTHER ENTITIES Internal
members
HOSPITAL’S
PERFORMANCE

Suppliers

Consumers
and purchasers 6
 What is performance
□ Outcomes
□ Hospital and related care
□ High quality, appropriate, timely
□ Patient experience
□ Suited to needs, informed, seamless, safe
□ Sustainability
□ Respond, adapt
□ Progress measures
□ Waiting times, adverse events, patient
satisfaction
□ Outputs
□ Rates of services, training positions
 What is performance:
Report on Government Services

□ Public hospitals, maternity services

□ Outputs
□ Equity
□ access
□ Effectiveness
□ access, appropriateness, quality (safety,
responsiveness, capability, continuity), sustainability
□ Efficiency
□ Outcomes
 What is performance:
Productivity Commission’s Public and Private Hospitals

□ Hospital and medical costs

□ Included measures of costs, productivity and access
□ Hospital-acquired infections
□ Included other safety and quality indicators
□ Rates of fully informed financial consent for
privately insured patients
 What is performance:
other views

□ Only some statistical information is ‘labelled’ as

‘performance indicators’ in those frameworks
□ Other statistics may be also viewed as measuring
performance by stakeholders:
□ MOH highlighted numbers of doctors and nurses
in a speech to parliament last week
□ PERMAPKIN highlighted occupancy rates in its
Public Hospital Report Card ?
□ Adelaide Advertiser’s front page story on
numbers of people leaving emergency
departments before being seen by a doctor
 What is performance?
Other than national…
1. Performance measurement for different purposes
□ local or state-level management of hospitals
□ funding agreements (public and private hospitals)
□ accountability or public reporting at the local or state
level
2. Measurement designed to support hospital quality
improvement activities
□ Hospital benchmarking or comparison activities
Otonomi RS: Petunjuk Implementasi
STRATEGIC PLAN FOR PERFORMANCE
MEASUREMENT
 4 Categories of Equip For Future Skills
Communication Skills
□Read With Understanding
□Convey Ideas in Writing
□Speak So Others Can Understand
□Listen Actively
□Observe Critically
Interpersonal Skills
□Cooperate With Others
□Guide Others
□Advocate and Influence
□Resolve Conflict and Negotiate
Decision-Making Skills
□Solve Problems and Make Decisions
□Plan
□Use Math to Solve Problems and
Communicate
Lifelong Learning Skills
□Take Responsibility for Learning
□Learn Through Research
□Reflect and Evaluate
□Use Information and
Communications Technology
 KERANGKA ACUAN DALAM
PENGUKURAN
□ Balanced Scorecard
□ Critical Few – Set of Measures
□ Performance Dashboards
□ Malcom Baldrige National Quality
Award Criteria
 Sistem Sistem Informasi Rumah Sakit
Manajemen RS

Sumber Aplikasi Keluaran

Sistem Diagnosis,
Perawatan Pasien Perencanaan
Financial
Data Strategis

Sistem Rekam Biaya per

Medis Prosedur, Pasien /
Keuangan hari , Rawat Jalan
Standar
Profil Produk
Sistem Jadwal Dewan
dan Perjanjian
Direksi
Pasien Analisa Utilisasi
Per Departemen Per
Standar
Profil
Kontrol Dokter
Sistem Akuntansi
Pasien Pelayanan

Service
Sistem Keuangan Data Pasien Pemeriksaan
dan Akuntasi Laporan Layanan
Teknologi Pasien Berbarengan
Pengeluaran RS

Sistem
Kepegawaian Data Klinik Personalia
Statistik
Layanan Per
Departemen
Sistem Pelayanan
Penunjang Kontrol
Data Internal
Perencanaa
n
Sistem Laporan
Kinerja
Manajemen
Kontrol
 USING PERFORMANCE INFORMATION
Heemskerk & van Kanji & Sá (2003) FLEMISH HOSPITALS
Zandwijk (2004)
communication to communication and
employees reporting
(external) justification
giving account
giving account

strategic planning &

(internal) direction examining progress
implementation
improving
driving improvement
performance
resource allocation
supervision decision-making
decisions

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Organisasi Mengoperasikan Sebagai Sebuah Sistem
 PETUNJUK PROSES PERFORMANCE MANAGEMENT
Identifikasi Rumah Sakit

Present Structure of Decision

Evaluasi Kinerja
Making

Decision Making

Process

Design

Nature & Performance

Autonomy and Organization Model of Internal Consensus
Extent of Evaluation
the health sector al Model Autonomy Organization Building
Autonomy Criteria

Key Intervention

Governance & Human Resources Procurement Hospital

Finance
Administration Management Information System
 Healthcare Solutions Practice – Sample Measures
Category Metric
Admission &
Discharge # of Admissions per day

Avg. Admissions per day

Dimensions
# of Discharges
Overall
Avg. Discharges per day Facility Code
Admission Vs Discharge - # per day Financial Class
Admission Vs Discharge - Avg per day Insurance carrier

Length Of Stay Avg. Length Of Stay Zip Code

Outpatient # of Outpatient Visits

Admitting Physician
Time of a day
Emergency # of ED Visits
Day of a week
% of ED Patients Admitted
Service
Avg time for ED Patient to be Admitted

Census Emergency Department Census

Census by Physician

Others Operating Room Activity

Observation Patients
 PENGELOMPOKAN PENGUKURAN
KINERJA RS
□ Sebagian besar ukuran kinerja dapat dikelompokkan ke dalam salah satu dari
enam kategori berikut umum, namun, organisasitertentu dapat mengembangkan
kategori-kategori mereka sendiriyang sesuai tergantung pada misi organisasi.
□ Efektivitas. Karakteristik proses yang menunjukkan sejauh manaproses output (produk
kerja) sesuai dengan persyaratan (yang kita lakukan hal yang benar?)
□ Efisiensi. Karakteristik proses yang menunjukkan sejauh manaproses
menghasilkan output yang dibutuhkan pada biaya sumber daya minimal (yang kita
lakukan hal yang benar)
□ Kualitas. Sejauh mana produk pelayanan memenuhi persyaratanpelanggan dan harapan
□ Ketepatan waktu. Tindakan apakah unit kerja dilakukan dengan benar dan tepat waktu.
□ Produktivitas. Nilai tambah oleh proses dibagi dengan nilaitenaga kerja dan
modal dikonsumsi
□ Keselamatan. Tindakan kesehatan keseluruhan dari organisasi dan lingkungan
kerja karyawan.
PERFORMANCE MEASURE
TREES
PENGUKURAN KINER DI TINGKAT
ORGANISASI
CARA MEMBANGUN TIM
 Setting Effective Goals
□ Quick Tips
□ S.M.A.R.T. Goals
□ Specific
□ Measurable
□ Achievable/Agreed Upon
□ Relevant
□ Time-bound
□ Aligned Set Goals Communicate

□ Adjustable

Evaluate Observe
 Performance Appraisal Practice

□ Review Performance Appraisal for items that are:

□ Under-rated
□ Over-rated
□ Poorly stated
□ Refer to employee background
□ Rewrite Performance Appraisal using tools
reviewed today
□ Make sure to fill out the form completely including
the Goals section
Common Performance
Challenges
 What will be measured in 2020?
□ More safety and quality
□ against national clinical safety and quality standards
□ Healthcare associated infections
□ Readmission and mortality rates
□ Pressure ulcers
□ Other outcomes?
□ Indicators being developed/proposed by KAN
□ Patient experience
□ Waiting times – after Emergency Department care, for
radiotherapy
□ Better measures of comparative service use, eg against need
□ Affordability
□ Appropriateness
□ Sustainability
□ Other indicators associated with national health reform
□ Financial performance
Common Mistakes

□ Labeling
□ Recency
□ Central
Tendency
□ Leniency
□ Horns/Halo Effect
□ Constancy
□ Similarity
 Healthcare management practice findings
▪ Management practice is strongly related to:
Management  Clinical outcomes
really matters  Patient satisfaction
 Hospital financial performance

▪ MOH healthcare management practice:

There is large  Good MOH average score Vs others
variation  Large intra-country variation creates a real opportunity
for improvement

▪ 5 factors are associated with better management practice:

Improvement  Share of clinically trained managers
is possible  Degree of competition
 Hospital size
 Managerial autonomy
 Hospital ownership
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 We use a hospital speciality–level assessment tool to evaluate
management practices

Management Example dimensions Dimension Scoring

practices evaluated criteria

Performance dialogue 1. Measures tracked do not

Hospital and review indicate directly if overall
Operations hospital objectives are
Management being met. Tracking is
Interconnection ad hoc
Performance of targets
and target 2. Most key performance
management indicators are tracked
formally. Tracking is
Performance tracking
overseen by senior staff
Talent and People
management 3. Performance is
Target balance continuously tracked and
communicated, formally
and informally, to all staff
using a range of visual
Consequence management tools
measurement

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The overall hospital management practice score is the average of assessments
across 20 dimensions

Dimensions Score

1. Lay out of patient flow 2

Hospital 2. Rationale for introducing standardisation 3
operations and/or pathway management
Manage- 3. Standardisation and protocols 2
ment 4. Continuous Improvement … 3
5. Good use of human resources 4
Overall
management
7. Consequence management 3 practice score,
8. Quality of targets 2 on scale of 1–5,
Performance
manage- 9. Target stretch 3 is calculated
ment 10. Clarity of goals and measurement 3 from average
11. … across all 20
dimensions
13. Rewarding high performers 3
14. Promoting high performers 4
Talent
manage- 15. Making room for talent 3
ment 16. … 4

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 There are also questions for other stakeholders
Academic ▪ What role can PERMAPKIN’s play in developing more clinically
Health Science trained and excellent managers?
Centres ▪ Are PERMAPKIN’s fully capturing the potential export
opportunity?

▪ How do commissioners ensure access to top performing

Commissioners hospitals?
▪ What implications, if any, are there for GP Commissioners?

▪ How can viable investment opportunities be unlocked?

Investors ▪ What would make Indonesian healthcare a more attractive
investment?

▪ What are you going to need/demand to ensure you are best

Patients informed and able to execute choice?

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 CHALLANGES

□ too many PI’s and unclear definitions

□ “not reflecting the performance”
□ “difficult to find reliable and valid indicators”
□ no participation of employees in the selection

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 PERFORMANCE MEASUREMENT

□ - measurement on the departmental

level

□ - several employees are involved

□ - mostly supported by ICT

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 USING PERFORMANCE INFORMATION

□ “what gets measured, gets done”

= ‘the most famous aphorism of performance measurement’ (Behn, 2003)

□ VERSUS

□ “to raise questions, not to provide

answers”
(Likierman, 1993)

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 RESULTS
□ BUT

- employees are not informed

- external use, but limited internal use

□ cf. „information is too general to use‟
□ cf. „PM is not embedded in the decision
structure of the organization‟

- PM does not achieve its goal

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 DISCUSSION

□ FOCUS ON USING PERFORMANCE

INFORMATION
1. Comparison among hospitals
2. Having decisions made by external stakeholders
 Cf. Accreditation
 Cf. pay-for-performance
 Public disclosure of performance information
 Cf. rankings

Improving the performance of hospitals

(Chandrima, 2005; Hamblin, 2007; Helm, Holladay & Tortella, 2007)
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 DISCUSSION

□ COMPARISON AMONG HOSPITALS


- incomplete and incorrect measures
- different ways of measuring indicators
- different indicators
- different definitions
- based on different strategies
- different input !
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 DISCUSSION
□ DECISION-MAKING BY EXTERNAL STAKEHOLDERS AND PUBLIC DISCLOSURE

- reflecting performance?
□ cf. tunnel vision (Vakkuri & Melkin, 2006)

- is standardization possible?
□ cf. differences between hospitals
□ cf. do hospitals have a sector-specific strategy?

- getting a good score in stead of improving performance

□ cf. risk of misrepresentation (Vakkuri & Melkin, 2006)
• specializing in a few domains
• refusing patients who lower score

- risk of ossification (Vakkuri & Melkin, 2006)

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 DISCUSSION

 CAUTION IS RECOMMENDED
• revising previous steps before use
• Reflection
• systematization

 adjustment for patients’ characteristics

 performance measures are “flags requiring cautious

interpretation in the light of local circumstances”
(Veillard et al., 2005; p. 492)

 involvement of different stakeholders

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 Interesting references
□ Behn, R.D. (2003). Why measure performance? Different purposes require
different measures. Public Administration Review, 63( 5), 586-606.
□ Aidemark, L.-G. (2001). The meaning of balanced scorecards in the health
care organisation. Financial Accountability & Management, 17(1), 23-40.
□ Bauer, K. (2004). KPIs – the metrics that drive performance management. DM
Review, 14(9), 63-64.

□ Becker, B., Formisano, A., & Roger, M.D. (2006). Strategic planning for
departmental divisions in an academic health care centre. The American
Journal of Medicine, 199(4), 357-365.

□ Chandrima, B.C. (2005). Accreditation in hospitals. Expressed Healthcare

Management. Retrieved May 7, 2008, from
http://www.expresshealthcaremgmt.com/20050915/accreditation01.shtml.

□ Heemskerk, P., & Van Zandwijk, M.C. (2004). Verantwoordingsprocessen in de

zorg op basis van de balanced scorecard. Zoetermeer: het Expertise Centrum.

□ Helm, C., Holladay, C., & Tortorella, F.R. (2002). What’s in a name? Reporting
data from public institutions. CMAJ, 22(2), 193-194.

□ Kanji, G.K., & Sá, P.M. (2003). Sustaining healthcare excellence through
performance measurement. Total quality management, 14(3), 269-289.

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 Interesting references
• Kollberg, B. Elg, M., Lindmark, J. (2005). Design and implementation of a performance
measurement system in Swedish health care services. Quality Management in Health
Care, 14(2), 95-111.

• Rooney, A.N., & van Ostenberg, P.R. (1999). Licensure, accreditation, and certification:
approaches to health services quality. Center for Human Services. Retrieved May 4,
2008, from http://www.qaproject.org/pubs/PDFs/accredmon.pdf

• Tarantino, D.P. (2003), Using the balanced scorecard as a performance management

tool. The Physician Executive, September-October, 69-72.

• Ten Asbroek, A.H.A., Arah, O.A., Geelhoed, J., Custer, T., Delnoij, D.M., & Klazinga, N.S.
(2004). Developing a national performance indicator framework for the Dutch health
system. International Journal for Quality in Health Care 16(1), 165-171.

• Vakkuri, J., & Meklin, P. (2006). Ambiguity in performance measurement: a theoretical

approach to organisational uses of performance measurement. Financial
Accountability & Management, 22(3), 235-250.

• Veillard, J., Champagne, F., Klazinga, N., Kazandjian, V., Arah, O.A., & Guisset, A.I.
(2005). A performance assessment framework for hospitals: the WHO regional office for
Europe PATH project. International Journal for Quality in Health Care, 17(6),487-496.

• Yap, C., Siu, E., Baker, G.R., Brown, A.D., & Lowi-Young, M.P. (2005). A comparison of
systemwide and hospital-specific performance measurement tools. Journal of
Healthcare Management, 50(4), 251-264.

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 INFORMASI HUBUNGI

Pradnya Paramita

+ 62 818 708 468

pritaparamita@gmail.com

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