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Learning Task LT 5

CASE 1

After the medicines have been lost several times, dr. Drupadi evaluates the system of managing
facilities and utilities in her clinic.

1. What are the principles of managing facilities and utilities?

 Efficient right goods-right place-right time

Artinya obat atau supplies digunakan sesuai dengan indikasi, lalu waktu penggunaan tepat

(tidak expired), penempatan yang gampang dijangkau operator.

 Determine stocking levels time, price, lag time, purchasing cost

Memastikan biaya odal yang harus dikeluarkan (purchasing cost), mempertimbangkan

berapa waktu yang diperlukan hingga bahan habis atau alat haus diganti, harga jual

 Storekeeper

Pencatatan dan pelaporan bahan yang terpakai, bahan sisa, dan bahan yang perlu diorder

 Insist on bin card

Sistem pencatatan dengan bin card

 Ordering system

Bagaimana cara mengatur atau menyusun. Bisa berdasarkan abjad, fungsi, masa exprired,

dll

 Store ledger

Berdasarkan apa pemakaian bahan yang diberikan pada pasien.

 Defined procedures

Merupan suatu alur (SOP). Contohnya: kapan seharusnya obat mulai dipesan; prosedur

2. Explain briefly each of the principles!


3. Describe the possible causes of discrepancies in facilities and utilities management.
4. What efforts should be done to prevent the discrepancies happened again?
5. What rules should be determine in managing drugs and chemical agent?
6. What principles should be noticed in managing drugs and vaccines?

CASE-2
Dr. Drupadi’s clinic is going very well. The number of patients has already increased from 5-10 patients
per day in first few years, to 20-30 patients per day now. The nurse finds difficulties to look for medical
records of the patients. The doctor also finds difficulties in making diagnosis because the previous
medical records cannot be found.

1. What are the benefit of using medical records? Why is it very important?
2. What are the principles of managing patients’ medical records?

Prinsip Manajemen rekam medis :

1. Have a workable filling system : Memiliki sebuah system pengisian yang dapat bekerja
misalnya system pengisian dengan nama, keluarga, dan alamat atau kombinasi diantaranya.

2. Have a filling discipline : Pengisian merupakan tugas yang membosankan yang memiliki
peluang kemungkinan terjadinya missing records sehingga dibutuhkan spesifikasi batas waktu
yang mengizinkan untuk menyimpan data ke file lainnya. Dan juga memindahkan data rekam
medis yang dibutuhkan sebagai track.

3. Have operational rules for missing records : Pencatatan rekam medis temporer dan
penggabungannya ketika rekam medis utama dibutuhkan untuk dilaporkan.

4. Have a culling procedure : Rekam medis yang ada semaikn lama akan semakin tebal,
sehingga beberapa pemilihan diperlukan. Pada umumnya rekam medis disimpan samapi
jangka waktu 7 tahun, tapi terdapat pengecualian untuk rekam medis anak dan rekam medis
medikolegal yang penting.

3. What are the differences between SOMR and POMR? Which one is better?
4. What steps should be taken to manage the medical record better?
5. How are the principles of computer usage in managing medical records?
6. How is the using of PDA to look for an information?

CASE-3

One day, Dr. Drupadi saw somebody in medical record room whom are known as a boyfriend of a
nurse in that medical record room. She saw him openned and read several medical records on the
nurse’s table. After gave advices and told him to go out, dr. Drupadi called some nurses that worked
in medical records room.

1. What information will dr. Drupadi tell to her nurses?


2. When are medical records able to be informed to people other than patients?

Ketika memperoleh izin dari pasien

Ketika hukum yang meminta

Ketika dibutuhkan dalam kepentingan orang banyak seperti penelitian

Adapun mengenai isi rekam medis diatur lebih khusus dalam Pasal 12 ayat (2) dan ayat (3)
Peraturan Menteri Kesehatan Nomor 269/MENKES/PER/III/2008 tentang Rekam Medis
(“Permenkes 269/2008”). Pasal ini mengatakan bahwa isi rekam medis merupakan milik
pasien yang dibuat dalam bentuk ringkasan rekam medis. Dalam Pasal 12 ayat (4) Permenkes
269/2008 dijelaskan bahwa ringkasan rekam medis dapat diberikan, dicatat, atau dicopy oleh
pasien atau orang yang diberi kuasa atau atas persetujuan tertulis pasien atau keluarga pasien
yang berhak untuk itu.

CASE-4

After being operated for 5 years, dr. Drupadi’s clinic shows an increasing of the number of patients.
However, she has never got a high income even though the finance capital has never runned out. Her
wish to develop a clinic in Kuta has not been realized. All this time, dr. Drupadi manage her clinic’s
finance, helped by one of her nurse.

1. What should be done to manage a clinic’s finance?


2. What is the meaning of:
1. financial records?
2. financial statement?
3. financial audit?
3. Do we need to do an external audit?

CASE-5

Based on an audit result of a public accountant, the doctor and the nurse has already made a complete
finance records. However dr. Drupadi has not made a good financial planning, particularly in
calculating the unit cost of each services in the clinic.

1. What is the meaning of financial planning?


2. What is the definition of unit cost?
3. Why is it mportant to determine the unit cost?6

CASE-6

Based on the audit result, dr. Drupadi then calculates the unit cost of her clinic’s services. First, she
determines the components such as fix cost, operational cost and maintenance cost. Then she
determines the output of the working unit which is an outpatient care and calculates the total of fix,
operational and maintenance cost. After that she divides the total cost by production of each working
unit to get the unit cost. At last, she determines the marginal cost to get the tariff.

1. What is the definition of fix cost? Give the example!


2. What is the deinition of marginal cost? Give the example!
3. Is unit cost the same as tariff? Discuss your answer!

Learning Task LT 6

There are wide variations in standards on health-care delivery within and between health-care
systems. The aim of managing quality is optimizing resource use and expanding coverage based on a
specified standard. The process of improving quality in health-care would be based on sound local
strategies in order to achieve the best results by optimizing resources use and new investment.
1. Describe quality of health-care based on point of view of patients and healthcare providers.
2. Describe dimensions of health-care quality, and give example for each dimension.
3. Describe assessment of health-care quality, and what indicators do we use?
4. Describe the difference between quality goals and health goals, and give examples.
5. Describe seven activities (elements) those are grouped into three categories (analysis,
strategy and implementation) for quality improvement, and give examples foe each element.
6. Describe six domains of quality intervention, and give examples for each domain.
7. Explain what quality assurance program in health-care is.
8. Explain the importance of self-auditing or self evaluation for quality assurance program, and
what aspects?

Mengingat kembali masa lalu


Orang berkata masa lalu adalah guru yang baik. Mengapa? karena itu akan
mengembalikan memori kita dan memberi kita suatu pelajaran.
Berpikir dan Menganalisa
Setelah mengingat, lalu pikir kan, ada masalah apa dengan masa laluku? kenapa
masalah itu bisa terjadi?
Mencari sumber masalah
Kalau sudah tau latar belakang masalah, umumnya mudah menemukan sumber
masalahnya. Sumber masalah adalah hal yang menyebabkan itu terjadi. Kalau hal itu
tidak ada, maka tidak akan muncul masalah.
Pecahkan masalah
Nah inilah bagian terpenting diantara semuanya. Seolah menjawab pertanyaan
“bagaimana caranya agar sumber masalah itu tidak muncul?”. Alhasil, kamu tidak
akan pernah mengulang kesalahan lagi karena sumber masalah sudah teratasi.

Case: MELATI Health Center


Health Centre of Melati that located in suburban area was always crowded by ambulatory patients,
especially on Monday. Some patients often stand on their own legs in a relative inconvenient space
because of unfriendly weather and limited seats in the waiting room. That was quite common; the
patients have to wait 2 hours until they got turn of medical service. However, Melati Health Centre
becomes the first choice of community for seeking health services, because of some reasons. The price
of visit to Melati Health Centre is relatively very cheap, and the location is not so far from most of the
community.

Monday at 9.30 AM: Conversation between patients in waiting room

Mrs Ani: “Finally the doctor is coming too. Last week I had same experience, wait from 7 AM, and did
not know what time the doctor would come. Then I had turn at 10 AM”.

Mrs Mur: “There are 2 doctors here, which one you will meet?”

Mrs Ani: “Who knows, which doctor would come. I just need my daughter get examination and
medicine”.

Mrs Mur: “What’s happened with your daughter?”


Mrs Ani: “At the beginning my daughter was suffered from high fever, and the followed by bad
coughing. That was 4 four days already. Three days ago she was treated here but she won’t recover.
Even she was getting difficulties to breathe and fever again. To go to private doctor must be very
expensive, maybe I can’t afford it”.

Mrs Mur: “Yes, the condition of my son is almost same as your daughter. Two days ago I came about
11 AM. One staff here got angry with me, why I came late at afternoon, and I forgot to bring the
control card of my son. At that time there was no doctor, because of official meeting somewhere. My
son was treated by one midwife, and up to now he won’t recover”.

At 10 AM the same day: between doctor and patient

Doctor: “What’s happened with your daughter?”

Patient: “My daughter was treated three days ago, but she still suffered from high fever. Please
Doctor, help my daughter”.

Doctor: “Your daughter was 4 years old, yes? (Saw the card). Please, lying down there (pointed the
bed). Woo, your daughter is quite ill”

Patient: “Please help doctor, I want my daughter get recover”

Doctor: “Ye, if she still gets fever, please control again (writing prescription). Please, you get medicine
next door”.

At 11 AM: at Pharmacy of Health Centre

Pharmacy’s staff: “Mom, there was no stock of antibiotic that was written in this prescription. The
doctor should write other kind of antibiotic”

Patient’ mother: “Do I have turn back to the doctor?”

Pharmacy’s staff: “No need Mom. Maybe the antibiotic could not be changed. (the pharmacy’s staff
knows that was no stock of other antibiotics). Mom, there is one pharmacy not so far from here.
Maybe you can buy the antibiotic over there.

Patient’ mother: “............... ?????” (I am worried that my money is not enough).

Questions:

1. From the above case, please analyze how was the health service quality of Melati Health
Centre? Analyze each dimension of quality!

2. What kind of strategy that you can implement in order to increase the health service quality
in that health centre?

Learning Task LT 7

Case:
Dr. Ketut Cespleng is a famous general practitioner in Denpasar. Not less than 15 patients get
treatment in 2 hours at his practice. His equipments are modern such as USG, ECG, roentgen,
laboratory, and drug store beside his practice. Putu Gd Ajum, a patient, came to his practice
complaining headache, nausea and fever since in the morning. To make the diagnosis, dr. Ketut did an
anamnesis, physical examination, additional examination such as ECG, USG, roentgen and laboratory
examination, and then give 5 branded medicine to Putu Gd Ajum. He then paid (a fee for services) Rp
555.500,-. Putu Ajum was very satisfied to get complete medical care and many kinds of medicine; the
doctor was also very friendly. Spending a lot of money was not a problem for him because he was very
rich.

LEARNING TASK :
Discuss in your group:
1. Did dr. Cespleng use the managed care approach in his practice? Explain the reasons of your
answer!
Jawab : Tidak karena dokter dan pasien bertransaksi secara langsung sehingga ini masih
termasuk convensional (indemnity)

2. What were the possible reasons why dr. Cespleng uses that kind of practice method?
3. How is the cost effectiveness of the medical care given by dr. Cespleng?
4. Mention several factors why dr. Cespleng’s patients feel satisfied with the services!
5. Did his ability to satisfy the patients mean he had already worked professionally?
6. Describe several consequences that are possible to happen if the above services are applied
for patients with health insurance.
7. What are the obstacles of managed care application in Indonesia?

Case:
The populations of CintaDamaiVillage are members of social health insurance program (Jaminan
Pemeliharaan Kesehatan Masyarakat/JPKM). They have to pay a same premium of Rp
20.000/family/month. The health services covered by the insurance are comprehensive cares
(primary, secondary and tertiary cares). Dr. Koming is acting as the primary health provider in the
village. Tut Bagus, a member of the JPKM program, came to see dr. Koming complaining his penis had
been swollen. He felt very painful during passing water. He also has morning discharge for several
days. He honestly confessed that he had sex with a prostitute several times. Without talking and
advising too much, dr. Koming gave the medicine. On the next 3 days, Tut Bagus came back with his
wife to dr. Koming’s practice. His wife complained with vaginal discharge and swollen vulva. Dr.
Koming then gave a medicine to her. One week later Tut Bagus came back again and complaining of
being very weak, difficult to sleep and lost his appetite.

Learning Task
Discuss in your group:
1. Based on the scenario above, which one of health insurance program was followed by Tut
Bagus? Describe the reasons of your answer!
2. Had dr. Koming given a comprehensive care? Explain your answer!
3. Had dr. Koming applied the managed care concepts? Explain your answer!

Tidak, lebih bertujuan untuk penyembuhan dan tidak ada program peningkatan mutu
pelayanan karena dr. koming hanya meresepkan obat tanpa memberikan edukasi untuk
menyelesaikan sumber permasalahannya, cakupan perawatan yang diberikan tidak
komprehensif sedangkan manage care memberikan pelayanan yang komprehensif
seperti biaya yang ditanggung oleh pihak asuransi.
4. What can be concluded from frequent attendance of Tut Bagus to dr. Koming’s practice?
5. Is there an over-utility aspect? In which component?