‘The Clock is Ticking’

PERAN MANAJEMEN
MENUJU RUMAH SAKIT BERMUTU, PRODUKTF DAN KOMPETITIF
DI ERA NEW NORMAL

Dr Kuntjoro Adi Purjanto, Mkes

Ketum Umum PERSI ( Perhimpunan Rumah Sakit Seluruh Indonesia )
Jogjakarta, 05 April 2021
 SISTEMATIKA
I. PENGANTAR;

II. KEBIJAKAN

III. HAKEKAT RUMAH SAKIT

IV. DIMENSI MUTU

V. TANTANGAN & STRATEGI

 Gagal
Mencapai UHC
Kinerja Without
Strategis Harm

Best practice
Quality
Assesment?
Piutang vs Hutang disruption sebagai perubahan
secara radikal dan revolusioner
yang bisa memicu ketegangan
karena ada unsur 3 S “sudden,
speed , dan surprise”.

Era
CoVid 19,
Banyak
Resiko

Silent Killer
Gagal
Komunikasi
“ DARK TRIAD “

Pelayanan kesehatan di dunia saat ini menghadapi kondisi VUCA ( volatile, uncertainty, complexity dan
ambiguity ) karena dihadapkan pada disruption in healthcare.

Volatility Uncertainty Complexity Ambiguity

Bergejolak, berubah2 Memiliki ketidakpastian Saling berhubungan, Menimbulkan
yang tinggi saling tergantung, rumit Keragu-raguan
3
KEBIJAKAN TATA KELOLA

Penjelasan
KEWAJIBAN RUMAH SAKIT
 KEBIJAKAN KOMITE MUTU
The Joint Commission's 2021 national patient
safety goals for hospitals are:
1. Improve the accuracy of patient identification.
2. Improve staff communication.
3. Improve the safety of medication administration.
4. Reduce patient harm associated with clinical alarm
systems.
5. Reduce the risk of healthcare-associated infections.
6. Better identify patient safety risks in the hospital.
7. Better prevent surgical mistakes.

International Patient Safety Goals

Goal One. Identify patients correctly.
Goal Two. Improve effective
communication.
Goal Three. Improve the safety of high-
alert medications.
Goal Four. Ensure safe surgery.
Goal Five. Reduce the risk of health care-
associated infections.
Goal Six. Reduce the risk of patient harm
Komite mutu diminta di PMKP 1, sub komite manajemen risiko diminta
resulting from falls. di MFK 2, Sub Komite Keselamatan Pasien diminta di PMKP 1 -->

Prognas satandar 1 EP 6 hanya meminta pengukuran mutu tetapi tidak

meminta analisis insiden/audit kasus tersebut
Terkait PMKP 9, kejadian sentinel yang terjadi, dan harus dilakukan
RCA
KEBIJAKAN KESELAMATAN PASIEN

1. Peraturan Menteri Kesehatan No.

1691/MENKES/PER/VIII/2011 Tentang Keselamatan Pasien
2. Peraturan Menteri Kesehatan No.
251/MENKES/SK/VII/2012 Tentang Komite Keselamatan
Pasien Rumah Sakit .
3. Keputusan HK.02.02 / MENKES/ 535/ 2016 Tentang Komite
Nasional Keselamatan Pasien Rumah Sakit.
4. Peraturan Menteri Kesehatan No 11 th 2017 Tentang
Keselamatan Pasien
 KEBIJAKAN PPI

KOMPETENSI PIMPINAN RS
DALAM SNARS ED 1.1

• PAHAM PERATURAN
 Ruang lingkup PERUNDANGAN
Permenkes: FKRTL dan FKTP: TERKAIT R.S (TKRS
Mencegah2terjadinya
) episenter/kluster baru selama masa pandemic
 Pasal 3 ayat 1 :  Merupakan kebijakan operasional strategis untuk melindungi nakes
• PENCEGAHAN PENGENDALIAN INFEKSI (
Setiap Fasilitas Pelayanan Kesehatan harus melaksanakan
KKS.8. ) Covid - 19
dan non nakes, pasien maupun pengunjung di lingkungan fasilita
• PMKP Pencegahan
(PENINGKATAN MUTU
dan Pengendalian DAN KESELAMATAN PASIEN) (PMKP 3)
Infeksi pelayanan kesehatan
 Mencegah penularan dalam lingkungan pelayanan kesehatan
• MANAJEMEN RISIKO (PMKP 12)

1. Komitmen RS untuk Menerapkan Kebijakan PPI di RS dengan membentuk tim PPI, Pelatihan kepada Nakes
2. Melakukan Surveilans
3. Melakukan SOP Skrining untuk mengurangi beban kerja dari Nakes yang melayani Covid
4. Melakukan Edukasi 3 M
5. Melakukan analisis beban kerja terhadap kebutuhan dan kemampuan RS
6. Mengatur jadwal tenaga kesehatan dan non kesehatan serta menggunakan APD sesuai level resiko area  6
jam/hari
7. Memperhatikan Keselamatan dan Kesehatan baik Jasmani maupun Jiwa SDM Nakes dan Non Nakes  dengan
pemeriksaan rutin kesehatan/PCR
8. Melakukan pencatatan dan pelaporan
9. Melakukan audit interna
KEBIJAKAN TATA KELOLA RS PP 47/2021
1 Naisbitt, J. and Aburdene, P., 1991. Megatrends 2000—Ten Dir ections for the 1990s. Megatrends 2000: Ten Directions for the 1990s.
2 https://www.economist.com/news/business/21717990-telemedicine-predictive-diagnostics-wearable-sensors-and-host-new-apps-willtransform-how
 Health equity framework

Diadaptasi dari: Deloitte Insights,2021

Mulai 2030 Indonesia akan mengalami aging population

1980 2010
Population by Age and Sex,
Indonesia Census 1980
Population by Age and Sex,
Indonesia Census 2000

Not Stated

85 + 75+
80 - 84
70-74
75 - 79
65-69
70 - 74
65 - 69
60-64

60 - 64 55-59
55 - 59 50-54
Age Group

50 - 54
45-49

Age Group
45 - 49
40-44
40 - 44

35 - 39
35-39

30 - 34 30-34
25 - 29 25-29
20 - 24
20-24
15 - 19
15-19
10 - 14

5-9
10-14

0-4 5-9

20 15 10 5 0 5 10 15 20 0-4
0
Percentage Percentage 20 15 10 5 0 5 10 15 20
Male Female Percentage Percentage

Male Female

2050 2030
Population by Age and Sex, Population by Age and Sex,
Indonesia 2050 Indonesia 2030

75+ 75+
70-74 70-74
65-69 65-69
60-64 60-64

55-59 55-59

50-54 50-54

45-49 45-49
Age Group

Age Group
40-44 40-44

35-39 35-39

30-34 30-34

25-29 25-29

20-24 20-24

15-19 15-19

10-14 10-14

5-9 05-9

0-4 0-4

20 15 10 5 0 5 10 15 20 20 15 10 5 0 5 10 15 20

Percentage Percentage Percentage Percentage

Males
Male Female
Male Female
 Belanja Kesehatan di Indonesia
relatif masih rendah dibandingkan negara lain
Total Belanja Kesehatan ( % PDB, 2016 )

17,2

7,7

5,5
4,8 4,4
3,8 4,0 4,3
2,8

Indonesi India Thailand Phillipines Malaysia Singapore China Korsel USA

a * * * *

*Sumber: WHO, 2015

 BEBAN PENYAKIT DI INDONESIA
Prediksi DALYs Loss di Indonesia, 2015 dan 2019

59,30%
57,10%

30,30%
28,30%

12,60% 12,30%

Kasus Cedera Penyakit Menular Penyakit Tidak Menular

2015 2019

 Meningkatnya jumlah kasus Penyakit Tidak Menular (PTM) dan kasus trauma / cedera membutuhkan pelayanan yang
lebih kompleks dan tenaga kesehatan terlatih.
 Proyeksi jumlah kasus PTM dan trauma / cedera pada tahun 2015 akan menjadi 111.895.440 dan 2.662.730.
 Proyeksi pada tahun 2019 masing-masing akan menjadi 120.946.480 dan 2.788.180; hal tersebut akan menjadi beban
berat untuk Sistem Pelayanan Kesehatan Indonesia.

Sumber: Agenda Pembangunan Kesehatan 2015-2019, Depkes RI

15
20 Peringkat teratas DALYs
Tahun 1990 dan 2017
di Indonesia
 RUMAH SAKIT TEREGISTRASI DI INDONESIA
RS Berdasarkan Kelas RS Total = 3.022 RS RS Berdasarkan Penyelenggara Total = 3.022 RS
1.800 2000 1895

1.557 1800
1.600
1600
1.400
1400
1.200
1200
1.000
880 1000

800 800
604
600 600
436
400 400

200 152 165

200 107
89 36 36 26 1
60
0
- Kemkes Pemprop Pemkab Pemkot TNI/POLRI BUMN Kementerian Swasta RSDC Wisma
Kelas A Kelas B Kelas C Kelas D dan D Pratama Belum Ditetapkan Lain Atlet

RS Berdasarkan Jenis RS Total = 3.022 RS RS Rujukan Covid-19 SK Menkes = 132 RS

SK Gubernur = 847 RS
3.000 Total = 981 RS

350 326
2.455
2.500
300
292

250
2.000
200

150
1.500
100 79*
56 63 52
50 20 31 18 26
1.000 7 2 9
0
SK Menkes SK Gubernur
567
500
Kemkes Pemprop Pemkab Pemkot TNI/POLRI BUMN/KL Swasta

-
RS Umum RS Khusus *2 RS Belurm teregistrasi

Sumber data: RS Online 1 Maret 2021

 SEBARAN TEMPAT TIDUR PERAWATAN DI RUMAH SAKIT PER PROVINSI

Total Tempat Tidur Perawatan Tempat Tidur Intensif Covid-19

Tempat Tidur Isolasi Covid-19

Jawa Barat 55.553

DKI Jakarta 15.003 DKI Jakarta 1269
Jawa Timur 53.977
Jawa Barat 11.662 Jawa Barat 1094
Jawa Tengah 45.718
Jawa Timur 10.811 Jawa Timur 1081
DKI Jakarta 35.775
Jawa Tengah 8.005 Jawa Tengah 1053
Sumatera Utara 24.382
Banten 3.333 Banten 307
Sulawesi Selatan 16.036
Sulawesi Selatan 2.719 Sulawesi Selatan 296
Banten 14.302
Sumatera Utara 2.561 Sumatera Utara 262
Sumatera Selatan 10.182
Kalimantan Timur 1.912 Bali 225
Aceh 9.415
Bali 1.894 Sumatera Barat 193
Bali 8.546
Sumatera Selatan 1.650 Riau 146
Riau 8.538
Riau 1.504 Sulawesi Utara 142
DI Yogyakarta 8.253
Sulawesi Utara 1.342 Kalimantan Timur 128
Lampung 8.149
DI Yogyakarta 1.339 DI Yogyakarta 124
Kalimantan Timur 7.817
Kalimantan Tengah 1.150 Sumatera Selatan 104
Sumatera Barat 7.524
Sumatera Barat 1.085 Kalimantan Barat 91
Sulawesi Utara 6.676
Kalimantan Selatan 1.031 Aceh 90
Kalimantan Selatan 6.399
Lampung 909 Papua 89
Kalimantan Barat 5.921
Kepulauan Riau 901 Nusa Tenggara Barat 87
Nusa Tenggara Timur 5.499
Papua 735 Kalimantan Selatan 83
Sulawesi Tengah 4.899
Aceh 730 Kepulauan Riau 79
Papua 4.672
Nusa Tenggara Timur 727 Nusa Tenggara Timur 69
Jambi 4.580
Nusa Tenggara Barat 696 Sulawesi Tenggara 63
Nusa Tenggara Barat 4.538
Sulawesi Tengah 562 Kepulauan Bangka Belitung 56
Kepulauan Riau 4.354
Jambi 551 Sulawesi Tengah 47
Kalimantan Tengah 3.786
Kalimantan Barat 522 Maluku 46
Sulawesi Tenggara 3.544
Maluku 514 Lampung 43
Maluku 2.981
Sulawesi Tenggara 472 Kalimantan Tengah 40
Bengkulu 2.909
Papua Barat 467 Jambi 33
Kepulauan Bangka Belitung 2.291
Kalimantan Utara 382 Bengkulu 32
Gorontalo 2.275
Kepulauan Bangka Belitung 307 Papua Barat 21
Papua Barat 2.057
Gorontalo 255 Kalimantan Utara 19
Maluku Utara 1.655
Sulawesi Barat 238 Sulawesi Barat 15
Sulawesi Barat 1.614
Bengkulu 230 Gorontalo 13
Kalimantan Utara 1.529
Maluku Utara 121 Maluku Utara 12
- 10.000 20.000 30.000 40.000 50.000 60.000
- 5.000 10.000 15.000 20.000 0 500 1000 1500
Total = 386.346 TT
Total = 76.320 TT Total = 7.452 TT

Sumber data: RS Online 17 Maret 2021

 RUMAH SAKIT TERAKREDITASI
RS Terakreditasi Nasional Total = 2.386 RS
1.000

RS Terakreditasi Berdasarkan Penyelenggara

900
858
1600
1.480
800 788
1400

700
1200

600 1000

800
500

600

466
400

400

301
300 290 131 147
200
85
29 48

200 0
Kemkes Pemprop Pemkab Pemkot TNI/POLRI BUMN/KL Swasta
149 Tingkat Paripurna 27 74 152 48 54 28 475
Tingkat Utama 2 22 68 9 25 2 173
Tingkat Madya 15 64 11 19 4 177
100 Tingkat Dasar 6 37 4 5 2 95
Lulus Perdana 14 145 13 44 12 560

Total = 2.386 RS
-
Lulus Perdana Tingkat Dasar Tingkat Madya Tingkat Utama Tingkat Paripurna

Sumber data: KARS 1 Maret 2021

 Quality
Assesment?
RS SEBUAH KOTA BANYAK BANYAK BANYAK SDM &
MODERN PROSEDUR PEMERIKSAAN BANYAK PROFESI

HAKEKAT RUMAH SAKIT

BANYAK BANYAK BANYAK

PENDIDIKAN &
JENIS OBAT PASIEN TEHNOLOGI PENELITIAN
CANGGIH
Magula, M,1982
Laksono T, 2014

………………………………………. etc……..
 KESADARAN AKAN POTENSI TERJADINYA KESALAHAN

In a Hospital :
Because there are
hundreds of
medications, tests
and procedures,
and many patients
and clinical staff
members in a
hospital, it is quite
easy for a mistake
PELAYANAN PASIEN KOMPLEKS to be made. . . .

Di Rumah Sakit :
…banyaknya jenis

“Hutan”
obat,jenis pemeriksaan
dan prosedur, serta
jumlah pasien dan staf
Rumah Sakit yang cukup
besar, merupakan hal
yang potensial bagi
terjadinya kesalahan.

Adib Y, 2014 “ To err is human, to cover up is unforgivable, and to fail to learn is inexcusable ”
Sir Liam Donaldson World Health Organization Envoy for Patient Safety
 10 FAKTA KESELAMATAN PASIEN (WHO)

Nico l,2020
Most Common Root Causes
of Medical Errors
1. Communication problems
2. Inadequate information flow
3. Human problems
4. Patient-related issues
5. Organizational transfer of
knowledge
6. Staffing patterns/work flow
7. Technical failures
8. Inadequate policies and
procedures
NEW NORMAL = BALANCING ACT

SAAT NEW NORMAL RUMAH SAKIT

MEMILIKI BEBAN GANDA:
COVID 19 DAN PASIEN UMUM

“ Balancing Act ”, perawatan untuk pasien

COVID 19 tetap berjalan disaat bersamaan
pelayanan pasien umum juga berjalan dengan
resiko penularan seminimal mungkin 4
The Hospital readiness checklist sheet consists
of 12 key components that are essential to
managing COVID-19 in a hospital or facility

Component 1. Leadership and incident management

system
Component 2. Coordination and Communication
Component 3. Surveillance and information
management
Component 4. Risk communication and community
engagement
Component 5. Administration, finance and business
continuity
Component 6. Human resources
Component 7. Surge capacity
Component 8. Continuity of essential support
services
Component 9. Patient management
Component 10. Occupational health, mental health
and psychosocial support
Component 11. Rapid identification and diagnosis
Component 12. Infection prevention and control
 GLOBAL HOSPITAL TREND

Profit
Capping
Value
based
Less service
person
Use of
Artificial
Digitalized intelligence
Hospital.
 Future-state health care delivery models

Diadaptasi dari: Deloitte Insights,2021

Diadaptasi dari: Deloitte Insights,2021
Fathema MD, 2021
 The importance of DIGITALIZATION & Interoperable Data

Pairing Digital Transformation And Radically

Interoperable Data
1. Digital transformation can help generate significant benefits for patients, clinicians, and
health systems, especially when paired with radically interoperable data and insights.

2. Data interoperability allows different information systems, devices, and applications to

access, exchange, integrate, and cooperatively use data in a coordinated, standardized
manner, within and across organizational, regional, and national boundaries.

3. It is an essential building block for a health system without walls—one that provides timely
and seamless portability of information, leverages advanced analytics to generate novel
insights, and optimizes the health of individuals and populations globally.

4. Radical data interoperability is a required foundational capability to enable health care

providers, insurers, and other stakeholders to deliver patient-facing programs and
associated technologies.

• Increasing efficiency of care delivery as providers can

leverage technology to more efficiently treat patients
This could • Reducing the total cost of care through more effective and
improve ROI efficient population health management techniques
• Increasing revenue and growth through an improved patient
experience

Diadaptasi dari: Deloitte Insights, Fathema 2021

 What actions can help our organization accelerate digital
transformation and enable radically interoperable data?
1.Create a robust health IT infrastructure. Consider a cloud-based solution that includes
reliable connectivity, safe and sufficient data storage, consented access to health data, and data-
sharing. Also, implement accessible and integrated EHR systems and basic digital technologies
that accelerate digitalization.
2.Invest in virtual health technology and train clinicians in its use. Improve telehealth
capabilities and design a process whereby consumers can access their own physicians instead
Actions of third-party services; this could help organizations streamline and maximize the benefits of
virtual health. Our surveys show that while consumers are keen on future virtual visits, it is not
health care leaders only access that matters: They are still not completely satisfied with their interactions with the
should consider for doctor or clinician. Training personnel in building virtual interpersonal relationships can be a
major step toward improving consumers’ virtual visit experience.
2021 3.Address the challenge of data interoperability. Underpin data-sharing with interoperable
health data built on universal standards and carried on a personal, longitudinal life record.
Standardize health platforms and EHRs to enable the aggregation of data lakes to which
organizations can apply AI and predict, for example, early onset of behavioral disorders, and
recommend interventions to improve behavioral health outcomes.
4.Establish a robust governance framework to support change management and a culture of digital
transformation, including clarity over data ownership, cybersecurity, patient consent, and patient
education.
5. Develop digital leadership skills and improve the digital literacy of both clinical and nonclinical
staff; provide learning opportunities for staff and patients.
Diadaptasi dari: Deloitte Insights, Fathema 2021
 TANTANGAN PEMBANGUNAN SDM DI INDONESIA

Prevalensi Stunting 27,67%

26 dari 100 kematian penduduk usia 30 – (Survei Status Gizi Balita Indonesia 2019)

Penyakit
70 tahun disebabkan oleh

Tidak Menular

urutan ketiga
Menempati

dunia dengan kasus

Tuberkulosis tertinggi
ROKOK 23 dari 100 remaja
(menyebabkan 1.3 juta laki-laki usia 13-15 tahun merokok
kematian) prevalensi merokok pada usia < 18 tahun
terus meningkat
(9,1 per 2018 – Riskesdas)

NAPZA dari 3,3 juta pengguna Narkoba,

sebanyak 24 persen atau 810.267 orang pengguna adalah
pelajar
(BNN, 2017)
 Goes back a long way…………………

PRIMUM, NON NOCERE

FIRST, DO NO HARM
HIPPOCRATES’S TENET
Be Smart ( 460-335 BC )

SMART Quality
HOSPITAL Assesment?
 DIMENSI MUTU: RS YANG PROFESIONAL
WHO 2018

1. Effective, 2. Safe, 3. People-centred,

4. Timely, 5. Equitable. 6. Integrated, 7. Efficient

Accessible
Defining In addition, in order to realize the benefits of
quality health care, health services must be:
quality health care • Timely: reducing waiting times and
sometimes harmful delays for both those
Quality health care can be defined in many
who receive and those who give care.
ways but there is growing acknowledgement
that quality health services across the world • Equitable: providing care that does not
should be: vary in quality on account of age, sex,
gender, race, ethnicity, geographical
 Effective: providing evidence-based
location, religion, socioeconomic status,
health care services to those who need
linguistic or political affiliation.
them.
• Integrated: providing care that is
 Safe: avoiding harm to people for whom
coordinated across levels and providers and
the care is intended.
makes available the full range of health
 People-centred: providing care that services throughout the life course.
responds to individual preferences,
• Efficient: maximizing the benefit of
needs and values
available resources and avoiding waste.
 PERUBAHAN PARADIGMA
PELAYANAN RUMAH SAKIT
1. Hospital Accreditation as a learning process 
Learning Organization  TAAT PROTOKOL  TAAT
REGULASI
2. Continuous quality improvement
3. Interprofessional collaboration
4. Patient Safety
5. People centered care-Integrated
6. Equitable-Timely
7. Effective-Efficient
8. Digital-IoT-AR-VR-3D-SMART System  SMART Hospital
9. Manager-Leader-Leadership-Hospitalpreunership-
Driver-ITInnovation
 BEYOND THE RRP-PARADIGM

Source: Author’s own illustration ( 2016 )

 STRATEGI
MENINGKATKAN MUTU & MENURUNKAN BIAYA

CRITERIA STRATEGY
Foundational 1. Governance priority: visible and determined leadership by CEO and board
elements 2. Culture of continuous improvement: commitment to ongoing, real-time
learning
3. IT best practices: automated, reliable information to from the point of care
Infrastructure
fundamentals 4. Evidence protocols—effective, efficient, and consistent care
5. Resource use: optimized use of personnel, physical space, and other
resources
6. Integrated care: right care, right setting, right providers, right teamwork
Care delivery 7. Shared decision making: patient-clinician collaboration on care plans
priorities 8. Targeted services: tailored community and clinic interventions for
resource-intensive patients

9. Embedded safeguards: supports and prompts to reduce injury and infection

Reliability and 10.Internal transparency—visible progress in performance, outcomes, and
feedback costs
Cosgrove D, et al, 2013
 A forced reset of our society
is the perfect opportunity
to explore new areas for
growth!

‘The Clock is
Ticking’

TERIMA KASIH
Shifts in behavior, new regulation,
accelerated adoption of tech –it's the
moment innovators have been waiting for.