Pertama-tama perkenankanlah saya

menyampaikan puji syukur kehadirat Tuhan yang telah senantiasa melimpahkan rahmat dan
karuniaNya sehingga pada hari ini kita dapat berkumpul dalam keadaan sehat walafiat untuk
menghadiri seminar dengan tema

Hadirin yang berbahagia,

Mutu pelayanan dan keselamatan pasien rumah sakit: Bukti empirik yang mengejutkan

Setiap orang pasti ingin mendapat pelayanan kesehatan yang bermutu dan bebas dari risiko.
Pertanyaannya adalah, bagaimana memilih pelayanan kesehatan yang bermutu? Memilih pelayanan
rumah sakit dapat diibaratkan seperti memilih restoran. Pada awalnya kita mungkin tertarik untuk
mencoba restoran tertentu oleh karena dikunjungi banyak orang, pelayan yang ramah, makanan
yang cepat tersaji, area parkir yang luas, dan tempat yang nyaman. Dimensi mutu pelayanan
tersebut tentu saja penting, akan tetapi menjadi tidak berarti apabila masakannya ternyata tidak
enak, apalagi bila setelah itu mengakibatkan diare, atau bahkan harus ditangani di rumah sakit.

Memilih rumah sakit dapat dipengaruhi oleh banyak faktor: saran orang lain, dokter yang terkenal
reputasinya, perawat yang ramah, pelayanan yang cepat serta bangunan fisik yang nyaman.
Paradigma mutu pelayanan kesehatan juga bermula dari service excellence (pelayanan prima).
Dalam perkembangannya, dimensi tersebut tidaklah cukup. Rumah sakit dipilih oleh karena
pelayanan klinisnya yang prima (clinical excellence) serta mengutamakan keselamatan pasien
(patient safety). Pada saat ini mutu pelayanan kesehatan telah memasuki era keselamatan pasien.

Masalah mutu pelayanan dan keselamatan pasien semakin berkembang menjadi masalah kesehatan
masyarakat yang serius. Meskipun secara alamiah pasien telah memiliki risiko akibat penyakit yang
dideritanya, risiko akibat KTD tentu akan semakin memperparah kondisi pasien. Ibarat sudah jatuh,
tertimpa tangga pula. Publikasi terbaru di Amerika tahun 2011 menunjukkan bahwa 1 dari 3 pasien
yang dirawat di rumah sakit mengalami KTD. Jenis yang tersering adalah kesalahan pengobatan,
kesalahan operasi dan prosedur serta infeksi nosokomial (Classen et al., 2011). Studi di 10 rumah
sakit di North Carolina menemukan hasil yang serupa. Satu dari 4 pasien rawat inap mengalami KTD,
63% diantaranya sebenarnya dapat dicegah (Landrigan et al., 2010). Frekuensi KTD ini hampir 10 kali
lebih tinggi daripada hasil penelitian pada periode tahun 1990-2005. Ternyata, upaya penurunan
KTD di negara maju berjalan lambat.

Bagaimana halnya dengan di Indonesia? Di Indonesia keselamatan pasien telah menjadi perhatian
serius. Penelitian pertama dilakukan di rawat inap 15 rumah sakit dengan 4500 rekam medik (Utarini
et al., 2000). Hasilnya menunjukkan angka KTD yang sangat bervariasi, yaitu 8,0% hingga 98,2%
untuk diagnostic error dan 4,1% hingga 91,6% untuk medication error. Sejak itu, bukti-bukti tentang
keselamatan pasien di Indonesia pun semakin banyak. Mengingat masih tingginya angka KTD akibat
tindakan medik di rumah sakit, slogan “buy one, get one free” tidaklah terlalu keliru. Alih-alih
sembuh dari penyakit dan segera meninggalkan rumah sakit, beberapa pasien justru mendapat
bonus KTD, mulai dari yang ringan hingga menimbulkan kecacatan dan kematian. Studi mengenai
infeksi luka pasca operasi merupakan salah satu contoh slogan tersebut. Bukannya sembuh dan
segera meninggalkan rumah sakit, pasien harus menjalani perawatan lebih lama akibat infeksi luka
operasi. Hasil beberapa studi menunjukkan angka infeksi luka pascaoperasi di rumah sakit di
Indonesia berkisar antara 11,5% hingga 47,7% (Manuaba, 2006; Priharto, 2005; Yulianto, 2007)

Sejak dicanangkannya gerakan keselamatan pasien pada tahun 2005 oleh Menteri Kesehatan RI,
telah dikembangkan pula sistem pelaporan KTD secara sukarela di rumah sakit. Meskipun angka
pelaporan KTD relatif masih rendah, yaitu hanya sekitar 300 kasus pada tahun 2009, hal ini cukup
menggembirakan sebagai awal tumbuhnya budaya organisasi rumah sakit yang berorientasi pada
keselamatan pasien.

Hadirin yang saya muliakan,

Di Indonesia, mutu pelayanan kesehatan dan keselamatan pasien telah mempunyai landasan hukum
yang kuat. Undang-undang (UU) Kesehatan no. 36/2009 mengamanatkan bahwa pelayanan
kesehatan yang aman, bermutu dan terjangkau merupakan tanggungjawab pemerintah dan hak
setiap orang (pasal 5 dan 19). Demikian pula UU Praktik Kedokteran (UUPK) no 29/2004 dan UU
Rumah Sakit (UURS) no 44/2009 tegas menyatakan bahwa mutu pelayanan dan keselamatan pasien
merupakan dasar dan tujuan praktik kedokteran dan penyelenggaraan rumah sakit.

http://kebijakankesehatanindonesia.net/sites/default/files/ISI%20PIDATO%20ADI
%20UTARINI_140711.pdf

First of all, please allow me……………………………….

Good morning to everyone present here today. I feel honored and blessed to be given this
opportunity to give a speech on” the impact of evidence – based practice in nursing : improving
patient safety “ . I hope everyone learns something from this speech.

Dear guests,

Hospital patient safety and service quality: Surprising empirical evidence

Everyone would want to get quality health services and free from risk. The question is, how to
choose quality health services? Choosing a hospital service can be likened to choosing a restaurant.
At first we might be interested in trying a certain restaurant because it is visited by many people,
friendly waiters, fast food, large parking area, and comfortable place. The dimension of service
quality is of course important, but it becomes meaningless if the food turns out to be bad, especially
if afterwards it results in diarrhea, or even has to be treated in a hospital.

Choosing a hospital can be influenced by many factors: other people's suggestions, reputable
doctors, friendly nurses, fast service and comfortable physical buildings. The paradigm of health
service quality also starts from service excellence. In its development, these dimensions are not
enough. The hospital was chosen because of its excellent clinical services (clinical excellence) and
prioritizing patient safety. At this time the quality of health services has entered the era of patient
safety.

The problem of service quality and patient safety is increasingly developing into a serious public
health problem. Even though the patient naturally has a risk due to the disease he is suffering from,
the risk due to unwanted events will certainly worsen the patient's condition. It's like having fallen,
hit by a ladder anyway. The latest publication in America in 2011 showed that 1 in 3 patients who
were hospitalized had an adverse event. The most common types are medication errors, surgical and
procedure errors and nosocomial infections (Classen et al., 2011). The study at 10 hospitals in North
Carolina found similar results. One in 4 hospitalized patients experiences an adverse event, 63% of
which can actually be prevented (Landrigan et al., 2010). The frequency of adverse events is almost
10 times higher than the results of research in the 1990-2005 period. In fact, efforts to reduce
adverse events in developed countries have been slow.

How about in Indonesia? In Indonesia patient safety has become a serious concern. The first study
was conducted in 15 hospital inpatients with 4500 medical records (Utarini et al., 2000). The results
show that the incidence of adverse events varies greatly, from 8.0% to 98.2% for diagnostic errors
and 4.1% to 91.6% for medication errors. Since then, there has been increasing evidence of patient
safety in Indonesia. Considering the high number of adverse events due to medical procedures at
the hospital, the slogan "buy one, get one free" is not too wrong. Instead of recovering from their
illness and leaving the hospital immediately, some patients actually get a bonus for unwanted
events, ranging from the mild to causing disability and death. The study of postoperative wound
infections is one example of this slogan. Instead of recovering and leaving the hospital immediately,
the patient had to undergo longer treatment due to a surgical wound infection. The results of
several studies show the rate of postoperative wound infection in hospitals in Indonesia ranges from
11.5% to 47.7% (Manuaba, 2006; Priharto, 2005; Yulianto, 2007)

Since the declaration of the patient safety movement in 2005 by the Minister of Health of the
Republic of Indonesia, a voluntary accident reporting system has also been developed in hospitals.
Even though the number of reported adverse events was still relatively low, namely only around 300
cases in 2009, this was quite encouraging as the beginning of the growth of a hospital organizational
culture that was oriented towards patient safety. Honorable guests,

In Indonesia, the quality of health and patient safety services has a strong legal basis. Law (UU)
Health no. 36/2009 mandates that safe, quality and affordable health services are the government's
responsibility and everyone's right (articles 5 and 19). Likewise, the Law on Medical Practice (UUPK)
No. 29/2004 and the Law on Hospitals (UURS) No. 44/2009 unequivocally state that the quality of
service and patient safety is the basis and objective of medical practice and hospital administration.

To conclude this speech, Service and patient safety in Indonesia are very dependent

on the mechanisms of internal regulation, co-regulation and meta-regulation. So that

responsive, each strategy needs to adopt the regulatory pyramid principle.

For example, hospital accreditation will be more responsive if

starting from education about accreditation standards, giving feedback

positive feedback to the hospital, financial implications for

achievement of accreditation, granting of recognition by the association of houses

sick, to the provision of information to the public in order to get

recognition from a wide audience.