REVIEW ARTIKEL

ANALYSIS OF POLICY IMPLEMENTATION OF LOCAL PUBLIC SERVICE

AGENCY IN HOSPITAL

Mata Kuliah
AKUNTANSI SEKTOR PUBLIK

Disusun Oleh:
RESTIYANSI ANDREA
C30223003

PROGRAM STUDI MAGISTER AKUNTANSI

FAKULTAS EKONOMI DAN BISNIS
UNIVERSITAS TADULAKO
2023
 STATEMENT OF AUTHORSHIP

Saya dengan ini menyatakan bahwa review ini adalah hasil pemahaman saya sendiri
terhadap artikel yang diulas. Saya ingin menekankan bahwa saya tidak memiliki hak cipta
atas artikel tersebut, dan semua hak cipta tetap milik penulis asli.

Tanggapan dan pandangan dalam review ini adalah pandangan pribadi saya dan tidak
mewakili pandangan atau posisi lembaga atau tempat saya bekerja. Saya telah berusaha
untuk memberikan evaluasi dan analisis yang obyektif serta memberikan tanggapan yang
relevan terhadap isu-isu yang diangkat dalam artikel ini. Saya tidak memiliki konflik
kepentingan yang memengaruhi peninjauan saya atas artikel ini.

Mata Kuliah : Akuntansi Sektor Publik

Judul Tugas : Review Artikel

Tanggal : 1 November 2023

Dosen : Prof.Dr. Ridwan, SE.,M.Si.,Ak.,CA.,CGAA

Dr. Nina Yusnita Yamin, SE.,M.Si.,Ak.,CA.,CGAA

Nama Mahasiswa : Restiyansi Andrea

Stambuk : C30223003
Judul Analysis of Policy Implementation of Local Public Service Agency in
Hospital
Jurnal International Journal of Community Medicine and Public Health
Volume Vol. 5, No. 12
Tahun 2018
Penulis Shelvy Haria Roza & Inge Angelia
Pendahuluan Pendahuluan artikel ini memberikan konteks yang kuat untuk penelitian yang
akan dilakukan. Artikel ini memulai dengan menggambarkan masalah umum
yang dihadapi oleh masyarakat Indonesia dalam hal pelayanan publik yang
kurang memuaskan. Lebih dari 50% pengguna layanan publik mengeluhkan
pelayanan yang mereka terima. Penyebab utama yang disorot adalah
birokrasi yang rumit, waktu pelayanan yang lama, biaya yang tinggi, serta
ketidakmampuan untuk mencapai prinsip-prinsip tata kelola yang baik.
Beberapa keluhan utama adalah kurangnya informasi dan kesulitan mencari
lembaga-lembaga yang menyediakan layanan publik. Konteks tersebut
sangat relevan, terutama ketika membahas implementasi kebijakan LPSA di
rumah sakit.
Tujuan Tujuan penelitian dalam artikel ini adalah menganalisis implementasi
Penelitan kebijakan LPSA di rumah sakit. Dengan demikian, penelitian ini
mengidentifikasi sejauh mana rumah sakit berhasil menerapkan kebijakan
ini. Penentuan tujuan penelitian yang jelas membantu dalam memberikan
fokus yang kuat terhadap penelitian.
Teori dan Walaupun artikel ini memberikan gambaran umum tentang masalah
Referensi Utama kebijakan publik dan implementasi, artikel tersebut bisa memperdalam
pemahaman dengan merujuk pada kerangka teoritis yang lebih kaya dan
penelitian terdahulu yang relevan tentang kebijakan publik atau
implementasi LPSA. Namun demikian, artikel ini sudah mencantumkan
informasi yang cukup untuk memahami dasar-dasar konsep dan masalah
yang dibahas.
Metode Artikel ini menggunakan metode deskriptif dengan pendekatan kualitatif,
Penelitian yang sesuai dengan tujuan penelitian untuk menganalisis implementasi
kebijakan LPSA. Penggunaan metode deskriptif sangat sesuai untuk
mendapatkan gambaran menyeluruh tentang bagaimana implementasi
kebijakan ini berjalan di rumah sakit. Artikel memberikan gambaran yang
jelas tentang pemilihan informan, teknik pengumpulan data, dan alat yang
digunakan.
Temuan/ Hasil penelitian menunjukkan bahwa RSUD Dr. Rasidin Padang memiliki
Interpretasi sumber daya manusia yang cukup, fasilitas yang memadai, dan dana dikelola
 dengan baik. Implementasi kebijakan LPSA juga sesuai dengan standar
kebijakan yang berlaku. Selain itu, penulis juga mencatat bahwa para
pelaksana kebijakan memiliki sikap yang positif terhadap implementasi
LPSA, dan komunikasi mengenai kebijakan ini cukup jelas. Namun, ada
kendala dalam pengawasan implementasi kebijakan, karena RSUD Dr.
Rasidin Padang belum memiliki badan pengawas yang sesuai dengan
regulasi. Hasil penelitian juga menunjukkan bahwa implementasi kebijakan
LPSA telah berdampak positif pada kinerja rumah sakit, termasuk
peningkatan pendapatan, pelayanan kesehatan, dan kualitas layanan.
Meskipun demikian, penulis mencatat bahwa kualitas layanan masih perlu
ditingkatkan.
Keterbatasan Periode penelitian yang relatif singkat tidak cukup untuk mengidentifikasi
Penelitian perubahan atau tren jangka panjang dalam pelaksanaan kebijakan LPSA di
rumah sakit. Lebih banyak waktu mungkin diperlukan untuk mengevaluasi
dampak jangka panjang dari implementasi kebijakan ini. Penelitian ini
merupakan penelitian deskriptif kualitatif, sehingga tidak melibatkan analisis
data kuantitatif untuk mengukur dampak numerik dari implementasi
kebijakan. Analisis kuantitatif mungkin diperlukan untuk memberikan data
empiris yang lebih kuat tentang efektivitas kebijakan.
Peluang Penelitian selanjutnya dapat membandingkan beberapa rumah sakit dengan
Penelitian status LPSA di berbagai wilayah di Indonesia. Hal ini akan membantu
Selanjutnya memahami perbedaan dalam implementasi kebijakan antar rumah sakit dan
faktor-faktor yang mempengaruhinya. Penelitian dapat lebih dalam menggali
dampak budaya dan nilai-nilai organisasi dalam pelaksanaan kebijakan.
Faktor-faktor budaya seringkali memengaruhi cara implementasi kebijakan
dilakukan. Selain itu, melibatkan pandangan dan pengalaman dari berbagai
pemangku kepentingan, termasuk pasien, keluarga pasien, dan pihak
eksternal lainnya dalam penelitian akan memberikan pemahaman yang lebih
lengkap tentang implementasi kebijakan.
Refleksi Artikel Artikel ini membahas permasalahan implementasi kebijakan di rumah sakit
sebagai badan layanan publik lokal di Indonesia. Isu utama yang dibahas
adalah ketidakpuasan masyarakat terhadap pelayanan publik, khususnya
dalam konteks layanan kesehatan di rumah sakit. Saya sepakat bahwa
implementasi kebijakan LPSA di rumah sakit adalah langkah yang penting
dalam upaya meningkatkan pelayanan publik di Indonesia. Artikel ini
memberikan gambaran yang jelas tentang sejumlah faktor kunci yang
memengaruhi keberhasilan kebijakan ini, seperti sumber daya manusia yang
berkualitas, fasilitas yang memadai, dan komunikasi yang efektif. Saya juga
setuju bahwa birokrasi yang rumit dan kurangnya informasi yang jelas adalah
masalah yang perlu diatasi. Temuan dalam artikel ini memiliki implikasi
penting untuk perbaikan layanan kesehatan dan implementasi kebijakan di
sektor publik di Indonesia. Jika sumber daya manusia yang berkualitas dapat
dikelola dengan baik dan komunikasi yang jelas dapat ditingkatkan, maka
hal ini dapat berkontribusi pada peningkatan kualitas pelayanan kesehatan di
rumah sakit. Hal ini juga dapat membantu menciptakan kepuasan masyarakat
dan meningkatkan efisiensi operasional rumah sakit.
Berdasarkan apa yang saya pelajari dari artikel ini, saya merekomendasikan
peningkatan pelatihan staf di rumah sakit dalam pemahaman dan
pelaksanaan kebijakan LPSA. Hal ini dapat membantu meningkatkan
pengetahuan dan keterampilan staf dalam menjalankan kebijakan dengan
baik. Selain itu, perlu ada upaya untuk meningkatkan komunikasi dan
sosialisasi kebijakan kepada seluruh staf rumah sakit, bukan hanya kepada
pihak yang langsung terlibat dalam LPSA. Hal ini akan membantu
menciptakan pemahaman yang lebih baik dan mendukung implementasi
kebijakan yang lebih efektif. Terakhir, jika pendapatan rumah sakit mencapai
ambang batas yang ditetapkan, penting untuk mempertimbangkan
pembentukan dewan pengawas sesuai peraturan yang berlaku. Dengan
demikian, pengawasan dapat ditingkatkan untuk memastikan kepatuhan
terhadap kebijakan dan mencapai hasil yang lebih baik dalam pelayanan
publik.
International Journal of Community Medicine and Public Health
Roza SH et al. Int J Community Med Public Health. 2018 Dec;5(12):5036-5040
http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20184774
Original Research Article

Analysis of policy implementation of local public service

agency in hospital
Shelvy Haria Roza*, Inge Angelia

Department of Public Health, Institute of Health Sciences Syedza Saintika, Padang, Indonesia

Received: 13 September 2018

Revised: 21 October 2018
Accepted: 23 October 2018

*Correspondence:
Dr. Shelvy Haria Roza,
E-mail: shelvyhr@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The level of public satisfaction with public hospital services is still quite low, with almost more than
50% complaining about the services it receives. The demand for hospital service quality, the government imposed the
policy of local public service agency (LPSA) in the hospital. This study aimed to analyze the implementation of
LPSA policy.
Methods: This research was a descriptive research with qualitative approach. This research was conducted in Dr
Rasidin Hospital in Padang, during July to October 2017. Key informants were chosen by purposive sampling as
many as five people who understand about LPSA policy. Data were collected through indept interview, document
review, and observation. Qualitative data were analyzed by thematic analysis.
Results: The result of the research showed that the implementation of LPSA policy from policy standard has been run
well, has a sufficient and adequate resources. Disposition of executives were positive in support of this policy to
service activities. Communication has not spread evenly across all employees, only revolving around employees who
directly handle the local public service agency. The bureaucratic structure was clear.
Conclusions: Implementation of public service agency policies has worked well in terms of the standard policy,
disposition, resources, communications, bureaucratic structure.

Keywords: Policy implementation, Policy of local public service agency

INTRODUCTION public complaints, especially those who were

Public services in Indonesia still do not satisfy the public
expectations, because almost more than 50% of public
service users complain about the services it receives.1
This is because the red tape boreaucarcy which is a
convoluted procedure, long service time, expensive cost,
still far from good governance principles.2 lack of
information and agencies are difficult to find so the
public area are neglected.3
West Sumatera is one of the provinces that have a less
satisfactory level of public service, as the hospital one of
the institution that provide the services.4 Number of
disappointed with the hospital service, in terms of quality,
convenience and service.5 Health services provided by
government hospitals are still considered low is caused
by too complicated bureaucracy, lack of human resources
support and difficulty in measuring performance and
financial management systems for either public or private
hospitals are less well-managed.6
Based on Mayor's Decree No. 517/2015 RSUD Dr
Rasidin Padang set up as a local public service agency
with full status since November 2015. Changes in
hospital status, by becoming a local public servie agency
(LPSA), hospitals are required to conduct performance
appraisals to assess how services provided by the hospital

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5036
 Roza SH et al. Int J Community Med Public Health. 2018 Dec;5(12):5036-5040
to the community.7 In addition, as the policy of LPSA in
RSUD Dr Rasidin Padang run, it requires comprehensive
monitoring by external parties. It is useful to measure a
program implementation to improve customer
satisfaction and facilitate the hospital independence.8
Therefore, an in-depth study on the implementation of
LPSA policy in RSUD Dr. Rasidin Padang is needed.
This study aimed to analyze the implementation of LPSA
policy in the hospital.
METHODS
This research was a descriptive research with qualitative
approach. The study was conducted at dr Rasidin
Hospital in Padang for 4 months (July-October 2017).
Data were collected with in-depth interviews,
observation, and documentation studies. Variables in this
study are LPSA policy implementation with variables:
resource, implementing organization characteristics,
implementer attitudes, communication between
organizations (transmission, consistency, clarity). Data
were collected with in-depth interviews, observation, and
documentation studies. Qualitative data were collected by
conducting in-depth interviews to key informants selected
by purposive sampling. Key informants of this research
was Dr Rasidin Padang Hospital focused on LPSA
Committee Team such as director of hospital, accountant
of hospital, commitment maker official of LPSA, head of
medical service department, dan head of nursery
department. Observations were done to staff in hospital in
performing health services. Documentation study source
at BLUD documents and policies at Rasidin Hospital
Padang, operational standard procedures, strategic plans
and hospital budget plans. The tools used to collect data
in this study are form of interview guidelines, notebook,
tape recorder and observation sheets. Technique for
testing the validity of data was triangulation technique.
Qualitative data was analyzed by thematic analysis.
RESULTS
LPSA policy implementation in Dr Rasidin Hospital
Padang resources
There were adequate recources in managing LPSA in Dr
Rasidin Hospital Padang, where the personnel involved
were as many as 27 people. For managers of LPSA,
leaders have divided main job and function in accordance
with educational background, experience, and years of
service. Hospitals have been working in improving the
ability of the staff in understanding LPSA management
with training. This was evidenced by the realization of
training activities conducted in 2015 and 2016, as well as
evidences of training certificates. This means, the
hospital has been able to utilize the available human
resources that can improve the quality of human
resources. However, the knowledge about LPSA has not
been comprehensive for all hospital staff, due to the lack
of socialization of LPSA to all hospital staff.
International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12
Table 1: The informants’s knowledge of LPSA policy
implementation.
No Information Informant
"LPSA managers at hospital
seems quite well and they have
been trained, but there are some
1 (If-2)
that have not been appropriate
but until now there is still no
significant obstacles."
Yes... hospitals annually
regularly conduct training for
LPSA management officers.. it is
2 (If-1)
about financial accounting
system, and financial
management of LPS”
Standard facilities that support the implementation of the
LPSA policy refer to standard C type hospital facilities.
In general, no special facilities are required in LPSA
management. The LPSA system itself is a system that is
integrated into the operational activities of the hospital.
Here are the interviews with informants:
Table 2: The informants’s about components
resourches of LPSA policy implementation.
No Information Informant
"So far, facilities are sufficiently
1 supportive in the management of (If-5)
LPSAs in this hospital”
“The existence of LPSA can give
2 us the independency to manage the (If-5)
necessary budget.”
Funds is resource in achieving successful policy
implementation. Dr Rasidin Hospital Padang funds came
from services, education, cooperation, and interest. Funds
managed were in accordance with the plan prepared in
providing the needs of the hospital. In financial
management the hospital LPSAs provide flexibility in the
use of funds, where hospitals can use the funds obtained
and operational without complicated procedures.
Policy standards
The results of the study showed that dr Rasidin Hospital
has complied the LPSA policy standards, by the existence
of business strategic plan (BSP), budget business plan
(BBP), and financial operational standard. Based on the
results of the analysis, the implementation of governance
patterns of Dr Rasidin Hospital Padang has been running
well in accordance with Permendagri No 61/2007.
Organizations and governance that was executed was in
accordance with the needs of the organization, mission
and strategy development, and the paradigm of
organizational culture unit in Dr Rasidin Hospital Padang
where the paradigm of making hospital independent. In
addition, the organizational structure of the LPSA holder
was explicit and in accordance with the vision, mission,
Page 5037
 Roza SH et al. Int J Community Med Public Health. 2018 Dec;5(12):5036-5040
strategy and culture of the organization in Dr Rasidin
Hospital Padang.
Supervision in LPSA management in Dr Rasidin Hospital
Padang was not running well. This should be due to not
having a supervisory board because according to the
regulation of the supervisory board it is required for
hospitals whose income more than 30 billion to have one,
while Dr Rasidin Hospital income is still 25 billion / year.
In accordance with article 43 of Permendagri 61/2007
which stated only LPSAs with a certain turnover or asset
value may (not compulsory) have a Supervisory Board.
However, the hospital kept its internal supervision in the
presence of an ICU (internal control unit) which was
conducted by an internal auditor based directly under the
LPSA leader. Internal audit unit (SPI) has not been
supported with adequate human resources competence to
carry out supervision with a very wide scope, so its
existence has not given optimal result in supervising the
improvement of LPSA performance in dr Rasidin
Hospital.
Accounting system and LPSA financial statements in Dr
Rasidin Hospital Padang have been in accordance with
financial accounting standards (FAS) which based on
Regulation of the Minister of Finance No. 76 / PMK.05 /
2008 and accounting guidelines general hospital service
Board issued by the Directorate General of Medical
Services Ministry of Health.
Table 3: The informants’s about policy standars of
LPSA policy implementation.
No Information Informant
"LPSA management in this
hospital is in accordance with the
1 (if-1)
major’s regulation number 8 of
2016"
“About the supervision, hmm, we
do not have the supervisory board
because the hospital income is still
2 (if-2)
under 25 m, so there is no
supervisory board. But we are
always audited by BPKD”.
Disposition (attitude of implementers)
The LPSA policy implementer has a good attitude
towards LPSA management. Where employees have a
positive view of the implementation of LPSA policy in dr
Rasidin Hospital Padang. The LPSA policy implementer
had the same perspective as the policy maker in which
there were agreements between the policy maker and the
policy implementer in executing the policy itself without
leaving the set goals.
Communication
Clarity of information on policy standards has been well
implemented to the level of the implementor. Information
International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12
was delivered by the head of hospital directly to the
hospital LPSA team. The head has transcribed the
information clearly and comprehensively to the policy
implementer, so this information can be useful for the
executor in carrying out the activity well. However,
LPSA information has not spread evenly across all
employees, only revolving around employees who
handled the LPSA itsself.
Table 4: The informants’s about disposition of LPSA
policy implementation.
No Information Informant
“We really support the management
1 of LPSA, and hope to improve the (if-5)
performance of this hospital.”
“So far it has been performing
according to the task and authority
2 (if-4)
given to me, although there are still
many things to be fixed”
Bureaucratic structure
The organizational structure in the LPSA management
existed and had a clear job description in each LPSA
implementer in Dr Rasidin Hospital Padang. The LPSA
team was formed based on the Director's Decree. This
team was formed based on Major’s Regulation No.
108/2011.
Coordination among implementers was running well,
with the implementers has performed their tasks in
accordance with the flow and process. However, in
carrying out the activities they still experienced some
obstacles due to the absence of clear procedure
operational standard such as financial accounting system
guidelines.
Table 5: The informants’s about bureaucratic
structure of LPSA policy implementation.
No Information Informant
“The organizational structure of
the LPSA management exists, the
plot is clear. For the formulation
1 (if-2)
of tasks are in accordance with the
instructions of the leaders and with
the involvement of other staff”
“I work in accordance with the
2 assigned duties and authorities, ie (if-4)
as accountant LPSA”
DISCUSSION
Policy as a series of proposed activities in a particular
environment where there are constraints and
opportunities on the implementation of such policy
proposals in order to achieve certain objectives.9 To
assess the success of the implementation activity in the
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 Roza SH et al. Int J Community Med Public Health. 2018 Dec;5(12):5036-5040
study it is assessed from five factors. These factors are
policy standards, resources (staff, facilities, funding
sources), organizational characteristics, organizational
attitude, inter-organizational communication (trans-
mission, consistency, clarity).10
The availability of resources is a key determinant factor
in policy implementation.11 According to Edward III, the
resources included are staff, facilities, and funds. Human
resources, of course, greatly assist the organization in
realizing the implementation of new policies within the
organization.12 In this case, dr Rasidin Hospital had an
adequate and appropriate human resources in managing
the LPSA policy. This staffs determined the direction of
the implementation of LPSA system in Dr Rasidin
Hospital Padang. Hospital have been able to utilize the
available human resources optimally which can improve
the quality of human resources. According to
Rondonowu's research, each stage before implementing
the policy requires the existence of qualified human
resources in accordance with the work specified by the
established policy.13 According to Roza research, The
number and quality of human resources are very
dependent on the workload and scope of work. The
number and quality of staff are strongly influenced by
their classifications and educational qualifications.14
The existence of facilities that support the
implementation of the LPSA system in Dr Rasidin
Hospital where already integrated in hospital operations
activities.11 The availability of facilities depends on the
activities provided by the hospital, where the facility
standard refers to the general standards issued by the
public health service applicable to hospitals in general,
such as minimum hospital service standards and hospital
accreditation. The implementation of the LPSA policy in
Dr Rasidin Hospital Padang caused an increase in
hospital income since its enactment in 2015. The
tendency of increase in hospital income means there is an
influence of policy implementation on the financial
performance of the hospital. In addition, the
implementation of the LPSA policy provides the
hospitals in managing the finances, providing health
services that meet the needs and health problems
experienced by the hospital. The availability of health
services are in accordance with the needs of the
community that will accelerate the healing of patients that
can ultimately lead to patient satisfaction on the quality
of services provided.5,15,16
Implementation of governance pattern of RSUD Dr.
Rasidin Padang has been running well in accordance with
Permendagri No 61/2007 Organizations and governance
that is executed is in accordance with organizational
needs, mission and strategy development, and paradigm
of organizational culture of the organization unit in dr
Rasidin Hospital Padang. Implementation according to
the standards in LPSA in RSUD Undata are Pattern of
governance, business strategic plan, budget business plan,
well-executed financial statements.17
International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12
Good attitude of policy implementor in running the LPSA
management in Hospital where staffs really support this
policy in operational activities run the policy as well as
what the policy makers want. When implementors have
different attitudes or perspectives with policy makers, the
policy implementation process is also ineffective.18
Clarity of information on policy standards has been well
implemented to the level of the implementor. The Leader
has transcribed the information clearly and
comprehensively to the policy implementer, so that the
transmission of information is clear. Insufficient
communication to the implementers seriously influences
policy implementation.
Coordination among implementers was already running
well, with the implementers performing their tasks in
accordance with the flow and process. However, in
carrying out the activities of implementers were still
experiencing obstacles and obstacles due to the absence
of some clear procedure operational standard in carrying
out activities such as financial accounting system
guidelines. The success of a policy implementation is
supported by a permanent procedure for policy actors in
implementing the policy and the responsibility in
implementing a policy in order to achieve the objectives
with good coordination.11
From the analysis on the financial performance, service,
and quality and benefits for the hospital before and after
the application of LPSA, it was seen that there were
increase of budget, and the income of RSUD Dr. Rasidin
Padang, and the increasing of hospital service
performance, and the improvement of the quality and the
benefit for the society. The results of this study were in
line with Kusnadi's research that changes in hospital
institutional status significantly proved to have an effect
on service performance.20,21 Similarly, the Meidyawati
study at the national stroke hospital that the
implementation of the LPSA policy has provided
increased income, and the independence of the hospital.6
The results of this study were in line with Roza’s research
that Implementation of public service agency policies has
an influence on the service performance, but less has an
influence on the quality service.21
CONCLUSION
The implementation of the policy of LPSA Dr Rasidin
Hospital Padang from the policy standard has met the
technical requirements in the procedure, has adequate
resources such as personnel, facilities, and funds. The
implementing disposition has a positive attitude and
supports this policy in service activities. Inter-
organizational communications on the information of the
LPSA have not spread evenly across all employees, but
only revolve around the employees who handle the
LPSA.
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 Roza SH et al. Int J Community Med Public Health. 2018 Dec;5(12):5036-5040
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Roza SH, Angelia I. Analysis of
policy implementation of local public service agency
in hospital. Int J Community Med Public Health
2018;5:5036-40.
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