r
a
C
d
Se
e
R
r
i
e
s
r
t
itaC an
n
d
e
e
r
C
kr e d asie
A
t
RS
n
i
P
m
e
s
e
a
t
n
l
i
ae n uha
ita
d
d
e
s
r
P at
C
kt
k
A
ien
u
s
A
d
a
m
n
n
It i e l dala dalam han P
r
a
d a
a
su
A
Stan P glob nduk
m
d
I
la
Tren ndar bal da
Sta nd glo
Tre
CURRICULUM VITAE
Nama : Dr. Nico A. Lumenta, K.Nefro, MM, MHKes
Lahir
: Magelang, 5 Nov 1943
Alamat : Jl. Kayu Mas I/4, Pulo Mas,Jkt Timur
Pendidikan
: Dokter, 1970, FK.UKI, Jakarta
Konsultan Nefrologi (Ginjal-Hipertensi) 1982, Pernefri
(Perhimpunan Nefrologi Indonesia)
Magister Manajemen, 1994, Sekolah Tinggi Manajemen PPM,
Jkt.
Magister Hukum Kesehatan, 2013, Unika Soegijapranata,
Semarang
Jabatan RS : RS Mediros : Ketua Komite Medis, Koordinator
KSM PD.Ginjal-Hipertensi
Organisasi:
KARS Kepala Bidang Publikasi & Pemasaran 2014 - 2018
KARS (Komisi Akreditasi Rumah Sakit) Dep Kes RI : Ketua
Bidang Akreditasi 2011-2014, Surveior / Pembimbing
Akreditasi sejak 1995
Member Advisory Council Asia Pacific, Joint Commission
International, sejak 2009
KARS Dr.Nico Lumenta
Asuhan Pasien
(Patient Care)
Cure
KARS Dr.Nico Lumenta
Care
Dalam konteks
Asuhan Pasien
(Patient Care)
PCC
PFP
PASIEN
UU 44/2009 ttg
RS, Peraturan
Per UU an
lainnya
Standar
Manajemen
PMKP, PPI,
TKP, MFK,
KPS, MKI
Sasaran KP
Sasaran
MDGs
Sistem
Manajemen
PCC
Std Yan
Fokus Pasien
APK, HPK,
AP, PP,
PAB, MPO
PPK
Sistem Pelayanan
Klinis
Regulasi :
Kebijakan
Pedoman,
Panduan
SPO
Program
Indikator :
Ind. Area
Klinis
Ind Klinis
Ind SKP
Ind Upaya
Manajemen
Dokumen
Implementasi
Standar Pelayanan Pasien : Tujuan utama pelayanan kes RS adalah pelayanan pasien.
Pelayanan
Fokus Pasien
Manajemen
Risiko RS
(Patient Centered
Risiko Klinis
fs
o
os n
l
i
F
ie
s
p
a
se n p re)
n
Ko uha nt ca
As Patie
(
4 Fondasi
Asuhan pasien
Asuhan
Asuhan
Asuhan
Asuhan
Medis
Keperawatan
Gizi
Obat
Care)
Etik
Mutu
Kebutuhan
Patient
Pasien
Safety
EBM
VBM
KARS Dr.Nico Lumenta
(Nico A Lumenta & Adib A Yahya, 2012)
Po
la
24
Safety is a
fundamental principle
of patient care and a
critical component of
Quality Management.
(World Alliance for Patient
Safety, Forward Programme,
WHO, 2004)
Evidence Based
Medicine
Value Based Medicine
ISQua
Fokus Pasien
Quality & Safety
of Patient Care
Patient
Centered Care
1988:The term
patient-centered
care was coined by
Harvey Picker
1.
2.
3.
4.
5.
6.
Safe.
Effective.
Patient-centered.
Timely.
Efficient.
Equitable.
Enam elemen ini dilahirkan oleh IHI Institute for Helathcare Improvement
Publikasi pertama PCC oleh IOMKARS Dr.Nico Lumenta
WHO menjadikan 6 elemen ini sbg definisi mutu pelayanan kesehatan
MANAJEMEN RISIKO
RUMAH SAKIT
l
ica
ed
M af
St sks
Ri
l
ia
nc
na ks
Fi Ris
Hospital
Risk
Management
Property
Risks
Em
pl
R i oy e
sk e
s
Ot
Ri he r
sk
s
Patient Risks
of
The
Business
The
Patient
of
The
Hospital Health Care
Safety
Worker
of
of
The
The
Environment Facilities
IDENTIFIKASI RISIKO
ANALISA RISIKO
ASESMEN RISIKO
EVALUASI RISIKO
TEGAKKAN KONTEKS
KELOLA RISIKO
RISK REGISTER
17
PATIENT-CENTRED
CARE
(PELAYANAN FOKUS
PASIEN)
BPIS
is
n
i
f
e
Patient-Centered
Care
Picker Institute :
1.Respect for patients values, preferences and expressed
needs
2.Coordination and integration of care
3.Information communication and education
4.Physical comfort
5.Emotional support and alleviation of fear and anxiety
6.Involvement of family and friends
7.Continuity of care and smooth transition
8.Access to Care
1.
2.
3.
4.
5.
6.
7.
8.
Asuhan Pasien
Model Traditional
Asuhan
Asuhan Pasien
Pasien
Model
Model
Patient
Patient Centered
Centered
Care
Care
KARS Dr.Nico Lumenta
poten
disi
si kon a 2 Kubu,
flik le
bih ti
nggi
!!
Dokter = Captain of the
ship
Perawat
Apoteker
Dokter
Radio
grafer
Disease
centered
care
Analis
Pasien
Ahli
Gizi
Lainnya
Barrier
(Medical paternalism)
(Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building
a safer health system. Washington, D.C.: National Academy Press, 2000.)
t
e
f
a
ts
n
tie id ak n !!
a
t
P
i
m
rja
e
t
Laporan
Institute of Medicine IOM
TO ERR IS HUMAN
Building a Safer Health
System
Wake-up
.bagi duniaCall
pelayanan kesehatan.
KARS Dr.Nico Lumenta
t
a fe
Laporan
Institute of Medicine - IOM
ts
n
ti e id a k !!
a
P
t
in
m
a
j
t er
RS - RS
TO ERR IS HUMAN
Building a Safer Health System
(Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building
a safer health system. Washington, D.C.: National Academy Press, 2000.)
AE
Mati
(>50% krn
ME)
Di
Colorado
2.9 %
Pasien
tsb
: Admisi
/year
:Mati sb
AE
33.6 juta
3.7 %
Mati sb
lain
(Extrapolasi)
44,000 - KLL :
6.6 %
&
Utah(1992)
Di New
York(1984)
Pasien
RS di US
13.6 %
KARS Dr.Nico Lumenta
43,458
98,000 -Cancer :
42,297
!!!
-AIDS :
Estimasi
biaya: $17 - 16,516
-
$50 milyar
D A L A M 1 TAHUN
S E T I A P H A R I
1 PESAWAT JUMBO JET
BERPENUMPANG 268 ORANG
J A T U H !!! (Pasien !!)
Hospitals 'more
dangerous' than air
travel
If you feel safer in hospital than on a airplane,
think again.
in a developed country
O
H
W
n
e
n asie
e
d
Sli Insidtan P
ma
a
l
se
Ke
IRELAND:
Failure to detect
an excessively
high blood
calcium level
USA:
Failure to communicate
diagnosis of spinal
cancer leading to
delay treatment
UK:
Leg operation
MRSA.4 years
remain ill amputation
thru knee
UK:
A chemotherapy drug
(Vincristine) incorrectly
administered into
his spine instead of vein
MEXICO:
Fetal distress & untreated
neonatal jaundice causing
brain damage
PASIEN
Quality & Safety
Active Failure
Unsafe Act
Sistem Pelayanan
Klinis
Jajaran
Manajemen
nt
Lat
e
Sistem
Manajemen
Fai
lur
Pemilik
Asuhan Pasien
Model Traditional
Asuhan
Asuhan Pasien
Pasien
Model
Model
Patient
Patient Centered
Centered
Care
Care
KARS Dr.Nico Lumenta
Perawat/
Bidan
Clinical/Team Leader
Koordinasi
Kolaborasi
Sintesis
Interpretasi
Integrasi asuhan
komprehensif
Psikologi
Klinis
Pada
mode
l
hanya ini terkond
isi
1K
poten
si kon ubu,
f l ik r e
ndah
DPJP
Apoteker
Pasien ,
Keluarga
Penata
Anestesi
Ahli
Gizi
Fisio
terapis
Lainnya
iri
d
n
Ma
s
a
g
o Tu blok
o 2 iatan
keg
Asesmen Pasien
(Skrining, Periksa Pasien)
Nakes
Profesional
Pemberi Asuhan
S
O
Implementasi Rencana/
Pemberian Pelayanan
Monitoring
31
Asesmen
Ulang
Std AP 1
Std PP 2 EP 1, PP
R 2.1, 5, Std AP 2,
PAB 5, 7, 7.4.
2. Implementasi
Monitoring
Pemberian pelayanan/asuhan, pelaksanaan rencana, beserta
monitoringnya
Std PP 2, EP 2, PP
5 EP 2 & 3, PAB 3
EP 5, 5.3, 6, 7.3,
32
i
Sis n
ie
Pas
i
Sis n
ie
Pas
Si s i
ional n
s
e
f
o
Pr
suha
A
i
r
e
Pemb
1. Interdisciplinary Team
Profesional Pemberi Asuhan diposisikan mengelilingi pasien
Kompetensi yang memadai
Berkontribusi setara dalam fungsi profesinya
Tugas mandiri, kolaboratif, delegatif, bekerja sebagai satu kesatuan
memberikan asuhan yang terintegrasi
2. Interprofessionality
Interprofessional Collaboration
Interprofessional Education
Interprofessional Collaborative Practice Competency
3. DPJP adalah Clinical Leader.
DPJP melakukan koordinasi, sintesis, review dan mengintegrasikan
asuhan pasien
4. Personalized Care & BPIS (Bila Pasien Itu Saya)
Keputusan klinis selalu diproses berdasarkan juga nilai-nilai pasien
Setiap Dr memperlakukan pasiennya sebagaimana ia sendiri ingin
diperlakukan
KARS Dr.Nico Lumenta
(Sintesis berbagai refernsi, 2014)
American
Hospital
and Institute
for Family
Centered
2004)
Senior Vice President,
Patient
andAssociation
Family Centered
Care,
MCG
HealthCare,
System
eri
b
Pem
.
f
ro
P
an
i
h
s
u
i
S
As
Interprofessionalit
y
(Framework for Action on Interprofessional Education & Collaborative Practice, WHO, 2010)
er i
STANDAR KOMPETENSI DOKTER INDONESIA
b
m
e
r
iP n:D
Konsil Kedokteran Indonesia 2012
s
i
S C.
a
h
Penjabaran Kompetensi
Asu
KARS
Dr.Nico
Lumenta
(Framework
for Action
on Interprofessional
Education & Collaborative Practice, WHO, 2010)
Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice:
Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative, (2011)
KARS
Dr.Nico
Lumenta
(Framework
for Action
on Interprofessional
Education & Collaborative Practice, WHO, 2010)
io n
s
s
e
f
o
pr
Inter cation
Edu
al
Interprofessional Education Collaborative Expert Panel.. Core competencies for interprofessional collaborative practice:
KARS
Dr.Nico
Lumenta D.C.: Interprofessional Education Collaborative, (2011)
Report of an
expert
panel. Washington,
(10)
Bekerja bersama Nakes dari profesi lain untuk memelihara iklim saling
respek (menghormati) dan berbagi nilai2.
Ranah Kompetensi 2:
Roles/Responsibilities
(9)
Ranah Kompetensi 3:
Interprofessional Communication
(8)
Ranah Kompetensi 4:
(11)
(10)
(8)
Interprofession
Behavioral demonstrations of
al Competency
an integrated set of knowledge, skills and attitudes for
working together across the professions, with other
health care workers,
and with patients/families / communities / populations
to improve health outcomes in specific care contexts
KARS Dr.Nico Lumenta
WORKING CULTURE
MECHANISMS
Figure 8.
ENVIRONMENTAL MECHANISMS
Examples of mechanisms
that Lumenta
shape collaboration at the practice level
KARS Dr.Nico
Elements of collaborative
practice
1. Tanggung
jawab - Responsibility
2.
3.
4.
5.
6.
7.
8.
Akuntabel
- Accountability
Koordinasi
- Coordination
Komunikasi - Communication
Kerjasama
- Cooperation
Asertif
- Assertiveness
Otonomi
- Autonomy
Percaya & Respek - Mutual trust and respect
(Kasperski M. Implementation strategies: Collaboration in primary care - family doctors and nurse practitioners delivering
KARS Dr.Nico
Lumenta
shared
care. Toronto, ON: Ontario College of Family Physicians, 2000)
sien
Sisi Pa
(Partnering with patients to drive shared decisions, better value, and care improvement. INSTITUTE OF MEDICINE, 2014)
KARS Dr.Nico Lumenta
e
A c t i v at
d
s
P at i e n t
Pasien
Pasif
Pasrah
(Partnering with patients to drive shared decisions, better value, and care improvement. INSTITUTE OF MEDICINE, 2014)
KARS Dr.Nico Lumenta
Fisio
terapis
Apoteker
Pasien ,
Keluarga
Radio
grafer
Analis
Lainnya
Yan Kes
/ RS Lain
Dokter
Keluarga
Ahli
Gizi
MPP
Case
Manager
Asuransi
Perusahaan/
KARS Employer
Dr.Nico Lumenta
BPJS
Yan
Keuangan/
Billing
Dunn,N : Practical Issues Around Putting The Patient in Centre of Care, J R Soc Med.Jul 2003
Bensberg, M :Patient Centred Care Literatur Review, Dandenong District Division of General Practice, October 2007
KARS Dr.Nico Lumenta
Pasien
Kurang percaya diri bertanya
Dunn,N : Practical Issues Around Putting The Patient in Centre of Care, J R Soc Med.Jul 2003
Bensberg, M :Patient Centred Care Literatur Review, Dandenong District Division of General Practice, October 2007
KARS Dr.Nico Lumenta
(Luxford,K., Safran,DG., Delbanco,T . Promoting patient-centered care: a qualitative study of facilitators and barriers in
healthcare organizations with a reputation for improving the patient experience.
Journal for Quality in Health Care, vol 23, 2011)
KESIMPULAN
1. Pada model asuhan pasien yang tradisional, Dokter merupakan pusat dari asuhan
pasien, sebagai Captain of the ship, namun patient safety belum terjamin
2. Asuhan pasien terdiri dari 4 pilar : Etik, Kebutuhan Pasien, Mutu-Keselamatan
Pasien, EBM-VBM, dpayungi oleh Manajemen Risiko RS dan PCC
3. Pada model PCC, pasien adalah pusat, profesional pemberi asuhan (PPA)
diposisikan mengelilingi / melayani pasien, & semua PPA tsb berkolaborasi dlm
fungsi yg setara, sehingga disebut Interdisciplinary team dgn Kolaborasi
Interprofesional. Dr adalah Team Leader / Coach. Pasien memperoleh asuhan
yg terbaik & bermanfaat bagi pasien
4. PCC dalam pelaksanaan asuhan pasien, masih belum dipahami sepenuhnya,
belum sepenuhnya dihargai
5. Dengan PCC terjadi perubahan mendasar dlm cara Manajemen RS. Saat ini PCC
merupakan Mainstream model, sdh menjadi Trend global pelayanan
kesehatan di Rumah Sakit di dunia
6. Disadari atau tidak, akar masalah arus pasien keluar negeri adalah karena belum
sepenuhnya RS di Indonesia menerapkan PCC
7. Standar Akreditasi RS v.2012 mengharuskan & mengoptimalkan penerapan PCC
8. Terapkan PCC langkah demi
- one step at a time
KARS langkah
Dr.Nico Lumenta
PASIEN
Pasien
Sistem Pelayanan
Klinis
Asuhan Pasien / Patient Care
Manajemen
Sistem
Manajemen
KODEKI Pasal 18
Setiap Dr memperlakukan
teman sejawatnya
sebagaimana ia sendiri
ingin diperlakukan
Fisio
terapis
Dokter
Radio
grafer
Perawat
Apoteker
BPIS
Pasien
Analis
Ahli
Gizi
Lainnya
Enthusiatic
Patient
Kepuasan Pasien
Pasien
Bila
(
Pas BPIS
ien
Itu
S
aya
)