Anda di halaman 1dari 59

MANAJEMEN UNIT

dr. Adib Abdullah Yahya, MARS


Hospital Processes
MANAJEMEN PELAYANAN MEDIK
DI RUMAH SAKIT
Pelayanan medik khususnya medik
spesialistik merupakan salah satu Ciri
dari Rumah Sakit yang membedakan antara
Rumah Sakit dengan fasilitas
pelayanan lainnya.
PENGERTIAN

Tenaga Medik :
- Menurut Permenkes No.262/1979 yang dimaksud
dengan tenaga medis adalah lulusan Fakultas
Kedokteran atau Kedokteran Gigi dan "Pascasarajna"
yang memberikan pelayanan medik dan penunjang
medik.

Pelayanan medik di Rumah Sakit : adalah salah satu


jenis pelayanan Rumah Sakit yang diberikan oleh tenaga
medik
Pelayanan Medik sebagai Suatu Sistem

A. Komponen INPUT yang terdiri dari :


a. Tenaga medik yaitu dokter umum, dokter gigi dan dokter spesialis.
Perhitungan kebutuhan tenaga medik Rumah Sakit dapat melalui
berbagai cara antara lain : Peraturan Menkes, Indikator Staff Needs
(ISN) dan standar minimal.

b. Organisasi dan Tata Laksana


Kedudukan tenaga medik ada pada :
- Staf Medik (Fungsional) yang dikoordinasi oleh kepala SM(F)
yang dipilih dan bertanggung jawab kepada Direktur Rumah Sakit.
- Komite Medik yang bertugas membantu memonitor dan
mengembangkan SM ditinjau dari aspek teknis medis termasuk hukum
dan etika profesi .
- Wakil Direktur (Wadir) Pelayanan (Rumah Sakit Kelas B), Seksi
pelayanan (Kelas C & D) yang mengelola sistem pelayanan medik
sehingga dihasilkan suatu pelayanan medik yang bermutu sesuai
dengan visi dan misi Rumah Sakit.
Tugas Wadir pelayanan sekurang-kurangnya meliputi pelayanan rawat
jalan, rawat inap, rawat darurat, bedah sentral, perawatan
intensif,radiologi, farmasi, gizi, rehabilitasi medis, patologi klinis,
patologi anatomi, pemulasaraan jenazah, pemeliharaan sarana
Rumah Sakit dan kegiatan bidang pelayanan, keperawatan serta
urusan ketatausahaan dan kerumahtanggaan.
Tugas bidang pelayanan mengkoordinasikan semua kebutuhan
pelayanan medis, penunjang medis, melaksanakan pemantauan
dan pengawasan penggunaan fasilitas serta kegiatan pelayanan
medis dan penunjang medis, pengawasan dan pengendalian
penerimaan dan pemulangan pasien. Tugas ini juga dilaksanakan
oleh seksi pelayanan pada Rumah Sakit Kelas C.
c. Kebijakan Direktur
Tentang pelayanan medik di Rumah Sakit termasuk hak dan kewajiban
pasien, hak dan kewajiban petugas medik dan peraturan-peraturan
lainnya.

d. Sarana dan Prasarana Pelayanan Medik yang meliputi :


- Gedung rawat jalan, rawat inap, ruang bedah, UGD, penunjang
medik radiologi, laboratorium, gizi dan lain-lain yang harus memenuhi
syarat sesuai dengan arsitektur Rumah Sakit yang berlaku.
- Sarana dan prasarana alat kesehatan sederhana maupun canggih
untuk terlaksananya pelayanan medik yang bermutu.
e. Dana
Ada beberapa sumber dana yang dapat digunakan untuk terselenggaranya
pelayanan medik, antara lain :
- Pendapatan Asli Rumah Sakit
- APBN - APBD
- Asuransi
- Subsidi
- dll.
Dana tersebut digunakan untuk :
l. Investasi peralatan medik yang diperlukan sesuai dengan jenis pelayanan yang
diberikan.
2. Operasional yang terdiri dari :
- Jasa pelayanan medis yaitu jasa yang diberikan kepada petugas kesehatan
(medis, paramedis maupun non-medis) atas pelayanan yang diberikan.
- Jasa Rumah Sakit yaitu jasa yang digunakan untuk operasional dan
pemeliharaan Rumah Sakit sehingga dapat memberikan pelayanan.
- Bahan habis pakai yaitu bahan-bahan yang digunakan untuk terselenggaranya
suatu kegiatan pelayanan kepada pasien.
Ketiga komponen operasional tersebut tercermin pada tarif Rumah Sakit.
f. Pasien/klien

Dilihat dari status sosio-ekonomi dan budaya masyarakat


pasien dapat digolongkan pada pasien tingkat menengah
ke atas dan tingkat menengah ke bawah.
Pada perencanaan suatu Rumah Sakit perlu
memperhitungkan status pasien yang akan menjadi pangsa
pasar Rumah Sakit sesuai dengan visi dan misi Rumah
Sakit.
B. Komponen Proses
a. Perencanaan
- Tenaga yang dibutuhkan sesuai dengan jeni pelayanan
yang diberikan, beban kerja yang ada dengan
memperhitungkan kecenderungan (TREND) pada masa
yang akan datang.
- Sumber daya lain yang dibutuhkan untuk terselenggaranya
suatu pelayanan medis.
b. Pengorganisasian
- tenaga medik ini diorganisir melalui staf medik,
sedangkan pengelolaan pelayanan medik di bawah Wadir
Pelayanan Medik

c. Penggerakan
- kegiatan inilah yang paling sulit dilakukan karena
beberapa dilema.
- kebutuhan akan tenaga dokter spesialis khususnya bagi
Rumah Sakit Swasta cukup tinggi karena tidak
mempunyai tenaga dokter tetap
d. Pelaksanaan pelayanan medis
- Falsafah dan tujuan
Pelayanan medis yang diberikan harus sesuai dengan
ilmu pengetahuan kedokteran mutakhir serta
memanfaatkan kemampuan dan fasilitas Rumah Sakit
secara optimal.
Tujuan pelayanan medis adalah mengupayakan
kesembuhan pasien secara optimal melalui prosedur dan
tindakan yang dapat dipertanggungjawabkan sesuai
dengan standar masing-masing profesi.
- Administrasi dan pengelolaan

Wadir pelayanan medis/seksi pelayanan medis ditetapkan


sebagai ADMINISTRATOR yang mempunyai fungsi antara
lain :
Membuat kebijakan dan melaksanakannya.
Mengintegrasi, merencanakan dan mengkoordinasi
pelayanan.
Melaksanakan pengembangan DIKLAT
Melakukan pengawasan termasuk medikolegal
- Staf dan pimpinan
Penetapan staf dan hak/kewajibannya ditentukan oleh
pejabat yang berwenang, dengan prinsip seleksi : dapat
memberikan pelayanan profesional, sesuai kebutuhan
Rumah Sakit dan masyarakat serta ada rekomendasi
profesi.

- Fasilitas dan peralatan


Tersedia fasilitas pelayanan yang cukup sehingga tujuan
pelayanan efektif tercapai, misalnya ruang pertemuan staf
medis, fasilitas untuk berkomunikasi, tenaga, administrasi
untuk pencatatan kegiatan medis.
- Kebijakan dan prosedur
Perlu dibuat kebijakan dan prosedur klinis maupun
nonmedis sesuai dengan standar yang ada.

- Pengembangan staf dan program pendidikan


Hal ini diperlukan untuk peningkatan mutu pelayanan medis.

- Evaluasi dan pengendalian mutu


Ada program pengendalian mutu yang menilai konsep, hasil
kerja dan proses pelayanan medis.
Dilaksanakan oleh Komite medis.
e. Pengawasan dan pengendalian

- Pengawasan pelaksanaan pelayanan termasuk


medikolegal oleh wadir/seksi pelayanan.
- Pengawasan teknis medis oleh komite medis
Keduanya bertanggung jawab kepada Direktur Rumah
Sakit.
Pengawasan ini harus secara periodik dan kontinyu
dilakukan baik dengan audit medis/audit manajemen
maupun dengan upaya-upaya peningkatan mutu yang lain,
C. OUTPUT

- pelayanan medis yang bermutu, terjangkau oleh


masyarakat luas dengan berdasarkan etika profesi dan
etika Rumah Sakit.
- tolok ukur keberhasilan pelayanan di Rumah Sakit
seperti angka kematian di Rumah Sakit, kejadian infeksi
nosokomial, kepuasan pasien, waktu tunggu dan lain-
lain akan berubah.
- meningkatkan CITRA Rumah Sakit yang merupakan
pemasaran Rumah Sakit.
D. FAKTOR yang mempengaruhi

a. Pemilik Rumah Sakit (Pemerintah Pusat, PEMDA, Yayasan, PT, PMA


dll)
Missi dan dukungan pemilik sangat menentukan keberhasilan
pelayanan medik.

b. Depkes
Peraturan dan kebijakan dengan sanksi yang tegas akan
meningkatkan sistem pelayanan medis di Rumah Sakit.

c. IPTEK (Ilmu Pengetahuan dan Teknologi)


Kemajuan IPTEK harus diikuti sesuai falsafah Rumah Sakit yaitu
memberikan pelayanan sesuai IPTEK kedokteran yang mutakhir.

d. Sosio-ekonomi-budaya masyarakat
FAKTOR YANG MEMPENGARUHI

1.Pemilik 2. DEPKES 3. IPTEK


2.4. Sosio-ekonomi-budaya-masyarakat

INPUT PROSES OUTPUT

1. Tenaga medis 1. Perencanaan


2. Organisasi & 2. Pengorganisasian Pelayanan
Tata laksana 3. Penggerakan medik yang
3. Kebijakan Direktur 4. Pengawasan & bermutu
4. Sarana & Prasarana pengendalian
5. Dana
MASALAH-MASALAH YANG TIMBUL DALAM
MANAJEMEN PELAYANAN MEDIK

1. Tenaga, khususnya tenaga medis spesialis masih kurang dan tidak


merata (di Pulau Jawa lebih banyak dibanding daerah lain).
2. Belum semua Rumah Sakit menerapkan/mengacu kepada struktur
organisasi yang efektif karena keterbatasan kualifikasi tenaga
yang ada.
3. Fasilitas yang belum sesuai dengan standar.
4. Kecenderungan untuk memiliki alat canggih tanpa memperhitungkan
efisiensi dan efektivitas.
5. Sikap dan perilaku tenaga medis yang kurang mendukung sistem
pelayanan medis maupun Rumah Sakit sebagai suatu sistem.
6. Sikap dan perilaku pimpinan Rumah Sakit yang kurang tegas dalam
pelaksanaan pelayanan medis.
MANJEMEN OPERASIONAL PELAYANAN
PASIEN DIRUMAH SAKIT
ALUR PELAYANAN KESEHATAN

Pasien
Pasien
Pasien
Pasien GAWAT DARURAT
PASIEN
PASIEN

PRIMARY
PRIMARY
CARE
CARE

PERLU YA
PERLU
PEM/ PERLU RAWAT
PEM/TIND
TIND RS
RS
PERLU RAWAT
SPESIALIS RAWAT
RAWATINAP
INAP INAP
INAP
SPESIALIS RUJUKAN

TIDAK TIDAK

PASIEN RAWAT
RAWAT PELAYANAN
PELAYANAN
PASIEN JALAN OBAT
PULANG
PULANG JALAN OBAT

PASIEN
PASIEN
PULANG
PULANG
PATIENT ACCESS SERVICES
( ADMITTING )
HEALTH CARE ORGANIZATIONS MUST BE :
- FINANCIALLY VIABLE
- COST EFFECTIVE
- SENSITIVE TO THE NEEDS OF PATIENTS.

PATIENT RELATIONS ARE INFLUENCED BY :


- EMPLOYEE ATTITUDES
- EFFECTIVE INFORMATION GATHERING AND
PROCESSING SYSTEM
- SCHEDULING
- INTERDEPARTEMENTAL COMMUNICATIONS
AND COORDINATION
PENGERTIAN

HOSPITAL ADMISSION / REGISTRATION


SYSTEM (PATIENT ACCESS) IS A SYSTEM
USED TO INPUT INFORMATION IN AN ORDERLY
MANNER TO PREVENT OVERBURDENING THE
ORGANIZATION AND ITS RESOURCES

THE PATIENT ACCESS DEPARTMENT IS


RESPONSIBLE PRIMARILY FOR THE TIMELY,
COURTEOUS, AND ACCURATE REGISTRATION
OF PATIENTS.
MANAJEMEN UNIT RAWAT JALAN
DAN RAWAT INAP
BENTUK AMBULATORY CARE :
- KLINIK SPESIALIS
- KLINIK INDUSTRI
- KLINIK PELAYANAN SATU HARI
- PUSAT REHABILITASI
- UNIT RAWAT JALAN RUMAH SAKIT

UNIT RAWAT JALAN PENTING :


- JUMLAH TERBANYAK PELAYANAN PASIEN DI RS
- FUNGSI KELANJUTAN PELAYANAN RS
- PROFIT CENTER
- GERBANG MASUK PASIEN RS
ALUR PASIEN RAWAT JALAN
PASIEN

LAMA BARU
KARTU BEROBAT STATUS ISI DATA PASIEN
PASIEN

PENDAFTARAN

PENDAFTARAN
AMBIL KARTU &
KARCIS BEROBAT

PROSES DATA PASIEN RM PROSES DATA PASIEN

POLI YG DITUJU

SIMPAN DATA PASIEN


PEMERIKSAAN DR

JENIS TINDAKAN

KASIR

PEMBAYARAN

AMBIL RESEP

PULANG
ALUR PASIEN RAWAT INAP
PASIEN

LAMA BARU
KARTU BEROBAT STATUS ISI DATA PASIEN
PASIEN

PENDAFTARAN

PENDAFTARAN
AMBIL KARTU &
KARCIS BEROBAT

PROSES DATA PASIEN RM PROSES DATA PASIEN

RUANG PERAWATAN

SIMPAN DATA PASIEN


PEMERIKSAAN DR

KEADAAN
PASIEN
TIDAK SEMBUH
SEMBUH

KASIR

BUKTI PEMBAYARAN

PULANG
MANAJEMEN PELAYANAN GAWAT DARURAT

CIRI KOMPLEKSITAS PELAYANAN GAWAT DARURAT :

- PELAYANAN 24 JAM
- AMBULANS HARUS SIAP
- PENUNJANG HARUS SIAP
- TIDAK ADA UANG MUKA
- RAWAN KONFLIK
ALUR PROSES PELAYANAN

MENGANCAM JIWA GAWAT BIASA

PENERIMAAN PASIEN

TAHAP I P.BARU P.LAMA

RESUSITASI
TAHAP II ATASI SHOCK PEMERIKSAAN, DIAGNOSE, PENGOBATAN
ATASI PERDARAHAN

TAHAP III TINDAKAN LANJUTAN


(OPERASI, GIPS,DLL

TRANSFER PASIEN :
- RAWAT INAP
TAHAP IV - RAWAT JALAN
- RS LAIN
- KAMAR JENASAH
- PULANG
PRINSIP-PRINSIP DASAR
PENATAAN ALUR KEGIATAN
PELAYANAN PASIEN DI RUMAH SAKIT
Definition

Patient flow is the order of a patient's experience in a


hospital or outpatient clinic. The flow is divided into
operational steps or processes that dictate what
happens to the patient during his visit, from
administrative to clinical tasks.

Patient flow encompasses the systematic process of


attending to patients, from the time they walk into a
medical facility to the time they check out for
discharge. Patient flow includes both medical and
administrative functions, which may often overlap
Function

The patient flow evaluates the length of time required


for patients to be admitted, fill out their paperwork,
submit their vitals and see a doctor. The goal of patient
flow is to provide treatment to patients in a timely and
effective manner.

Patient flow begins when the patient steps foot into


your facility, and ends when she is out the door. Patient
flow measures how long it takes for a patient to check
into a facility, have her paperwork processed, have her
vitals taken, see the doctor and, if necessary, be
assigned an inpatient bed.
HOSPITAL
Hospitals are the most complex of building types.
Each hospital is comprised of a wide range of services and functional units.
These include :
- diagnostic and treatment functions, such as clinical laboratories,
imaging, emergency rooms, and surgery;
- hospitality functions, such as food service and housekeeping; and
- the fundamental inpatient care or bed-related function.
This diversity is reflected in the breadth and specificity of regulations, codes,
and oversight that govern hospital construction and operations.
Each of the wide-ranging and constantly evolving functions of a hospital,
including highly complicated mechanical, electrical, and telecommunications
systems, requires specialized knowledge and expertise. No one person can
reasonably have complete knowledge, which is why specialized consultants
play an important role in hospital planning and design.
Good hospital design integrates functional requirements with the human
needs of its varied users.
Hospital functions

The basic form of a hospital is, ideally, based on its


functions:

bed-related inpatient functions


outpatient-related functions
diagnostic and treatment functions
administrative functions
service functions (food, supply)
research and teaching functions
Physical relationships between these functions determine the configuration of the hospital.
Certain relationships between the various functions are required
as in the following flow diagrams.

ADMINISTRATION

INPATIENT

DIAGNOSTIC & TREATMENT OUTPATIENT

SERVICE

RESEARCH & TEACHING

GENERAL HOSPITAL RELATIONSHIPS


MAJOR CLINICAL RELATIONSHIPS

RECEPTION & REGISTRATION

ADMIT

RECORD

DIAGNOSTIC & TREATMENT


INPATIENT WARDS OUTPATIENT
LABORATORIES
MEDICAL
MORGUE OUTPATIENT CLINICS
SURGICAL SURGERY
X-RAY DEPT. EMERGENCY
PSYCHIATRIC
P.M.E.R

PHARMACY

DISCHARGE DISCHARGE

POST HOSPITAL CARE


Patient Flow and Patient Tracking

Moving patients through the facility is an important aspect of patient tracking and
patient flow.

Whether patients are taken from the waiting area, to the patient's room, to the
operating room, to another floor or another unit, or to be discharged, efficient
transfers and monitoring is vital in ensuring optimal patient tracking and patient flow.
INTRA HOSPITAL PATIENT FLOW
These flow diagrams show the movement and communication of people,
materials, and waste.The physical configuration of a hospital and its
transportation and logistic systems are inextricably intertwined. The
transportation systems are influenced by the building configuration, and
the configuration is heavily dependent on the transportation systems. The
hospital configuration is also influenced by site restraints and
opportunities, climate, surrounding facilities, budget, and available
technology.

In a large hospital, the form of the typical nursing unit, since it may be
repeated many times, is a principal element of the overall configuration.
Nursing units today tend to be more compact shapes than the elongated
rectangles of the past. Compact rectangles, modified triangles, or even
circles have been used in an attempt to shorten the distance between the
nurse station and the patient's bed.
Flows for Key Departments

1. Emergency Department

The ED is extremely busy and crowded, and suffers long waits.


This is due in part to waits for admission to inpatient beds.
When inpatient beds are unavailable the ED patients often must
wait in ED beds until then can be moved.
Also, processes are slowed in ED due to limited accessibility of
certain ancillary services. Radiology, for example, is on a different
floor and ED patients must sometimes be moved up to that floor for
diagnostic services and then moved back down to the ED.
2. Radiology

Bottlenecks and problems :

Out patients arrive hours before their appointment time, hoping to be


served earlier.Thus, waiting rooms are full and the patient spends a
longer time at the hospital

Since there are many residents, considerable time is spent in


teaching tasks that slow the availability of results.

Staffing shortages and insufficiently experienced staff create idle


equipment, even when there are patients waiting.

Time between a doctor's order for a test and receipt of the results is
lengthy,
3. Pharmacy

Pharmacy services are provided inpatients, outpatients and patient


discharges.
Patients don't pay at the pharmacy in advance for their medicine. After
the order is ready, patients are given a cash receipt and are sent to
the cashier to pay. After payment, they come to pick up the
medicines.
Pharmacy staff and other personnel noted bottlenecks and problems:
Staffing shortages and insufficiently experienced staff
Waiting for medications was said to contribute to delays in
discharging patients from hospital inpatient beds.
On discharge the doctor is supposed to provide prescriptions in
advance, on the day before, but they often don't write it until their
morning rounds,
4. Laboratory

The GH lab provides a centralized service for a wide variety of


tests. The primary flow is: specimens, mostly blood in tubes, are
received in the lab area by pneumatic tube, hand carried to a
receiving window or gathered by an outside transportation
contractor to gather samples from various satellite locations.
An initial set of steps involves receiving the material and
paperwork; a second phase involves organizing the samples (for
which they have automated equipment) and then doing the test
itself.
5. Surgery

Surgeries are of three basic types: emergency, inpatient and


outpatient (or day surgeries).
Non-emergency surgeries are scheduled one day in advance.
Surgery days are blocked out for various specialties on a two-week
rotation pattern. Thus, a room is scheduled weeks in advance
for a specific type of surgery (such as ''cardiac") and may not
be available for that type of surgery again for days or weeks.
Doctors from each specialty define the sequence of patients within
their specialty.
Queues for each specialty may be weeks or months in length.
Bottlenecks related to surgery include:

Inpatient beds unavailable, which cause a back up of patients


completing surgery.
Patients for day surgeries who do not show up as expected.
Incorrect or unavailable ancillary service results (Radiology, lab
reports. Medical records).
Staffing shortages resulting in fewer rooms or services available.
Frequent rescheduling and bumping of surgeries for a variety of
causes.
Slow clean-up between surgeries.
Delays in transport service and waits for elevators.
Allocation of rooms to specialties may not match the relative
demand among specialties.
Paperwork is not always available or correctly completed on time.
Patient Flow
Analysis
Patient delays depend in part how he or she physically flows through
the hospital, and in part on how information, equipment and other
objects flow through the hospital.

The system for managing patient flows in a hospital should be designed


and operated to achieve these goals:

Minimizing waits as patients transition from department to department.


Achieving a high level of synchronization among patients, employees
and resources, so that services begin promptly on patient arrival
and are provided with high efficiency.
Identifying and resolving system level bottlenecks that impede the flow
of patients.
What is Patient Flow Analysis?

A process that tracks patient flow and use


of personnel time in clinic settings

Used to
Identify problems in flow
Identify personnel needs
Identify space needs
Track personnel costs
Benefits of PFA

To Staff/ Personnel
Ability to respond to staff/personnel concerns
Better understanding of roles and needs of
different departments
Increases information available to managers
To Customer
Refocuses on customers
Improved continuity of care
To Hospital
Team-building tool
Greater communication
How to Make a Patient Flow Analysis
1. Identify each procedure that patients have contact with during their
clinic visit. Start with the parking lot if patients complain about their
experience there. Examine each procedure in turn, starting with
registration.
2. Devise measuring devices to determine how long patients are involved
in each procedure. You can create a time log that enables employees
to record how long each patient is in each procedure of the process.
3. Explore what factors not directly related to the procedures affect the
patient flow. Find out if staff absences for illness, meetings, breaks or
lunch increase waiting time.
4. Examine the data from the patients' and employees' perspectives.
Search the data by days of the week and by the hour. Determine if
bottlenecks are related to inefficient implementation of procedures, to
the scheduling of patients in ways that put stress on the system or to
indirectly related factors. Plan improvements when your data are
completed and you have identified the trouble areas
Ideal Throughput Model - All Patients

Dispo Decision to Arrival to Triage =


Discharge = 5min.
10 min.

Triage Time =
Ideal Time 5min.
Arrival to Discharge
90 percent <=2 Hours
Rad Result to Dispo
____________________
Decision =
Includes 10 minutes MD time
10 min.
with patient
Triage to Bed =
5min.

Radiology = Lab Time =


30 min. 40 min.

Lab Result to Dispo


Decision = Bed to MD =
10 min. 5min.

Source: The Abaris Group, 2005


Thank you

Anda mungkin juga menyukai