CUSTOMER CARE

IN
OPERATING THEATRE

Prof. Dr. Budi Anna Keliat, SKp, MAppSc

E_mail: budianna_keliat@yahoo.com; Hp: 08128100821
Disampaikan pada PELATIHAN MANAJEMEN KAMAR BEDAH,
11-15 Desember 2014, JAKARTA
 EXCELLENCE SERVICE
.
 Mutu : - berkualitas
- efektif Provider
- efisien

 Memuaskan : - kebutuhan
Pelanggan
- keinginan (customer)

“ BERI LEBIH DARI YANG

DIHARAPKAN PELANGGAN “
 Customer Service/Care
COMPANY
( Management )

Internal Marketing External Marketing

( enabling the promise) ( setting the promise )

EMPLOYEES Interactive Marketing CUSTOMERS

( delivering the promise )
The Service Encounter Triad

Service
Organization

Efficiency Efficiency
versus versus
autonomy satisfaction

Contact
Customer
Personnel Perceived
control
Focus on the Care Cycle
Information &
Operating
Operating room
room Decision support Intensive
Intensive
Monitoring
Monitoring Care
Care unit
unit
Imaging Monitoring
Imaging Treatment Monitoring

Diagnostics
Step
Step down
down
Diagnostics
Diagnostics facility
Imaging facility
Imaging Monitoring
Monitoring

Follow Up
Pre-Hospital/
Pre-Hospital/
Ambulance Home
Home
Ambulance Monitoring
Monitoring Monitoring
Monitoring
Akses Perawatan & Kesinambungan
Hand Over Hand Over

1. Pulang ke
IGD / URI Rumah
URJ Ruangan - Ruangan 2. Rujuk YanKes

Hand Over
Asesmen & Perawatan Pasien

STANDAR ASESMEN
KELUHAN UTAMA/ALASAN MASUK DIAGNOSIS

ASKEP/ASMED & PENDIDKAN KES

PASIEN KELUARGA

KOLABORASI
DOKTER/PERAWAT TIM KES LAIN: AHLI GIZI, FARMASI DLL
 TUGAS PERAWAT (Pasal 29)

 Pemberi Asuhan Keperawatan;

 Penyuluh dan konselor bagi Klien;
 Pengelola Pelayanan Keperawatan;
 Peneliti Keperawatan;
 Pelaksana tugas berdasarkan pelimpahan wewenang;

dan/atau
 Pelaksana tugas dalam keadaan keterbatasan tertentu.

 Semua dapat dilakukan oleh perawat profesi

 Untuk vakasi perlu dianalisis
 WEWENANG PERAWAT (pasal 30)

 Melakukan pengkajian Keperawatan secara holistik

 Menetapkan diagnosis Keperawatan
 Merencanakan tindakan Keperawatan
 Melaksanakan tindakan Keperawatan
 Mengevaluasi hasil tindakan Keperawatan
 Melakukan rujukan
 Memberikan tindakan pada keadaan gawat darurat
sesuai dengan kompetensi
 Memberikan konsultasi Keperawatan dan
berkolaborasi dengan dokter
 Melakukan penyuluhan kesehatan dan konseling
 Melakukan penatalaksanaan pemberian obat
kepada Klien sesuai dengan resep tenaga medis
atau obat bebas dan obat bebas terbatas
 THE HARM PRODUCED
BY INEFFECTIVE HANDOVER

 WRONG TREATMENT
 DELAY IN MEDICAL DIAGNOSIS
 LIFE-THREATENING ADVERCE EVENT
 PATIENT COMPLAINTS
 INCREASES HEALTH CARE EXPENDITURE
 INCREASED HOSPITAL LENGTH OF STAY
• GIVE AS MUCH AS TIME NECESSARY 4
• VERBAL AND WRITTEN COMMUNICATION 3
• TWO WAY COMMUNICATION 2
• FACE TO FACE 1
HANDOVER
 Pre-Op OR
 Planned surgical  Antibiotics to be
Procedure given
 Universal Protocol

 Planned anesthesia  Significant medical

type history
 Allergies

 Last voided
 Family contact
information
 Preop medications
Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
 Equipment needs
 OR OR
• Procedure  Irrigation
• Surgeon Plan and  Medications

Preferences (where we are  Instrumentation on

in the case)
and off field
• Anesthesia type  Specimens on and

• Allergies off field

 Equipment needs
• Significant Medical  Tubes, Lines, Hoses
History
• Counts
Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
 OR Team PACU

 Surgical procedure  Significant medical

(completed vs. planned)
history (e.g., contact
 Anesthesia type precautions)

 Estimated Blood Loss Family contact



 Input & Output information?

(e.g., straight catheter, foley)  Equipment needs
 Allergies (e.g., sequential compression
devices)
 Medications  Other issues (e.g., blood
(received intra-op) products, anesthesia concerns)

Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
KOMUNIKASI PADA KONSUMEN
70 % PENYEBAB MASALAH

Rekomendasi dari:
AORN (ASSOCIATION OF PERIOPERATIVE RN)

 I-SBAR
I PASS THE BATON
 FIVE-Ps
 PACE
 IS B A R
I ●
Introduction

S ●
Situation

B ●
Background

A ●
Assessment

R ●
Recommendation
 Introduction

 State your name and unit

 I am calling about
(patient name)

18
Situation
•
Patient age
• Gender
• Pre-op diagnosis
• Procedure
• Mental status
pre-procedure
• Patient stable/unstable

19
Background

• Pertinent medical history

• Allergies
• Sensory Impairment
• Family location
• Religion/culture
• Interpreter required
• Valuables deposition
20
Background Intra operation

• Meds given
• Blood given – units available
• Skin integrity
• Musculoskeletal restrictions
• Tubes/drains/catheters
• Dressings/cast/splints
• Counts correct
• Other – lab/path pending
21
Assessment

•Vitals
• Isolation required
• Skin
• Risk factors
• Issues I am concerned
about

22
Recommendation/Request

•
Specific care required
immediately or soon

• Priority areas
⁻ Pain control
⁻ IV pump
⁻ Family communication
23
I PASS THE BATON

24
 I PASS THE BATON
I - Introduction: Introduce yourself
P - Patient: Name: identifiers, age, sex location
A - Assessment: “The problem” procedure etc.
so far in the process
S - Situation: Current status/Circumstances,
uncertainty, recent changes
S - Safety concerns: Critical lab values/reports;
threats, pitfalls and alerts
25
 I PASS THE BATON

B - background: Co-morbidities,
previous episodes, current meds, family
A - actions: What are the actions to be taken
and brief rational
T - Timing: Level of urgency, explicit timing,
prioritization of actions
O - Ownership: Who is responsible
(person/team) including patient/family
N - Next: What happens next? Anticipated
changes? Contingencies

26
 “5-Ps”
 Ensures proper information is passed during patient
transfers or provider shifts change.

 Use the 5 Ps:

◦ Patient
◦ Plan
◦ Purpose
◦ Problems
◦ Precautions

 After instituting guidelines with the behavior-based

expectations, Sentara Health experienced a
21%
Quality increase
for All Americans: in effective
Celebrating Success, handoffs.
Gary Yates, Sentara Healthcare. Panel 1—Promising Quality Improvement Initiatives: Reports From the Field. AHRQ Summit—Improving Health Care
Measuring Progress, Moving Forward ; 2004.
27
 PACE
P ●
PATIENT / PROBLEM

A ●
ASSESSMENT / ACTION

C ●
CONTINUING / CHANGE

E ●
EVALUATION
 FIVE Ps
P ●
PATIENT

P ●
PLAN

P ●
PURPOSE

P ●
PROBLEM

p ●
PRECAUTION

Ps ●
PHYSICIAN (ASSIGNT TO COORDINATE)
Dimensions of Service Quality

1. Reliability dependable over

time
2. Responsiveness keeping
customers waiting
3. Assurance
reputation, credentials, confidence, track record
4. Empathy being a
good listener, putting yourself in their place
5. Tangibles cleanliness,
physical appearance
 Service Quality Gap Model

C u sto m er C usto m er Satisfa ction C u sto m er

GAP 5
Perception s E xpectation s

M an agin g th e C ustom er / U n d erstan d in g

E vid en ce M arketing R esearch th e C u sto m er
C om m un ication
GAP 4 GAP 1
M an age m en t
Service
Perception s
D elivery of C u sto m er
E xpectation s
C on forma nce
D esign G A P 2
GAP 3
C o n fo rm an ce Service D esign
Service
S tan d ard s
Perceived Service Quality

Word of Personal Past

mouth needs experience

Service Quality Expected

Dimensions service Service Quality Assessment
Reliability 1. Expectations exceeded
Responsiveness
Assurance Perceived ES<PS (Quality surprise)
Empathy service 2. Expectations met
Tangibles ES~PS (Satisfactory quality)
3. Expectations not met
ES>PS (Unacceptable quality)
CARE FOR CUSTOMERS

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