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Herkutanto
Guru Besar Fakultas Kedokteran UI Pendidikan dibidang Kedokteran
Doktor (S3), Dokter, Spesialis Forensik - Universitas Indonesia Grad. Dip. Forens.Med. - Monash University, Australia

Pendidikan dibidang Hukum Sarjana Hukum (SH) Universitas Indonesia, Fakultas Hukum Master of Laws (LL.M) La Trobe University, Australia School of Law Ketua Sub-Komite Kredensial FKUI
RSCM Majelis Kehormatan Disiplin Kedokteran Indonesia

PROFESSIONALISME DAN GOOD CLINICAL GOVERNANCE


Herkutanto

Dip. Forens. Med - Netherland School of Public Health, Nederland

TUJUAN PEMBICARAAN
Penyamaan persepsi tentang professionalisme dalam rumah sakit Penerapan professionalisme melalui mekanisme kredensial dalam komite medis

PROFESSIONALISME
Dasar Filosofi Kredensial Dasar Good Clinical Governance

Herkutanto 2009

Herkutanto 2009

Herkutanto, Kongres PERSI XI, Oktober 2009

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SOCIAL CONTRACT
PROFESSIONALS - COMMUNITY
Medical Council

Clinical privilege Self Credentialing Self licensing Clinical privilege Moral responsibility High standard of competence Market control Working condition Registered Practitioners

PROFESSIONALISM Masyarakat / Pasien

William M Sullivan, Medicine under threat: Professionalism and professional identity, CMAJ 2000:162(5): 673 identity,

AKIBAT TIDAK ADANYA MEKANISME PENGATURAN PROFESI

Terbaurnya provider medis non medis

Terbaurnya medis non medis

Herkutanto, Kongres PERSI XI, Oktober 2009

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Theory of Bad Apple


Membuang apel busuk mekanisme pendisiplinan

CLINICAL GOVERNANCE
Clinical Governance describes a systematic approach to maintaining and improving the quality of patient care. Oversee the professionals:
Entering to the profession Expelling from the professiona
Department of Health, United Kingdom

PEER REVIEW
Core of professional quality of care A critical and judicious evaluation which is perfomed by one of equals Begin in 8th Century in Syria: It was the duty of physicians to make duplicate notes of the conditions of the patients treated Those notes would be then be examined by a local Council according to the standard of that time On the basis of the ruling of the council, the physician could be sued for damages by a patient who had been mistreated
Ishap bin Ali Al Rahwi (854-931)

Herkutanto, Kongres PERSI XI, Oktober 2009

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Two Types of Competencies In Healthcare Organizations


Employee Competencies

STRATEGI CLINICAL GOVERNANCE

Unique Factor That make an Organization Competitive

Organization Competencies

Individual Ability To perform activities Within an occupation Or function to the Standard expected in an employement

Antisipasi masalah Sedini mungkin

Business Objectives

Organization Competencies

Staffs Competencies

CREDENTIAL / SELECTION Herkutanto 2011

CREDENTIALING vs PRIVILEGING
CREDENTIALING Verification of credentials to practice medicine Information should be verified from the original source PRIVILEGING
What can a provider do to a patient? The challenge is to match privileges granted to demonstrated current competence The JCI requires that privileging be an objective, evidence-based process

Delineasi Clinical Privilege


Mekanisme Kredensial Clinical Appointment

Herkutanto 2011

Herkutanto 2009

Herkutanto, Kongres PERSI XI, Oktober 2009

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risk risk

D E risk F E N risk C E S

risk risk

D E F INCIDENT E N risk C ACCIDENT E S

INCIDENT Clinical Privileges Clinical Privileges Clinical Privileges Clinical Privileges Tindakan Medis Tindakan Medis Tindakan Medis Tindakan Medis ACCIDEN T

CREDENTIALING HOSPITAL

CLINICAL PRIVILEGE Cricothyrotomy Endotracheal (Nasal/Oral) Neuromuscular blockade Mechanical ventilation Percutaneous transtracheal ventilation Therapeutic decompression

risk risk risk risk risk risk

Medical Director

Executive Director

Governing Board Steering Committee

Clinical Privilege Appointment

MEDICAL SERVICES MEDICAL PROFESSION Credentialing


Clinical Privilege recommendation Fit Registered Practitioners Medical Practice Disciplinary Tribunal

Re-Credentialing HOSPITAL

MEDICAL PROFESSION

Herkutanto, Kongres PERSI XI, Oktober 2009

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Check List Clinical Privilege

Check List Clinical Privilege

TARGET KREDENSIAL
Setiap dokter memiliki surat clinical appointment dari Direksi RS sesuai dengan clinical privilege berdasarkan mekanisme credentialing

Hanya dokter yang memiliki clinical appointment sajalah yang diperbolehkan melakukan tindakan medis di rumah sakit

Herkutanto, Kongres PERSI XI, Oktober 2009

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PROSES KREDENSIAL
Rekomendasi Clinical Appointment

SEGITIGA KREDENSIAL
(Herkutanto, 2009)

Mitra Bestari

DAFTAR Mitra Bestari

Aplikasi Clinical Privilege Praktisi Medis Buku Putih Clinical Privilege

Formulir Clinical Privilege

Buku Putih Clinical Privilege

MASALAH
Sejauh mana sistem yang ada di rumah sakit dapat mencegah kecelakaan medis?
Peran Komite Medis ? Pengaturan Medical staff bylaws ? Keseragaman Pengertian Credential ? Penerapan Clinical Privilege ?

FUNGSI KOMITE MEDIS


Credential Menyaring tenaga medis yang baik Clinical Privilege Maintaining Professionalism Audit medis Recredential Expelling Professionals Sub-komite Disiplin Panitia Ad-Hoc (peer)

Herkutanto, Kongres PERSI XI, Oktober 2009

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KONSEP LAMA KREDENSIAL


1 Medical Director 3 HOSPITAL

2 Peer Review

SK Pegawai

Sub-Komite Kredensial

Sub-Komite Mutu Profesi

Sub-Komite Disiplin

Medical Practice

Medical Committee MEDICAL PROFESSION

MEDICAL STAFF BYLAWS

KONSEP MUTAKHIR KREDENSIAL


1
Medical Director

HOSPITAL

Initial Assessment 2 6 4
Registered Practitioners

Peer Review 3

Delineation of Clinical Privilege

Medical Committee
Medical Practice Clinical Privilege recommendation
Herkutanto 2009

Herkutanto, Kongres PERSI XI, Oktober 2009

MEDICAL PROFESSION

Clinical Privilege Appointment

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