TANTANGAN PELAYANAN RUMAH SAKIT YANG BERMUTU

DI ERA PENERAPAN ADAPTASI KEBIASAAN BARU

Dr Kuntjoro Adi Purjanto, Mkes

Ketum Umum
PERSI ( Perhimpunan Rumah Sakit Seluruh Indonesia )
Medan, 24 Febuari 2021
 SISTEMATIKA
I. PENGANTAR;

II. KEBIJAKAN

III. UPAYA

V. PENUTUP

“ The secret of change is to focus all of your energy, not on fighting the old, but on building the new ”
- Socrates -
KEBIJAKAN TATA KELOLA

Penjelasan
KEWAJIBAN RUMAH SAKIT
KEBIJAKAN DISASTER BENCANA DAN NON ALAM
DI ERA PANDEMI COVID 19
KEBIJAKAN KOMITE MUTU
The Joint Commission's 2021 national patient
safety goals for hospitals are:
1. Improve the accuracy of patient identification.
2. Improve staff communication.
3. Improve the safety of medication administration.
4. Reduce patient harm associated with clinical alarm
systems.
5. Reduce the risk of healthcare-associated infections.
6. Better identify patient safety risks in the hospital.
7. Better prevent surgical mistakes.

International Patient Safety Goals

Goal One. Identify patients correctly.
Goal Two. Improve effective
communication.
Goal Three. Improve the safety of high-
alert medications.
Goal Four. Ensure safe surgery.
Goal Five. Reduce the risk of health care-
associated infections.
Goal Six. Reduce the risk of patient harm
resulting from falls.
 UHC
BENCANA Without
Harm
Gagal
Mencapai
Kinerja
Strategis
Best practice

Piutang vs Hutang
Quality
Assesment? disruption sebagai perubahan
secara radikal dan revolusioner
yang bisa memicu ketegangan
karena ada unsur 3 S “sudden,
speed , dan surprise”.

Era
CoVid 19,
Banyak
Resiko

Silent Killer
Komunikasi
Internal ?
“ DARK TRIAD “

Pelayanan kesehatan di dunia saat ini menghadapi kondisi VUCA ( volatile, uncertainty, complexity dan
ambiguity ) karena dihadapkan pada disruption in healthcare.

Volatility Uncertainty Complexity Ambiguity

Bergejolak, berubah2 Memiliki ketidakpastian Saling berhubungan, Menimbulkan
yang tinggi saling tergantung, rumit Keragu-raguan
7
RS SEBUAH KOTA BANYAK BANYAK BANYAK SDM &
MODERN PROSEDUR PEMERIKSAAN BANYAK PROFESI

HAKEKAT RUMAH SAKIT

BANYAK BANYAK BANYAK

PENDIDIKAN &
JENIS OBAT PASIEN TEHNOLOGI PENELITIAN
CANGGIH
Magula, M,1982
Laksono T, 2014

………………………………………. etc……..
 KESADARAN AKAN POTENSI TERJADINYA KESALAHAN

In a Hospital :
Because there are
hundreds of
medications, tests
and procedures,
and many patients
and clinical staff
members in a
hospital, it is quite
easy for a mistake
PELAYANAN PASIEN KOMPLEKS to be made. . . .

Di Rumah Sakit :
…banyaknya jenis

“Hutan”
obat,jenis pemeriksaan
dan prosedur, serta
jumlah pasien dan staf
Rumah Sakit yang cukup
besar, merupakan hal
yang potensial bagi
terjadinya kesalahan.

Adib Y, 2014 “ To err is human, to cover up is unforgivable, and to fail to learn is inexcusable ”
Sir Liam Donaldson World Health Organization Envoy for Patient Safety
 10 FAKTA KESELAMATAN PASIEN (WHO)

Nico l,2020
 Goes back a long way…………………
PRIMUM, NON NOCERE
FIRST, DO NO HARM
HIPPOCRATES’S TENET
( 460-335 BC )

Be Smart

Theme: Health Worker Safety: A Priority for Patient Safety

Slogan: Safe health workers, Safe patients.
Call for action: Speak up for health worker safety.
 DIMENSI MUTU: RS YANG PROFESIONAL WHO 2018

1. Effective, 2. Safe, 3. People-centred,

4. Timely, 5. Equitable. 6. Integrated, 7. Efficient

Accessible
Defining
quality health care
Quality health care can be defined in many
ways but there is growing acknowledgement
that quality health services across the world
should be:
 Effective: providing evidence-based health affiliation.
care services to those who need them.
 Safe: avoiding harm to people for whom
the care is intended.
 People-centred: providing care that
responds to individual preferences, needs • Efficient: maximizing the benefit of available
and values
In addition, in order to realize the benefits of
quality health care, health services must be:
• Timely: reducing waiting times and
sometimes harmful delays for both those who
receive and those who give care.
• Equitable: providing care that does not vary
in quality on account of age, sex, gender,
race, ethnicity, geographical location, religion,
socioeconomic status, linguistic or political
• Integrated: providing care that is
coordinated across levels and providers and
makes available the full range of health
services throughout the life course.
resources and avoiding waste.
 NEW NORMAL = BALANCING ACT

SAAT NEW NORMAL RUMAH SAKIT

MEMILIKI BEBAN GANDA:
COVID 19 DAN PASIEN UMUM

“ Balancing Act ”, perawatan untuk pasien

COVID 19 tetap berjalan disaat bersamaan
pelayanan pasien umum juga berjalan dengan
resiko penularan seminimal mungkin 4

“ Shifts in behavior, new regulation, accelerated adoption of tech –it's the moment innovators have been waiting for “
SAFETY PROTOCOL LEBIH KETAT

1 Sterilisasi yang lebih massive

di fasilitas kesehatan4

2 Universal mask-penggunaan
masker untuk semua orang3

3 Prosedur screening yang lebih

ketat-rapid test, PCR2
4 Pengaturan jadwal kunjungan,
jaga jarak
5 Pemisahan fasilitas untuk pasien
COVID-19 dan non COVID-192

6 Pembatasan bagi pengunjung

dan pendamping pasien2
Priority service-pelayanan diprioritaskan kepada
kasus emergency, life-threatening situation, dan
severity/keparahan1
Telemedicine / virtual care-memaksimalkan
platform komunikasi yang ada untuk pelayanan
kesehatan5
Rapid test / PCR-menjadi requirement sebelum
tindakan (pre-op screening)1

Remote screening1

Sistem rujukan-travel restriction akan mempengaruhi

rujukan antar pulau
The Hospital readiness checklist sheet consists
of 12 key components that are essential to
managing COVID-19 in a hospital or facility

Component 1. Leadership and incident management

system
Component 2. Coordination and Communication
Component 3. Surveillance and information
management
Component 4. Risk communication and community
engagement
Component 5. Administration, finance and business
continuity
Component 6. Human resources
Component 7. Surge capacity
Component 8. Continuity of essential support
services
Component 9. Patient management
Component 10. Occupational health, mental health
and psychosocial support
Component 11. Rapid identification and diagnosis
Component 12. Infection prevention and control
 The Hospital readiness checklist sheet consists
of 12 key components that are essential to
managing COVID-19 in a hospital or facility

Component 2. Coordination
and communication
Accurate communication and
timely coordination are necessary
to ensure that risk analyses and
decision-making are informed by
data and there is effective
collaboration, cooperation and
confidence among all hospital staff
and stakeholders. This component
includes communication and
coordination both within the
hospital and through links with
local and national authorities,
including communities and primary
health care services

Reference;
1. Hospital readiness checklist for COVID-19: interim document, version 5, 10 February 2020. Washington, DC: World Health Organization, Pan American Health Organization.
(https://www.paho.org/en/documents/hospital-readiness-checklist-covid-19, accessed 13 March 2020).
2. Hospital readiness checklist for COVID-19: interim version, February 24, 2020. Copenhagen: World Health Organization, Regional Office for Europe (https://apps.who.int/iris/handle/10665/333972,
accessed 13 March 2020).
3. Hospital readiness checklist for COVID-19: interim document, version 1, March 29, 2020. Cairo: World Health Organization, Regional Office for the Eastern Mediterranean
(http://www.emro.who.int/images/stories/coronavirus/documents/hospital_readiness_checklist_for_covid_1 9.pdf?ua=1, accessed 28 May 2020).
 The range of approaches and interventions for
achieving continuity of care

Lembaga-lembaga Kesehatan yang

seharusnya mempunyai Knowledge
tentang Covid19 dengan baik;
• Policy maker/Regulator: Kemenkes,
DinKes
• Organisasi Pengelola Dana Kesehatan:
BPJS
• Organisasi pemberi pelayanan
kesehatan kuratif pemerintah/swasta:
RS, FKTP
• Organisasi pemberi pelayanan
preventif/promotif
• Lembaga-lembaga pendidikan/pelatihan
tenaga kesehatan
• LSM di bidang kesehatan
• ……………
Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health services, 2018
Drivers of continuity and care coordination

Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health
services, 2018
 PERUBAHAN PARADIGMA
PELAYANAN RUMAH SAKIT
1. Hospital Accreditation as a learning process
 Learning Organization  TAAT PROTOKOL
 TAAT REGULASI
2. Continuous quality improvement
3. Interprofessional collaboration
4. Patient Safety
5. People centered care-Integrated
6. Equitable-Timely
7. Effective-Efficient
8. Digital-IoT-AR-VR-3D-SMART System 
SMART Hospital
9. Manager-Leader-Leadership-
Hospitalpreunership-Driver-ITInnovation
 Setuju untuk
Be Tidak
Smart Quality HAM sepakat
Assesment?

INTEGRITY ?
 BEYOND THE RRP-PARADIGM

Source: Author’s own illustration ( 2016 )

TANTANGAN RESIKO RUMAH SAKIT
“ Category “

• Patient n Family Centre Care-People Centre Care,

PATIENT CARE Patient Safety, Terminal Care, Microba Resistensi,
Hospital Malnutrition, Safety Device, ….etc

• Good Clinical Governance, Good Ethic Governance,

Competent, Inter collaboration,trans profession,
MEDICAL STAFF Clicical Pathway, Code of Ethic, Code of
Conduct,Code of Professional…..etc

• the organization’s ability to acquire, manage,and

maintain a human workforce. Workers’
Compensation,occupational and environmental
EMPLOYEE hazards, turnover, absenteeism, workplace violence,
harassment, and discrimination all fall under this
domain.

• Good Corporate Governance, associated with an

organization’s ability to raise and maintain access to
capital, contracting issues, cost of risk, and
FINANSIAL evaluation of supplier support. This domain includes
risks eligible for risk financing techniques, such as
insurance,Potensial fraud, kickback
 STRATEGI
MENINGKATKAN MUTU & MENURUNKAN BIAYA
Criteria Strategi
Foundational 1. Governance priority: visible and determined leadership by CEO and board
elements 2. Culture of continuous improvement: commitment to ongoing, real-time learning

Infrastructure 3. IT best practices: automated, reliable information to from the point of care
fundamentals
4. Evidence protocols—effective, efficient, and consistent care
5. Resource use: optimized use of personnel, physical space, and other resources

Care delivery 6. Integrated care: right care, right setting, right providers, right teamwork
priorities 7. Shared decision making: patient-clinician collaboration on care plans
8. Targeted services: tailored community and clinic interventions for resource-intensive
patients
Reliability and 9. Embedded safeguards: supports and prompts to reduce injury and infection
feedback
10.Internal transparency—visible progress in performance, outcomes, and costs

Cosgrove D, et al, 2013

A forced reset of our society is the
perfect opportunity to explore
new areas for growth!

TERIMA KASIH
Shifts in behavior, new regulation,
accelerated adoption of tech –it's the
moment innovators have been waiting for.
If you want to travel fast, you travel alone…
If you want to go far, travel with others…