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Procedia - Social and Behavioral Sciences 00 (2015) 000–000
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Analysis of Performance Regional Public Hospital;

Used the Regulation of the Minister of Health no. 1171/Menkes/Per/VII/2011,
The Balanced Scorecard and Intellectual Capital Approach
Yurniwatia, Erinos. NRb, Dissa Elvarettac, Nisa Fajrinad
a
Accounting Department,Andalas University, Padang, 25163, Indonesia
b
Accounting Department, Padang State University, Prof. DR. Hamka, Padang, , Indonesia
c
Accounting Department, Andalas University, Padang, 25163, Indonesia
d
Accounting Department, Andalas University, Padang, 25163, Indonesia

Abstract

Performance refers to view of implementation of achievement level of activities/ programs/ policies in order to reach the target,
goals, vision, and mission of organization. This study aims to assess the performance of the Regional Public Hospital of dr.
Rasidin (RSUD dr. Rasidin) which is an asset of Padang local government. The performance of RSUD dr. Rasidin was assessed
with three approaches based on the Regulation of the Minister of Health no. 1171/Menkes/Per/VII/2011, the Balanced Scorecard
approach, and Intellectual Capital approach.
Data used in this study consists of primary and secondary data as well as qualitative and quantitative data. Methods of primary
data collection using questionnaire, respondents consist of customers and employees. Sampling method is a non-probability
sample that is using accidental sampling. Variables Measurement of Intellectual Capital performance uses the Pulic method
(1997). The method of analysis is descriptive comparative analysis.
The results showed that in 2011 and 2013 RSUD VAIC were negative, but positive in 2012. BSc Performance based on revenue
growth has increased from 2011-2013, TATO in 2013 decreased. Expenses decreased, the target and actual revenue was
decreased. From the customer’s perspective, customer acquisition has increased, especially for outpatient services. Customer
satisfaction is also quite high. On the internal business perspective has increased, and from the growth and learning perspective,
productivity of employees was increase and employee retention was high.

Keywords: Intelectual Capital, Balance Scorecard dan Performance

1. Introduction

Hospital is an organization that gives health services with activities that are done by medical, paramedical
and non-medical professions. It needs supporting equipment, infrastructures and human resources that are its assets.
In order to fulfil those needs, it certainly needs more investments. Entering competition in global market, hospital
needs to design its strategic planning. Hospital also needs to improve its quality, operations, services, quantity and
controls in order to compete in more competitive market. Consumers will certainly choose hospital which gives
excellent and professional services with competitive price to them. It can be a consideration to the hospital
managements to design the appropriate strategy that fits in with consumers’ needs. The chosen strategy has to fits in
with hospital’s vision and mission. Then, those vision and missions are translated to a set of strategic goals that will
be achieved in the future. To make sure that the strategic planning are good, hospital management need to
implement those plans in accordance with the determined goals. After that, hospital performance evaluation both
financial and non-financial needs to be done as management’s evaluation and control activities.
Performance is the result of the organization’s activity and operations in a period. It reflects the success of
personnel, team or organization’s unit in achieving determined strategic goals with the expected behaviour.
(Mulyadi, 2007: 419). There are many tools to measure organization performance both financial and non-financial
*Corresponding Author . Tel +628 1363 792432 (Yurniwati)
Email address : Yurniwati_feunand@yahoo.co.id (Yurniwati)
1877-0428 © 2015 The Authors. Published by Elsevier Ltd.
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 2

performance (Suta, 2007). Financial performance can be classified as accounting based performance (ROE, sales
growth, profitability, ROA, liquidity) and market based performance (stocks, stocks distribution, market
capitalization, stocks liquidity and other market ratios). Another performance measurement can use balanced
scorecard approach (Kaplan and Norton, 2000), intellectual capital (Pulic, 1998) and for the governnmental hospital
can use the regulation of health minister of Republic of Indonesia no. 129/Menkes/SK/II/2008.
This research aims to analyse hospital performance with using national services standard (the regulation of
health minister of Republic of Indonesia no. 129/Menkes/SK/II/2008), Balanced Scorecard (Kaplan and Norton,
2000) and Intellectual Capital (Pulic, 1998). This research is essential to be done, because hospital is a services
organization which uses medical experts and equipment that requires significant investment. Medical experts in
hospital such as doctor, is intangible asset with high value, so that they need to be included in measuring
organization performance. So that, financial aspects are not enough to measure hospital performance.
Why is so important to use these three performance evaluation methods?
First, the results of the previous research about Balanced Scorecard emphasizes performance measurement
is useful to evaluate the determined strategies of the organization based on four different perspectives. Kenton B.
Walker (2006) studied about productivity and performance improvements of a hospital with Balanced Scorecard
approach. He found that hospital needs to improve its services quality and productivity with using creativity and
initiative in order to make its image and management looks good in its stakeholder’s views. In this case, Balanced
Scorecard is able to measure and drive company’s productivity improvement, in order to achieve company’s goals.
Second, the previous research’s result about intellectual capital stated that the importance of intellectual
capital based performance evaluation. Firer and William’s research (2003), Intellectual Capital Measures of
Corporate Performance, found that the relationship among each of IC elements with financial performance is varied
and is influenced by industrial types. Structural capital has the most significant relationship if it’s compared with
human capital and costumer capital elements. Yurniwati (2010) studied Intellectual Capital & manufacturing and
services companies’ performance; found that VAIC TM has significant influence on manufacturing and services
firms’ performance, but with different significance level where services companies are more influenced than on
manufacturing companies.

2. Literature Review And Hypotheses

2.1 Organization Performance

Performance is the result or the level of overall individual or organizational success in one period. It is also
a set of results that can be achieved and refers to the act of the achievement and implementation of the done job.
Performance needs to be assessed or measured its goal, in order to determine how the plan’s achievement level that
has implemented . It can also be used to determine strategy’s implementation level that has been determined. In
addition, performance can be used as a tool in control and evaluation.
Performance is defined as something that is achieved, achievement that is shown and work ability. It is
capability with using power (Indonesian Dictionary, 1995). According to Pratolo (2007), performance is an action
pattern that is done in order to achieve the goals measured by going upon a comparison with various standards.
Balanced scorecard is one of the performance measurement methods that combine financial and non-financial
measures. It has been implemented in many manufacturing companies and recently becomes a trend in hospital
performance measurement. Moreover, balanced scorecard is also being the best tool in in designing strategic
planning (Pieper S.H, 2005). Balanced scorecards is strategic management system which translates organization’s
vision and strategy into an operational purpose and measure that is stated in four perspectives, such as financial,
customers, internal business process and learning and growth perspective(Kaplan and Norton, 1996). According to
Anthony and Govindarajan (2003) , Hansen and Mowen (2006: 521), Tunggal (2002) and Mulyadi (2005),
Balanced scorecards is a tool to see the organization distinctly, communication improvement, build organizational
goals and feedbacks for strategy.

2.2 Business Performance Perspective Measured in Balanced Scorecard

There are four types of business performance measured in balanced scorecard, namely:
a. Financial Performance, Financial perspective’s targets are distinguished in each stage of business cycle
(Kaplan and Norton , 2000): Growth Stage, Sustain Stage and Harvest Stage. It should be admitted that
financial performance is still be in the spotlight. It is very reasonable because financial measure is an
economic consequences’ summary which is caused by decision and economic act in the past. Financial
performance can be measured based on liquidity, solvability, and return on investment, profit margin and
operation ratio.
b. Customer Performance. Kaplan and Norton (2000: 58) explained that there were two related
measurement groups in customer perspective, namely: Core Measurement Market Share , Customer
Acquisition, Customer Retention, and Customer Satisfaction level. Supporting group (performance
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 3

drivers); Product Attributes,Relationship with customer, Company’s image, reputation and products in the
eyes of its customers and consumers.
Performance is essential today because of the more intense competition in maintaining existing market and
size the new market share.
c. Internal Business Process Performance. According to Kaplan and Norton (2000: 83), in internal business
process manager must be able to identify important internal process where company is required to do well
because that internal process has the desired values of consumer and can provide the expected return by
shareholders. Steps in internal business process include: Innovation, Operational Process and Products or
Services Delivery Process to Customers
d. Learning and Growth Performance. The factors that must be considered are (Kaplan and Norton, 2000:
110): People, Related to human resources, there are three things that need to be reviewed in implementing
balanced scorecard:

2.3 Implementation of Performance Measurement Using Balanced Scorecard Approach at The Hospital
Although performance measurement by using balanced scorecards is more used in companies which
produce goods, but it can also be implemented in a hospital which produces services. Therefore, hospital’s
ability in mobilizing and exploiting its intangible assets can be seen. For example, Peel Memorial Hospital
Vancouver Canada uses balanced scorecard as an evaluation and performance measurement framework &
applies it in its organizational strategic planning to improve its performance. Mayo Clinic, a health institution in
United States also develops a performance measurement system using balanced scorecard to its outpatient
business unit. John R. Griffith and John G. King in Journal of Healthcare Management Jan/Feb 2000 edition
and Chee W Chow et. al in the same journal but in May 1998 edition also advocate the use of balanced
scorecard in health organization. By knowing the description of hospital’s performance through those four
perspectives, required improvement processes to make hospital survive in its industry can be done.

2.4 Intellectual Capital

Intellectual capital is a value and competitive advantage driver of a company, so that It needs an
appropriate measure to assess it (Chen et al, 2005). Pulic (2000) introduces an intellectual capital measure to
assess value added efficiency as a result of company’s intellectual ability (Value added Intellectual Coefficient –
VAICTM). The core component of VAICTM can be seen from company’s resources, namely physical capital (value
added human capital employed – VACE), human capital (value added human capital – VAHC) and structural
capital (value added structural capital – VASC). Leif Edvinsson (1997), an intellectual capital’s academician and
practitioner, identified intellectual capital as a hidden value of a business. Intellectual capital “hidden”
terminology is used to two related things. First, intellectual capital especially intellectual assets or knowledge is
generally invisible like traditional asset. Second, assets like intellectual assets are usually not seen in financial
statements. Leif Edvinsson illustrated intellectual capital in a company with an interesting picture, that is a fruit
tree picture. Intellectual capital is like the root of a fruit tree or a company (Figure 1).

Figure 1
Illustrasion of Fruit Tree (Intellectual Capital)

Source: Edvinsson, 1996

 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 4

2.5 Conceptual Framework

Based on previous explanation, this research’s conceptual framework can be seen as follows:
Figure 2 Conceptual Framework

*NSS = Indonesia National Services Standard or Standar Pelayanan Nasional (SPN).

3. Methodology

3.1.Research Goal;
This research has goal to determine the differences with three approaches, there are: Intellectual capital,
Regulation of Minister of health, and Balance scorecard.
3.2 Sample and Data Collection;
This research is a descriptive comparative research with qualitative and quantitative data analysis. It
discusses performance level of regional public hospital dr. Rasidin (RSUD dari. Rasidin) using balanced
scorecard approach. This research uses primary and secondary data analysis. Primary data were collected
qualitatively by doing observation. While secondary data were obtained from the data available in the hospital.
Research’s location is in regional public hospital dr. Rasidin (RSUD dari. Rasidin) and research is done from July
to September 2014.
3.3 Research Design
3. 3. 1According to National Services Standard (Standar Pelayanan Nasional) of hospital in Indonesia, based on
regulation of health minister of Republic of Indonesia no. 1171/Menkes/Per/VII/2011, namely:

1. Financial Performance; Revenues budget realization is to know how far hospital is able to realize targeted
budget revenues. Error! Reference source not found. x 100%
Cost increase or decrease is a guidance to know whether hospital has been able to achieve cost efficiency
in using cost allocated by the government.
Formula: Error! Reference source not found. x 100%
2. Hospital Services Standard
There are six categories of hospital’s services standard based on regulation of health minister of Republic
of Indonesia no. 1171/Menkes/Per/VII/2011, namely:
Bed Occupancy Rate (BOR) is total bed used compared with total bed available in a certain period.
BOR =Error! Reference source not found. x 100%
Where: BOR ideal value is 60 to 85
Average Length of Stay (ALOS) is the average length of a patient being treated.
ALOS = Error! Reference source not found.
Where: ALOS ideal value is 6 to 9 days

 BTO (Bed Turnover Rate) is the frequency of bed occupancy, how many times in a certain period
hospital’s bed used.
BTO = Error! Reference source not found.
Where: BTO ideal value is 40 to 50 times
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 5

 Turn Over Interval (TOI) is the average days of unused bed usage turnover from the time when the
bed used to the next usage of the bed in a year. Formula:
TOI = Error! Reference source not found.

Where: TOI ideal value is 1 to 3 days

 GDR (Gross Death Rate) is general mortality rate of each 1,000 patients out.
Formula:
GDR = Error! Reference source not found. x 1000 mil

Where: GDR ideal value is < 45/1000 patients out

 NDR (Net Death Rate) is mortality rate of patients after 48 hours being treated of each 1,000
patients out. This indicator gives a description of services quality in the hospital.

Formula: NDR = Error! Reference source not found. x 1000 mil

Where: NDR ideal value is < 25/1000 patients out

3.3.2 Balanced Scorecard

1. Analyzing quantitative data for measuring performance of RSUD dr. Rasidin based on balanced scorecard and
score obtained from each measurement both based on hospital’s standards and balanced scorecard, then the
result of analysis is compared. Measurement with higher score shows better level of accuracy. This
measurement is useful to know whether hospital performance during observation period is good or not based
on balanced scorecard method. The formulas used to measure the performance of RSUD dr. Rasidin with
balanced scorecard approach are:
a. Financial Perspective
Financial perspective is a very important measure in knowing how the performance of economical action
which has been taken. Financial performance measure provides an assessment on financial target reached
by the organization in achieving its vision and missions. Financial perspective in this research includes:
Revenue growth measured by deducting current period revenues with previous year revenues and then
divided by previous year revenues & multiplied by 100 %
Total Asset Turnover(TATO) is a measure to assess how well hospital in managing its assets to generate
revenue.Formula: TATO = Error! Reference source not found.
Cost increase or decrease is a guidance to know whether hospital has been able to achieve cost efficiency in
using cost allocated by the government.
Revenues budget realization is to know how far hospital is able to realize targeted budget revenues.
Formula: Error! Reference source not found. x 100%
b. Customer Perspective
This perspective uses calculation as follows:
Customer Acquisition; is useful for measuring success level of hospital in increasing its total customers,
even for attracting new customers, by comparing total inpatient visits, outpatient, and emergency room in
2011 to 2013.
Customer Satisfaction; is used to measure how satisfied customers are on health services provided by
hospital. It is measured by using primary data through questionnaire spreading to hospital’s patients.
Patients can give their assessment on hospital’s services by answering the questions list in the questionnaire
in accordance with its satisfaction level. Value given is classified as follows: 1) very dissatisfied, 2)
dissatisfied, 3) satisfied enough, 4) satisfied, 5) very satisfied.
Consumer Satisfaction Index (CSI) is used to measure customer satisfaction. It is the result of addition of
value obtained from respondents like what Sugiyono (2002:79) has formulated, namely:
CSI = PP ; Explanation: CSI= Customer Satisfaction Index, PP = Perceived Performance
To define minimal value which must be obtained by respondents to be categorized as satisfied, with seeing
minimal value which all respondents have to achieve to be categorized as: 1) very dissatisfied, 2)
dissatisfied, 3) satisfied enough, 4) satisfied, 5) very satisfied.
c. Internal Business Process Perspective
In internal business perspective, hospital has to be able to identify various important processes to achieve
customers and employees’ purposes. In this perspective, performance is viewed from two parts, namely
operational and innovation process. This perspective sees how hospital performs best quality health
services process with using measurement standard from regulation of health minister of Republic of
Indonesia no. 1171/Menkes/Per/VII/2011.
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 6

1) Operational Process
a) Total Outpatient Visits
The measurement by comparing total outpatient visits each year, from 2010 to 2013.
b) Total Inpatient Visits
To see how the development of total patients every year by comparing it with the previous period.
2) Innovation Process
Innovation process level will determine how high the level of quality improvement of services offered
in term of availability of new medical equipments.
d. Learning and Growth Perspective
Measuring performance of learning and growth perspective uses calculations as follows:
 Employee Productivity = Error! Reference source not found.

 Employee Retention = Error! Reference source not found. x 100%

 Employee Satisfaction
This measurement is done for measuring employees’ satisfaction level on hospital where it is a
precondition for the improvements of productivity, responsiveness, quality and services to customers
(patients). It is conducted by spreading questionnaire to employees. To know employees’ satisfaction
level, we can use given value of respondents in the questionnaire, namely: 1 = Strongly Disagree
(SDA, 2 = Disagree (DA) , 3 = Agree Enough (AE) , 4 = Agree (A) , 5 = Strongly Agree (SA)

3.3.3 Intellectual Capital

Intellectual capital is calculated based on VAICTM core components which can be seen from company’s
resources VAIC™ = VACA + VAHU + STVA. Formulation of VAIC™ calculation comprises of several phases,
namely:
1. Measuring Value Added (VA)
Value added (VA) is the difference between output and input. Based on stakeholders’ perspective,
researchers used wider definition in calculating VA (Donaldson and Preston, 1995). Stakeholders’ perspective
stated that each group which can influence or is influenced by achievement of company’s objectives has to have
a stake/foothold in company. These shareholders include shareholders, employees, lenders, goverment and
society. Therefore, in measuring company’s performance, the wider value added measure by stakeholders is
better than accounting profit which only calculates return for shareholders.
Explanation:
Output (OUT): is income obtained by company from its main operational activity (operating income).
Input (IN) : includes the whole company’s expenditure in generating revenues, either directly or indirectly,
but not include company’s expenditure for salary, depreciation, tax interest, rental expense and dividends.
Value added can also be calculated by using company’s financial data in its financial statements, namely:
where:
VA = OUT – IN VA = OP + EC + D + A
OP = operating profit; EC = employee costs; D = depreciation; A = amortisation
2. MeasuringCE(Capital Employed), HU(Human Capital) and SC (Structural Capital)
According to several studies such as Mu Shun Wang (2011), Chen et. al (2005), Ulum (2005), Rini (2004
), Firer and Wiliams (2003) and Pulic’s research (2000), those three core components of resources: CE, HU and
SC based on its definition are:

CE = Physical Capital + Financial Asset HU = Total expenditure on employess

SC =Asset
= Total Asset - Intagible Value Added-Human Capital
Dividing company’s resources into CE and HU is consistent with corporate resource-based view or
company’s resources-based perspective (Riahi-Belkaoui, 2003). The resource based view stated that company’s
resource is the main incentive of company’s effectiveness and performance. This resource includes tangible and
intangible assets. CE is an estimation of tangible resources and HU is the main intangible resources measure.
To determine capital employed can be seen in total net assets in company’s financial statements, while
financial assets can be seen on investment or invested financial assets to generate value added for company’s
finance. Human capital is defined as all expenditures relating to company employees which includes total
salaries, wages and employees’ benefits. In intellectual capital concept, human capital is a key source
(investment). Employees use and invest their knowledge and skills in all company’s activities and are reflected in
generating value added.
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 7

3. Measuring three components of Value Added Intellectual Coefficient (VAICTM), using formula as follows:

 Value Added Efficiency of Capital Employed (VACA)

Value Added Capital Employed(VACA) shows contribution of each unit of CE on organization’s value
added. VACA = VA : CE
 Value Added Efficiency of Human Capital (VAHU)
Value Added Human Capital (VAHU) shows contribution of each Indonesian rupiah (IDR) invested in
HC on organization’s value added. VAHU is calculated with using the following formula: VA: HU
 Value Added Efficiency by Structural Capital (STVA)
Value Added Structural Capital (STVAmeasures ) total SC required to generate each Indonesian rupiah
(IDR) from VA and is the indication on how successful SC in generating value.STVA = SC : VA
After getting values of each component, then to measure intellectual capital performance can be calculated by using
measurement method of value added intellectual coefficient (VAIC™). This method formula is as follows:

VAIC™ = VACA + VAHU + STVA

Value Added Intellectual Coefficient (VAIC™) indicates organization’s intellectual ability. In simpler words,
VAIC™ measures how much “new value” created in each invested monetary unit in company’s resources.
Population, Sample and Sampling
Based on above formula to calculate sample, this research minimum sample is 100 patients of 44,680 patients.
Population size as 44,680 patients is total of both inpatient and outpatient visits of RSUD dr. Rasidin during 2013.
Sample collection method used to assess employees satisfaction level is probability sampling technique, namely
with simple random sampling which provides unlimited opportunity to each individual in population to be chosen
as sample.
Sample size used is as follows:
n = Error! Reference source not found. ; n = Error! Reference source not found. ; n = 78,35 rounded
into 78. Sample size for employees is determined as 78 of 362 employees. Population size as 362
employees is total employees of RSUD dr. Rasidin in 2013.

2.1. Analyses and Results

The calculation result using these three approaches gives an overview of various performance. RSUD’s
performance is stated less good if only measured based on regulation issued by Health Minister. It is proven by
measurement indicators that are adjusted to National Hospital Services Standards based on regulation of health
minister of Republic of Indonesia no. 1171/Menkes/Per/VII/2011 such as Bed Occupancy Rate (BOR), Average
Length of Stay (ALOS), Turn Over Internal (TOI), Bed Turn Over (BTO), Gross Death Rate (GDR) and Net Death
Rate (NDR). These indicators show that services standard which has been implemented by RSUD is categorized as
less good. It is occurred because the calculation results are lower than standard values which Health Minister of
Republic of Indonesia has been determined.
If hospital’s performance measured by using balanced scorecard approach, then will provide different
conclusion. RSUD’s performance is categorized as good enough. It is caused by several assessment perspectives
show good results during the research period. Based on financial perspective, RSUD dr. Rasidin’s performance
shows less good performance and is not optimal yet in generating revenues for hospital and its investors. Two
indicators in this perspective have been achieved, namely revenues growth and the existence of reduction in
spending every year but three other indicators such as Total Assets Turnover (TATO) , revenues budget realization
and Return on Investment (ROI) are not achieved. TATO shows a high enough decline in percentage because
RSUD dr. Rasidin is in the period of improvement and development. Therefore, there is significant addition in its
assets which makes an increase in its total assets and is not directly proportional to revenues realization obtained by
RSUD dr. Rasidin. ROI also shows the same indication where ROI value is low and negative but has increased from
year to year .Based on customer perspective, RSUD dr. Rasidin’s performance is stated to be good. Customer
perspective indicators, namely customer acquisition and satisfaction have been achieved well. Patients were satisfied
enough with the existing services provided in RSUD dr. Rasidin. But It will be good if RSUD dr. Rasidin further
improves its health services in order to achieve higher level of customer satisfaction. Based on internal business
process perspective which consists of two main indicators: operational and innovation process. These two indicators
have been assessed good enough. Although in operational process variable is still not achieving optimum standards
overall, but there is an increase in every year. The increase in operational process is to optimize business operational
process in accordance with standards from Health Ministry of Republic of Indonesia. While innovation process has
been assessed good because RSUD dr. Rasidin is in growing, improvement and development stages. In learning and
growth perspective, RSUD dr. Rasidin has been assessed good in both employee productivity and satisfaction
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 8

indicators. But employees’ retention is high in 2013. It is because of employees’ mutation ordered by the
government of Padang. Hospital’s performance based on this perspective has been considered good enough and
showed that RSUD dr. Rasidin’s employees are responsible in carrying out tasks that have been assigned. RSUD dr.
Rasidin has established good relationships with its employees. Overall total scores obtained by RSUD dr. Rasidin is
three scores of total standard weights, so obtained average score is 3/19 = 0.16. Then make a scale to assess that
total score, so that RSUD dr. Rasidin’s performance can be said as “less good”, “good enough” and “good”.
According to Mulyadi (2001), if the total score is lower than 50% (0 score), then performance is said as “less good”,
and performance is said as “good” if it is higher than 80% that is equal to 0.6. But if the total score is between 0 to
0.6, then the performance is said as “good enough”. Performance measurement standard of RSUD dr. Rasidin using
balanced scorecard approach shows that it is in “good enough” category, because of its total score is in 0 to 0.6
interval.
Intellectual capital provides the same performance’s overview as BSc that RSUD dr. Rasidin’s
performance is assessed as good enough. Performance measurement in 2011 shows that hospital’s performance is
less good. It is indicated by negative VAIC value. In 2012, there is an increase in performance measure with positive
VAIC value. And in 2013, hospital’s performance is also categorized as good because of its positive VAIC value.
Although VAIC showed positive value in 2013, but hospital’s performance declined from previous year. It was
occurred because of decrease in VAIC value in 2013. During research periods, hospital’s performance was
considered as good enough. VAIC value was composed of VACA, VAHU and STVA value. In 2011, component
affected VAIC value became negative is high capital expenditures spent by hospital but that expenditures were not
yet able to provide positive contribution on revenues obtained by hospital. Capital expenditures conducted by
hospital in 2011 is in the form of medical equipment procurement in order to fulfill the needs of rooms which were
in development process. In that year, there was development of surgical wards. Therefore capital expenditures were
referred to fulfill those rooms’ needs of equipments. VAHU value in 2011 also showed negative value. It proved
that employees’ capabilities such as skills, competence and knowledge have not been able to contribute on revenues
increase received by hospital. Negative VAHU values also occurred in the next two years: 2012 and 2013.
Intellectual properties possessed by employees have not been able to increase hospital’s revenue. Thus, hospital’s
VAHU values in 2011 to 2013 can be said less good. But company’s resources to generate revenues are not only
based on employees’ capability and its total assets. There is another factor that affects VAIC value, namely
structural capital. Structural capital is other resources used by hospital in order to create value added. In this case,
structural capital has contribution inversely proportional to human capital. Therefore, if VAHU has low contribution
in creating value added, then STVA will provide high contribution in that value creation. In 2011, VAIC obtained
showed negative value. It is what makes hospital categorized as having less good performance in that year. This less
good performance occurred because hospital’s resources, either intellectual assets or intellectual property were not
able to create value added for hospital. Different fact found in 2012 and 2013 where STVA showed positive value. It
provides contribution to hospital’s VAIC value for 2012 and 2013 to become positive. Thus, hospital could be
categorized as having a good performance in 2012 and 2013, even though there was a performance decline in 2013.

3. Conclusion and directions for future research

Performance measurement on RSUD dr. Rasidin is conducted based on Indonesia National Services
Standards (NSS), Balanced Scorecard and Intellectual Capital approach. These three approaches provide different
measurement results on each indicator. Every indicator gives an overview of overall performance of this hospital is
good, measured by using both financial and non-financial perspective.
Based on Indonesia National Services Standards (NSS), hospital’s overall performance is interpreted as less
good because the achievement levels of BOR, ALOS, BTO and TOI are also less good. While other indicators such
as GDR and NDR are assessed as good. Based on Balanced Scorecard approach, hospital’s performance is
considered as good enough. This approach measures performance based on financial and non-financial perspective.
In financial perspective, hospital’s performances is considered as good enough, and so are in other perspectives in
this approach: customer, internal business process and learning and growth perspective. Based on Intellectual
Capital approach, hospital’s performance is considered as good enough. Hospital performance is measured by using
VAIC components: VACA and VAHU indicators show less good performance while STVA indicator shows good
performance. Thus, hospital’s performance is entirely assessed as good enough seeing from VAIC value which
shows good enough performance.
Hospital management should use the results of this research to increase and improve all indicators which
are still in less good performance. This improvement will increase overall performance of hospital in the future.
Improvement can be done in both financial and non-financial aspects such as revenues realization, improvement in
quality, operation, services, quantity and quality control in order to compete in more competitive health services
market. Hospital management need to focus on inpatient services in hospital, where patients are still less satisfied
upon this services’ performance. It occurred because total beds available to use, total treatment days for inpatient
 Yurniwati et.al / Procedia - Social and Behavioral Sciences 00 (2015) 000–000 9

visits, usage frequency of beds and Beds Turnover Rate (BTO) are still not well-managed. Hospital management
should be able to increase its revenues from health services offered in order to achieve optimum level of revenues
realization and higher return on investment. Hospital management also need to be able to maintain its lower
employees’ turnover in order to provide optimum health services for its customers.

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