“PATIENT CENTERED CARE”

SEBAGAI TREND DAN ISSUE GLOBAL

PELAYANAN KESEHATAN

Dr. ADIB A YAHYA, MARS

INDONESIA COMMITTEE ON HOSPITAL PATIENT SAFETY
KOMITE KESELAMATAN PASIEN RUMAH SAKIT

BP3I : PELATIHAN KESELAMATAN PASIEN (PATIENT SAFETY IN NURSING)

“MEWUJUDKAN PELAYANAN KEPERAWATAN PROFESSIONAL
YANG BERORIENTASI PADA KESELAMATAN PASIEN “
JAKARTA \, 26 JANUARI 2017
 “TO ERR IS HUMAN” CORRIGAN, KOHN AND DONALDSON
US ACADEMY OF SCIENCES / INSTITUTE OF MEDICINE,
2000
• 1984 New York -2.9% of admissions suffered an adverse event, 58% of
which were preventable

• 1992 Colorado and Utah - 3.7% of admissions suffered an adverse event,

53% of which were avoidable

• Over 33.6Mn US hospital admissions pa between 44,000 and 98,000

avoidable deaths occur
8th most frequent cause of death
ahead of AIDS (16,516 deaths pa),
breast cancer (42,297 deaths pa) and
motor car accidents (43,458 deaths pa)

• Total cost to the US economy of avoidable deaths due to

healthcare error $17 - $29 Bn pa

HRRI.Healthcare Risk Resources International

To Err is Human:
Building a Safer Health System
(1999/2000)

IOM Study of Medical Errors

 (Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building
a safer health system. Washington, D.C.: National Academy Press, 2000.)

Laporan
Institute of Medicine – IOM
TO ERR IS HUMAN
Building a Safer Health
fe ty System
sa n !!
n t m i
a tie erja
P kt
a
tid

“Wake-up Call”
…….bagi dunia pelayanan kesehatan…….
Crossing the Quality Chasm: A
New Health System for the 21st
Century
  (2001)

IOM Study of Health Care Quality

 Crossing the Quality Chasm:

The chasm between what we know and what

we need to know to improve care

The chasm between care delivery and those

who do not fund, study, support, or publish
practical studies that address the real
problems of patients and care

The chasm between research and quality

improvement
IOM : Crossing the Quality Chasm
A New Health System for the 21st Century

Six Aims -- Health Care should be :

– Safe - No unintended injuries

– Effective - Based on evidence
– Patient-Centered
– Timely - No harmful delays
– Efficient - Waste avoided
– Equitable - No variance in quality
 Six aims for improvement health care system
Institute of Medicine : Crossing the Quality Chasm: A New Health System for the 21st Century,
2001
1. Safe. Avoiding injuries to patients from the care that is
intended to help them.
2. Effective. Providing services based on scientific knowledge
to all who could benefit and refraining from providing services
1. Safe. to those not likely to benefit (avoiding underuse and overuse,
respectively).
2. Effective.
3. Patient-centered. Providing care that is respectful of and
3. Patient-centered. responsive to individual patient preferences, needs, and
values and ensuring that patient values guide all clinical
4. Timely. decisions.
5. Efficient. 4. Timely. Reducing waits and sometimes harmful delays for
both those who receive and those who give care.
6. Equitable. 5. Efficient. Avoiding waste, including waste of equipment,
supplies, ideas, and energy.
6. Equitable. Providing care that does not vary in quality
because of personal characteristics such as gender,
ethnicity, geographic location, & socioeconomic status.

• Enam elemen ini dilahirkan oleh IHI Institute for Healthcare Improvement
• Publikasi pertama PCC oleh IOM
8
• WHO menjadikan 6 elemen ini sbg definisi mutu pelayanan kesehatan
 e fi nis i Patient-Centered Care
D

 IOM – Institute of Medicine

 Patient-centered care as “care that is respectful of and

responsive to individual patient preferences, needs and values,
and ensuring that patient values guide all clinical decisions.”

 ‘Patient-centered care’ sebagai “asuhan yang menghormati dan

responsif terhadap pilihan, kebutuhan dan nilai-nilai pribadi
pasien. Serta memastikan bahwa nilai-nilai pasien menjadi
panduan bagi semua keputusan klinis”
9
Tujuan utama pelayanan kesehatan
Rumah Sakit adalah
Pelayanan/Asuhan pasien.
“Core Business RS = Patient Care”

Asuhan Pasien
(Patient Care)

Cure Care
CARE = “Commitment – Attention – Respons – Empathy “
 Asuhan Pasien
Model Traditional

Asuhan Pasien
Model
Patient Centered
Care
Model Tradisional Pelayanan Kesehatan
“Dokter =
Perawat
Fisio Captain of the ship”
terapi Apoteker

Radio Dokter Pasien

grafer

Ahli
Analis Gizi
Lainnya

Pada Model tradisional pelayanan kesehatan, Dokter

merupakan unit sentral/pusat dalam model pelayanan
kesehatan, tetapi…..
Patient safety tidak terjamin !!
12
 Model Patient-centered Care
Staf Klinis
Perawat
“Dokter = Fisio
Team Leader” terapis Apoteker

>
“Interdisciplinary
Dokter Pasien
Team Integrasi Ahli
Model” Gizi

>
Radio
Kompetensi grafer Lainnya
Analis
yg memadai

 PCC merupakan pendekatan yg lbh modern dan inovatif dlm pelayanan kes sekarang,
diterapkan dgn cepat di banyak RS di seluruh dunia.
 Model ini telah menggeser semua PPK menjadi di SEKITAR PASIEN
 fokus pada pasien  Patient-centered Care
 Sbg tambahan, mereka semua sama pentingnya bila tiba pada kontribusi setiap
profesional dalam pelayanan kesehatan thd pasien dan tim
 “Interdisciplinary team model”  kompetensi-kewenangan yang memadai
 Professional Behavioral demonstrations of an
integrated set of knowledge, skills, and
Competency
attitudes that define the domains of work
of a specific health profession applied in
specific care contexts

Interprofessional Behavioral demonstrations of

Competency •an integrated set of knowledge, skills and attitudes for
•working together across the professions, with other health
care workers,
•and with patients/families / communities / populations
•to improve health outcomes in specific care contexts
14
 b eri
i Pem
Sis suha
n Interprofessionality
A
 Interprofessional Collaboration (IPC)
When multiple health workers from different professional
backgrounds work together with patients, families, carers, and
communities to deliver the highest quality of care
 Interprofessional Education (IPE)
When students from two or more professions learn about, from and
with each other to enable effective collaboration and improve health
outcomes

• The World Health Organization recognizes

interprofessional collaboration in education and practice
as an innovative strategy that will play an important role
in mitigating the global health crisis.
• We know that interprofessional collaboration is key to
providing the best in patient care.

(Framework for Action on Interprofessional Education & Collaborative Practice, WHO, 2010) 15
 b eri STANDAR KOMPETENSI DOKTER INDONESIA
i Pem
Sis suha
n Konsil Kedokteran Indonesia 2012
A

C. Penjabaran Kompetensi
1. Profesionalitas yang Luhur  Area Kompetensi
1.1. Kompetensi Inti…
1.2. Lulusan Dokter Mampu :
1. Berke-Tuhan-an (Yang Maha Esa/ Yang Maha Kuasa)
2. Bermoral, beretika, clan berdisiplin
3. Sadar dan taat hukum
4. Berwawasan sosial budaya
5. Berperilaku profesional
• Menunjukkan karakter sebagai dokter yang profesional
• Bersikap dan berbudaya menolong
• Mengutamakan keselamatan pasien
• Mampu bekerja sama intra- dan inter- profesional dalam tim
pelayanan kesehatan demi keselamatan pasien
• Melaksanakan upaya pelayanan kesehatan dalam kerangka system
kesehatan nasional dan global.
STANDAR KOMPETENSI DOKTER INDONESIA, Konsil Kedokteran Indonesia 2012 16
 IMPLEMENTASI
PATIENT CENTERED CARE
DI RUMAH SAKIT
 Standar Akreditasi Rumah Sakit
I. Kelompok Standar Pelayanan Berfokus pada Pasien
Bab 1. Akses ke Pelayanan dan Kontinuitas Pelayanan (APK)
Bab 2. Hak Pasien dan Keluarga (HPK)
Bab 3. Asesmen Pasien (AP)
Bab 4. Pelayanan Pasien (PP) PCC
Bab 5. Pelayanan Anestesi dan Bedah (PAB)
Bab 6. Manajemen dan Penggunaan Obat (MPO)
Bab 7. Pendidikan Pasien dan Keluarga (PPK)
II. Kelompok Standar Manajemen Rumah Sakit 
Bab 1. Peningkatan Mutu dan Keselamatan Pasien (PMKP)
Bab 2. Pencegahan dan Pengendalian Infeksi (PPI)
Bab 3. Tata Kelola, Kepemimpinan, dan Pengarahan (TKP)
Bab 4. Manajemen Fasilitas dan Keselamatan (MFK)
Bab 5. Kualifikasi dan Pendidikan Staf (KPS)
Bab 6. Manajemen Komunikasi dan Informasi (MKI) 18
III. Sasaran Keselamatan Pasien Rumah Sakit
Sasaran I : Ketepatan identifikasi pasien
Sasaran II : Peningkatan komunikasi yg efektif
Sasaran III : Peningkatan keamanan obat yg perlu
diwaspadai (high-alert)
Sasaran lV : Kepastian tepat-lokasi, tepat-prosedur,
tepat-pasien operasi
Sasaran V : Pengurangan risiko infeksi terkait
pelayanan kesehatan
Sasaran VI : Pengurangan risiko pasien jatuh
IV. Sasaran Milenium Development Goals
Sasaran I : Penurunan Angka Kematian Bayi dan
Peningkatan Kesehatan Ibu
Sasaran II : Penurunan Angka Kesakitan HIV/AIDS
Sasaran III : Penurunan Angka Kesakitan TB
19
 Standar PP.2.
Ada prosedur untuk mengintegrasikan dan mengkoordinasikan asuhan yang
diberikan kepada setiap pasien.
 Maksud dan Tujuan PP.2.
Proses asuhan pasien bersifat dinamis dan melibatkan banyak praktisi pelayanan kesehatan
dan dapat melibatkan berbagai unit kerja dan pelayanan.
Pengintegrasian dan koordinasi aktivitas asuhan pasien menjadi tujuan agar menghasilkan
proses asuhan yang efisien, penggunaan yang lebih efektif sumber daya manusia dan
sumber daya lain, dan kemungkinan hasil asuhan pasien yang lebih baik. Jadi para pimpinan
menggunakan perangkat dan teknik agar dapat mengintegrasikan dan mengkoordinasi lebih
baik asuhan pasien. (Contoh asuhan secara tim, ronde pasien multi departemen, kombinasi
bentuk perencanaan asuhan, rekam medis pasien terintegrasi, manager kasus/case
manager). 
Rekam medis pasien memfasilitasi dan menggambarkan integrasi dan koordinasi asuhan.
Khususnya, setiap catatan observasi dan pengobatan praktisi pelayanan. Demikian juga,
setiap hasil atau kesimpulan dari rapat tim atau diskusi pasien dicatat dalam rekam medis
pasien.
20
 Standar AP.4.
Staf medis, keperawatan dan staf lain yang bertanggung jawab atas
pelayanan pasien, bekerja sama dalam menganalisis dan mengintegrasikan
asesmen pasien.
Maksud dan Tujuan AP.4 dan AP.4.1.
Pasien mungkin menjalani banyak jenis asesmen diluar dan didalam RS oleh berbagai unit
kerja dan berbagai pelayanan. Akibatnya, terdapat berbagai informasi, hasil tes dan data lain
di rekam medis pasien. Manfaatnya akan besar bagi pasien, apabila staf yg bertangg-jawab
atas pasien bekerja sama menganalisis temuan pada asesmen dan mengkombinasikan
informasi dalam suatu gambaran komprehensif dari kondisi pasien. Dari kerja sama ini,
kebutuhan pasien di identifikasi, ditetapkan urutan kepentingannya, dan dibuat keputusan
pelayanan. Integrasi dari temuan ini akan memfasilitasi koordinasi pemberian pelayanan. 
Proses kerja sama adalah sederhana dan informal bila kebutuhan pasien tidak kompleks.
Pada pasien dengan kebutuhan yg kompleks kebutuhannya yg tidak jelas, mungkin
diperlukan pertemuan formal tim pengobatan, rapat kasus dan ronde pasien. Pasien,
keluarga dan orang lain yg membuat keputusan atas nama pasien dapat di ikutsertakan
dalam proses pengambilan keputusan, bila perlu.

21
 Standar MKI 6.
Informasi ttg asuhan pasien dan respon terhadap asuhan dikomunikasikan
antara praktisi medis, keperawatan dan praktisi kesehatan lainnya pd waktu
setiap kali penyusunan anggota regu kerja /shift maupun saat pergantian
shift.
Maksud dan Tujuan MKI 6.
Komunikasi dan pertukaran informasi diantara dan antar professional
kesehatan adalah penting utk mulusnya proses asuhan. Informasi penting dpt
dikomunikasikan dengan cara lisan, tertulis atau elektronik. Setiap RS
menentukan informasi apa yg dikomunikasikan, dgn cara apa, dan seberapa
sering informasi tsb dikomunikasikan dari satu praktisi kesehatan kpd
sesamanya, meliputi : status kesehatan pasien; ringkasan asuhan yg
diberikan; dan respon pasien terhadap asuhan.

22
 Case Manager
 KONTINUITAS PELAYANAN

*Standar APK.2. RS mendisain dan melaksanakan proses untuk

memberikan yan asuhan pasien yg berkelanjutan di dalam RS dan
koordinasi antar para tenaga medis.

*Standar APK.2.1 Dalam semua fase yan, ada staf yg kompeten sebagai
orang yg bertangg-jwb terhadap pelayanan pasien.

23
 T Catatan Perkembangan Pasien Terintegrasi
CPP
*Sem
Nama pasien ua
P
per
kem ember
“se banga i Asuha
mua n n
Tanggal (Tepi utk) (Tepi utk) mem pasien menu
bac d lis
Jam Dokter Staf Klinis lainnya a se isini, d ttg
mu a
a” n
10/5/13 S aaaa bbbbb ccccc hhhhhh vvvvvvv nbnnnnnn bbbbbbbbbb nn……..
7.30 O ddd eeee …..
A ggggg hhhhh kkkkk
P nnnn pppppp qqqqq
ttd, nama Perawat

8.15 S Ttttt fffff ppppp kkkkkk yyyyyy

O Eee ddddd xxxxx
A Aaaaa mmmmm dddd uuuuuuu aaaaaaaa mmmmmm ddddddddddd
P Rrrrr llll hhhh wwww
ttd, nama Dokter
9.10
S Ttttt fffff ppppp kkkkkk yyyyyy
O Eee ddddd xxxxx
A Aaaaa mmmmm dddd uuuuuuu aaaaaaaa ddddddddddd rrrr ccc.
Rrrrr llll hhhh wwww
P
ttd, nama Ahli Gizi
 T
CPP

25
The Core Concepts of
Patient Centered Care
 i
Sis n
ie
Pas What are the Core Concepts of Patient Centered Care?

1. Dignity and Respect. Health care practitioners listen to and

honor patient and family perspectives and choices. Patient and
family knowledge, values, beliefs and cultural backgrounds are
incorporated into the planning and delivery of care.
2. Information Sharing. Health care practitioners communicate and
share complete and unbiased information with patients and
families in ways that are affirming and useful. Patients and
families receive timely, complete, and accurate information in
order to effectively participate in care and decision-making.
3. Participation. Patients and families are encouraged and
supported in participating in care and decision-making at the
level they choose.
4. Collaboration. Patients and families are also included on an
institution-wide basis. Health care leaders collaborate with
patients and families in policy and program development,
27

implementation, and evaluation; in health care facility design;

and in professional education, as well as in the delivery of care.
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System.
Johnson, B et al. Institute for Family-Centered Care 2008
 Engaging Patients & Family :
A High Leverage Tool for Healthcare Leaders
b eri
i Pem (P. Sodomka in AHA Quality Update, 2006)
n
Sis suha
A
1. Pada model tradisional pasien & keluarga “dibangun” patuh kpd expertise
dari para pofesional yan kes  paternalistik.
2. Sedangkan pada model PCC diberlakukan kemitraan yg setara.
3. Dalam sistem yan kes masa kini, masih sulit bagi banyak orang utk
menghargai dan mengembangkan kolaborasi antar PPK dan pasien –
keluarga.
4. PCC memberikan perubahan mendasar dlm cara mengelola
RS !! ,konsep PCC terjalin ke dalam :
a. infrastruktur organisasi RS b. rencana stratejik,
c. visi dan nilai-nilai, d. rancang bangun fasilitas,
d. pola pelayanan, f. komunikasi, dokumentasi,
e. pengelolaan SDM, edukasi profesional, h. proses peningkatan mutu
serta keselamatan.

28
 b er
i WHO General Principles of Good Chronic Care
m
Pe n
si
Si suha (2003)
A
 
1.Develop a treatment partnership with your patient
2.Focus on your patient's concerns and priorities
3.Use the 5 A's: Assess, Advise, Agree, Assist, Arrange
4.Educate patient on disease and support patient self-management
5.Organize proactive follow-up
6.Involve "expert patients," peer educators and support staff in your
health facility
7.Link the patient to community-based resources and support
8.Use written information - registers, Treatment Plan, treatment cards
and written information for patients - to document, monitor, and remind
9.Work as a clinical team
10.Assure continuity of care

29
Framework for Nursing Practice

The Patient Centered Model of Care is grounded in the

Framework for Nursing Practice
 Framework for Nursing Practice
Nursing Framework is grounded in five guiding principles as well as the hospital’s core values:
 The Nurse
The role of the nurse is unique and essential to the care of the patient.
The nurse demonstrates that unique and essential function through the Seven Attributes of Hospital Nurse:
– Demonstrating compassion for patients and families
– Being knowledgeable in relation to complex patient care issues
– Being dynamic and proactive when planning, implementing and evaluating the plan of care
– Incorporating the role of patient advocate into the plan of care
– Working in collaboration with the interdisciplinary team
– Being accountable for nursing practice and adhering to professional standards
– Maintaining and advancing the practice of nursing and the professional image
Nursing
Nursing is both a science and an art.
art.
Nursing practice is evidence-based and blends research, knowledge and technology with individualized, compassionate
approaches to care.
Patient
The patient is at the center of care delivery.
Each patient is a unique human being with complex, dynamic needs.
Patients are encouraged to be active and engaged members of the healthcare team.
Family/Significant Other
Patients are part of a social support system.
Involvement of the patient's family and significant others is acknowledged and valued as an integral part of the plan of care.
Team
The nurse in collaboration with the patient/family and the interdisciplinary team develops an individualized, evidence-based plan
of care to promote health, ensure patient safety, facilitate recovery, and when appropriate, ensure a peaceful death for the patient.
 Expectations
• The nurse in collaboration with the patient, family, and the
multidisciplinary team develops an individualized plan of care to
promote health, ensure patient safety and facilitate recovery
• There is a team approach to achieve daily patient focused
individualized care goals
• Each team member is accountable for their role and responsibility
• Patient satisfaction will increase through anticipation of care needs
and consistency in the delivery of patient care
• The care approach used reflects the Patient Centered Model of
Care
• Staff satisfaction will increase through
improved communication and care coordination
 Patient Centered Care: Key Elements
Teams of RNs and PCTs collaborate to:

Engage your
patient in their
care during
bedside report

Communicate the Set daily individualized

plan of care and patient focused goals and
goal achievement work plans
to the next shift

Patient
Collaborate with your
patient, their family and Safety is a priority
the team in huddle with your team
interdisciplinary rounds

Pain, Toileting and

Positioning are key
during
hourly rounds

Everyone’s
For Every Patient Everyday
Responsibility

Drawn from the NMH Henderson Framework for Nursing Practice

 CONSUMER PARTNER
PATIENT

ISSUES :
ISSUES :
ISSUES : PARTNERSHIP
PREFERENCE,NEEDS,VALUE
IGNORANCY BUSINESS PCC
PATERNALISTIC EXPECTATIONS PFCC
“HALF MAN HALF GOD” DEMANDING FAP
LITIGIOUS SOCIETY PFAP
SUPPLIER INDUCED DEMAND
SUPPLIER REDUCED DEMAND DEFENSIVE PRACTICE MUTUAL TRUST
MUTUAL FAITH
 FINAL WORDS

" People don’t change when you tell them there is a better option.
They change when they conclude they have no other option “

Michael Mandelbaum

" It is not the strongest of the species that survives,

not the most intelligent,
but the one most responsive to change “

Charles Darwin
 Everybody will be happy

TERIMAKASIH 36