Analisis Faktor-Faktor Yang Berhubungan Dengan Kualitas Kolaborasi Antara Dokter Dan Perawat Di Rumah Sakit Permata Medika Semarang

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2017 ABSTRAK Irena Intania Analisis Faktor-Faktor Yang Berhubungan Dengan Kualitas Kolaborasi Antara Dokter Dan Perawat Di Rumah Sakit Permata Medika Semarang xviii + 100 halaman + 42 tabel + 2 gambar + 14 lampiran Kolaborasi yang tidak berjalan dengan baik dapat mempangaruhi kualitas pelayanan yang diberikan kepada pasien, sehingga hal tersebut dapat mempengaruhi kesembuhan pasien. Bagi profesi dampak buruknya kolaborasi mempengaruhi hubungan dan kepuasan kerja dokter maupun perawat, sedangkan bagi manajemen pengaruh kolaborasi yang tidak baik adalah turunnya BOR dan meningkatnya lama perawatan karena tidak efektifnya pelayanan kepada pasien hal tersebut dapat berdampak pada kepuasan pasien. Penelitian kuantitatif belah lintang (Cross Sectional) untuk menghitung kuisioner value customer dengan skala Likert dan kualitatif melalui observasi, telaah dokumen kolaborasi antara dokter dan perawat. Wawancara mendalam (in-depth interview) dan wawancara tidak terstruktur dengan informan teripilih dan ditentukan. Sampel dalam penelitian ini 15 dokter umum dan 15 Ners yang bekerja di RS Permata Medika sampai Desember 2016. Responden laki-laki (83,3%), perempuan (16,7%) Umur <25 (20%) umur 25-35 tahun (43,3%), >35 tahun (36,7%). Tingkat pendidikan dokter 50% dan ners 50%. Masa kerja responden 1-2 tahun (83,3%), >2tahun (16,7%) responden. Karakteristik individu berperan signifikan terhadap kolaborasi. Karakteristik individu yang paling berperan terhadap kolaborasi adalah usia. Temuan yang didapatkan peneliti untuk kontrol kekuasaan masih sulit terjadi akibat hubungan yang seimbang antara kedua profesi tersebut dan komunikasi yang terjalin kurang bagus. Tentang lingkup praktek telah terjalin kolaborasi yang baik antara dokter dan perawat. Untuk kepentingan bersama kedua profesi tidak memperhatikan dan melihat prosedur tetap pelayanan dan pada tujuan bersama kolaborasi dokter dan perawat terdapat tumpang tindih tanggungjawab dengan alasan pekerjaan yang terburu-buru tanpa memperhatikan Standar Operating Procedur (SOP) dan job description. Kata kunci : Kolaborasi, Karakteristik Individu, Dokter, dan Perawat Kepustakaan : 35 (1994-2013)Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2017 ABSTRACT Irena Intania Analysis of Factors relating to Collaboration Quality between Physicians and Nurses at Permata Medika Hospital of Semarang xviii + 100 pages + 42 tables + 2 figures + 14 appendices Not good collaboration influences a quality of provided services to patients by which it can affect their healing processes. Bad collaboration also influences the relationship between a physician and a nurse. For management, this condition can decrease BOR and increase the length of treatment due to ineffectiveness of services to patients that can affect to patients’ satisfaction. This was a cross-sectional study to calculate a questionnaire of customers’ value using Likert scale and using a qualitative method by observing, undertaking a review of collaboration documents between a physician and a nurse. Indepth interview and unstructured interview with selected informants were conducted. Samples of this study consisted of 15 medical doctors and 15 nurses who had been working at Permata Medika Hospital until December 2016. Proportions of the respondents based on sex differences were male (83.3%), female (16.7%). Proportions of the respondents based on their ages were <25 years old (20%), 25-35 years old (43.3%), and >35 years old (36.7%). Proportions of educational levels of a physician and a nurse respectively were 50% and 50%. Proportions of working period were 1-2 years (83.3%) and >2 years (16.7%). Individual characteristics significantly played an important role to collaboration. The most important individual characteristic was age. The findings of this study demonstrated that there was any difficulty in controlling authority because the relationship between these both professions was equal and communication was not good. Regarding a scope of practice, the collaboration between them was good. These both profession did not pay attention to a fixed service procedure. The goals of these both professions were overlap with the reasons that all works needed to be accomplished soon without paying attention to Standard Operating Procedure (SOP) and job descriptions. Keywords : Collaboration, Individual Characteristics, Physician, Nurse Bibliography: 35 (1994-2013

Analisis Faktor – Faktor Yang Mempengaruhi Potensi Terjadinya Fraud Klaim Pada Program Jaminan Kesehatan Nasional Di RSUD Dr. H Soewondo Kendal

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2017 ABSTRAK Saikhu Analisis Faktor – Faktor Yang Mempengaruhi Potensi Terjadinya Fraud Klaim Pada Program Jaminan Kesehatan Nasional Di RSUD Dr. H Soewondo Kendal xviii +97 halaman + 11 tabel + 5 gambar + 6 lampiran Penulisan resume medis yang tidak dilengkapi oleh dokter segera setelah pasien dilayani dan dirawat di rumah sakit umum dr. H. Soewondo Kendal dapat berpotensi terjadinya kekeliruan pada pengkodingan untuk klaim. Persoalan lain tentang perbedaan tarif antara tarif rumah sakit berdasarkan peraturan bupati dan besaran klaim sesuai tarif INA-CBGs yang terpaut jauh pada beberapa kasus penyakit diduga juga turut memicu potensi terjadinya fraud. Tujuan dari penelitian ini untuk mengungkapkan faktor – faktor yang mungkin dapat memicu potensi terjadinya fraud di rumah sakit dr. H. Soewondo Kendal Metode penelitian yang digunakan adalah jenis penelitian deskriptif dengan cara observasi dilanjutkan dengan focused group discussion (FGD) untuk menentukan prioritas yang paling memungkinkan munculnya potensi terjadinya fraud dan diteruskan dengan wawancara mendalam. Penelitian ini melibatkan 5 informan utama dan 2 informan triangulasi. Didapatkan 3 potensi terjadinya fraud yaitu: fragmentasi pelayanan (unbundling), upcoding dan self referal yang ditinjau dari 3 aspek yaitu opportunities, preasure, dan razionallization. Hasil penelitian menunjukkan bahwa terdapat belum maksimalnya pengawasan dan pengendalian ditiap tahapan pelaksanaan pelayanan pasien peserta BPJS Kesehatan. Ditemukan adanya kebijakan yang berpotensi menimbullkan potensi terjadinya fraud. Terdapat disparitas yang tinggi antara tarif yang berlaku berdasarkan peraturan bupati dengan tarif klaim InaCBGs yang juga berpotensi terjadinya fraud. Sistem pengkodingan diagnosa dan tindakan berdasarkan ICD-9 dan ICD-10 belum dipahami dengan baik oleh dokter yang menangani pasien. Rekomendasi dari penelitian ini adalah perlu dibentuknya tim pengendali Fraud. Kebijakan pelayanan pasien disesuaikan dengan kebijakan sistem Jaminan Kesehatan Nasional (JKN). Mengusulkan evaluasi tarif InaCBGs ke kementrian kesehatan setiap akhir tahun. Mengadakan pelatihan tentang penerapan ICD-9 dan ICD-10 bagi staf medis. Kata Kunci : Fraud, upcoding, self referral dan fragmentasi Kepustakaan : 38 (1995 – 2016)Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2017 ABSTRACT Saikhu Analysis of Factors Influencing the Potency of Fraudulent Claims in the National Health Insurance Program at Dr. H. Soewondo Public Hospital in Kendal xviii + 97 pages + 11 tables + 5 figures + 6 appendices Writing a medical summary that was not completed by a physician soon after providing services and treatment to patients at Dr. H. Soewondo Public Hospital in Kendal had a potency to make mistakes in coding for claim. Another problem was a big tariff difference for some diseases between the tariff of a hospital based on regent’s regulation and amount of claim based on the tariff of INA-CBGs that could trigger a potency of fraud. This study aimed at identifying factors that were potential to allow fraud to occur at Dr. H. Soewondo Public Hospital in Kendal. This was a descriptive study conducted by observing followed by Focus Group Discussion (FGD) to determine a priority that could trigger a potency of fraud and indepth interview. This study involved 5 main informants and 2 informants for triangulation purpose. There was three potencies that could lead to fraud namely unbundling, upcoding, and self-referral viewed from three aspects namely opportunity, preasure, and rasionalisation. The results of this study showed that monitoring and controlling in each step of implementation of patients who were BPJS members were not optimal. There was found some potencies that might lead to fraud. There was big difference between the tariff based on the regent’s regulation and the tariff of claim based on INA-CBGs that might allow fraud to occur. A coding system of diagnosis and action based on ICD-9 and ICD-10 had been well understood by physicians who provided treatment to patients. A team of fraud control needs to be formed. A policy of patients’ services needs to be adjusted with a policy of a National Health Insurance system. The tariff of INA-CBGs needs to be proposed to Ministry of Health in order to be regularly evaluated in the end of year. In addition, training of ICD-9 and ICD-10 implementation for medical staffs needs to be conducted. Keywords : Fraud, Upcoding, Self-Referral, Fragmentation Bibliography: 38 (1995-2016

Kajian Strategi Perekrutan Dokter Spesialis di RSUD Dr. R. Soetijono Blora

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2016 ABSTRAK Puji Basuki Kajian Strategi Perekrutan Dokter Spesialis di RSUD Dr. R. Soetijono Blora xviii + 93 halaman + 6 tabel + 6 gambar + 28 lampiran RSUD Dr. R. Soetijono Blora mengalami kekurangan dan kekosongan beberapa dokter spesialis. Hal ini sudah berlangsung lama yaitu lebih dari 10 tahun dan belum terpenuhi sampai saat ini. Tujuan dari penelitian ini adalah untuk mengetahui upaya strategis dalam perekrutan dokter spesialis di RSUD Dr. R. Soetijono Blora. Penelitan ini menggunakan metode kualitatif. Informan utama adalah Direktur rumah sakit, kepala bidang pelayanan, kepala seksi pelayanan medis rumah sakit Dr. R. Soetijono Blora, dokter spesialis penyakit dalam, dokter spesialis anak, spesialis bedah, PPDS. Sedangkan informan triangulasi adalah asisten 3 sekretaris daerah kabupaten Blora dan ketua komisi D DPRD kabupaten Blora. Hasil wawancara mendalam dengan para informan dilakukan analisis isi untuk mendapatkan proses upaya rekrutmen dokter spesialis oleh manajemen RSUD Dr. R. Sotijono Blora. Berdasarkan hasil dari indepth interview telah dilakukan upaya- upaya rekrutmen dokter spesialis akan tetapi belum mendapatkan dokter spesialis untuk memenuhi kebutuhan jumlah dokter spesialis. Upaya yang sudah dilakukan masih normatif yaitu dengan cara memberikan penawaran kepada dokter spesialis baru lulus dengan kerjasama center pendidikan dan penawaran kepada PPDS yang menjalani stase di RSUD Dr. R. Soetijono Blora. Dan saat ini Pemerintah Kabupaten Blora telah berupaya dengan memberikan beasiswa kepada dokter PPDS yang telah MOU dengan Kabupaten Blora. Kompensasi yang telah diberikan belum memberi daya tarik bagi dokter spesialis yang ada di RSUD Dr. R. Soetijono Blora. Perlu ada upaya strategis dalam merekrut dokter spesialis dengan cara dukungan yang lebih riil oleh pemerintah kabupaten Blora melalui anggaran APBD dalam pemberian kompensasi terhadap dokter spesialis yang sudah ada dan yang mau masuk ke RSUD Dr. R. Soetijono Blora. Sehingga ada daya tarik tersendiri untuk merekrut dokter spesialis. Kata kunci : Upaya Rekrutmen, Seleksi, Dokter Spesialis Kepustakaan : 50(1984- 2016) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2016 ABSTRACT Puji Basuki A Study of Recruitment Strategy of Medical Specialist at Dr. R. Soetijono Public Hospital in Blora xviii + 93 pages + 6 tables + 6 figures + 28 appendices Number of medical specialist at Dr. R. Soetijono Public Hospital in Blora is insufficient. This situation has happened since 10 years ago until now. The aim of this study was to figure out strategic efforts in recruiting medical specialist at the Dr. R. Soetijono Public Hospital in Blora. This was a qualitative study. Main informants consisted of director of a hospital, head of service department, head of medical service section, internist, paediatrician, surgeon, and PPDS. Informants for triangulation purpose consisted of three regional secretaries of Blora District and head of commission D at parliament of Blora District. Data were analysed using content analysis. The results of indepth interview showed that there was any effort to recruit medical specialists. Notwithstanding, medical specialists who met criteria had not been obtained. Some normative efforts were made by offering fresh graduate medical specialists cooperating with the centre of education. In addition, the offer also was provided to medical specialist students who undertook stase at the hospital. The local government of Blora District had provided scholarships for medical specialist students that had made MoU with Blora District. Provided compensation had not attracted medical specialists who worked at the Dr. R. Soetijono Public Hospital. Some strategic efforts need to be made for recruiting medical specialists by providing real support from the local government of Blora District like allocating regional budget for compensation for medical specialists who have been working at the hospital or those who are just interested in working at the hospital. These efforts are expected to attract medical specialists. Keywords : Recruitment Effort, Selection, Medical Specialist Bibliography: 50 (1984-2016

Analisis Perbedaan Sebelum dan Sesudah Penerapan Aplikasi Lean Hospital Berdasarkan Lead Time Dan Volume Berkas Pelayanan Rekam Medis bagi Pasien Peserta Jaminan Kesehatan Nasional Kartu Indonesia Sehat di Rumah Sakit Keluarga Sehat Kebupaten Pati

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2017 ABSTRAK Ahmad Syaifuddin Analisis Perbedaan Sebelum dan Sesudah Penerapan Aplikasi Lean Hospital Berdasarkan Lead Time Dan Volume Berkas Pelayanan Rekam Medis bagi Pasien Peserta Jaminan Kesehatan Nasional Kartu Indonesia Sehat di Rumah Sakit Keluarga Sehat Kebupaten Pati xiv + halaman + 16 tabel + 8 gambar + 2 lampiran Peningkatan jumlah kunjungan pasien JKN-KIS membuat beban peningkatan jumlah pelayanan rekam medis yang berdampak pada keterlambatan dalam melakukan proses klaim ke BPJS Kesehatan. Upaya perbaikan layanan dengan mempercepat proses klaim dapat dilakukan dengan menggunakan metode lean hospital. Penelitian ini menggunakan metode mixed method berupa purposive sampling dan focus group discussion (FGD). Penelitian membandingkan lead time, value activity, non necessary value activity dan waste sebelum dan sesudah penerapan aplikasi lean hospital di instalasi rekam medis RS Keluarga Sehat Pati. Metode kuantitatif dibuat dengan membandingkan lead time setiap bagian dalam pengerjaan rekam medis berupa assembling, coding dan analyzing dan mencari perbedaan value activity, non necessary value activity dan waste disetiap bagian tersebut. Hasil penelitian menunjukan perbedaan rerata waktu penyelesain sesudah dilakukan aplikasi lean hospital dibagian assembling sebesar 123,86 detik, dibagian coding sebesar 14,79 detik, dan dibagian analyzing sebesar 201,35 detik. Uji Wilcoxon-signed ranks test didapatkan hasil Signifikansi sebesar 0.000 < 0.05, maka terdapat perbedaan lead time rekam medis pasien BPJS kesehatan antara sebelum dan sesudah penerapan aplikasi lean hospital pada pelayanan rekam medis. Hasil perhitungan VAA (Value activityAssesment) untuk alur proses asembling sebelum penerapan lean memperlihatkan komposisi value activitydibanding non necessary value activity dibanding waste sebesar 42% : 8%.: 50%. Setelah penerapan lean memperlihatkan sebesar 80% : 20% : 0%. Bagian coding didapatkan hasil sebelum penerapan lean memperlihatkan value activity dibanding non necessary value activity dibanding waste sebesar 40% : 20%.: 40%. Setelah penerapan lean memperlihatkan sebesar 67% : 33% : 0%. Bagian analyzing didapatkan hasil sebelum penerapan lean memperlihatkan value activity dibanding non necessary value activity dibanding waste sebesar 43% : 14%: 43%. Setelah penerapan lean memperlihatkan sebesar 75% : 25% : 0%. Aplikasi lean hospital dapat membantumeningkatkat lead time dan perubahan value pada pekerjaan di rekam medis. Kata kunci : Lean Hospital, Lead Time, JKN Kepustakaan : 34 (1996-2014)Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2017 ABSTRACT Ahmad Syaifuddin Analysis of the Difference between Before and After Applying Lean Hospital Application based on a Lead Time and Volume of Documents of Medical Record Services for Patients of National Health Insurance Members of Healthy Indonesia Card at Healthy Family Hospital in Pati Regency xiv + pages + 16 tables + 8 figures + 2 appendices The increase of visit number of patients of National Health Insurance (NHI) Members of Healthy Indonesia Card (HIC) led to increase a number of medical record services that affected to lateness in claiming to Health Social Insurance Agency (HSIA). The efforts of service improvements were made by expediting a claim process using a method of a lean hospital. This was a mixed method using purposive sampling and focus group discussion (FGD). This study compared a lead time, value activity, non-necessary value activity, and waste before and after applying lean hospital application at a medical record installation of a Healthy Family Hospital in Pati Regency. A qualitative method was used by comparing a lead time in each part of medical record service like assembling, coding, and analysing and by finding the differences between value activity, non-necessary value activity, and waste in these parts. The results of this research showed that mean time differences for accomplishing after applying the lean hospital application at the assembling, coding, and analysing departments respectively were 123.86 seconds, 14.79 seconds, and 201.35 seconds. The results of a Wilcoxon-signed ranks test demonstrated that there was any significant difference in the lead time of medical record between before and after applying the lean hospital application at medical record services (p=0.000 < 0.05). The results of calculating Value Activity Assessment (VAA) for the process flow of assembling before applying the lean hospital application showed comparisons of compositions between value activity, non-necessary value activity, and waste respectively were 42%: 8%: 50%. In contrast, after applying the application, these composition changed to be 80%: 20%: 0% respectively. At the coding department, comparisons of compositions between value activity, non-necessary value activity, and waste before applying the application respectively were 40%: 20%: 40%. In contrast, after applying the application, these composition changed to be 67%: 33%: 0%. At the analysing department, comparisons of compositions between value activity, non-necessary value activity, and waste before applying the application respectively were 43%: 14%: 43% whereas after applying the application, they changed to be 75%: 25%: 0%. The lean hospital application could improve the lead time and change values on the jobs at the medical record unit. Keywords : Lean Hospital, Lead Time, NHI Bibliography: 34 (1996-2014

Pendekatan Lean Hospital Untuk Meminimalisasi Waste Pada Proses Discharge Di Ruang Rawat Inap VIP RS Keluarga Sehat Kabupaten Pati

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2017 ABSTRAK Hana Triwanggono Pendekatan Lean Hospital Untuk Meminimalisasi Waste Pada Proses Discharge Di Ruang Rawat Inap VIP RS Keluarga Sehat Kabupaten Pati xiv + 86 halaman + 9 tabel + 12 gambar + 6 lampiran Pelayanan kesehatan di rumah sakit menjadi sangat penting demi tercapainya kepuasan pelanggan. RS Keluarga Sehat masih menerima keluhan atas proses pemulangan pasien (discharge). Keluhan yang sering diajukan adalah mengenai lamanya waktu proses pemulangan. Tujuan penelitian ini adalah untuk menganalisis dan usulan perbaikan dengan meminimalisasi waste di ruang rawat inap VIP RS Keluarga Sehat dengan menerapkan pendekatan konsep Lean Hospital. Penelitian ini menggunakan metode campuran kuantitatif dan kualitatif. Pengumpulan data dilakukan dengan telaah dokumen, observasi pada 20 responden, dan wawancara mendalam terhadap manajer rawat inap, kepala ruang rawat inap, dan perawat. Hasil penelitian adalah bahwa proses discharge di instalasi rawat inap RS Keluarga Sehat sebelum penerapan Lean dimulai dari dokter mengizinkan pasien pulang hingga mengantar pasien pulang yang terdiri dari 16 tahapan. Setelah penerapan Lean, tahapan proses discharge berkurang menjadi 14 tahapan. Waste terjadi di sela-sela tiap aktivitas. Di antaranya menunggu dokter melengkapi rekam medis dan menulid resep, menungggu pengitungan alkes dan obat tidak terpakai, dan menunggu obat dari farmasi. Layout ruangan memengaruhi mobilitas perawat dalam melaksanakan aktivitas proses discharge. Kesimpulan dari penelitian ini adalah bahwa waktu keseluruhan proses discharge di ruang rawat inap VIP Rumah Sakit Keluarga Sehat sebelum penerapan Lean Management Hospital adalah 189 menit. Setelah penerapan Lean Management Hospital menjadi 162 menit. Waktu tunggu/waitting merupakan bentuk pemborosan yang paling dirasakan tidak nyaman bagi pasien/keluarga. Minimalisasi Waste gerakan (motion) dapat dilakukan dengan mengurangi motion perawat, mendesain pergerakan perawat ke pasien jauh lebih terarah dan menghindari pasien menunggu terlalu lama. Kata kunci : Lean Hospital, waste, discharge Kepustakaan : 24 (1992-2016)Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2017 ABSTRACT Hana Triwanggono Lean Hospital Approach to Minimise Waste on a Discharge Process at VIP Inpatient Rooms of Healthy Family Hospital in Pati Regency xiv + 86 pages + 9 tables + 12 figures + 6 appendices Health services at a hospital play an important role to satisfy customers. A Health Family Hospital still receives complaints of patients discharge process. The most patients complained about the length of discharge process time. This study aimed at analysing and proposing the improvement by minimising waste at VIP inpatient rooms of the Healthy Family Hospital using Lean Hospital approach. This was a mixed method design (quantitative and qualitative approaches). Data were collected by undertaking a literature review, observing to 20 respondents, and conducting indepth interview to managers of inpatient rooms, heads of inpatient rooms, and nurses. The results of this study showed that the discharge process at the inpatient rooms of the Healthy Family Hospital before applying Lean starting from issuing permits for patients to go home from physicians to accompanying them until arriving in their homes safely which consisted of 16 steps. In contrast, after applying Lean, number of the steps was reduced to be 14. Waste occurred during undertaking the activities such as waiting for a physician in completing medical record and writing a prescription, waiting for calculating unused health equipment and medicines, and waiting for medicines from a pharmacist. Layout of a room influenced a nurse’s mobility in conducting the activity of the discharge process. To sum up, overall time for the discharge process at the VIP inpatient rooms of the Healthy Family Hospital before applying the Lean Management Hospital (LMH) was 189 minutes, otherwise it decreased to be 162 minutes after applying the LMH. Waiting time was inconvenient for patients/their families. Waste could be minimised by reducing a nurse’s motion, designing a nurse’s motion to patients in order to be more focused and to avoid the waiting time that was too long. Keywords : Lean Hospital, Waste, Discharge Bibliography: 24 (1992-2016

Pencegahan Kecurangan (Fraud) sesuai dengan Permenkes No. 36 Tahun 2015 tentang Pencegahan Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan pada Sistem Jaminan Sosial Nasional di Rumah Sakit X

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan 2016 ABSTRAK Lina Umboro Styowati Pencegahan Kecurangan (Fraud) sesuai dengan Permenkes No. 36 Tahun 2015 tentang Pencegahan Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan pada Sistem Jaminan Sosial Nasional di Rumah Sakit X xii + 143 halaman + 8 tabel + 9 gambar +7 lampiran Perubahan pola pembayaran menggunakan CBG menyebabkan perubahan proporsi penerimaan rumah sakit serta perubahan beban resiko keuangan, hal ini yang mendorong timbulnya potensi fraud. Tindakan readmisi di Rumah Sakit X berkisar 29,35% pasien rawat jalan dan 3,6% pasien rawat inap mendapatkan perawatan lebih dari 1 (satu) kali dalam periode 1 (satu) bulan serta belum terciptanya kebijakan pencegahan kecurangan di Rumah Sakit X sebagaimana diamanatkan dalam Permenkes RI No. 36/ 2015. Lima tahapan formulasi dilakukan untuk merumuskan kebijakan, pada penelitian ini hanya melakukan 2 (dua) tahap formulasi yaitu fase pertama berupaya untuk mengidentifikasi tujuan dan program pencegahan kecurangan di Rumah Sakit X dan fase kedua formulasi yaitu menganalisa kelengkapan informasi. Jenis penelitian ini adalah kualitatif dengan menggunakan wawancara dan diskusi mendalam. Informan utama dalam penelitian ini adalah lima koder dan unsur pengambil keputusan. Teknik analisis data dengan analisis konten, meliputi wawancara dengan informan diolah kemudian dilakukan analisis data. Hasil penelitian menunjukkan masih lemahnya pemahaman petugas pelaksana tentang tindakan kecurangan, hal ini ditunjukkan melalui jawaban responden yang memiliki interpretasi berbeda maksud tindakan kecurangan JKN berdasarkan Permenkes No. 36/2015 serta belum adanya atensi dari pengambil keputusan terkait sistem pencegahan. Atensi dapat diketahui dari perhatian utama pengambil kebijakan hanya pada permasalahan pengkodean diagnosa yang memiliki over cost dan juga belum adanya pembaharuan SK Pengendali Asuransi sejak tahun 2013. Untuk mewujudkan sistem pengendalian efektif yang mampu mencegah, melaporkan dan memperbaiki potensi kecurangan di Rumah Sakit X dengan cara menciptakan program pencegahan dan deteksi dini berupa pendidikan anti fraud, investigasi internal melalui analisa data klaim dan program tindakan pelaporan dan pemberian sanksi. Diperlukan kelengkapan sistem berupa tim pencegahan kecurangan dan pedoman pencegahan yang berisi literature review, daftar tindakan yang dianggap potensi fraud, aspek pencegahan, deteksi dan penindakan serta petunjuk teknis pencegahan fraud, monitoring dan evaluasi serta pelaporan. Penelitian ini merekomendasikan untuk menerbitkan SK Tim Pencegahan Kecurangan , merumuskan draf final pencegahan kecurangan agar dapat disahkan menjadi pedoman pencegahan kecurangan, pengembangan sistem informasi untuk analisa data klaim. Kata kunci : Formulasi Kebijakan, Pedoman Pencegahan Kecurangan, Fraud Kepustakaan: 52 (2000-2015) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Administration and Health Policy 2016 ABSTRACT Lina Umboro Styowati Fraud Prevention based on the Health Minister Regulation Number 36 in 2015 about Fraud Prevention in the Implementation of the Health Insurance Program on the National Social Insurance System at X Hospital xii + 143 pages + 8 tables + 9 figures + 7 appendices The change of a payment pattern using CBG causes the change in the proportion of hospital income and the change in burden of financial risk that will lead to fraud. Readmission to X Hospital was approximately 29.35% of patients at outpatient unit and 3.6% of patients at inpatient unit who got treatment more than one in a month. In addition, there was no policy which referred to the Health Minister Regulation Number 36/2015 to prevent fraud at X Hospital. Five steps of formulation were conducted to arrange the policy. In this study, two of these five steps of formulation namely identifying objectives and a program of fraud prevention at X Hospital as the first step and analysing completeness of information as the second step were conducted. This was a qualitative study by conducting indepth interview. Main informants consisted of five coders and decision makers. Data were collected using a method of content analysis. The result of this study showed that the implementers did not really understand fraud activity. Each officer had different interpretation in defining fraud of JKN based on the regulation. In addition, decision makers did not pay attention to this problem. Attention could be identified from the main attention of policy makers that only focussed on a problem of coding diagnosis which had over cost. The Insurance Control Decree have not been renewed since 2013. To realise the effective control system that could prevent, report, and improve a potency of fraud at the X Hospital, it was conducted by creating a program of prevention and early detection like education of anti-fraud, internal investigation through analysing claim data, reporting, and punishing. There needed to complete system like a team of fraud prevention and a prevention guidance that consisted of a literature review, a list of actions categorised as fraud, aspects of prevention, detection, action, a technical guidance of fraud prevention, monitoring, evaluating, and reporting. The Decree of a fraud prevention team needs to be released. A final draft of fraud prevention needs to be arranged in order to be legalised to be a guidance of fraud prevention. In addition, information system needs to be developed to analyse claim data. Keywords : Policy Formulation; Guidance Of Fraud Prevention, Fraud Bibliography: 52 (2000-2015

Analisis Kepatuhan Bidan Praktik Mandiri dalam Merujuk Persalinan Ke Puskesmas sebagai Jejaring Jaminan Kesehatan Nasional di Kabupaten Grobogan

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2015 ABSTRAK Wahyu Dewi Hapsari Analisis Kepatuhan Bidan Praktik Mandiri dalam Merujuk Persalinan Ke Puskesmas sebagai Jejaring Jaminan Kesehatan Nasional di Kabupaten Grobogan xx + 140 halaman + 26 tabel + 7 lampiran Angka kematian ibu (AKI) di Jawa Tengah tahun 2013 meningkat dari 118,62/100.000 menjadi 126,55/100.000 Kelahiran Hidup di tahun 2014. Kabupaten Grobogan merupakan peringkat ketiga dari 35 daerah di Jawa Tengah yang memiliki AKI 43 kasus, maka dalam menurunkan AKI tersebut Pemerintah mengeluarkan kebijakan bahwa persalinan harus dilakukan di fasilitas pelayanan kesehatan dasar. Kebijakan tersebut menghimbau Bidan praktik mandiri untuk merujuk persalinan ke Puskesmas. Tujuan penelitian adalah untuk menganalisis faktor-faktor yang mempengaruhi kepatuhan (pengetahuan, sikap, peraturan Pemerintah dan motivasi) Bidan praktik mandiri dalam merujuk persalinan ke Puskesmas. Jenis penelitian ini adalah analitik observasional dengan pendekatan cross sectional terhadap 70 Bidan praktik mandiri dengan wawancara langsung menggunakan kuesioner terstruktur dengan analisis data chi-square serta regresi logistic. Hasil penelitian menunjukkan karakteristik umur responden 55,7% adalah dewasa penuh, 92,9% berpendidikan D3 Kebidanan dengan 92,9% masa kerja lama ≥ 5 tahun. Tingkat pengetahuan responden 64,3% sudah baik, sikap responden 58,6% baik, peraturan Pemerintah 87,1% sudah baik dalam mendukung, dan tingkat motivasi responden 88,6% tinggi. Terdapat hubungan yang bermakna antara pengetahuan, sikap, peraturan Pemerintah dan motivasi dengan kepatuhan Bidan praktik mandiri dalam merujuk persalinan ke Puskesmas sebagai jejaring Jaminan Kesehatan Nasional di Kabupaten Grobogan. Terdapat pengaruh bersama antara sikap dan motivasi terhadap kepatuhan Bidan praktik mandiri dalam merujuk persalinan. Faktor paling dominan yang berhubungan dengan kepatuhan Bidan praktik mandiri di Kabupaten Grobogan adalah motivasi. Saran penelitian adalah pihak DKK Grobogan segera melakukan regulasi yang memadai terhadap pelaksanaan pelayanan kesehatan ibu dan anak khususnya dalam pertolongan persalinan oleh BPM supaya tercapai tujuan yang optimal. Kata kunci : Analisis Kepatuhan, Merujuk Persalinan, Bidan Praktik Mandiri, Puskesmas, Jaminan Kesehatan Nasional Kepustakaan : 40 (2000-2015) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2015 ABSTRACT Wahyu Dewi Hapsari Obedience Analysis of Independent Practice Midwife in Referring a Delivery Process to a Health Centre as a Network of National Health Insurance in District of Grobogan xx + 140 pages + 26 tables + 7 appendices Maternal Mortality Rate (MMR) in Central Java increased from 118.62/100,000 live births in 2013 to 126.55/100,000 live births in 2014. District of Grobogan placed third rank from 35 districts in Central Java with 43 cases of MMR. To decrease MMR, the government released a policy that all delivery processes had to be conducted at basic health service facilities. That policy urged an Independent Practice Midwife (IPM) to refer a delivery process to a health centre. The aim of this study was to analyse factors (knowledge, attitude, government regulations, and motivation) influencing the obedience of IPM in referring a delivery process to a health centre. This was an analytic-observational study using a cross-sectional approach. Data were collected using direct interview to 70 midwives using a structured questionnaire and analysed using Chi-Square and Logistic Regression tests. The results of this research showed that more than half of the respondents were categorised as mature (55.7%), nearly all of them graduated from DIII midwifery (92.9%) and had working periods greater than or equal to 5 years (92.9%). In addition, most of them had good knowledge (64.3%), good attitude (58.6%), good support from government regulations (87.1%), and high motivation (88.6%). The factors of knowledge, attitude, government regulations, and motivation statistically significantly related to the obedience of IPM in referring a delivery process to a health centre as a network of the national health insurance in District of Grobogan. Attitude and motivation jointly influenced the obedience of IPM. The most dominant variable influencing the obedience of IPM was motivation. Grobogan Distriict Health Office needs to provide regulations for the implementation of maternal and child health services particularly for a delivery process by IPM in order to optimally achieve goals. Keywords : Obedience Analysis, Referring Delivery, Independent Practice Midwife, Health Centre, National Health Insurance Bibliography : 40 (2000-2015

Factors Affecting Team Effectiveness in Semarang Community Health Center Working Group After Accreditation

AbstrakAkreditasi puskesmas merupakan pengakuan yang diterbitkan Lembaga indipenden penyelenggara akreditasi yang ditetapkan oleh Menteri Kesehatan setelah memenuhi standar. Tujuan dilakukannya akreditasi puskesmas adalah untuk pembinaan peningkatan mutu. Studi ini bertujuan untuk menganalisis Pengaruh Konteks organisasi, Komposisi dan Proses Terhadap Efektivitas Kelompok Kerja Puskesmas Kota Semarang Pasca Akreditasi. Metode penelitian kuantitatif dengan desain potong lintang. Data dikumpulkan pada semua kelompok Kerja Puskesmas Kota Semarang. Pengumpulan data melalui pengisian kuesioner dan wawancara. Hasil penelitian menunjukkan bahwa kelompok kerja Puskesmas 45,9 % tidak efektif, sedangkan 54,1 % efektif. Hasil uji chi-square utk variabel konteks organisasi menunjukkan nilai p-value = 0,001 dan Prevalence Ratio = 2,911, 95% CI = 3,7480-3,8758.  Uji chi-square terhadap variabel komposisi tim, uji menunjukkan nilai p-value = 0,001 dan Prevalence Ratio = 2,871, 95% CI = 3,8856 - 4,049. Analisis terhadap variabel proses menunjukkan hasil nilai p-value = 0,001 dan Prevalence Ratio = 4,636, 95% CI = 3,7008 – 3,8696. Hasil tersebut menunjukkan ada pengaruh yang bermakna faktor konteks organisasi , komposisi tim dan proses terhadap efektifitas kelompok kerja Puskesmas di Kota Semarang. Kesimpulannya untuk membangun kelompok kerja puskesmas yang efektif di Kota Semarang perlu memperhatikan hal hal yang terkait dengan konteks organisasi, komposisi tim serta proses di dalam kelompok kerja. Kata kunci: kelompok kerja, efektivitas tim, akreditasi AbstractPuskesmas accreditation is acknowledgment issued by independent institution organizes accreditation determined by the Minister of Health after meeting the standards. The purpose of conducting puskesmas accreditation is to foster quality improvement. This study aimed to analyze the effect of organizational context, composition and process on the effectiveness of puskesmas working group after Accreditation. This research is quantitative method with cross-sectional design. Data was collected in all the Puskesmas working groups in Semarang city. The result of the study shows that the Puskesmas working group were 45.9% ineffective, while 54.1% were effective. The chi-square test for organizational context variables show p-value = 0.001, PR = 2.911, 95% CI = 3.7480-3.8758. Chi-square test on the variable team composition shows the p-value = 0.001 and PR = 2.871, 95% CI = 3.8856 - 4.049. Analysis of process variables shows tAhat the p-value = 0.001 and PR = 4.636, 95% CI = 3.7008 - 3.8696. The results showed that there was a significant effect of organizational context, team composition and process on the effectiveness of Puskesmas working group. The conclusion is puskesmas working group needs to pay attention to matters relating to the organizational context, the composition of the team and the process. Keywords: work group, team effectiveness, accreditatio

Analisis Stakeholder Program Usaha Kesehatan Sekolah (UKS) di Kabupaten Sragen

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2016 ABSTRAK Pramukti Dian Setianingrum Analisis Stakeholder Program Usaha Kesehatan Sekolah (UKS) di Kabupaten Sragen 97 halaman + 9 tabel + 3 gambar + 30 lampiran Implementasi Pedoman SKB 4 Kementerian tahun 2004 tentang UKS meskipun didukung SK Bupati tentang pembentukan Tim Pembina UKS sejak tahun 2013 belum dilaksanakan secara optimal hal ini dikarenakan tidak adanya koordinasi lintas sektor oleh para stakeholder. Tujuan penelitian menganalisis Stakeholder Pada Program UKS di Kabupaten Sragen. Desain penelitian kualitatif disajikan secara deskriptif eksploratif, menggunakan teknik non probability sampling dengan purposive sampling. Subjek penelitian 4 orang informan utama adalah Kasi kesejahteraan masyarakat, Kasi Upaya Kesehatan Institusi Pemberdayaan Masayarakat (UKI PM), Kasi Kesiswaan, Seni Dan Olahraga dan Kasi madrasah dan pendidikan agama islam pada sekolah Umum dan informan triangulasi terbagi dalam 2 kelompok yaitu 4 orang dari Kabid Kesra, Kabid Promkes dan kemitraan kesehatan, Kabag Kesiswaan, Seni Dan Olahraga dan Kabag Pendidikan Agama Islam pada Sekolah Umum dan 31 orang pelaksana TP UKS kecamatan dan sekolah. Data dikumpulkan dengan indepth interview, FGD, pengolahan data dengan metode analisis isi (content analysis). Hasil penelitian menunjukkan bahwa pemetaan stakeholder yang terlibat yaitu Pembuat keputusan (Decision Maker) yaitu Pemerintah Daerah (Kesra), Pelaksana kegiatan (Designer) meliputi Dinas kesehatan, Dinas Pendidikan, Kementerian Agama dan Sasaran (client) meliputi Kepala Puskesmas, Camat, Guru pelaksana pada tingkat SD/SMP/SMU, dan Guru pelaksana pada tingkat MI/MTS/MAN. Analisis peresepsi menunjukan bahwa sebagian besar stakeholder memiliki sikap yang mendukung terhadap implementasi program UKS, Pada kelompok stakeholder pengambil keputusan yaitu pemda (kesra) belum dapat memenuhi kriteria sebagai leading sector pada program UKS, sehingga berada pada kelompok Raksasa tidur (sleeping giant), dinas kesehatan memiliki posisi potensial sebagai “Penyelamat” (saviour), Dinas pendidikan sebagai provider berada pada kelompok Kawan” (friend) dan Kementerian Agama yang juga sebagai provider diposisikan sebagai “pemerhati” (acquaintance) Kata kunci : Program UKS, Analisis Stakeholder. Sikap, Power, Urgency Kepustakaan : 42 (2004-2014). Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2016 ABSTRACT Pramukti Dian Setianingrum Stakeholder Analysis of School Health Efforts (UKS) Program in District of Sragen 97 pages + 9 tables + 3 figures + 30 appendices A Joint Decree guideline of four ministries in 2014 about UKS and Regent’s Decree about a form of an UKS supervisory team in 2013 had not been optimally implemented yet. This condition was due to no coordination between inter-sectors conducted by stakeholders. The aim if this study was to analyse stakeholder on the program of UKS in District of Sragen. This was a qualitative study presented using descriptive and explorative methods. Subjects were selected using a technique of non-probability sampling (purposive sampling). Main informants consisted of four persons, namely head of community welfare section, head of institution health efforts -community empowerment section, head of student, art, and sport section, head of madrasah and Islam education at general schools. Meanwhile, informants for triangulation purpose consisted of two groups namely four heads of community welfare department, health promotion and health partnerships department, student, art, and sport department, and Islam education at general schools and 31 implementers of UKS at subdistrict and school levels. Data were collected using indepth interview, FGD and analysed using content analysis. The involved stakeholders consisted of a decision maker namely Local Government (community welfare), implementers (designers) namely health office, education office, and religion ministry. Target (clients) consisted of head of health centre, head of sub district, teachers at levels of elementary/junior/senior high schools, and teachers at levels MI/MITS/MAN. Perception analysis showed that majority of stakeholders supported the implementation of the UKS program. A decision maker had not met criteria as a leading sector at the UKS program and was included as a group of a sleeping giant. Health office potentially could be as a saviour. Education office as a provider played a role as a friend. Meanwhile, ministry of religion as a provider placed on position as an acquaintance. Keywords : UKS Program, Stakeholder Analysis, Attitude, Power, Urgency Bibliography: 42 (2004-2014

Evaluasi Kinerja Rumah Sakit QIM Batang Pada Era JKN Menggunakan Balanced Scorcard

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Rumah Sakit 2017 ABSTRAK Lilis Restuningsih Evaluasi Kinerja Rumah Sakit QIM Batang Pada Era JKN Menggunakan Balanced Scorcard xviii + 167 halaman + 28 tabel + 14 lampiran Rencana Strategi Bisnis Rumah Sakit QIM Batang merupakan dokumen perencanaan yang bersifat indikatif memuat program-program pelaksanaan kegiatan yang akan dilaksanakan oleh Rumah Sakit QIM Batang untuk kurun waktu 2015–2019, disusun dengan menggunakan balanced scorecard. Dilakukan evaluasi untuk memperoleh informasi tentang sejauh mana suatu kegiatan tertentu telah dicapai, bagaimana pencapaian itu bila dibandingkan dengan target yang telah ditetapkan. Penelitian ini diklasifikasikan kedalam penelitian deskriptif dengan pendekatan kualitatif. Metode pengolahan data menggunakan Balanced Scorecard dengan pengumpulan data melalui observasi dan telaah dokumen kinerja Rumah Sakit QIM Batang, wawancara mendalam (in-depth interview) dan wawancara tidak terstruktur dengan informan. Selanjutnya dilakukan analisa data Hasil dari penelitian ini adalah skoring kinerja rumah sakit, masing- masing perspektif dan key performance indicator. Skor Perspektif Finansial adalah 73,03 ( kuning / kurang berhasil), skor Perspektif Pelanggan 95 ( hijau / berhasil), skor Proses Bisnis Internal 89 (hijau / berhasil), dan skor perspektif SDM adalah 81,9 (hijau/ berhasil). Kinerja Rumah Sakit QIM Batang pada tahun 2015 ( era JKN) secara keseluruhan berdasar empat perspektif dalam Balanced Scorecard memperoleh skor 85,45 , artinya pencapaian kinerja Rumah Sakit QIM pada Era JKN termasuk dalam kategori baik Penelitian ini merekomendasikan beberapa saran yaitu. diperlukan sosialisasi, pencatatan dan pelaporan lebih baik kepada staf dan pegawai agar hasil kinerja bisa terdokumentasi sehingga hasil penilaian kinerja dengan balanced scorecard bisa lebih akurat. Perlu kendali biaya terutama menghadapi implementasi pola pembayaran dengan INA-CBGs. Penilaian kinerja dengan metode balanced scorcard dapat membantu manajemen dalam mengambil langkah langkah koreksi dan meningkatkan kinerja dimasa depan Kata kunci : Evaluasi Kinerja, Balanced Scorcard Kepustakaan : 59 (1996-2015) xviiiDiponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Hospital Administration 2017 ABSTRACT Lilis Restuningsih A Work Performance Evaluation of QIM Batang Hospital in the Era of National Health Insurance using Balanced Scorecard xviii + 167 pages + 28 tables + 14 appendices A business strategic plan of QIM Batang Hospital is a document of an indicative plan containing implementation programs of activities undertaken by the hospital during the period of 2015-2019 and arranged using balanced scorecard. This study aimed at figuring out information of to what extent a target of an activity had been achieved and comparing the achievement with a determined target. This was a descriptive study using a qualitative approach. Data were processed using a method of balanced scorecard and collected by observing and conducting a document review of the QIM Batang hospital’s performance, indepth interview, and unstructured interview with informants. Furthermore, data were analysed. Scoring of the hospital’s performance consisted of perspective and key performance indicators. Score of financial perspective was 73.03 (yellow/unsuccessful), score of customer perspective was 95 (green/successful), score of internal business process was 89 (green/successful), and score of human resource perspective was 81.9 (green/successful). Overall, the hospital’s performance in 2015 (in the era of national health insurance) based on these four perspective indicators had achieved score of 85.45 (good). Socialising, recording, and reporting for all staffs need to be improvedin order to document the performance and to accurately obtain the results of the performance assessment using balanced scorecard. In addition, there needs to control cost especially in facing a payment pattern with INA-CBGs. The performance assessment using balanced scorecard can assist management in determining steps of correction and in improving performance in the future. Keywords : Performance Evaluation, Balanced Scorecard Bibliography: 59 (1996-2015) xi