ANALYSIS OF SERVICE QUALITY BASED ON PATIENT’S ASSESSMENT AND EXPECTATION IN MOTHER AND CHILD HOSPITAL OF SURABAYA

Background: Service quality at Kendangsari Merr Mother and Child Hospital is expected to compete with other private hospitals, especially maternity hospitals. Nevertheless, several months after its opening, the hospital received a few complaints from its patients.Aims: This study analyzed patient satisfaction to increase the service quality at Kendangsari Merr Mother and Child Hospital using RATER parameters.Methods: This study was an observational study that used a cross-sectional design. It was conducted at Kendangsari Merr Mother and Child Hospital from 27 to 31 October 2014. The respondents were taken from a total population of all inpatients and outpatients during the survey. The instrument used was a questionnaire using service quality indicators, such as Reliability, Assurance, Tangible, Empathy and Responsiveness (RATER) parameters.Results: The respondents’ assessment of the service quality at Kendangsari Merr Mother and Child Hospital was good with an average score of 81%. In terms of assurance, tangible, and empathy factors, most of the patients assessed that they received better services than what they expected.Conclusion: Some other poor aspects of the service quality should be improved. They include the punctuality of doctor practice, doctors’ skills, public facilities, politeness and awareness of staff pharmacists in treating patients’ drugs as prescribed. Keywords: assessment, expectation, patient satisfaction, service quality

An examination of factors that challenge and facilitate implementation of the Baby Friendly Hospital Initiative in Australia and Ten Steps to Successful Breastfeeding in Indonesia: a convergent parallel mixed-methods study of two hospitals

Background Breastfeeding, which brings benefits to both mother and infant health, the environment and the economy, is a human rights issue. However, only 48% of babies are breastfed within one hour of birth and only 41% of babies are exclusively breastfed globally. The first few days after birth is a critical period for establishing breastfeeding. WHO and UNICEF launched the Ten Steps to Successful Breastfeeding (Ten Steps) in 1989 (revised in 2018) to ensure that mothers receive adequate breastfeeding education and support. In 1991, the Baby Friendly Hospital Initiative (BFHI) was launched to encourage maternity facilities to implement the Ten Steps; however, in 2016 only 10% of babies were born in BFHI-accredited hospitals globally. Australia and Indonesia face similar issues regarding implementing the BFHI and the Ten Steps. Only 26% of Australian hospitals were BFHI-accredited in 2020, and only 8% of Indonesian government hospitals were considered to be implementing the Ten Steps in 2011. Methods Convergent parallel mixed methods were used to examine facilitators and challenges to BFHI and the Ten Steps implementation in Australia and Indonesia. The quantitative component evaluated the Social Return on Investment (SROI) of implementing these policies. The qualitative component utilised focus groups discussions with midwives and nurses in each context, regarding their experiences and perceptions of implementing the BFHI or the Ten Steps. The two components were integrated using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework. Findings The results of the quantitative component found that every US$1 invested in maintaining BFHI accreditation in an Australian hospital and implementing the Ten Steps in an Indonesian hospital brought an equivalent of US$ 37 and US$ 49 social return to the community, respectively. The qualitative findings from the Australian hospital emphasized how midwives' belief in breastfeeding was critical in enabling them to negotiate challenges to implementation. While the Indonesian case study highlighted their awareness and understanding of the human rights of children and mothers to manage challenges in implementing the Ten Steps. The importance of continuity of care and adequate time with midwives throughout pregnancy, birth and the postpartum period were described as critical for implementation of the BFHI and Ten Steps in both settings The two components converged through the social value studies results that indicate a misalignment of social returns with individual organization and clinical level returns. Furthermore, the qualitative studies highlighted that the costs of implementing the BFHI and Ten Steps are only partially being born by the hospital, rather than by the individual midwives and nurses doing the ongoing work of the implementation. This also occurs in peer-support groups and community health services who are critical for implementation but receive no return on their investment. The NASSS integrative analysis highlighted the complexity of implementing policy into health services and clinical practice. Conclusion The complexity of the implementation of the BFHI and the Ten Steps requires national multi-sectoral collaboration. This study provides the first evidence of the social return on investment of implementing the BFHI and Ten Steps in public maternity facilities, providing important incentive for global reinforcement of these initiatives. The NASSS framework focuses on challenges and facilitators of the BFHI and Ten Steps through multiple lenses. Most of these have the potential to be unpredictable. Despite WHO having updated the Ten Steps and BFHI in 2018, it is recommended that barriers, such as the lack of continuity of care and fragmented Ten Steps implementation across health systems must be addressed as a matter of urgency

Kepuasan Pelanggan Sebelum dan Setelah BLUD di RSUD Kabupaten Sidoarjo

ABSTRACTPrestasi kerja merupakan gambaran tingkat pencapaian atas penerapan program/kebijakan dalam rangka mewujudkan tujuan, misi dan visi organisasi, yang sudah tertulis di rencana strategis rumah sakit. Penilain prestasi merupakan salah satu petunjuk untuk menilai kualitas pelayanan rumah sakit. Penelitian ini bertujuan untuk menganalisa kepuasan pelanggan sebelum dan sesudah RSUD Kab Sidoarjo menjadi badan layanan umum daerah (BLUD). Penelitian ini menggunakan pendekatan observasi. Responden adalah 150 orang pasien rawat jalan dan rawat inap yang menggunakan jasa rumah sakit pada saat penelitian dilaksanakan, sebelum (sebelum 1998) dan sesudah rumah sakit menjadi BLUD. Penelitian ini dilaksanakan tgl 28 agustus 2013 sampai 2 september 2013 dengan metode observasi dan wawancara dan menggunakan questionnaire. Hasil-nya mayoritas pelanggan merasa puas , selebihnya tidak memuaskan

THE EFFECTIVENESS OF FORMING BREASTFEEDING SUPPORT GROUP PROGRAM TO IMPROVE EXCLUSIVE BREASTFEEDING

 Background: Exclusive breastfeeding is a problem of maternal and child health in Indonesia. With Breastfeeding Support Group, exclusive breastfeeding is expected to improve. Sugihwaras Village and Sumbergede Village have been initiating Breastfeeding Support Group program. However, the framework of Breastfeeding Support Group program and intervention methods for pregnant and breastfeeding mothers in both villages were different.Aim: It analyzed the effectiveness of forming Breastfeeding Support Group program and intervention programs for pregnant and breastfeeding mothers to improve exclusive breastfeeding in Sugihwaras Village and Sumbergede Village.Methods: This study used a case study approach to the formation of Breastfeeding Support Group program. Comparative analysis was done descriptively by selecting samples from the Fieldwork Report of Group 14 and 15 in the period of 2017/2018, Faculty of Public Health, Universitas Airlangga. This study applied total sampling technique and descriptive analysis by comparing community’s characteristics (as input), a form of intervention and program management (as a process), and results of evaluating the formation of Breastfeeding Support Group (as an output).Results: Community’s characteristics in both villages tend to be similar, and the average duration of each program was the same. Sumbergede Village focused on the readiness of forming cadres for Breastfeeding Support Group program, while Sugihwaras Village focused on breastfeeding mothers and their husbands. Indicator analysis of the program showed that Sumbergede Village (80.00% achieved) had a 5.71% higher percentage of attainment compared to Sugihwaras Village (85.71% achieved). Analysis of the program’s strengths and weaknesses pointed out that Sumbergede Village had more values and power in resources in its region.Conclusion: The intervention program in Sumbergede Village tends to be more effective. It has greater potential to be a sustainable program in the following year to improve 100% exclusive breastfeeding. Keywords: Breastfeeding Support Group, exclusive breastfeeding, intervention, effectiveness

Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study

Background: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital’s Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results: The social return from the BFHI in this facility was calculated to be AU$1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equityThis study is funded by Indonesian Endowment Fund for Education (LPDP) and Department of Health Services Research and Policy, Research School of Population Health, Australian National University

Breastfeeding policy analysis in Indonesia

The rate of exclusive breastfeeding in Indonesia did not meet the national target which was set at 80% in 2014 but reduced to 50% in 2019. Based on Basic Health Research (2013), only 38% of babies aged 05 months were exclusively breastfed. The Indonesian Ministry of Health (Indonesian Health Profile, 2016) reported that only 55.7% of babies were exclusively breastfed. Though it seems that the national target rate was reached, in fact some provinces had low exclusive breastfeeding rates. Indonesia has published regulations for breastfeeding such as Government Regulation Number 33 Year 2012 on Exclusive Breastfeeding. The objective of this research was to analyse breastfeeding policy and its implementation in Indonesia. The research methodology was a literature review on Indonesian regulation. The review demonstrates that policy implementation still needs to be monitored and evaluated. Recommendations are made for the medical professional association and the government

Penerapan Program Sepuluh Langkah Kesehatan untuk Peningkatan Pemberian ASI Eksklusif: Model Evaluasi CIPP (Context, Input, Process, Product)

Penelitian ini bertujuan untuk mengevaluasi sepuluh langkah keberhasilan implementasi kebijakan ASI sebagai dasar untuk meningkatkan pencapaian praktik ASI eksklusif di Kabupaten Kediri. Penelitian ini merupakan penelitian evaluatif dengan model CIPP (Context, Input, Process, Product). Ada tujuh Puskesmas rawat inap yang terlibat dalam penelitian ini. Responden dalam penelitian ini adalah kepala atau staf puskesmas (7 orang) dan seluruh bidan (94 orang). Hasil penelitian menunjukkan bahwa berdasarkan evaluasi konteks, berupa tujuan pelaksanaan kebijakan tercapai 77,6%. Evaluasi masukan menunjukkan bahwa sarana dan prasarana serta dukungan tenaga kesehatan kurang memadai, hanya tercapai 56,4%. Berdasarkan hasil evaluasi proses, Puskesmas belum melakukan perumusan kebijakan dan pembentukan kelompok pendukung ASI, sehingga capaiannya hanya 73,9%. Evaluasi produk, pemberian ASI eksklusif menurun pada tahun 2018 dan tertinggal dari tren selama empat tahun terakhir. Target rencana strategis yang disusun oleh pemerintah daerah belum terpenuhi. Kesimpulan: kebijakan sepuluh langkah keberhasilan menyusui di Puskesmas rawat inap belum terlaksana dengan baik. Disarankan agar pemerintah daerah menyusun regulasi tentang ASI eksklusif. Dinas Kesehatan Kabupaten hendaknya mensosialisasikan kesepuluh langkah sukses menyusui dan memasukkannya ke dalam elemen penilaian dalam akreditasi Puskesmas. Selain itu, dibutuhkan pembentukan kelompok KP-ASI di masyarakat