Upaya Manajemen Rumah Sakit Dalam Mendukung Kolaborasi Antara Dokter Umum Dan Spesialis Di Instalasi Gawat Darurat

Background: General practitioners play a major role in runningthe service in the emergency department. As members ofthe team, general practitioners often disagree with specialistdoctors. Problems in communication and coordination oftenhave an impact on the poor service. They even have legalconsequences for the hospital.Objective: This study identified problems of collaboration betweengeneral practitioners and specialists in the managementof patients in the emergency unit, factors that impede thecollaborative process and evaluated efforts of hospital managementin supporting the collaborative process.Methods: This descriptive and exploratory study obtaineddata from in-depth interviews, official documents and routing,as well as participant observation and field observations.Results: General practitioners and specialists have a poorworking relationship that can be coined the legal consequencesin the management of patients in the emergency unit. Individualfactors such as a lack of confidence in the competence ofspecialist physicians, social closeness, the arrogance of specialiststo general practitioners, incomplete standards of carein the emergency unit, and physician adherence to hospitalpolicies and regulations are all obstacles in implementing cooperationteamwork in the emergency unit. The hospital management,on the other hand, takes a losing position in thepresence of doctors. Hospital management failed to prioritizethe development and the implementation of hospital bylawsthat control poor professional coordination and communication.The hospital management still has problems in contractsystem with the doctor, the procedures in the recruitment process,debriefing doctor, and the standard of care in the emergencyunit. This situation becomes more complicated with theexistence of blaming culture, no informal meetings betweendoctors, tacit practices in the supervision and guidance of themedical staff, as well as management's lack of assertivenessoffenses committed by doctors on hospital policies and regulations.Conclusion: This study shows that general practitioners andmedical specialists fail to understand the legal consequencesof poor cooperation in emergency services. If a hospital managerdevelop and enforce the hospital bylaws relevant to situationalproblems in emergency care, reluctance and barrierscollaboration between physicians, personal issues, and professionalbias in medical practice would no longer a source ofpoor team performance. Hospital managers should enforcetheir hospital bylaws to control personal and professional arrogance

TEN-YEAR RETROSPECTIVE STUDY OF DIAZEPAM CONSUMPTION IN INDONESIA

Objective: This study aimed to evaluate annual consumption during 2004-2013 of diazepam, an essential medicine which is controlled under the 1971 Convention on Psychotropic Substances in Indonesia and to investigate factors influencing its use in health facilities.Methods: This was a case study with quantitative and qualitative approaches. Annual consumption was calculated from the quantity of exports and imports. The use of diazepam was calculated from consumption deducted by 20% buffer stock. The consumption and use of diazepam were presented in kilogram and also in defined daily doses for statistical purposes (S-DDD). In-depth interviews were conducted to investigate factors that influence the use of diazepam. Triangulation was conducted to confirm the qualitative and quantitative findings.Results: The annual average consumption in 2004-2006 was 530 kg. Furthermore, it decreased 38% during 2011-2013 to 329 kg. Calculated use of diazepam also decreased. The average consumption for the 10-year period of diazepam was 470 kg, and the calculated use was 376 kg (0.45 S-DDD). Considering the approximate need of diazepam to treat various health problems, its use should ideally be around 1-2 S-DDD. Therefore, the calculated use of diazepam was considered too low as confirmed by frequent stockouts. The interviews revealed that among the factors influencing its use was its limited production. There was an increased use of alprazolam, but it was unlikely to compensate for the diazepam stockouts.Conclusion: Consumption and use of diazepam for medical purposes in Indonesian decreased over 10 years, and stockouts are often reported. The government should improve its availability and correct impediments for adequate production and supply of diazepam

Peran Pengelola Kesehatan dalam Berinovasi Program Kesehatan Masyarakat Tingkat Kabupaten di Provinsi YOGYAKARTA

Role of local health managers in innovating district level public health programs in Yogyakarta ProvincePurpose: The study aimed to describe the strategic decision making by the heads of the DIY health departments concerning the issue of maternal and child health and nutrition.Methods: This qualitative research was an exploratory study.Results: The district health office for Yogyakarta city in the Special Region of Yogyakarta does not have many strategic decisions to solve problems about maternal and child health and nutrition. However, the decisions are always hampered by human resources. Only the Gunung Kidul District Health Office stated that there was no political involvement in decisions by the head of the health department.Conclusions: The decisions made by heads of health department are still limited to the strategic plan and local medium term development plan (RPJMD). Not many innovations are developed to overcome the problems of maternal and child health and nutrition

Peran Kepala Puskesmas SKM dan Non SKM dalam Meningkatkan Kemampuan Manajerial Puskesmas di Kabupaten Oku Timur

Role of the head of public health centers from public health graduates and others on improving managerial skills in East OkuPurposeThis study aimed to understand how public health and non-public health backgrounds affect management skill of primary health care heads, based on ten managerial roles. MethodsThis study was a descriptive study with case-series method, using qualitative methods supported by quantitative data. Eight people were recruited as respondents. They consisted of 4 people that were primary healthcare heads with public health background and 4 people that were primary healthcare heads with non-public health background. Respondents were recruited by purposive sampling. Data collection was performed using in-depth interviews and questionnaire. ResultsPrimary healthcare head with public health background owned more work experience than those with non-public health background. Period of employment in primary health care had an influence on managerial capabilities. There were no significant differences of period of employment in primary health care head positions among the longest with the least to the managerial capabilities. Primary health care heads who had been trained with PIM IV training and other structural positions were known to have better management capabilities, especially compared to the leadership role of those who had not been trained.ConclusionThere was no significant difference in managerial capacity between primary health care heads with public health and those with non-public health background

Pengembangan Rencana Strategis Sistem Informasi dan Teknologi Informasi (Renstra Si/ti) pada Dinas Kesehatan Kabupaten Bima Menggunakan Model Zachman Framework

Latar Belakang : Perencanaan Strategis Sistem Informasi bertujuan untuk keselarasan antara rencana kegiatan sistem informasi dengan rencana strategi organisasi. Untuk mengatasi resiko yang timbul terkait Perubahan organisasi, Perubahan kebijakan, Perubahan posisi, diperlukan alat kontrol yang efektif dalam mengontrol performa dan keberhasilan implementasi SI/TI. Tujuan penerapan Renstra SI/TI di Dinas Kesehatan adalah agar tercapai eHealth yang terintegrasi dan interoperabilitas system bisa berjalan dengan baik. SI/TI di bidang kesehatan meliputi pelayanan kesehatan perorangan, pelayanan kesehatan masyarakat, dan administrasi kesehatan. Perencanaan strategis SI dibutuhkan dengan harapan permasalahan di Dinas Kesehatan dapat teratasi sehingga penerapan SI/TI menjadi efektif dan pelayanan kesehatan bisa lebih produktif. Pengembangan Rencana Strategis SI/TI Dinas Kesehatan memerlukan dukungan, keterlibatan dan komitmen Stakeholder agar tercapai tujuan dan sasaran sesuai visi dan misi organisasi.Tujuan: Penelitian ini bertujuan untuk menyusun Rencana Strategis SI/TI menggunakan model Zachman Framework yang digunakan sebagai acuan pengembangan Rencana Strategis Sistem Informasi di Dinas Kesehatan Kabupaten Bima dengan berpedoman pada pencapaian Visi dan Misi Organisasi.Metode: Jenis penelitian bersifat Kualitatif dan desain penelitian menggunakan Action Research. Identifikasi permasalahan dan analisis kebutuhan menggunakan analisis SWOT, Value Chain, dan Mc.Farlan GirdHasil: Sistem Informasi di Dinas Kesehatan Kabupaten Bima cukup memadai, tetapi belum terintegrasi sehingga butuh pengembangan dengan peningkatan sumber daya manusia TI, infrastruktur, jaringan, tatakelola SI, Standar Operational Procedure (SOP) SI/TI sebagai protap, komitmen stakeholder, dukungan dana, regulasi/kebijakan yang tepat melaui penyusunan portofolio perencanaan, kebijakan, infrastruktur, dan aplikasi sesuai kebutuhan. Kesimpulan: Berdasarkan hasil analisis lingkungan internal dan eksternal bahwa Dinas Kesehatan Kabupaten Bima masih dibutuhkan pengembangan SI baru atau pengembangan SI yang sudah ada untuk menunjang kegiatan pelayanan organisasi. Oleh karena itu Rencana Strategis SI/TI pada Dinas Kesehatan Kabupaten Bima disusun dalam 3 tahapan dengan jangka waktu 5 tahun (20162020) yang meliputi pengembangan data center, sistem informasi, infrastruktur, kemananan jaringan, SDM, organisasi, manajemen dan proses kerja. Tujuannya agar selaras dengan visi dan misi SI/TI yang telah dirumuskan