EVALUASI AKREDITASI RUMAH SAKIT DI INDONESIA OLEH KOMISI AKREDITASI RUMAH SAKIT (KARS) : PERSEPSI RS DAN STANDAR ISQUA

Intan Irfianti, Prof. dr. Adi Utarini, MSc, MPH, PhD; dr. Hanevi Djasri, MA

2011 | Tesis | S2 Ilmu Kesehatamn Masyarakat

Latar belakang: Di Indonesia salah satu penilaian eksternal utama terhadap mutu pelayanan kesehatan rumah sakit dilakukan melalui akreditasi KARS. Sampai dengan Mei 2011 baru 720 (42,4%) dari 1699 rumah sakit di Indonesia yang mengikuti akreditasi KARS. Efektifitas akreditasi dapat dinilai melalui 2 (dua) perspektif, yaitu melalui perspektif pengguna (RS) maupun melalui perspektif lembaga akreditasi seperti yang dikembangkan oleh ISQua (2007) melalui International Accreditation Program. IAP merupakan satu-satunya program internasional yang mengakreditasi lembaga akreditasi. Hasil penelitian ini dapat digunakan sebagai masukan kepada KARS dan Kementrian Kesehatan dalam perbaikan sistem akreditasi rumah sakit di Indonesia untuk meningkatkan dampak akreditasi terhadap mutu pelayanan rumah sakit. Tujuan: (1) mengevaluasi efektifitas sistem akreditasi RS oleh KARS di Indonesia (2) Menilai dampak akreditasi RS oleh KARS terhadap mutu pelayanan RS di Indonesia (3)Menilai sistem akreditasi KARS menggunakan standar International Accreditation Program dari ISQua Metode: Penelitian ini merupakan penelitian deskriptif. Subyek penelitian ada dua jenis yaitu, sistem akreditasi RS yang terdiri dari komponen lembaga akreditasi (KARS), standar akreditasi dan program pelatihan surveyor untuk penelitian efektivitas akreditasi menurut perspektif lembaga akreditasi, dengan menggunakan panduan ISQua. Subyek lainnya adalah RS terakreditasi KARS untuk penilaian akreditasi menurut perspektif pengguna, dengan menggunakan mailed questionnaire , yang dikirimkan kepada 181 RS. Hasil: Responden secara umum berpendapat setuju bahwa akreditasi mempunyai dampak terhadap peningkatan mutu RS. Sebanyak 95,8% RS setuju bahwa akreditasi mendorong keterlibatan staf RS dalam upaya peningkatan mutu dan 83,9% RS setuju akreditasi berdampak terhadap mutu RS. Namun jumlah RS yang setuju mengenai dampak akreditasi terhadap kinerja klinis RS hanya 61,5% RS. Sebanyak 67,9% RS dapat mengidentifikasi adanya berbagai bentuk pengaruh akreditasi terhadap mutu RS. Jawaban atas pertanyaan terbuka memberikan informasi mengenai saran perbaikan terhadap sistem akreditasi, antara lain mengenai pembinaan, penilaian dan tindak lanjut, standar akreditasi dan kompetensi serta konsistensi surveyor akreditasi. Pengelolaan lembaga KARS hanya memenuhi 7 (8,4%) dari 78 kriteria dalam prinsip pengelolaan lembaga akreditasi dari ISQua. Standar akreditasi KARS hanya memenuhi 19 (33,9%) dari 56 kriteria dalam prinsip standar Akreditasi dari ISQua. Program pelatihan surveyor KARS memenuhi 17 (70,8%) dari 24 kriteria dalam prinsip program pelatihan surveyor dari ISQua Kesimpulan: Menurut persepsi RS, sistem akreditasi KARS efektif untuk mendorong keterlibatan staf, cukup efektif mendorong upaya peningkatan mutu RS namun kurang efektif terhadap kinerja klinis RS. Standar ISQua tentang lembaga, standar dan program pelatihan surveyor tidak dapat dipenuhi oleh sistem akreditasi KARS.

Background: In Indonesia, one of the main external assessment towards hospital healthcare were conducted through KARS’ accreditation. Until 2011 there were only 720 (42,4 %) out of 1699 hospitals in Indonesia that already have KARS accreditation. The effectivity of the accreditation could be judged by using two persectives; the users’ perspective (hospitals) and the accreditation body’s perspective such as one that were developed by ISQua (2007) through the International Accreditation Program. This is the only international program that ‘Accredits the Accreditors’ in health care. The results of this research can be used as an input to KARS and the Health Ministry in order to improve the hospital accreditation system in Indonesia to enhance the impact of the accreditation towards the quality of hospital healthcare. Objective: (1) to evalluate the effectivity of hospital accreditation by KARS in Indonesia (2) Assessing the impact of hospital accreditation towards the quality of hospital healthcare in Indonesia (3) Assessing Kars’ hospital accreditation system using IAP standars from ISQua. Method: This is a descriptive research. The subject of the research is consisted of two subjects, which are the hospital accreditation system that comprised of components of accreditation body (KARS), accreditation standards and the surveyor training programs for research on effectivity of accreditation according to the accreditation bodies’ perspective by using the ISQua guide. Other subject is KARS’ accreditated hospitals for assessment of accreditation according to the users’ perspective by using mailed questionnaire that were sent to 181 hospitals. Result: Generally, respondents agreed that accreditation managed to provide impact to the improvement of hospital’s quality. 95.8% hospitals agreed that accreditation has encourage the participation of hospital staffs in the effort to improve quality and 83.9% hospitals agreed that accreditation has impacted the quality of hospitals. However, only 61.5% hospitals thought that accreditation could affect the clinical performance of hospitals. As many as 67.9% of the hospitals managed to identify various forms of accreditation’s effect to the hospitals’ quality. Answers to open questions provided information on suggestions of improvements to the accreditation systems, such as stewardship, assessment and follow ups, accreditation standards and the consistency of accreditation surveyors. The management of the KARS’s body only meet 7 (8.4%) out of 78 criteria stated in the international accreditation standars for health care external evaluation organisations of ISQua. The accreditation standards of KARS only meet 19 (33.9%) of 56 criteria stated in international principles for health care standard of ISQua. The surveyor’s training programs of KARS managed to meed 17 (70.8%) out of 24 criteria in the surveyor training standars programs of ISQua. Conclusion: According to the hospitals’ perception, the KARS accreditation system were effective in encouraging staff’s engagement, adequately efffective in ecouraging the effort to improve the quality of hospitals but were less effective towards clinical performance of hospitals. The ISQua standard regarding the institution, standards and training programs of surveyors were not able to be met by KARS’ accreditation system.

Kata Kunci : Mutu pelayanan kesehatan, Akreditasi KARS, International Accreditation Program, ISQua