PENYUSUNAN INDIKATOR PEMANTAUAN KEBERLANJUTAN PENINGKATAN MUTU DAN KESELAMATAN PASIEN PASCA AKREDITASI PUSKESMAS DI KABUPATEN JEMBER
TABITA RIONICA AYU W, Prof. dr. Adi Utarini, M.Sc., MPH., Ph.D.; Dr.dr. Hanevi Djasri, MARS.
2019 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKATLatar Belakang: Peningkatan mutu dan keselamatan pasien merupakan isu penting dalam pelayanan kesehatan yang merupakan fokus utama dalam akreditasi Puskesmas. Dinas Kesehatan Kabupaten/Kota mempunyai peran untuk melakukan penilaian dan pendampingan pra-akreditasi serta pendampingan pasca akreditasi secara berkesinambungan. Namun, di Kabupaten Jember saat ini masih sekedar penilaian dan pendampingan pra-akreditasi. Hal ini menyebabkan keberlanjutan peningkatan mutu dan keselamatan pasien di Puskesmas tidak terpantau. Meskipun sudah ada pedoman dan instrumen pendampingan pasca akreditasi yang mencakup Peningkatan Mutu Puskesmas serta Keselamatan Pasien, tetapi belum ada indikator yang mencakup komponen-komponen CQI secara spesifik yaitu structure, process, dan outcome. Tujuan: Mengembangkan indikator pemantauan keberlanjutan peningkatan mutu dan keselamatan (PMKP) pasca akreditasi Puskesmas di Kabupaten Jember. Metode: Penelitian ini menggunakan rancangan penelitian action research. Subyek penelitian adalah Tim Pendamping Akreditasi Puskesmas dan Tim Mutu Puskesmas di Kabupaten Jember. Pengumpulan data dilakukan dengan analisis hasil wawancara mendalam untuk mengidentifikasi komponen indikator, telaah pustaka (guidelines) dan lokakarya untuk menyusun daftar indikator potensial, analisis uji coba, serta lokakarya akhir untuk menetapkan indikator. Hasil: Ketiadaan instrumen pendampingan pasca akreditasi menjadi kendala utama dalam proses pemantauan PMKP pasca akreditasi sehingga dibutuhkan instrumen yang memudahkan prosesnya berupa indikator. Penyusunan indikator melewati proses kajian pustaka, seleksi dan konsensus awal, uji coba, evaluasi hasil uji coba, hingga dirumuskan 18 indikator pemantauan keberlanjutan PMKP pasca akreditasi Puskesmas di Kabupaten Jember (8 indikator pada komponen structure dan 10 indikator pada komponen process). Kesimpulan: Implementasi indikator pemantauan keberlanjutan PMKP pasca akreditasi Puskesmas di Kabupaten Jember perlu didukung dengan penetapan kebijakan, pembenahan sistem informasi, serta revitalisasi peran Dinas Kesehatan sebagai pendamping akreditasi Puskesmas.
Background: Improving the quality and safety of patients is an important issue in health services which is the main focus in the accreditation of primary health care center. District Health Office has a role to conduct pre-accreditation assessment and mentoring as well as post-accreditation assistance continuously. However in Jember, only pre-accreditation assessment and mentoring were conducted. This caused the continual improvement in quality and patient safety in primary health care center not monitored. Although there are guidelines and instruments for postaccreditation mentoring that cover Quality Improvement and Patient Safety (QIPS) of primary health care center, there is no indicator that cover spesific components of CQI i.e. structure, process, and outcome. Objective: Developing indicators for monitoring the QIPS continuity postaccreditation of primary health care center (PHCC) in Jember. Method: This research using action research design. The research subjects are the PHCC Accreditation Mentor Team and the PHCC Quality Team in Jember. Data collection is done by analyzing the in-depth interviews to identify the indicator components, literature and guideline review also workshop to compile a list of potential indicators, analysis of trials, and the final workshop to set the indicators. Result: The abstence of post-accreditation monitoring instrument become a major obstacle in the post-accreditation QIPS monitoring process, so some instruments in the form of indicators are needed to facilitate the process. The forming of indicators went through the process of literature review, selection and initial consensus, trials, evaluation of trial results, until 18 indicators were formulated (8 indicators of structure component and 10 indicators of process component). Conclusion: The implementation of indicators for monitoring the QIPS continuity post-accreditation of primary health care center in Jember needs to be supported by the policies, revamping the information system, and revitalizing the role of District Health Office as PHCC accreditation mentor.
Kata Kunci : indikator, peningkatan mutu dan keselamatan pasien, akreditasi puskesmas, action research
