Hubungan Interorganisasi Dinas Kesehatan dan Rumah Sakit pada Aktivitas Tanggap Darurat Krisis Kesehatan di Kota Surakarta: Pembelajaran dari Pandemi COVID-19

Valentina Lakhsmi Prabandari, Syahirul Alim, S.Kp., M.Sc., Ph.D

2023 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latarbelakang: Penguatan kolaborasi terus menerus direkomendasikan dalam upaya penguatan respon sistem kesehatan terhadap kedaruratan kesehatan masyarakat. Penanggulangan pandemi COVID-19 memberikan pengalaman berharga mengenai bagaimana membangun jaringan kolaboratif antar stakeholders dalam sistem kesehatan di bawah komando dinas kesehatan sehingga dibutuhkan kajian yang merefleksikan pembelajaran dari pengalaman ini. 

Tujuan: Penelitian dilakukan untuk mengeksplorasi hubungan interorganisasi antara dinas kesehatan dan rumah sakit pada aktivitas tanggap darurat COVID-19 di Kota Surakarta dan memperoleh pembelajaran dari pengalaman tersebut sebagai masukan untuk memperkuat penanggulangan krisis kesehatan di masa mendatang.

Metode: Penelitian menggunakan desain qualitative content analysis dan merujuk pada adapted 3C model yaitu Communication, Coordination, dan Cooperation yang membentuk kolaborasi pada situasi krisis. Tujuh belas partisipan dari dinas kesehatan dan rumah sakit serta dua informan kunci dari Satuan Tugas COVID-19 Kota dipilih melalui purposive sampling. Data dikumpulkan pada Desember 2022-Maret 2023 dengan wawancara mendalam, telusur dokumen, dan observasi, dan dianalisa menggunakan teknik content analysis. Trustworthiness dipastikan dengan teknik triangulasi dan member checking. 

Hasil: Hubungan interorganisasi Dinas Kesehatan Kota Surakarta dan RS dalam penanggulangan COVID-19 berkaitan erat dengan karakteristik krisis yaitu adanya ketidakpastian dengan tuntutan yang tinggi sementara ketersediaan sumber daya sangat terbatas sehingga menuntut adanya kolaborasi melalui proses communication, coordination, dan cooperation dengan pendekatan dan cara-cara yang berbeda dari situasi normal. Komunikasi dilakukan dengan pendekatan yang berbeda untuk memperoleh respon dan keputusan cepat. Informasi yang dibagikan digunakan untuk mengoordinasikan sumber daya dan aktivitas tanggap darurat yang membutuhkan sumber daya lebih tinggi dari situasi normal. Komunikasi dan koordinasi menunjang kerjasama aktivitas tanggap darurat COVID-19 yang membutuhkan penyesuaian proses kerja. Ditemukan faktor-faktor dan tantangan yang mempengaruhi hubungan interorganisasi terkait karakteristik krisis dan konteks Kota Surakarta.

Kesimpulan: Hubungan interorganisasi Dinas Kesehatan Kota Surakarta dan rumah sakit dalam penanggulangan COVID-19 merupakan hubungan kolaborasi yang dibangun dari keterkaitan proses komunikasi, koordinasi, dan kerjasama yang dilakukan dengan pendekatan dan cara yang berbeda dari situasi normal. Peningkatan kemampuan network manager, perbaikan pada proses komunikasi, koordinasi, dan kerjasama serta mengenali tantangan, menyiasati faktor penghambat, dan mengoptimalkan faktor pendukung dapat dilakukan untuk memperkuat hubungan interorganisasi.

Interorganizational Relationship between District Health Office and Hospital in Emergency Activities of Health Crisis Management in Surakarta: Lesson Learned from COVID-19 Pandemic

Background: Improving stakeholder collaboration is a continuously emerging recommendation to strengthen the health system's response to any public health problems. Experiences in tackling the COVID-19 pandemic bring some lessons learned about establishing a collaborative network of health ecosystem stakeholders under the command of the District Health Office (DHO).

Objective: This study aims to explore the local actors' views and experiences of the process of interorganizational relationship (IOR) between DHO and hospitals in establishing coordinated emergency activities and responses to tackle the COVID-19 pandemic in Surakarta City, Central Java, Indonesia.

Method: The study used the qualitative content analysis design and referred to the adapted 3C model which includes Communication, Coordination, and Cooperation that articulate collaboration in an emergency situation. Seventeen informants from DHO and hospitals and two key informants from the regional COVID-19 Taskforce were purposefully selected. The informants were involved in the COVID-19 pandemic response. Data were collected from December 2022-March 2023 through in-depth interviews, document reviews, and observation and analyzed using content analysis techniques. Triangulation and member checking were conducted to improve the trustworthiness of the data.

Findings: IOR between DHO and hospitals in COVID-19 countermeasures was related to characteristics of the crisis situation, i.e., uncertainty, high demand, resource constraints, and inability to respond individually, thus organizations were required to be involved in collaboration through the process of communication, coordination, and cooperation with different approaches from normal situation. Communication between DHO and hospitals utilized extraordinary approaches to allow rapid response and decisions. The information shared was used to coordinate resources and activities in different ways from non-crisis settings due to the higher need for resources and the busyness of activities during the COVID-19 pandemic. The coordination was supported by government policies as COVID-19 was stated as a priority mandate. Communication and coordination affected cooperation in COVID-19 countermeasures per organizations' main function in the health system which required work process adjustments. Barriers and facilitators were found to influence the collaboration process along with challenges related to characteristics of the crisis situation and the context of Surakarta.

Conclusion: The collaboration of DHO and hospitals in Surakarta was articulated by exceptional communication and coordination approaches to actively cooperate in the COVID-19 pandemic response. Assigning a capable network manager, improving these 3Cs, fathoming the context, minimizing the barriers, and strengthening the facilitators are needed for the collaboration to be effective.

Kata Kunci : hubungan interorganisasi, krisis kesehatan, penanggulangan COVID-19