Persepsi pasien terhadap mutu pelayanan uskesmas Kota Yogyakarta :: Studi kasus di Puskesmas yang menerapkan sistem manajemen mutu ISO dan yang tidak menerapkan sistem manajemen mutu ISO

OROH, Olwin Stella, dr. Tjahjono Kuntjoro, MPH.,DrPH

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. dan Manaj. Pe

Latar belakang. Meningkatkan pelayanan publik melalui pelayanan kesehatan di Puskesmas merupakan tujuan utama pemerintah kota Yogyakarta. Namun penelitian yang pernah dilaksanakan di seluruh Puskesmas kota Yogyakarta tahun 2005 tentang kepuasan pasien, masih ditemukan adanya prosedur pelayanan dokter yang kurang, persepsi pasien terhadap waktu tunggu lama, dan etika pelayanan seperti keramahan masih dirasakan kurang oleh pasien. Pada tahun 2005 Puskesmas Mantrijeron dan Puskesmas Umbulharjo II telah melaksanakan manajemen mutu berdasarkan ISO 9001:2000. Tujuan penelitian. Penelitian ini bertujuan mengetahui persepsi pasien terhadap mutu pelayanan di Puskesmas kota Yogyakarta yang sudah menerapkan sistim manajemen mutu ISO dan yang tidak menerapkan sistim manajemen mutu ISO menggunakan IKM (Indeks Kepuasan Masyarakat). Metode Penelitian. Jenis penelitian ini quasi experimental, dengan rancangan post-test only with control design. Populasi penelitian adalah pasien yang berkunjung di BP umum Puskesmas Mantrijeron, Puskesmas Umbulharjo II (sebagai kelompok perlakuan) serta Puskesmas Wirobrajan, Puskesmas Pakualaman (sebagai kelompok kontrol). Data mengenai persepsi pasien dianalisis berdasarkan pedoman IKM dan uji statistik independent sample t-test. Untuk uji beda harapan dan kenyataan pelayanan juga dilakukan dengan menggunakan independent sample t-test, sedangkan waktu tunggu dianalisis dengan statistik deskriptif dan chi- square test. Hasil penelitian. Persepsi pasien tentang mutu pelayanan berdasar IKM di empat Puskesmas yang diteliti termasuk kategori baik. Secara keseluruhan tidak ada perbedaan yang bermakna antara Puskesmas yang sudah dan yang belum menerapkan sistim manajemen mutu ISO (p>0.05). Yang berbeda secara bermakna hanya unsur keadilan, (p<0.05), dimana puskesmas ISO lebih tinggi. Untuk pelayanan yang diterima pasien hanya dimensi reliability yang berbeda secara bermakna (p<0.05), dimana puskesmas ISO lebih tinggi. Bila dibandingkan antara Puskesmas Mantrijeron (menerapkan ISO) dan Puskesmas Wirobrajan (belum menerapkan ISO), unsur kemampuan petugas, kesopanan dan keramahan, lebih tinggi di Puskesmas Mantrijeron, sedangkan unsur kecepatan pelayanan lebih tinggi puskesmas Wirobrajan. Sedangkan antara Puskesmas Umbulharjo II (menerapkan ISO) dan Puskesmas Pakualaman (belum ISO) tidak terdapat perbedaan secara untuk mutu pelayanan, harapan, kenyataan, dan gap antara harapan dan kenyataan (p>0.05). Untuk waktu tunggu pelayanan, Puskesmas ISO lebih lambat dengan OR=10,897 untuk loket pendaftaran, OR=3,527 untuk pelayanan pemeriksaan pasien BP umum, OR=2,306 untuk pelayanan obat. Secara statistik ada perbedaan secara bermakna untuk waktu tunggu di loket pendaftaran, pelayanan pemeriksaan pasien BP umum dan pelayanan obat antara Puskesmas ISO dan belum ISO, dimana untuk puskesmas ISO waktu tunggunya lebih lama dibandingkan yang belum ISO. Kesimpulan. Berdasarkan IKM, mutu pelayanan Puskesmas ISO maupun belum ISO dalam kategori baik. Tidak ada perbedaan yang bermakna antara mutu pelayanan Puskesmas ISO dan belum ISO.

Background. Improving public services through health services in health centers is the main purpose of the Yogyakarta City government. Nevertheless, the research conducted at all health centers in Yogyakarta in 2005 on patients’ satisfaction, there were still found lack on doctors’’ service procedures, the patients’ perception on the long waiting time, and the lack of service ethics such as hospitality. In the year of 2005, Mantrijeron Health Center and Umbulharjo II Health Center have implemented quality management based on ISO 9001:2000. Objective. The objective of this research was to investigate patients’ perception on service quality of health centers in Yogyakarta City with ISO quality management system or without ISO, by using IKM (Community Satisfaction Index). Methods. This research was quasi experimental research with post-test only with control design. The research population were patients visited health service units of Mantrijeron Health Center and Umbulharjo II Health Center (as tre atment group), also Wirobrajan Health Center and Pakualaman Health Center (as control group). Data on patients’ perception were analyzed based on IKM guidance and analyzed statistically using independent sample t-test. Independent sample t-test was also used to analyze gap differences between service expectations and facts, while data on waiting time were analyzed by using descriptive statistic and chi-sguare test. Results. Patients’ perceptions on service quality based on IKM at four observed health center were categorized as good. In general, there was no significant difference between health center with ISO and without ISO (p>0.05). Only fairness element which was significantly different (p<0.05), whrere health centers with ISO had higher score.On services received by patients, only reliability dimension which was significantly different (p<0.05), where health centers with ISO had higher score. If compared between Mantrijeron Health Center (with ISO) and Wirobrajan Health Center (without ISO), Mantrijeron Health Center had higher scorer in health officers’, ability, politeness, and hospitality. On the other hand, Wirobrajan Health Center had higher score in service speediness. Meanwhile there were no significant differences on service quality, expectations , facts, and gaps between expectations and between Umbulharjo II Health Center (with ISO) and Pakualaman Health Center (without ISO). It was found that health center with ISO were longer in service waiting time, with OR= 10.897 for registration lockets, OR= 3.527 for patients’ examination services at health service units, and OR= 3.527 for medicines services between health centers with ISO and without ISO, where health centers with ISO had longer waiting time compared to those without ISO. Conclusion: Based on IKM, the service quality of health center with ISO and without ISO was categorized as good. The was no significant difference on service quality of health centers with ISO and without ISO

Kata Kunci : Puskesmas,Mutu Layanan,Persepsi Pasien