ANALISIS BIAYA MUTU (COST OF QUALITY) DALAM PENINGKATAN MUTU LAYANAN KESEHATAN DI PUSKESMAS KABUPATEN SLEMAN PROVINSI DAERAH ISTIMEWA YOGYAKARTA

Tri Astuti Sugiyatmi, Dr. Tjahjono Kuntjoro, MPH, DrPH

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Banyaknya keluhan pelanggan bahkan sampai tuntutan hukum menunjukkan belum baiknya mutu pelayanan kesehatan kita. Dukungan dari pihak terkait dalam membangun mutu dirasakan masih kurang. Perhitungan biaya mutu di puskesmas diperlukan untuk memperoleh gambaran berapa cost of good quality yang harus dialokasikan dalam upaya membangun mutu. Penelitian bertujuan untuk memperoleh informasi biaya mutu dan upaya membangun mutu puskesmas melalui komitmen manajemen puncak dan dukungan dari stakeholder di puskesmas Kabupaten Sleman. Metode : Jenis penelitian ini adalah studi kasus deskriptif dengan rancangan desain multikasus terjalin. Unit analisisnya adalah empat puskesmas yang menerapkan SMM dan dua yang belum menerapkan SMM. Subyek penelitian adalah dokumen realisasi anggaran tahun 2010 dengan instrumen check list model PAF (prevention, appraisal, failure). Data kualitatif diperoleh dari wawancara. Hasil : Rata-rata biaya mutu puskesmas SMM Rp. 70.000.803,00 sedangkan di puskesmas Non SMM mencapai Rp. 31.421.450,00 termasuk di dalamnya terdapat biaya kegagalan eksternal sebesar Rp. 252.500,00. Berdasarkan kategori biaya mutu pada puskesmas SMM adalah P= 67%; A=33%; Finternal=0% dan Feksternal=0 %. Pada puskesmas non SMM P= 92%; A=7%; Finternal=0% dan Feksternal=1 %. Kesimpulan : Mutu puskesmas tetap harus diperjuangkan, namun ratarata biaya mutu pada puskesmas SMM yang 2,2 kali lipat daripada puskesmas Non SMM dengan mutu yang tidak jauh berbeda membuat ISO 9001:2000 perlu ditinjau ulang atau dikendalikan biayanya. Upaya membangun mutu puskesmas diawali dengan adanya komitmen manajemen puncak dan dukungan stakeholder yang berupa pengalokasian anggaran biaya mutu khususnya biaya pencegahan.

Background : A lot of customer complaints and even lawsuits show that our health care has not been in a good quality yet. There is also no enough support from any relations to the problem. In this case, the calculation of quality cost in Public Health Centers (PHC) is needed to obtain a picture of how much the cost of good quality should be allocated to reach such quality. This study aims to obtain the amount of the quality cost and the efforts to improve the quality of PHC through the commitment of the top management and the support of the stakeholders in Sleman PHC, DIY. Method : The research is a case study with a multi-case intertwined draft design. The analysis units are four PHC that apply quality management system (QMS) and two centers that have not apllied it yet. The subjects of the research are the 2010 budget documents with the instrument of PAF (prevention, appraisal, failure) checklist model. The qualitative data is done by interviewing some informants. Result :The average quality cost of the PHC with QMS implementation is IDR 70,000,803; while the clinics with Non QMS implementation reach IDR 31,421,450. The categories of quality costs at the PHC with QMS implementation are P = 67%, A = 33%; Internal F = 0% and eksternal F= 0%. The categories at the clinics with Non QMS implementation are P = 92%, A = 7%; Internal F= 0% and Eksternal F = 1%. Conclusion : The quality of the PHC shoul remain to be improved. However, the average quality cost of the PHC with QMS that is 2,2 times more than the one without QMS, and their quality that is not quite different make ISO 9001:2000/9001:2008 needs to be reviewed or the cost should be controlled . The Efforts to improve the quality of PHC begin with the commitment of the top management and the support of the stakeholders in the form of budget allocation, particularly in the prevention cost.

Kata Kunci : biaya mutu, ISO, SMM, biaya pencegahan, biaya kegagalan, biaya pemeriksaan/pengawasan, puskesmas