IMPLEMENTASI TATA KELOLA KLINIS OLEH KOMITE MEDIK DI RUMAH SAKIT UMUM DAERAH DI PROVINSI JAWA TENGAH
Kasyfi Hartati, Prof. dr. Adi Utarini, M.Sc., MPH, Ph.D.
2013 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar belakang: Clicinal governance (tata kelola klinis) merupakan sistem mutu yang dikembangkan sejak era 1990-an. Dengan sistem ini masyarakat dijamin akan mendapatkan pelayanan klinis yang terbaik. Di Indonesia masalah tata kelola klinis diatur dalam Undang-Undang No 44 tahun 2009 tentang Rumah Sakit. Aturan pelaksanaannya adalah Peraturan Menteri Kesehatan No 755/Menkes/Per/IV/2011 tentang Penyelenggaraan Komite Medik di Rumah Sakit. Komite medik adalah perangkat RS untuk menerapkan tata kelola klinis agar staf medis di RS terjaga profesionalismenya. Tujuan: Mengukur tingkat implementasi tata kelola klinis oleh komite medik di RSUD di Provinsi Jawa Tengah. Metode: Penelitian ini adalah penelitian diskriptif dengan rancangan penelitian cross sectional survey. Subyek penelitian ini adalah 48 RSUD di Jawa Tengah terdiri dari 1 RSUD kelas A, 17 RSUD kelas B, 26 RSUD kelas C dan 4 RSUD kelas D. Data diperoleh menggunakan kuesioner yang diadaptasi dari Clinical Governance Standarts for Western Australian Health Services, Clinical Governance Survey dari Lugon & Secker-Walker, Optimizing Health Care Governance (OPTIGOV), Permenkes Republik Indonesia No 755 Menkes/Per/IV/2011 dan Standar Akreditasi KARS 2007. Kuesioner untuk menilai implementasi struktur dan proses tata kelola klinis. Pengukuran implementasi tata kelola klinis ini ada 8 variabel pada struktur dan 13 variabel pada proses. Kuesioner dikirimkan kepada responden melalui jasa pengiriman dan jawaban diberikan dengan wawancara atau jawaban tertulis. Analisa data secara diskriptif. Hasil dan pembahasan: Data diperoleh dari 30 RSUD yang terdiri dari 1 RSUD kelas A, 12 RSUD kelas B, 14 RSUD kelas C dan 3 RSUD kelas D). Rata-rata tingkat implementasi tata kelola klinis di RSUD di Jawa Tengah adalah 67%, ratarata tingkat pemenuhan struktur tata kelola klinis adalah 75% dan rata-rata tingkat pelaksanaan proses tata kelola klinis 58%. Tingkat pelaksanaan tugas komite medik adalah audit medis 3,3%, kredensialing 3,3%, pengembangan profesi berkelanjutan bagi staf medik 50% dan pembinaan profesionalisme kedokteran 70%. Kendala dalam pelaksanaan Permenkes No 755/Menkes/Per/IV/2011: penyebaran dokter spesialis tidak merata, kurangnya dukungan dari pihak manajemen RS. Kesimpulan dan saran: Implementasi tata kelola klinis oleh komite medik di RSUD di Jawa Tengah belum sesuai dengan peraturan yang ada. Perlu adanya penguatan untuk komite medik. Perlu kiranya pembuatan pedoman tata kelola klinis oleh yang berwenang dan monitoring pelaksanaannya.
Background: Clicinal governance is a quality system developed since the 1990s . With this system, people are guaranteed to get the best clinical care . In Indonesia, the clinical governance issues stipulated in Law No. 44 of 2009 on Hospital. Implementation rules are the Minister of Health Decree No. 755/Menkes/Per/IV/2011 on the Iplementation of Medical Committee on the Hospital. Medical committee in hospital is in charge of implementing cinical governance so that the medical staff at the hospital maintained their professionalism. Objective: Measure the level of implementation of clinical governance by the medical committee at district general hospitals in Central Java Province. Methods : This study was a descriptive study with cross-sectional survey research design . The study subjects were 48 District General Hospitals in Central Java consisting of 1 class A hospital , 17 class B hospital , 26 class C hospital and 4 class D hospital. Data obtained using questionnaires adapted from the Clinical Governance Standarts for Western Australian Health Services , Clinical Governance Survey by Lugon & Secker-Walker , Optimizing Health Care Governance (OPTIGOV) , Minister of Health of the Republic of Indonesia rules No. 755/Menkes/Per/IV/2011 and Accreditation Standards 2007. Questionaires measure structure and proses clinical governance implementation. There are 8 variables on clinical governance structures and 13 variables on clinical governance processes. Questionnaires sent to respondents through a courier service and answers given by interviews or written responses . Descriptive data analysis . Results and discussion : Data obtained from 30 hospitals (1 class A hospital, 12 class B hospital , 14 class C hospital and 3 class D hospital). The average level of clinical governance implementation in district’s hospitals in Central Java is 67%, the average level of fulfillment of clinical governance structure is 75% and the average rate of implementation of clinical governance processes 58%. Implementation of the medical committee assignments is a medical audit 3.3%, credentialing 3.3%, sustainable professional development for medical staff 50% and professional development medicine 70% . There is several constraints in implementation the Minister of Health Decree No. 755/Menkes/Per/IV/2011 because of: the uneven spread of specialists, lack of support from hospital management. Conclusions and suggestions : Implementation of clinical governance by the medical committee in district hospitals in Central Java has not been in accordance with existing regulations. There needs to be strengthened for the medical committee. It would need to manufacture clinical governance guidelines by the authorities and monitoring its implementation.
Kata Kunci : tata kelola klinis, komite medik, rumah sakit umum daerah; clinical governance , medical committee, district’s hospital
