Developing quality performance framework and indicators in emergency department DR. Saiful Anwar General Hospital

WARDHANI, Viera, dr. Tjahjono Kuntjoro, MPH.,Dr.PH

2001 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latarbelakang: Sebagai pusat rujukan pelayanan gawat darurat di malang, Instalasi Rawat Darurat (IRD) Rumah Sakit Saifil Anwar harus mampu memenuhi standar mutu internasional. Upaya tersebut diwujudkan melalui: .pembenahan sistem, peningkatan kompetensi submerdaya manusia, dan pembentukan jaringan prehospital emergency care. Evaluasi sementara menunjukkan hasil kurang memuaskan jika ditinjau dari tidak adanya penurunan angka kematian dan tingginya angka kematian tercegah. Karena itu diperlukan kerangka pengukuran kinerja dan indikatornya guna mengerahakan uapaya peningkatan mutu pelayana kesehatan. Metode: Metode yang digunakan untuk mengembangkan kerangka kinerja serta memeahami proses penembangannya adalah rriset action. Kerangka kinerja dikembangkan melalui dua tahap interview mendalam dengan empat responden yaitu perawat IRD, dokter IRD, manajer IRD dan rumah sakit dilanjutkan dengan diskusi kelompok bersama 10 responden. Peneliti berperan sebagai fasilitator dan partisipan observer. Fase kedua, pengembangan indikator kinerja dilakukan menelalui interview mendalam, review pustaka, diskusi kelompok dua tahap serta interview terstruktur mengenai isi database, pengumpulan data dan mekanisme analisis dan pelaporan. Hasil: Penelitian menghasilkan kerangka kinerja pelayanan emergensi yang terdiri dari empat perspektif yang tersusun secara hirarkis. Perspektif kinerja yang pertama adalah kompetensi sumberdaya manusia dan kesadaran masyarakat. Perspektif kedua adalah program pendidikan dan pelatihan yang handal sebagai dasar dalam membentuk perspektif ketiga yaitu kualtias pelayanan emergensi yang didukung oleh sistem pelayanan emergensi pre-hospital yang efektif. Ketiga perspektif tersebut merupakan dasar dalam mencapai perspektif puncak yaitu pusat pelayanan emergensi yang bermutu. Sepuluh indikator yang direkomendasikan adalah: kecepatan respon ambulance, survival rate dari kejadian henti jantung pre-hospital, audit kematian emergensi, kematian tercegah, waktu tunggu pelayananan emergensi, proporsi kasusu emergensi yang mendapat terjangkau sistem pre-hospital, jumlah perawat dan dokter yang memenuhi pelatihan dasar emergensi, waktu pemeriksaan laboratorium dan permintaan konsultasi spesialis. Selama proses pengembangan perawat memegang peranan positif di seluruh proses. Faktor penghambat utama adalah perbedaan kepentingan antar pihak dan keengganan untuk mengukur, sedangkan faktor pendukung adalah pemahaman yang tumbuh selama proses pengembangan. Kesimpulan: Perspektif dasar kinerja IRD adalah kesadaran masyarakat dan kehalian sumberdaya manusia, dengan mutu pelayanan yang berarti cepat, tepat dan efisien yang didukung oleh sistem pre-hospital sebagai perspektif utama untuk mencapai perspektif puncak yaitu pusat pelayanan emergensi yang bermutu

Background: As the highest referral centers for emergency services in Malang, the Emergency Department (ED) in Saihl Anwar General Hospital (SAGH) has to provide a world classes quality. The result from the past three basic programs in quality improvement was unsatisfactory, showed by no significant mortality decrease and significant amount of preventable death (26.4%). Therefore the organization performance framework and indicator was needed to improve the quality of health service. Methods: A study using action research was conducted to develop the ED performance framework and to understand the problem during the process. The framework was developed through two stage in-depth interview with four respondents, i.e. ED nurse, ED physician, ED manager and hospital manager followed by group discussion with 10 respondents. Researcher played as participant observer during the process. The indicator development phase was conducted trough in-depth interview, literature review, two stages group discussion and structured interview on database content, collection analysis and reporting. Result: The study proposed four key perspectives for ED performance framework in logical order. The basic perspective is faculty expertise and community awareness. The next perspectives is strengthen education and training program in emergency service and increase faculty specialties which needed to develop the third perspective, i.e. quality in emergency service supported by effective pre-hospital triage to obtain continuous fhding support. These three perspectives is the link to achieve the top perspective, organization vision, i.e. recognized emergency center. Ten indicator were recommended: ambulance response time, survival rate from out-of-hospital cardiac arrest, emergency death audit, preventable death, emergency waiting time, proportion of emergency case having pre-hospital first live saving, number of nurse completed basic emergency skill course, number of physician completed certified emergency course, time for completing laboratory examination and specialist consultation time. During the process nurses was considered as positive key players in the whole process. The most restraining forces is the different interest between parties and resistant to measure, while the driving forces is the understanding developed during the process Conclusion: The basic perspective in ED performance framework is community awareness and faculty expertise as basis perspective, with quality in emergency service meaning prompt and timely treatment and efficient use of resources supported by effective pre-hospital triage as the main process perspective to obtain the top perspective: an excellent emergency service center.

Kata Kunci : Manajemen Rumah Sakit, Layanan Eemergensi, Peningkatan Mutu, Emergency Service, Performance Framework and Indicator, Quality Inipro venient.