St1 1 Ihf Indonesia Hongkong Nxpowerlite

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Effort to Increase The Quality andEffort to Increase The Quality and

Competitive Advantage In The Capability ofCompetitive Advantage In The Capability of

Competing and Providing Medical Service toCompeting and Providing Medical Service toPoor People Through a Change ManagementPoor People Through a Change Management

In Hospital IndonesiaIn Hospital Indonesia

Indonesian Hospital Association (IHA)Indonesian Hospital Association (IHA)

M.Natsir Nugroho MD,MHA


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Capital : Jakarta Population : 222 millionAge 0-14 = 28.8%, 15-64 = 65.8%, >65 = 5.4% 17,000 islands, 1.9 million sq km, 33 Provinces More than 300 languages, main : Bahasa Indonesia

Indondonesiaesia


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STIMULUS TO CHANGESTIMULUS TO CHANGE

GREAT NATURAL DISASTER IN INDONESIAGREAT NATURAL DISASTER IN INDONESIA WTOWTO

GATSGATS

LOW LEVEL OF HEALTH QUALITYLOW LEVEL OF HEALTH QUALITY

INCREASE OF POORINCREASE OF POOR

COMPETITIVE ADVANTAGECOMPETITIVE ADVANTAGE

OUTBREAK DISEASEOUTBREAK DISEASE

MEDICAL ERROR ISSUEMEDICAL ERROR ISSUE

DECREASE IMAGE OF ANDDECREASE IMAGE OF AND

BELIEF IN MEDICAL SERVICEBELIEF IN MEDICAL SERVICE


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Since the landmark report of IOM : TO ERR ISHUMAN, Building a Safer Health System (2000),

Patient Safety rapidly become a global and a highprofile issue.

WHO in October 2004 launched the World Alliancefor Patient Safety - Forward program, whichincluded interested data from various countriesdeclaring that medical services for in-patients inhospital there is about 1 36 % adverse event

IHF (Indonesian Health Federation) has initiatedthis patient safety programs

Even, in 2005, data on Medical error issue, 48 cases

reported to Indonesian Police and 160 Cases to civilcases


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PATIENT SAFETY ACTIVITYPATIENT SAFETY ACTIVITYPATIENT SAFETY ACTIVITY

z PS ACTIVITY IS CARRIED OUT IN TWOWAYS :

z EXTERNAL ENVIRONMENT FROM HOSPITALz REGULATION AND LEGISLATION{INDONESIAN GOVERNMENT POLICY, ex: LAW NO.20

(2004) REGARDING MEDICINE PRACTICE{IHA attracting its members to implement program Patient

Safety

{Professional groups (IDI) --- Realization of standard ofpractice by paying attention to patients safety and startimplementing it by numerous continuing medicaleducation activities

z INTERNAL ENVIRONMENT FROM HOSPITAL


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INTERNAL ENVIRONMENT HOSPITALINTERNAL ENVIRONMENT HOSPITAL

zCHANGING CORPORATE CULTURE

zREORGANIZATION

zEFFICIENCY


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Patient Safety Initiatives inIndonesia

1. On June 1st, 2005 Indonesian Hospital PatientSafety Committee was established by the

Indonesian Hospital Association, supported by theMinistry of Health

2. On August 21st, 2005 the Minister of Health Dr. Siti

Fadillah Supari inaugurate the Patient SafetyMovement in the National Seminar of theIndonesian Hospital Association in Jakarta

3. At the end of 2005, Hospital Patient SafetyCommittee published Seven Steps toward HospitalPatient Safety A guide book for hospital staff

4. Followed by the publication of Patient SafetyGlossary


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InagurationInaguration of the Hospital Patient Safety Movementof the Hospital Patient Safety Movement

byby

Ministry of HealthMinistry of Health

DR. Dr. Siti Fadillah Supari, Sp.JPDR. Dr. Siti Fadillah Supari, Sp.JP((KK))

atatIndonesian Hospital Association National SeminarIndonesian Hospital Association National Seminar

Jakarta Convention CentreJakarta Convention Centre

2121A ustusA ustus 20052005


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5. In March 2006 : collaboration between the MOH, the

Indonesian Commission on Hospital Accreditation (ICHA), theIndonesian Hospital Association (IHA) and the IndonesianHospital Patient Safety Commission (IHPSC) : has beenpublished : NATIONAL GUIDE FOR HOSPITAL PATIENT

SAFETY

6. The National Guide for Hospital Patient Safetyconsists of :

1.Concept of Patient Safety2.Hospital Patient Safety Standard3.Seven Steps toward Hospital Patient Safety

4.Incident Report System and Form5.Hospital Patient Safety Glossary6.Instrument for Hospital Patient Safety

Accreditation

cont


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7. Draft of Hospital Act (2006). Patient Safety program is compulsory for

Hospitals Incident report shall not be subjected to

disciplinary investigations or criminal sanctions

by the courts.

8. Try out and socialization HPS programa. From end of June up to August 2006, teams with

members from the MOH, ICHA, IHA and IHPSCvisited 12 cities for a road show

b. . . . .

cont


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b. In every city, hospitals are invited for a presentationwhich consists of explanation and training on NationalGuide for HPS. Followed by choosing 3-5 hospitals to runa try out of implementation on the standards of HPS, alsothe Seven Steps and practice on submission of Incident

Reportc. In October 2006, hospitals who ran the try out has tosubmit the detailed report on the result of the try out

9. Indonesian Hospital Association Congress, 22-25

November 2006 in Jakarta.Out of the reports submitted by the hospitals, willbe chosen two best reports to be presented by the

hospital representative in a plenary session of IHACongress. Other reports will be included in a PosterSession

10. Education & Training Program

cont


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Objective of Patient Safety System

1. To create patient safety culture in hospital

2. To increase hospital accountability onpatient and society

3. To decrease Adverse Events in hospital

4. To implement programs to preventrecurrence of adverse events

National Guide Hospital Patient Safety, MOH, 2006


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AFTER SOCIALIZATION AND ADVOCACYAFTER SOCIALIZATION AND ADVOCACY

to 12 PROVINCESto 12 PROVINCES

zSocialization to : 523 Hospital

zReported to IHA : 264 report (50 %)z Incidences : 117 incident

z Honestly, it is acknowledged that an

awareness of making make incidencereporting has not yet been successfully.


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2. Padang

5. Bandung

7. Yogya

12. Manado

1.

3.

4. 6.

8.

10. Banjarmasin

9.

11.

Socialization and try out of HPS program in 12 cities

June August 2006


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INCREASING DEGREE OF HEALTH,ESPECIALLY FOR THE POOR

zData Of Central Bureau of Statistics in 2007

z Number of poor in Indonesia = 39.1 million withlevel of income being Rp.5000 per day

zData of World Bank

z Number of poor In Indonesia = 108.78 million,

with level of income being US $ 2 per day

LOW LEVEL OF HEALTH QUALITYLOW LEVEL OF HEALTH QUALITY


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GOVERNMENT POLICIES

z Program Social Security Net

z Poor People Medical Insurance (ASKESKIN)z Budget from state budget (2.5 % GDP)

zIn 2007 state has provide Rp.1.7 trillion, but untilApril these budget not enough. Alongside theprocess, proposed additional Rp. 1.8 trillion.

z Participants of ASKESKIN Registered recently is76.4 million with 70 % (world bank data) of thepoor people.


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HOSPITALS IN INDONESIA

Hospital ByOwnership

# of

Hosp

Percent # of

Beds

Percent

4.State-owned Corp

Hospital

78 6.3% 6,527 4.9%

TOTAL 1246 100% 132,231 100%

1.Private Hospital 621 49.8% 49,775 37.6%2.Vertical (MOH),Provincial, RegencyHospital

435 34.9% 65,123 49.3%

3.Military & PoliceHospital

112 9.0% 10,796 8.2%

Hospital List Book, Directorate General of Medical Care,

MOH, 2005


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CHANGE MANAGEMENTCHANGE MANAGEMENT

VERTICAL/DISTRICT HOSPITALVERTICAL/DISTRICT HOSPITAL

z In order to optimize medical services to the poorpeople, government has set up vertical /

provincial hospital to be a Public Services Board(Law No.1 year 2004)

z BLU (Public Services Board) refers to any of

government agencies that has implementedBLUs financial management model, that is setup to give services to the community in form ofgoods and services sold without prioritizing profitand, in its program implementation, it is basedon efficiency an productivity principles(Purinto,2006)


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CHARACTERISTIC OF BLU (Public

Services Board) 1. Domiciles as government agency (non properties of state

dissociated)

2. BLU is non profit organization

3. Produce a services and sell to public

4. Managed otonomously with efficiency and productivityprinciples of corporation

5. Plan and accountabili ty consolidate at institution

6. Earnings & contribution is applied directly

7. Human Resources can be consisted of governmental and Non-governmental employee

8. Not as tax subject


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STRATEGIC FOR PRIVATE HOSPITALSTRATEGIC FOR PRIVATE HOSPITAL

zMedical service process efficient

zDevelop cost leadership


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z In line with effort increases quality and

zpatient safety, Hospital in Indonesia alsocopes assists government in increasing

degree of health of Indonesia public,

zespecially poor people by developingzefficient and effective defrayal.


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