Effort to Increase The Quality and Competitive Advantage In The Capability of Competing and Providing Medical Service to Poor

People Through a Change Management In Hospital Indonesia

M.Natsir Nugroho MD,MHA Indonesian Hospital Association (IHA)

Indonesia

Capital : Jakarta Population : 222 million Age 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

STIMULUS TO CHANGE
COMPETITIVE ADVANTAGE
GREAT NATURAL DISASTER IN INDONESIA

WTO
GATS
MEDICAL ERROR ISSUE

INCREASE OF POOR

LOW LEVEL OF HEALTH QUALITY

DECREASE IMAGE OF AND BELIEF IN MEDICAL SERVICE

OUTBREAK DISEASE

 Since the landmark report of IOM : TO ERR IS HUMAN, Building a Safer Health System (2000), Patient Safety rapidly become a global and a high profile issue. WHO in October 2004 launched the World Alliance for Patient Safety - Forward program, which included interested data from various countries declaring that medical services for in-patients in hospital there is about 1 36 % adverse event IHF (Indonesian Health Federation) has initiated this patient safety programs Even, in 2005, data on Medical error issue, 48 cases reported to Indonesian Police and 160 Cases to civil cases

PATIENT SAFETY ACTIVITY

z PS ACTIVITY IS CARRIED OUT IN TWO WAYS : z EXTERNAL ENVIRONMENT FROM HOSPITAL z 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 of practice by paying attention to patients safety and start implementing it by numerous continuing medical education activities

z INTERNAL ENVIRONMENT FROM HOSPITAL

INTERNAL ENVIRONMENT HOSPITAL

z CHANGING CORPORATE CULTURE z REORGANIZATION z EFFICIENCY

Patient Safety Initiatives in Indonesia

1. On June 1st, 2005 Indonesian Hospital Patient Safety Committee was established by the Indonesian Hospital Association, supported by the Ministry of Health 2. On August 21st, 2005 the Minister of Health Dr. Siti Fadillah Supari inaugurate the Patient Safety Movement in the National Seminar of the Indonesian Hospital Association in Jakarta 3. At the end of 2005, Hospital Patient Safety Committee published Seven Steps toward Hospital Patient Safety A guide book for hospital staff 4. Followed by the publication of Patient Safety Glossary

Inaguration of the Hospital Patient Safety Movement by Ministry of Health DR. Dr. Siti Fadillah Supari, Sp.JP(K) at
Indonesian Hospital Association National Seminar Jakarta Convention Centre 21 Agustus 2005

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

cont

Indonesian Commission on Hospital Accreditation (ICHA), the Indonesian Hospital Association (IHA) and the Indonesian Hospital Patient Safety Commission (IHPSC) : has been published : NATIONAL GUIDE FOR HOSPITAL PATIENT SAFETY

6. The National Guide for Hospital Patient Safety consists of :

1.Concept of Patient Safety 2.Hospital Patient Safety Standard 3.Seven Steps toward Hospital Patient Safety 4.Incident Report System and Form 5.Hospital Patient Safety Glossary 6.Instrument for Hospital Patient Safety Accreditation

cont 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 program a. From end of June up to August 2006, teams with members from the MOH, ICHA, IHA and IHPSC visited 12 cities for a road show b. . . . .

b. In every city, hospitals are invited for a presentation

cont

which consists of explanation and training on National Guide for HPS. Followed by choosing 3-5 hospitals to run a try out of implementation on the standards of HPS, also the Seven Steps and practice on submission of Incident Report c. In October 2006, hospitals who ran the try out has to submit 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, will be chosen two best reports to be presented by the hospital representative in a plenary session of IHA Congress. Other reports will be included in a Poster Session

10. Education & Training Program

Objective of Patient Safety System

1. To create patient safety culture in hospital 2. To increase hospital accountability on patient and society 3. To decrease Adverse Events in hospital 4. To implement programs to prevent recurrence of adverse events
National Guide Hospital Patient Safety, MOH, 2006

AFTER SOCIALIZATION AND ADVOCACY to 12 PROVINCES

z Socialization to : 523 Hospital z Reported to IHA : 264 report (50 %) z Incidences : 117 incident z Honestly, it is acknowledged that an awareness of making make incidence reporting has not yet been successfully.

1. 12. Manado 2. Padang 10. Banjarmasin 3. 4. 5. Bandung 7. Yogya 6. 8. 9. 11.

Socialization and try out of HPS program in 12 cities June August 2006

INCREASING DEGREE OF HEALTH, ESPECIALLY FOR THE POOR

z Data Of Central Bureau of Statistics in 2007 z Number of poor in Indonesia = 39.1 million with
level of income being Rp.5000 per day

z Data 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 QUALITY

GOVERNMENT POLICIES
z Program Social Security Net z Poor People Medical Insurance (ASKESKIN) z Budget from state budget (2.5 % GDP) z In 2007 state has provide Rp.1.7 trillion, but until April these budget not enough. Alongside the process, proposed additional Rp. 1.8 trillion. z Participants of ASKESKIN Registered recently is 76.4 million with 70 % (world bank data) of the poor people.

HOSPITALS IN INDONESIA
Hospital By Ownership
1.Private Hospital 2.Vertical (MOH), Provincial, Regency Hospital 3.Military & Police Hospital 4.State-owned Corp Hospital

# of Hosp
621 435

Percent 49.8% 34.9%

# of Beds
49,775 65,123

Percent 37.6% 49.3%

112 78

9.0% 6.3%

10,796 6,527

8.2% 4.9%

TOTAL

1246 100%

132,231

100%

Hospital List Book, Directorate General of Medical Care, MOH, 2005

CHANGE MANAGEMENT VERTICAL/DISTRICT HOSPITAL

z In order to optimize medical services to the poor people, 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 implemented BLUs financial management model, that is set up to give services to the community in form of goods and services sold without prioritizing profit and, in its program implementation, it is based on efficiency an productivity principles (Purinto,2006)

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 productivity principles of corporation 5. Plan and accountability consolidate at institution 6. Earnings & contribution is applied directly 7. Human Resources can be consisted of governmental and Nongovernmental employee 8. Not as tax subject

STRATEGIC FOR PRIVATE HOSPITAL

zMedical service process efficient zDevelop cost leadership

z In line with effort increases quality and z patient safety, Hospital in Indonesia also copes assists government in increasing degree of health of Indonesia public, z especially poor people by developing z efficient and effective defrayal.