Pemahaman tentang

Pelayanan Fokus Pasien (PCC)

Dr Djoni Darmadjaja,SpB,MARS,FINACS
Dr Djoni Darmadjaja, SpB,MARS
HP 08129146524

Palembang 22 Juni 1953

kapuyux@gmail.com
 Patient-Centered Care

 IOM – Institute of Medicine

 Patient-centered care as “care that is respectful of and responsive to individual patient

preferences, needs and values, and ensuring that patient values guide all clinical
decisions.”

 ‘Patient-centered care’ sebagai “asuhan yang menghormati dan responsif terhadap

pilihan, kebutuhan dan nilai-nilai pribadi pasien. Serta memastikan bahwa nilai-nilai
pasien menjadi panduan bagi semua keputusan klinis”

KARS
Nothing about me , without me
 SEJARAH
PATIENT CENTERED CARE
PENGALAMAN MR PICKER
• Harvey Picker ( 1915 – 2008)
• He was the founder of the Boston-based Picker Institute,
whose goal is to promote patient-centered healthcare. Standar Akreditasi
• The term patient-centered care was coined by Harvey Picker,
1988
Fokus Pasien
• He believed that the American health care system was
technologically and scientifically outstanding, but overall
was not sensitive to patients' concerns and their comfort Quality & Safety
• In The Year 1986, they founded the Picker Institute, dedicated of Patient Care
to developing a patient-centered approach to healthcare

Patient
Centered Care
ISQua

KARS
  Picker Institute : 1.Respect for patients‘ values, preferences and expressed
needs
2.Coordination and integration of care
3.Information communication and education
4.Physical comfort
5.Emotional support and alleviation of fear and anxiety
6.Involvement of family and friends
7.Continuity of care and smooth transition
8.Access to Care
1. Hormati nilai2, pilihan dan kebutuhan yg diutarakan oleh pasien
2. Koordinasi dan integrasi asuhan
3. Informasi, komunikasi dan edukasi
4. Kenyamanan fisik
5. Dukungan emosional dan penurunan rasa takut & kecemasan
6. Keterlibatan keluarga & teman2
7. Asuhan yg berkelanjutan dan transisi yg lancar
8. Akses thd pelayanan.
KARS
 Six aims for improvement health care system
Institute of Medicine : Crossing the Quality Chasm: A New Health System for the 21st Century, 2001

1. Safe. Avoiding injuries to patients from the care that is

intended to help them.
2. Effective. Providing services based on scientific
knowledge to all who could benefit and refraining from
1. Safe. providing services to those not likely to benefit
(avoiding underuse and overuse, respectively).
2. Effective.
3. Patient-centered. Providing care that is respectful
3. Patient-centered. of and responsive to individual patient
4. Timely. preferences, needs, and values and ensuring that
patient values guide all clinical decisions.
5. Efficient. 4. Timely. Reducing waits and sometimes harmful delays
for both those who receive and those who give care.
6. Equitable. 5. Efficient. Avoiding waste, including waste of equipment,
supplies, ideas, and energy.
6. Equitable. Providing care that does not vary in quality
because of personal characteristics such as gender,
ethnicity, geographic location, & socioeconomic status.
• Enam elemen ini dilahirkan oleh IHI Institute for Health care Improvement
Publikasi pertama PCC
• Lumenta
KARS Dr.Nico oleh IOM
• WHO menjadikan 6 elemen ini sbg definisi mutu pelayanan kesehatan
 PERUBAHAN
KONSEP ASUHAN PASIEN DI RS
 Asuhan Pasien
Model Traditional

Asuhan Pasien
Model
Patient Centered
Care
KARS
 Model Tradisional Asuhan Pasien

“Dokter = Captain of the ship”

Fisio Perawat
terapis Apoteker
Radio Dokter
grafer
“Disease Pasien
centered
care”
Ahli
Analis Gizi
Barrier
Lainnya
(“Medical paternalism”)

Dokter merupakan PUSAT / UNIT SENTRAL dalam

Model Tradisional asuhan pasien, tetapi…..
Patient safety tidak terjamin !!
 IMPLEMENTASI PCC-ASUHAN PASIEN TERINTEGRASI

DPJP
Perawat Apoteker
Clinical/Team Leader
• Koordinasi Fisio Ahli
• Kolaborasi terapis Pasien, Gizi
Keluarga
• Interpretasi
• Sintesis Radio
• Integrasi asuhan  Analis
grafer
komprehensif
Lainnya

Yan Kes
/ RS Lain
MPP
Case
Yan Manager
Keuangan/
Billing Asuransi Dokter
Perusahaan/ Keluarga
KARS
Employer BPJS
 KONSEP PELAYANAN PASIEN SESUAI STANDAR AKREDITASI RS.

Pelayanan
Manajemen
Fokus Pasien
Risiko RS
(Patient Centered
 Risiko Klinis
Care)

“Safety is a
fundamental principle
Etik
of patient care and a
critical component of
• Mutu Quality Management.”
4 Fondasi Kebutuhan
• Patient
PPA Asuhan pasien Pasien
Safety (World Alliance for Patient
• Asuhan Medis
Safety, Forward Programme,
• Asuhan Keperawatan
EBM WHO, 2004)
• Asuhan Gizi/Nutrisi
• Asuhan Farmasi VBM • Evidence Based Medicine
• Value Based Medicine
KARS
(Nico A Lumenta & Adib A Yahya, 2012)
 APA YANG BERBEDA
PADA ASUHAN PASIEN DI RS
 What are the Core Concepts of Patient Centered Care?

1. Martabat dan Respek.

• Profesional Pemberi Asuhan mendengarkan, menghormati & menghargai pandangan
serta pilihan pasien & keluarga.
• Pengetahuan, nilai-nilai, kepercayaan, latar belakang kultural pasien & keluarga
dimasukkan dlm perencanaan pelayanan dan pemberian pelayanan kesehatan
2. Berbagi informasi.
• Profesional Pemberi Asuhan mengkomunikasikan dan berbagi informasi secara
lengkap pasien & keluarga.
• Pasien & keluarga menerima informasi tepat waktu, lengkap, dan akurat
• Dgn 3 asesmen: metode, substansi/kebutuhan edukasi, konfirmasi
3. Partisipasi.
• Pasien & keluarga didorong dan didukung utk berpartisipasi dlm asuhan,
pengambilan keputusan & pilihan mereka
4. Kolaborasi / kerjasama.
• Pimpinan pelayanan kesehatan bekerjasama dgn pasien & keluarga dalam
pengembangan, implementasi dan evaluasi kebijakan dan program;
Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System.
Johnson, B et al. Institute for Family-Centered Care 2008
 Core Concepts of Patient Centered Care

1. Interdisciplinary Team
• Profesional Pemberi Asuhan diposisikan mengelilingi pasien
• Kompetensi yang memadai
• Berkontribusi setara dalam fungsi profesinya
• Tugas mandiri, kolaboratif, delegatif, bekerja sebagai satu kesatuan memberikan asuhan yang
terintegrasi
2. Interprofessionality
• Kolaborasi Interprofesional
• Edukasi Interprofesional
• Kompetensi praktik kolaborasi interprofesional
• Termasuk bermitra dengan pasien-keluarga
3. DPJP adalah Clinical Leader.
• DPJP melakukan koordinasi, kolaborasi, sintesis, interpretasi, review dan mengintegrasikan
asuhan pasien
4. Personalized Care & BPIS (Bila Pasien Itu Saya)
• Keputusan klinis selalu diproses berdasarkan juga nilai-nilai pasien
• Setiap PPA memperlakukan pasiennya sebagaimana ia sendiri ingin diperlakukan
(Sintesis berbagai refernsi, 2014)
 BAGAIMANA
IMPLEMENTASI KONSEP PCC
 IMPLEMENTASI Patient Centered Care

Elemen-elemen Asuhan Pasien Terintegrasi

A. DPJP sebagai Clinical Leader *
B. PPA – Tim Interdisiplin
C. Case Manager
D. Integrated Clinical Pathway
E. Integrated Discharge Planning
F. Asuhan Gizi Terintegrasi
G. Keterlibatan Pasien – Keluarga
 DPJP
Clinical Leader : Perawat/ Apoteker
• Kerangka pokok Bidan
asuhan
• Koordinasi Psikologi Pasien, Nutrisionis/
Klinis Dietisien
• Kolaborasi Keluarga
• Sintesis 24 jam
• Interpretasi Penata Terapis
• Review Anestesi Fisik
• Integrasi asuhan
Lainnya

Lainnya
1. Pasien adalah pusat pelayanan, Pasien adalah bagian dari Tim

2. Nakes PPA (Profesional Pemberi Asuhan), merupakan Tim Interdisiplin,

diposisikan di sekitar pasien, tugas mandiri, delegatif, kolaboratif,
kompetensi memadai, sama penting / setara pd kontribusi profesinya

3. DPJP : sebagai Clinical Leader, melakukan Koordinasi, Kolaborasi,

Review, Sintesis, Interpretasi, Integrasi asuhan komprehensif

4. PPA  Integrasi Asuhan

 APA
SYARAT PELAKSANAN PCC
 Kompetensi Kolaborasi Interprofesional
Interprofessional Collaborative Practice Competency
Domains

Interprofessional Education Collaborative Expert Panel.. Core competencies for interprofessional collaborative practice:
Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative, (2011)
(Framework for Action
KARS Dr.Nico Lumentaon Interprofessional Education & Collaborative Practice, WHO, 2010)
Kesimpulan : Kesimpulan
 Patient- and family-centered care is a change
in thinking
• from serving patients and families
• to partnering with patients and
families.
• And that’s a very big difference !!
Senior Vice President, Patient and Family Centered Care,
MCG Health System

(Strategies for Leadership, Advancing The Practice of Patient- and Family-Centered Care, A
Resource Guide for Hospital Senior Leaders, Medical Staff and Governing Boards. American
Hospital Association and Institute for Family Centered Care, 2004)

KARS
 KLINISI

PASIEN

PERUBAHAN PERAN DALAM MEMBUAT KEPUTUSAN PELAYANAN

COURTESY FROM PROF BUDI HIDAYAT - FKMUI

 terima kasih ..
DJONI DARMADJAJA