memimpin peningkatan mutu dengan pendekatan sistem mikro klinik
TRANSCRIPT
Memimpin Peningkatan Mutu dengan Pendekatan Sistem Mikro Klinik dr. Robertus Arian Datusanantyo, M.P.H.
Koleksi Pribadi – Skrining Katarak di Puskesmas Ngulak, Kab. Musi Banyuasin, Sumsel
Ilustrasi Kasus • Tn. M (18) dan Ny. F (18) adalah pasangan
suami istri yang menantikan kelahiran anak kembar.
• Saat usia cukup bulan, Ny. F. kejang di rumah.
• Tn. M. membawa istrinya ke bidan praktek.
• Bidan membawa Ny. F. ke Puskesmas.
• IGD Puskesmas memberikan obat anti kejang dan pasien distabilkan, 30 menit kemudian pasien dirujuk ke RSUD.
• RSUD tahu bahwa ada ibu hamil cukup bulan dengan kejang sedang dalam perjalanan.
Ilustrasi Kasus (lanj.) • Ny. F. datang diantar tim Puskesmas di IGD
RSUD.
• IGD RSUD segera menyiapkan operasi, melakukan informed-‐consent, dan membereskan syarat Jampersal.
• Ny. F dioperasi dan anak kembarnya lahir sehat walau BBLR (2300 dan 1800 gram).
• Ny. F. pulih kesehatannya dalam perawatan di RSUD dan pulang dengan kedua anak dan suaminya.
• Kisah diinspirasi dari:http://klinik-‐gratis.blogspot.com/2012/09/hampir-‐saja-‐tak-‐tertolong-‐kasus-‐near.html
http://mentalfloss.com/sites/default/files/styles/article_640x430/public/95921224.jpg
Pasien Kejang di rumah
Pasien dibawa ke
bidan praktek
Pasien dibawa ke Puskesmas
Pasien distabilisasi
di Puskesmas
Pasien dikirim ke
RSUD
Pasien distabilisasi
di IGD RSUD
Pasien dioperasi di
kamar bedah RSUD
Pasien dirawat di bangsal RSUD
Pasien pulang
Pelayanan kepada pasien dikerjakan pada sistem mikro klinik (clinical microsystem) yang secara bersama-‐sama membentuk sistem pelayanan kesehatan yang paripurna dan lengkap. Lalu, apakah sistem mikro klinik itu?
Sistem Mikro Klinik 1. Tempat pertemuan pasien (& keluarga) dengan
tim pelayanan kesehatan. 2. Garda depan pelayanan kesehatan. 3. Tempat dilakukannya pelayanan, sekaligus:
1. Tempat keajaiban pelayanan terjadi, 2. Tempat kesalahan tragis terjadi.
4. Melibatkan: 1. Pasien, keluarga, pemberi layanan, 2. Proses, pola: budaya kerja, aliran informasi,
hasil pelayanan. (Nelson et al 2007)
Clinical Microsystem A clinical microsystem is a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients. It has clinical and business aims, linked processes, and a shared information environment, and it produces performance outcomes. Microsystems evolve over time and are often embedded in larger organizations. They are complex adaptive systems, and as such they must do the primary work associated with core aims, meet the needs of their members, and maintain themselves over time as clinical units.
(Nelson et al 2007)
(Nelson et al 2002)
Leadership. Roles: 1. Maintain constancy
of purpose; 2. Establish clear goals; 3. Foster positive
culture; 4. Advocate for the
microsystem in the larger organization.
Process Improvement. 1. Continuous
monitoring of care; 2. Use of
benchmarking; 3. Frequent test of
change; 4. Staff empowerement
to innovation.
Memimpin Sistem Mikro Klinik
Building Knowledge Basic structural characteristic of clinical microsystem;
Processes, unwanted variation & method.
Taking Action Having specific processes for making things happen; Involves taking action
on the patterns of work to promote the cooperative functioning of the whole group of people and to recognize members’ interdependence.
Reviewing and Reflecting Creating a structure for reflection; Having a process for honestly asking “Is the work getting done?” and “Is there a good match between the needs of
the beneficiaries and our work outputs?”
(Batalden et al 2003)
“Plan – Do – Study – Act” Cycle
Plan Objective; Questions and predictions; Plan to carry out the cycle.
Do Carry out the plan; Document problems & unexpected observations; Begin data analysis.
Study Complete data
analysis; Compare data to predictions;
Summarize what was learned.
Act What changes
are to be made; Next cycle?
(Nelson et al 2007)
“Standardize – Do – Study – Act” Cycle
Standar-‐ dize How shall we standardize the process & embed it in daily work?; What type of environment can support standardization?
Do What are we learning as we do the standardization?; Any problem or surprises?
Study What have we
learned?; What do the measures show?; Are there needs for
change?
Act Do we need to
modify the standardization?;
Design new PDSA.
(Nelson et al 2007)
Menulis Refleksi 1. Deskripsi
1. Apa yang terjadi? 2. Apa yang diperiksa / diselidiki?
2. Interpretasi 1. Apa yang penting/relevan/
bermanfaat? 2. Bagaimana menjelaskannya
dengan teori? 3. Apa yang sama dan berbeda?
3. Luaran 1. Apa yang telah dipelajari? 2. Apa kepentingannya untuk masa
depan? (Hampton 2010)
http://th09.deviantart.net/fs70/PRE/i/2009/352/b/b/Black_Mirror_girl_by_JeDavid.jpg
Kesimpulan 1. Penting untuk mengenali tempat pelayanan
kesehatan sebagai mikro sistem klinik.
2. Pendekatan mikro sistem klinik dapat digunakan untuk peningkatan mutu.
3. Memimpin peningkatan mutu di sistem mikro klinik memerlukan strategi.
4. Siklus PDCA – eksperimen.
5. Siklus SDSA – standarisasi.
http://w
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dneo
nsolutions
.co.uk
Referensi • Batalden, P.B., Nelson, E.C., Mohr, J.J., Godfrey M.M., Huber, T.P.,
Kosnik, L., Ashling, K., 2003. Microsystems in Health Care: Part 5. How Leaders Are Leading. The Joint Commission Journal on Quality and Patient Safety, 29(6), pp.297-‐308.
• Berwick, D., 2002. A user’s manual for the IOM's “Quality Chasm”report. Health Affairs, 21(3), pp.80–90.
• Hampton M. 2010. Reflective Writing: A Basic Introduction. Available at: http://www.port.ac.uk/media/contacts-‐and-‐departments/student-‐support-‐services/ask/downloads/Reflective-‐writing-‐-‐-‐a-‐basic-‐introduction.pdf
• Nelson, E.C., Batalden, P.B., Huber, T.P., Mohr, J.J., Godfrey M.M., Headrick, L.A., Wasson, J.H., 2002. Microsystems in Health Care: Part 1. Learning from High-‐Performing Front-‐Line Clinical Units. The Joint Commission Journal on Quality and Patient Safety, 28(9), pp.472-‐493.
Referensi • Nelson EC, Batalden PB, Godfrey MM (Ed.). 2007. Quality By Design,
A Clinical Microsystem Approach. San Fransisco: Jossey-‐Bass.
• Nelson, E.C., Godfrey, M.M., Batalden, P.B., Berry, S.A., Bothe, A.E., McKinley, K.E., Melin, C.N., Muething, S.E., Moore, G., Wasson, J.H., Nolan, T.W., 2008. Clinical Microsystems, Part 1. The Building Blocks of Health Systems. The Joint Commission Journal on Quality and Patient Safety, 34(7), pp.367-‐378.
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