Yogyakarta, 6 September 2014

1

THE FOUNDATION OF MALPRACTICE PREVENTION

AGUS PURWADIANTO

SAM TEKNOLOGI KESEHATAN & GLOBALISASI

TKBJ-PNPK

PERMISSIBLE LIMITATIONS

Foreign Service Supplier Presence

Other Criteria

Mode

Foreign service supplier not present within Indonesia

Service delivered within Indonesia from outside of Indonesia

CROSS-BORDER SUPPLY

Service delivered outside of Indonesia to an Indonesian national

CONSUMPTION ABROAD

Foreign service supplier present within Indonesia

Service delivered within Indonesia, with supplier present as a juridical person COMMERCIAL PRESENCE

Service delivered within Indonesia, with supplier present as a natural person

PRESENCE OF NATURAL PERSON

Modes of Supply

Ratifikasi : UU No. 7 Tahun 1994 ttg Pengesahan

Agreement Establishing The World Trade Organization

SAFETY SUSTAINABILITY

SOCIAL WELFARE

HEALTH CARING SHARING

ONE ASEAN - ONE COMMUNITY ONE HEALTH

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PANGKAL MODALITAS GLOBALISASI

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Tantangan

• Domestic regulation : belum rinci, ketinggalan, tidak sinkron antar K/L

• Jenis fasyankes blm rinci – khususnya tatanan rujukan mulai DLP – sekunder - tersier

• subspesialisasi terkendala Sp senior di FKG

• Jenis nakes tertentu tidak dikembangkan :

– Paramedic

– Insinyur kesehatan

– Dokter gigi terbang

– Kedekatan kompetensi dgn PEKERJA SOSIAL

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PELAYANAN JASA KESEHATAN MASA

DEPAN

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Potensial Changes in the Way that Patients Use Services

Old approach New (idealized) approach

Patients use the system in a series of

unconnected episodes

Need is anticipated and hospitals and

health system develop methods to

manage the whole pathway of disease,

support patients in their own home and

have electronic records that help to

ensure continuity of care

Patients are passive recipients of care Patients are involved in the management

of their own care

Patients are dealt with in batches and

spend most of their time within the

system waiting – this is because it is

important to keep expensive staff and

assets busy

Patients flow through the system with

minimal waits. Sweating the assets and

having staff busy is less important than

achieving a smooth flow through the

system

Investing In Hospitals of The Future, EU, 2009 TKBJ-PNPK 7

FUTURE HOSPITAL

Old approach New (idealized) approach

Interaction is face to face and on a one-to-

one basis

E-mail and telephone can be used and

group visits seem to work for some issues

Providers fdetermine follow –up and re-

referral

Patients can initiate follow-up and have a

right of return or direct access to specialist

help if they think they need it – even if they

have been discharged

Petients often die in hospital when they

would have preferred to die at home

Patients have plans for end-of-life care

Investing In Hospitals of The Future, EU, 2009 TKBJ-PNPK 8

Determinasi antar mode

WORLD CLASS HEALTH CARE :

Health care facilities menampung multi-profesi

Mode 3 (investor fasyankes PMA, strata tertinggi (DSubSp) > diminati krn > untung & sarat iptekdok

NKRI sbg G-20 – ke depan : jasa > produk perlu dikembangkan profesi “penentu” produk (devices,

drug, etc)

• Selagi mode 4 unbound perlu penguatan mode 3 keberadaan RS/klinik PMA

merupakan keniscayaan : VIA ASEAN 2015

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How to Implement the Healthcare MRAs?

Highly Over-regulated professions

Exchange of Information

Compilation

Adoption of Best

Practices

Standardised Procedures

Publication trhough website

Facilitate Mobility

Registration through

AJCCs

PRAs Process

(Evaluation , Registration etc)

Capacity Building

Visits Conferences

OBJECTIVES

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KERANGKA KESEPAKATAN BERIKUT: tentatively

1. Exchange of residents or trainees

2. Exchange of faculties

3. Clinical attachments

4. Joint final examinations (bilateral basis)

5. Reciprocal recognition

6. Registration by Medical Councils of Host Country and Home Country (Art 3, 3.1.1)

7. Time frame: 2015 and beyond

6-Sep-14 11 Bandung 24 Mei 2011

Implication’s Pathway

•

Info – best practice & Std

Static - requirements

Process of recognition

Dynamic - facilitation

Website

Licensure Database

AFAS – Nat PRA

secretariat

“desensitization”

Public protection

Malpractice insurance

MKEK

MKDKI

PN

DHO ?

TKBJ-PNPK 12

Stop kriminalisasi Dr !!! Antitesa thd “TESA PENDZOLIMAN” Pasien

Professional

Dignity

Patients’

Safety

Medical

Goals

Ethico-legal System

Agus Purwadianto, 2005

MEDICAL INDICATIONMEDICAL INDICATION CONTEXTUALITYCONTEXTUALITY BALLANCINGBALLANCING

CONFLICT OF INTERESTCONFLICT OF INTEREST

Health Personnel

Health Facilities

Health system

Health Personnel

Health Facilities

Health system

Law as

social engineering

Law as

social engineering Value of

Health (Micro)

LiabilityAccountability

DisciplineResponsibility

Ethics

SOCIAL CONTRACT

Patient/Client

FamilyCommunity

PROFESSIONALISM

BEST INTEREST,

PREFERENCES,

QUALITY OF LIFE

PUBLICPUBLIC

TRUSTTRUST

Being healed

Promise to heal Being ill

Ontology of medicine = phenomenology of orientation

Clinical encounters

Deepen structure – vertically Shared EXPERIENCE – horizontally

Dyadic relation

HOLISTIC

INTEGRATIVE CARE

FENOMENOLOGI: QoL – spiritualitas

Fitur Kontekstual

Pilihan/self-care

PROFESI

PENYEHAT

KLIEN/

PASIEN

intersubyektivitas

MITRA + PENOLONG

KOMPETENSI

KEWENANGAN

•JASA

•PRODUK

•S.I.M

Komunitas Sakit

& Sehat

(Sebelum

sakit, + risiko)

Individual Sakit / Menderita

Diagnosis Terapi Prognosis

Kedokteran Komunitas Kedokteran

Klinik Humaniora

Kedokteran

Biomedik

POSISI KESTRAD DLM RUMPUN ILMU KEDOKTERAN

UU NO. 20/2013 TTG DIKDOK

CONVENTIONAL MED. KESTRADINDO SBG

PENDEKATAN HOLISTIK

•

Kau kepedulian utama-ku Aku sopan & teliti kpd-mu

Martabat & privasi-ku ? Ya,ya ku-hargai

Kusimak & kehormati pendapat-mu

Kuberi info sesuai BHS-mu

Hak2-mu ? OK,

Ayo, ikut urun rembug !!!

Jaga penget & ketrampilan-ku

setiap saat

Tahu batas kompetensi pribadi-ku !!!

Hormati & Jaga Info RHS-mu

Jangan salah gunakan kekuasaan-ku

Inti Perilaku-Baik Profesi

Agus Purwadianto, 2008

Agama-ku tak membuat

prasangka terhadap-mu

Rèk ayo rèk !!

Kerjasama Tim Demi kepentingan

terbaik-ku

Jujur & Terpercaya !!!!!

Kalau tak

laik-praktek

Cepat tanggap bertindak

Lindungi Pasien

dari Risiko

Inti Perilaku-Baik Profesi-2

Agus Purwadianto, 2008

KESIMPULAN • Pencegahan mendasar malpraktek dokter gigi

adalah sikap tindak perilaku (STP) profesional yg senantiasa menempatkan pasien secara manusiawi dalam kepentingan terbaiknya sbg manusia.

• Kerjasama antara Drg – pasien yg sifatnya dyadic hingga tahap rapport sebagai landasan hubungan kepercayaan keduanya dalam bingkai sistem etikolegal dan diperankan secara unik dalam diri setiap Drg yg berperilaku baik merupakan wahana utk menjaga mutu STP profesional.

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Agus Purwadianto

• SAM Bid Teknolkes & Globalisasi & Plt Kabadan Litbangkes RI • Gurubesar I.K. Forensik & Medikolegal (07) • Doktor Filsafat (03) • MSi Sosio-Kriminologi (00) • SpF (konsultan etiko-medikolegal) (05) • Diplome of Forensic Med Groningen Univ (02) • SH (97), SpF (83), dr (79) • Ketua MKEK Pusat IDI, dosen IKF-ML FKUI/RSCM, Ketua Kolegium IK

Forensik Indonesia • Ex Kepala Badan Litbangkes (09-10) • Ex Staf Ahli Bid Hukum & HAM Kemenkokesra RI (08) • Ex Karo Hukor Depkes RI • Ex Anggota WHO Global Advisory Vaccine Safety Committee • Ex Anggota UNESCO Global Ethics Observatory Law • Wakil Ketua Komisi Bioetika Nasional • Perintis/dosen S3 Kekhususan Bioetika FKUI