Dody Firmanda 1997 - Evolusi Mutu Di Bidang Kesehatan

PERKEMBANGAN (EVOLUSI) MUTU DI BIDANG KESEHATAN

Dr. Dody Firmanda,Sp.A, MA.

Modul 3: Perkembangan (evolusi) mutu di bidang kesehatan Definisi Mutu (Quality) Evolusi Mutu Perspektif QA TotalQuality Assignment Dody Firmanda

1. DEFINISI MUTU (QUALITY)

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Definisi • Zerodefect • Fitnessfor purposes • Conformto standard dll

Definisi •

Banyak definisi tergantung sudut pandang, antara lain: 1. Sesuai standar (conform to standard) – banyak dianut untuk jasa pelayanan 2. Zero defect (dianut oleh industri) 3. dll

•

Pada saat ini bergeser ke arah yang terdiri dari 4 aspek: 1. 2. 3. 4.

•

Effectiveness Safety Timeliness Patient centeredness

Dengan kombinasi Donabedian: 1. Struktur 2. Proses 3. Outcome/Output

Ruang Lingkup Rumah Sakit Profesi lain

Pasien SMF

Instalasi

Komponen: Struktur

Proses

Outcome/Output

Effectiveness SPM, Clinical Pathways

Implementasi

Sembuh Meninggal Komplikasi

Safety

SPM, Clinical Pathways

Implementasi

Sembuh Meninggal Komplikasi

Timeliness

Jadwal Poli Jadwal Jaga Konsulen Jadwal Ruangan Jadwal Pendidikan

Implementasi

Ketepatan waktu

Patient centredness

Alur penerimaan pasien di Rawat Jalan, Kamar Operasi dan Rawat Inap

Implementasi

Sembuh Meninggal Komplikasi Komplain

Inspection Inspection

Quality Quality Control Control

2. EVOLUSI MUTU (QUALITY): dari Inspeksi sampai Total Quality

Quality Quality Assurance Assurance

Total Total Quality Quality

Understanding Understanding the business the business

a.a.Setting SettingStandards Standards b.b.Conform Conformwith withstandards standards (Audit/Akreditasi) (Audit/Akreditasi) c cMaintained Maintained&&Improve Improve

Understanding Understanding the customers the customers

Health Needs Assessment

NICE Clinical Clinical Governance Governance

Quality Quality System System

CQ CQ II

BSI 5751 EN/ISO 9000 MBNQA EQA Benchmarking Award Deming Prize Award SQL

Balanced Scorecard (SFO)

CHImp

Evidence-based Clinical Specialities

Clinical Epidemiology

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Readers’ Guides to Medical Literatures

Users’ Guides to Medical Literatures

80an

Evidencebased Medicine (EBM) 90an

Evidence-based Health Care (EBHC): Policy • Health Technology Assessment Others

Information Mastery

Abad 21

Quality Quality Tools Tools

6 5

3

2

1

4

Deming  Dianggap sebagai ‘bapak’ revolusi mutu dalam rekonstruksi Jepang pasca PD II  Mengubah paradigma/model tradisional ‘inspeksi’ menjadi fokus kepada mutu (‘quality centred’)  Dengan mutu = Biaya ↓, produktifitas ↑, profit ↑ & lapangan kerja ↑

Juran  Rekan kerja Deming pada tahun 1940an  1950an: ≥85% kegagalan organisasi karena sistem yang tidak benar, hanya 15% dikarenakan faktor manusia Melibatkan seluruh staf yang kreatif TQM

Crosby Fivepr inciples: 1. Conformanceto standards 2. No qualityproblems 3. No economicsquality 4. Performancemeasure : Costof quality 5. Performancestandard: Zerodefect

Donabedian  Structure  Process  Outcome

3. PRINSIP PRINSIP PENDEKATAN MUTU (QUALITY) Impact = Relevance + Effectiveness Wants Goals Accessibility = Relevance + Adequacy

Aims

Demands Needs

Objectives

Input

Process

Ouput

Outcome

Value/ Benefit

Relevance Adequacy Accessability

Efficiency Effectiveness

Maxwell

Impact Targets Input dodyfirmanda1997

Efficacy

Process

Outcome

Donabedian

1. Vision : futuristic mind-setting of the organisation 2. Missions: ways of the organisation towards the vision 3. Goals : are broad statements. There is generally one goal for a service/task. 4. Aims : There are a number of aims relating to the goal. They are specific to particular problems. 5. Objectives : For each programme aim, there may be a number of objectives which are specified in measurable terms. 6. Targets/Minimal Thresholds : For each objective, there may be various points on the way to the attainment of the objective. They are defined in relation to a point in a time. Systems/Standards Criteria

Indicators dodyfirmanda1997

4. QUALITY ASSURANCE

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5. TOTAL QUALITY MANAGEMENT/SERVICES Benchmarking

Understanding the business

Need Assessment Understanding the customers

PIP (Investors in People)

Total Quality Quality System

P A S/C

CQI

QA Setting standard

Quality Tools

QA Model: ISO 9000 D

TQM Model: MBNQA EQA EFQM

Statistical Process Control dodyfirmanda1997

Sangat dipengaruhi oleh sifat organisasi institusi: 1. ‘Split’ 2. ‘Bonded’

Berkembang sebagai tehnik RCA dalam Patient Safety Risk Assessment Digunakan utk membuat • Sistem • Alur (Process of Care, Clinical Pathways, SOP)

Digunakan dalam rangka CQI untuk meningkatkan standar

X1 X2

Masalah di: 1. X1 2. X2

1

2

3

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