dody firmanda 1997 - evolusi mutu di bidang kesehatan
DESCRIPTION
Artikel tulisan tahun 1997 dalam rangka menyusun Corporate Governance dan Clinical Governance. (Dody Firmanda)TRANSCRIPT
PERKEMBANGAN (EVOLUSI)MUTU
DI BIDANG KESEHATAN
Dr. Dody Firmanda,Sp.A, MA.
Dody Firmanda
Definisi Mutu (Quality)
Evolusi Mutu
Perspektif
QA
TotalQuality
Assignment
Modul 3:Perkembangan (evolusi) mutu di bidang kesehatan
1. DEFINISI MUTU (QUALITY)
dodyfirmanda1997
Definisi• Zerodefect
• Fitnessfor purposes• Conformto standard
dll
Definisi
• Banyak definisitergantung sudutpandang, antara lain:
1. Sesuai standar(conform to standard)– banyak dianut untukjasa pelayanan
2. Zero defect (dianutoleh industri)
3. dll
• Pada saat ini bergeserke arah yang terdiridari 4 aspek:
1. Effectiveness2. Safety3. Timeliness4. Patient centeredness
• Dengan kombinasiDonabedian:
1. Struktur2. Proses3. Outcome/Output
Ruang Lingkup
SMF
Instalasi
Profesi lain Pasien
Rumah Sakit
Komponen:
SembuhMeninggalKomplikasiKomplain
ImplementasiAlur penerimaan pasiendi Rawat Jalan, KamarOperasi dan Rawat Inap
Patientcentredness
Ketepatan waktuImplementasiJadwal PoliJadwal Jaga KonsulenJadwal RuanganJadwal Pendidikan
Timeliness
SembuhMeninggalKomplikasi
ImplementasiSPM, Clinical PathwaysSafety
SembuhMeninggalKomplikasi
ImplementasiSPM, Clinical PathwaysEffectiveness
Outcome/OutputProsesStruktur
InspectionInspection QualityControl
QualityControl
QualityAssurance
QualityAssurance
TotalQuality
TotalQuality
a. Setting Standardsb. Conform with standards
(Audit/Akreditasi)c Maintained & Improve
a. Setting Standardsb. Conform with standards
(Audit/Akreditasi)c Maintained & Improve
ClinicalGovernance
ClinicalGovernance
NICE
CHImp
Understandingthe customers
Understandingthe customers CQ
I
CQI
QualitySystem
QualitySystem Quality
Tools
QualityToolsUnderstanding
the business
Understandingthe business
Readers’Guides toMedical
Literatures
Users’ Guidesto MedicalLiteratures
Evidence-based
Medicine(EBM)
Evidence-basedClinical
Specialities
Evidence-basedHealth Care
(EBHC):Policy• Health
TechnologyAssessment
Others80an 90an
InformationMastery
Abad 21
ClinicalEpidemiology
BSI 5751EN/ISO 9000MBNQAEQABenchmarking AwardDeming Prize AwardSQL
HealthNeeds
Assessment
BalancedScorecard
(SFO)
dodyfirmanda1997
2. EVOLUSIMUTU
(QUALITY):dari
Inspeksisampai Total
Quality
1
2
3 4
5
6
DemingDianggap sebagai ‘bapak’ revolusi mutu dalam
rekonstruksi Jepang pasca PD II
Mengubah paradigma/model tradisional‘inspeksi’ menjadi fokus kepada mutu (‘qualitycentred’)
Dengan mutu = Biaya ↓, produktifitas ↑, profit ↑& lapangan kerja ↑
Juran
Rekan kerja Deming pada tahun 1940an1950an: ≥85% kegagalan organisasi
karena sistem yang tidak benar, hanya15% dikarenakan faktor manusiaMelibatkan seluruh staf yang kreatif
TQM
CrosbyFivepr inciples:1. Conformanceto standards2.No qualityproblems3.No economicsquality4. Performancemeasure : Costof quality5. Performancestandard: Zerodefect
Donabedian
Structure
Process
Outcome
Goals
Objectives
Wants
Demands
Needs Input Process Ouput Outcome
Aims
Value/Benefit
Targets
RelevanceAdequacy
Accessability
Impact
Effectiveness
Efficiency Efficacy
Input Process Outcome
Maxwell
Donabedian
Impact = Relevance + EffectivenessAccessibility = Relevance + Adequacy
dodyfirmanda1997
3. PRINSIP PRINSIP PENDEKATAN MUTU (QUALITY)
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 aservice/task.
6. Targets/Minimal Thresholds : For each objective, there may bevarious points on the way to the attainment of the objective.They are defined in relation to a point in a time.
5. Objectives : For each programme aim, there may be a number ofobjectives which are specified in measurable terms.
4. Aims : There are a number of aims relating to the goal. They arespecific to particular problems.
IndicatorsCriteria
Systems/Standards
dodyfirmanda1997
4. QUALITY ASSURANCE
dodyfirmanda1997
TotalQuality
Understanding thebusiness
Understanding thecustomers
QualitySystem
CQI
Quality Tools
Benchmarking
Need Assessment
PIP (Investors in People)
P
DS/C
A
Statistical Process Control
QA Model:ISO 9000
TQM Model:MBNQAEQAEFQM
Setting standard
QA
dodyfirmanda1997
5. TOTAL QUALITY MANAGEMENT/SERVICES
Sangat dipengaruhi oleh sifatorganisasi institusi:
1. ‘Split’2. ‘Bonded’
Berkembang sebagaitehnik RCA dalamPatient Safety Risk
Assessment
Digunakan dalam rangkaCQI untuk meningkatkanstandar
Digunakan utk membuat• Sistem• Alur (Process of Care,
Clinical Pathways, SOP)
X1
X2
Masalah di:1. X12. X2
1
2
3
dodyfirmanda1997