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