Dirjen Bina Upaya Kesehatan KEMENKES Prof Dr dr Akmal Taher ...
Transcript of Dirjen Bina Upaya Kesehatan KEMENKES Prof Dr dr Akmal Taher ...
Dirjen Bina Upaya Kesehatan KEMENKES Prof Dr dr Akmal Taher Sp U (K) mengawali presentasinya dengan menegaskan bahwa, “Harus ada keyakinan bahwa sistem AHS akan dapat membawa perbaikan. Yang penting dari harmonisasi adalah hasil positif adanya kesepakatan karena harmonisasi sistem pendidikan dengan pelayanan kesehatan sangat penting dan tidak mudah, lebih kompleks dari kolaborasi antara FK dan RS. Mutlak diperlukan resources sharing, bukan hanya dalam bentuk uang tetapi juga sumber daya manusia. Integrasi stuktural dan fungsional harus terlaksana.” Prof Akmal melanjutkan, “Pelayanan kesehatan primer harus diperkuat untuk menjadi kontak pertama pasien yang membutuhkan pertolongan. Hal ini akan memperbaiki pelayanan sekunder sehingga berbagai kasus yang sulit benar-benar ditangani dengan baik oleh spesialis. RS rujukan harus dapat menjalankan fungsinya dengan baik, sebagai contoh angka kematian karena penyakit jantung tidak sama saja dengan RS di bawahnya. Untuk menurunkan angka kematian tersebut jawabannya bukanlah mengirim kardiologis tetapi meningkatkan layanan primer. Pelayanan kita akan sangat dipengaruhi oleh adanya JKN. Pada langkah awal pembentukan AHS harus dibuat template untuk pelayanan yang kemudian diterapkan di pendidikan, bukan membuat template sendiri-sendiri. Yang diharapkan dari AHS adalah pelaksanaan pelayanan yang baik, penelitian dan pendidikan yang maju. Lebih jauh lagi diharapkan akan ada perkembangan pada kesehatan publik, (inovasi) penelitian baru untuk diagnosis dan terapi, dan berbagai manfaat lain. Target yang ingin dicapai adalah universal coverage”.
“Untuk menguatkan layanan primer (promotif dan preventif), salah satu faktor
yang paling penting harus terwujud adalah sistem kolaborasi pendidikan tenaga
kesehatan” ujar Prof Akmal. Sebagai penutup, beliau juga menekankan bahwa
AHS menjadi bagian dari proses strategis yang harus dilakukan segera untuk
mencapai pelayanan kesehatan primer yang prima dan model AHS akan
diimplementasikan di level nasional.
HARMONISASI SISTEM PENDIDIKAN KEDOKTERAN DENGAN PELAYANAN KESEHATAN DALAM KONSEP
ACADEMIC HEALTH SYSTEM (AHS)
Prof. Dr. Akmal Taher, Sp.U(K) DIREKTUR JENDERAL BINA UPAYA KESEHATAN
KEMENTERIAN KESEHATAN RI
• Harmony
– the combination of simultaneously sounded musical notes to produce chords and chord progressions having pleasing effect
– agreement or concord
Arah Pembangunan Kesehatan (2005-
2024)
Masyarakat
Sehat Yang
Mandiri Dan
Berkeadilan
RPJMN I
2005-2009
RPJMN II
2010-2014
RPJMN II
20102019
RPJMN IV
2020-2024
Pendukung/penunjang
Upaya Kuratif
Universal
Coverage
RPJMN III
2015-2019
Pelayanan Kesehatan Primer1. Kontak pertama untuk pasien yang
memerlukan pertolongan
2. Penanganan fokus pada pasien (bukan hanyapenyakit) berkesinambungan
3. Komprehensif
– Promotif
– Preventif
– Kuratif
– Rehabilitatif/paliatif
4. Koordinator bila diperlukan rujukan
Orientasi keluarga dan komunitas
PETA STRATEGI PELAYANAN KESEHATAN PRIMER 2014 - 2019
DAMPAK
1. MASYARAKAT INDONESIA SEHAT YANG MANDIRIPenurunan AKI, AKB, Gizi Buruk
Meningkatkan UHH
2. TERWUJUDNYA PELAYANAN KESEHATAN PRIMER YANG PARIPURNA
% Fasyankes primer yang terakreditasi Tingkat KepuasanMasy pd Yankes primer
Tingkat kepuasan Nakes di Yankes Primer
3. TERWUJUDNYA MASYARAKAT YANG PEDULI KESEHATAN
% kab/kota yang memiliki UKBM Aktif lebih dari 50 % Tingkat kepedulian Masy pd Kesehatan
OUTCOME
PROSES
STRATEGIS
YG HARUS
DILAKUKAN
5. OPTIMALISASI SISTIM RUJUKAN
4. OPTIMALISASI YANKES PRIMERSEBAGAI GATEKEEPER
7. PENINGKATAN EFEKTIVITAS UKBM
6. REVITALISASI UKM
8. ADVOKASI PEMBANGUNAN DAERAH BERWAWASAN KESEHATAN
9. TERWUJUDNYA SISTEM PERENCANAAN YANG
TERINTEGRASI
11. PENGUATAN SISTEM INSENTIF DAN PROMOSI
PARADIGMA SEHAT
10. TERWUJUDNYA SISTEM KOLABORASI PENDIDIKAN NAKES
12. TERWUJUDNYA KEMITRAAN YANG
BERDAYA GUNA TINGGI
13. TERBANGUNNYA INFORMASI BERBASIS DATA DAN PENGALAMAN (Knowledge management)
SUMBER DAYA
KESEHATAN
14. TERSEDIANYA SDM YANG KOMPETEN DAN BERBUDAYA KINERJA
15. TERSEDIANYA DUKUNGAN
REGULASI YANKES PRIMER
16. TERSEDIANYA SIK TERPADU
17. TERSEDIANYA SPA SESUAI STANDART, OBAT DAN DUKUNGAN PERBEKALAN KESEHATAN SESUAI
STANDART DAN KEBUTUHAN
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KEUANGAN
• The Affordable Care Act set in motion dramatic changes to the way that health care is delivered in the United States. Yet in the entire law, academic health centers (AHCs)—the institutions that include a medical school, other health professions training programs, and affiliated teaching hospitals and health systems—are mentioned only 10 times, and never in reference to the sweeping health care delivery reforms initiated by the law.
A New Conceptual Framework for Academic Health Center,
Borden et al. Academic Medicine. 90. 2015.
What do government & public expect from AHSCs?
• Conventional expectations:
• Excellence in clinical care
• Place where significant & cutting edge medical research is conducted
• Place for training of doctors, nurses and care providers
Building an innovating academic health system. Dzau, 2014
Future expectations:
• Clinical care includes improvement of
community health
• Research result in novel discoveries for dx &
therapies
• Research can impact community & population
health
• Develop new models of care delivery (including
IT)
• Training for the future
• Economic driver & community leader
ACADEMIC HEALTH CENTRE• AHC is not a single institution but a constellation of functions
and organizations commited to improving the health ofpatients and populations through the integration of their rolesin research education and patient care to produce knowledgeand evidence base that becomes the foundation for bothtreating illness and improving health.
• The integration involves more than the simultaneousprovision of education, research and patient care. It requiresthe purpose linkage of the roles so that research develops theevidence base, patient care applies and refines the evidencebase and education teaches evidence based and team-basedapproaches to care and prevention (United States Academy ofScience 2004)
AHCs should aspire to lead the transformation of healthcare & health
• Reorganizing biomedical research and health delivery systems into a seamless continuum from discovery to clinical delivery to population health. Moving from Academic Health Center (AHC) to Academic Health Sciences System (AHSS).
• Bench to Bedside to Population”
• • Vertical integration of care delivery with population health
• • Integrated translational model of Discovery-care continuum • Effective use of information for care & research : Learning Health System
• • Emphasize & accelerate Innovation
• • Community & Population Health • Globalization
• Transforming Academic Health Centers for an Uncertain Future– N Engl J Med 369;11 September 2013
• One key consideration will be balancing specialized clinical excellence and population health
• AHCs will have to become higher performing regional health systems, spanning the spectrum from community based and primary care to highly specialized hospital and tertiary acute care
Creation of Leadership and Management Programs
• Management and Leadership Pathway for Residents (MLPR) 15-18 months of project driven management rotations/modules combined with clinical training. Rotations aligned with clinical requirements, trainee interests, and institutional priorities where trainees are teamed with DUHS senior leadership
• Provides a management toolkit for mid-career clinicians, that allows them to lead and grow their departments and divisions with increased efficacy.
• The Master of Management in Clinical Informatics (MMCi) MMCi represents an innovative curriculum that develops the workforce of the future to address the needs of people who are fluent in the use of data to drive strategic decision making.
PENDAHULUAN
Public Hospital – Important roles•Provider of last resort
– Ensuring access to medical services for those who can not go elsewhere
•Major teaching institution– Undergraduate and postgraduate program
– Provider of highly specialized care
– The only route for non-paying patients to the most sophisticated diagnostic and treatment services and equipment
•Role– Provide medical services
– Education and research
BUMN 2005
PENDAHULUAN (2)
• How can Academic Medical Centre (AMC) compete, survive, and continue to fulfill their societal mission in highly competitive and hostile marketplace?
AMC : one teaching hospital and at least one school of medicine (parent university)
Productivity Press
Taylor & Francis Group
New York, NY 10016
2010
Developing integrated structure
Pursuing and supporting disease-related research
Educating the health work-force
Focusing attention on thebusiness of medicine
Restoring the outstanding care as the core missionand focus of Academic Medical Centre
• Research– 70% of top twenty AMC’s are integrated
– 50% of ranked 21-30 AMC’s are integrated
• Medical services and general quality (US News and World report)– 11 of the 17 top hospitals are integrated at some form
• Only 44% of American have an integrated structured
Organizational factors associated with high performance in quality and safety in academic medical centre
• The top-performing centers were integrated across the multiple components of the AMC
• The lower ranked institutions seemed –unable to resolve their internal conflicts between the missions
of patient care, teaching, and and research
– largely satisfied with the level of quality and safety at their institution
Academic Medicine 82 (12): 1178-86. 2007
KERJASAMA STOVIA & CBZ
• Pioner pelayanan spesialistik kedokteran di Indonesia 1924 (Dosen klinik STOVIA sebagai Kepala Bagian di CBZ)
• 1925 : Bagian Bedah, Bagian Kebidanan
• 1955 : Bagian Kesehatan Anak, Bagian THT
• 1960 : Bagian Penyakit Dalam, Bagian Penyakit Kulit & Kelamin
• 1961 : Bagian Mata
• 1962 : Bagian Bedah Saraf
• 1964 : Bagian Akupuntur
• 1965 : Bagian Anestesi, Laboratorium Kesehatan Pusat
Recomendations for integrating AMC structure
• Drive integration from the Top
• Include all stakeholders
• Develop a framework for integration that can withstand changes over time
• Ensure the central focus of integration is improved patient care
• Transforming Academic Health Centers for an Uncertain Future– N Engl J Med 369;11 September 2013
• One key consideration will be balancing specialized clinical excellence and population health
• AHCs will have to become higher performing regional health systems, spanning the spectrum from community based and primary care to highly specialized hospital and tertiary acute care
Toward JCI Accreditation in 2012
Accreditation (process & outcome)• Joint Commission International.
– Patient Safety.– Risk Adjusted Mortality Rate.– Difficult to Treat Cases Outcome.
.
DOSEN PENDIDIKAN KEDOKTERAN
Didalam UU Pendidikan Kedokteran Pasal 21 dinyatakan :
(1) Dosen dapat berasal dari perguruan tinggi, Rumah Sakit Pendidikan,danWahana Pendidikan Kedokteran.
(2) Dosen di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteranmelakukan pendidikan, penelitian, pengabdian kepada masyarakat, danpelayanan kesehatan.
(3) Dosen di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteranmemiliki kesetaraan, pengakuan, dan angka kredit yangmemperhitungkan kegiatan pelayanan kesehatan.
(4) Ketentuan lebih lanjut mengenai kesetaraan, pengakuan, dan angkakredit Dosen di Rumah Sakit Pendidikan dan Wahana PendidikanKedokteran sebagaimana dimaksud pada ayat (3) diatur dalamPeraturan Pemerintah.
Peraturan Pelaksanaan Undang-undang No.20 Tahun 2013 tentangPendidikan Kedokteran salah satunya mengenai peralihan Dokter PendidikKlinis menjadi Dosen harus ditetapkan paling lama 2 (dua) tahun terhitungsejak tanggal 6 Agustus 2013
–Aturan turunan dari UU Pendidikan Kedokteran (PP) mengenaikesetaraan dan pengakuan dosen PT dan dosen RS Pendidikan NIDN
–Aturan mengenai Dosen dan angka kreditnya di Rumah Sakit Pendidikandan Wahana Pendidikan Kedokteran ;
–Aturan mengenai insentif gaji, remunerasi di RS pendidikan
– Jenjang karir Dosen di RS Pendidikan
– Sertifikasi dosen kedokteran
–Aturan mengenai RS Pendidikan yang mengakomodasi kesetaraandosen: Sertifikasi dosen, kompetensi dosen, jabatan akademik
YANG PERLU DITINDAKLANJUTI DARI UU PENDIDIKAN KEDOKTERAN
GURU (UU No 14 thn 2005)
Pendidik profesional Mendidik, mengajar, membimbing, mengarahkan,melatih, menilai, dan mengevaluasi peserta didik pada pendidikan anak usia dini jalur pendidikan formal, pendidikan dasar, dan pendidikan menengah.
DOSEN(UU No 14 th 2005)
Pendidik profesional dan ilmuwan Mentransformasikan,mengembangkan, dan menyebarluaskan ilmu pengetahuan, teknologi, dan seni melalui pendidikan, penelitian, dan pengabdian kepada masyarakat.
DOKDIKNIS PerMenPan 17/2008
Pendidik profesional dan ilmuwan di RS Pendidikan Pelayanan kesehatan/medik, pengabdian masyarakat, pendidikan dokter dan atau dokter spesialis serta melakukan penelitian di Rumah Sakit Pendidikan
DOSEN
RS
PENDIDIKAN
UU DIKDOKThn 2013
Pendidikan 40%
Penelitian 40%
Penunjang 20%
Guru besar S3
Core competence of residents
The Accreditation Council for Graduate Medical Education (ACGME) Patient careMedical knowledgePractice-based learningInterpersonal and communication skillsProfessionalismSystems-based practice
Konsil Kedokteran Indonesia
Stanford University School of Medicine Faculty Handbook8.2 Criteria and Application of Criteria for Appointments, Reappointments andPromotionsA. CriteriaThe University recognizes that there are significant variations in how candidatesqualify for and secure initial appointment, reappointment and promotion,according to field and discipline. Candidates come from different backgrounds andreceive different educational training. In addition, there may be variation inemphasis among the components of activity (i.e., clinical care, teaching and, insome cases, scholarship and/or administrative duties). Given the many differentactivities in which Clinician Educators are engaged, such variations are expectedand are appropriate. Nevertheless, all faculty appointments have in common therequirement of excellence, however measured.
The major criterion for appointment, reappointment and promotion for ClinicianEducators, including Clinician Educators (Affiliated), is excellence in the overall mixofclinical care and clinical teaching appropriate to the programmatic need theindividual is expected to fulfill.
Specific/Supplemental Criteria for Clinical Associate Professorsa. Appointment as Clinical Associate ProfessorAppointment to the rank of Clinical Associate Professor in the Clinician Educator Linewill be considered for those who have demonstratedexcellence in the overall mix of clinical care and clinical teaching (and, if applicable,institutional service and/or scholarly activities). There shouldbe evidence that candidates have attained regional recognition as superior cliniciansand clinical teachers. There should be evidence that the candidates will successfullyfill the programmatic need for which the appointment is made and will makemeritorious contributions to their discipline and to the School.
Penilaian Kinerja Staf MedikRSUPN Dr. Cipto Mangunkusumo
Indicator yang dinilai sesuai dengan 6 area core competency (ACGME, ABMS) : • Medical / clinical knowledge• Patient care :–Outcome–Complication, in depth analysis
• Practice-based learning and improvement• Interpersonal and communication skill• Professionalism• System-based practiced
Enam Kompetensi Inti Staf Medik (1)
1. Medical/Clinical knowledge–Demonstrate knowledge of biomedical, clinical, and cognate
sciences and application to patient care.
• Indicators–Hospital Based CME
–New Training or Experience
–Board Cert-Initial or Renewal
Enam Kompetensi Inti Staf Medik (2)
2. Patient care–Provide patient care that is compassionate, appropriate, and
effective.
• Indicators (outcome and complication) –Organ Injury
–Prophyladic antibiotic within one hour to incision
–Compliance with DVT prevention
–Post wound infection
–Post- op ventilator associated pneumonia
Enam Kompetensi Inti Staf Medik (3)
• Indicators “Patient care” (Anesthesia)–Re-intubation in OR or PACU
–Anesthesia Incidents (Broken Teeth)
–MI within 48 hours post anesthesia
–Pneumothorax from CDIRECTOR Line Insertion
Enam Kompetensi Inti Staf Medik (4)
3. Practice-based learning and improvement– Investigate and evaluate patient care practices, appraise
and assimilate scientific evidence– Improve patient care practices
• Indicators – Illegible Orders sent for Review – Adherence to National Patient Safety Goals:• Abbreviations • Universal Protocol, as applicable
Enam Kompetensi Inti Staf Medik (5)
4. Systems-based practice–Provide cost-conscious, effective medical care .–Work to promote patient safety–Coordinate care with other health care providers
• Indicators –Documentation of appropriate pre-and post anesthesia
assessments–Medical Record Delinquency– Informed Consent Surgery
Enam Kompetensi Inti Staf Medik (6)
5. Professionalism
– Commitment to carrying out responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Indicators
–Complaints related to Professionalism from Staf
Enam Kompetensi Inti Staf Medik
6. Interpersonal & communication skills
– Demonstrate skills that result in effective information exchange
– Work effectively with other members of the health care team
• Indicators– Feedback related to communication skills
–Complaints from Patients/Famili
Kuantitas
• Jumlah pasien rawat jalan
• Jumlah pasien rawat inap
• Jumlah tindakan medik
SPO Survey penilaian profesionalisme dan communication skill
• Jumlah responden survey : (Alberta)– Dokter dan atasan = 6 orang– Pasien = 6 orang
RESPONDEN DOKTER• Penetapan responden sejawat dan atasan untuk masing masing dokter
oleh Tim Survey :– Penetapan nama responden (dalam soft copy)– Memasukkan form survey ke amplop tertutup– Mengirimkan amplop tertutup ke departemen dan meminta tanda terima
• Pelaksanaan Survey penilaian profesinalisme dan komunikasi staf medisdi Departemen :– PIC Departemen membagikan amplop ke responden di departemen / divisi– PIC Departemen mengambil hasil isian survey– PIC Departemen mengirimkan hasil penilaian ke Tim Survey Penilai Kinerja Medis
SPO Survey penilaian profesionalisme dan communication skill
RESPONDEN PASIEN• PENETAPAN RESPONDEN– Rawat jalan (3 orang) dilakukan setelah pasien diperiksa dokter– Rawat inap (3 orang) dilakukan saat pasien akan pulang (atas izin dokter maupun
pulang paksa)– Bila jumlah pasien dari salah satu tempat kurang dari 3 maka dapat dipenuhi pasien
dari tempat lainnya• Pelaksanaan Survey penilaian profesinalisme dan komunikasi staf medis di
unit layanan– Tim Survey membagikan kuisener dalam amplop terbuka kepada perawat unit kerja– Perawat unit kerja memberikan penjelasan kepada pasien / keluarga tentang survey
dan memberikan amplop survey ke pasien di unit kerja– Pasien mengisi kuesioner survey dan mengembalikan ke perawat unit kerja– Perawat mengumpulkan kuesioner yang telah diisi dan dimasukkan dalam amplop
tertutup dan menyerahkan ke Tim survey Unit– Tim Survey Unit mengirimkan isian survey dalam amplop tertutup ke Tim Survey
Korporat.
Academic Medical Center Hospital Standard
Medical Professional Education
• Hospital governance and leadership endorse of a set ofmetrics to monitor and evaluate the ongoing operation ofmedical education programs, and there is documented reviewof the monitoring data
• Hospital governance and leadership review, at least annually,the medical education programs within the organization, andthe review is documented
• The review includes the satisfaction of patients and staff withthe clinical care provided under the program
• Organization policy identifies the required level of supervision foreach level of trainee
• The level of to be provided is based on the demonstratedcompetency of the trainee
• Each trainee understands the level, frequency, and documentationof his or her supervision
• The organization provides the required level of supervision foreach trainee
• There is a uniform process for documenting the requiredsupervision that is consistent with organization policy, programgoals, and the quality and patient safety
MPE4 Supervision
• The operational structure for medical education in the organization has been determined and is in operation as required
• The leadership structure for medical education in the organization has been determined and is in operation required
• There is a complete and current list of all student in the organization
MPE5. Management of Medical Education in Hospital
Thank You