“To be the Indonesian Regional Class Hospital that shows

Excellence in Services”

As a Final Assignment in Corporate

Performance Management Course

Proposed by :

Syndicate 4

Ananto Veryadesa

Azolla Degita Azis

Corry Lamria D Hutahaean

Fikhi Adrian

Laurien Verschuur

Maurice Nibbelink

Stefanus Indra

Integrated Performance Management

System Proposal in Hasan Sadikin

General Hospital

Stage 1

Basic Information

1.1 Preliminary

Dr. HasanSadikin Hospital,or in bahasa Rumah Sakit Hasan Sadikin (RSHS), located at Jalan

Pasteur No.38 Bandung and is one of the technical units under the Medical Department. Therefore,

it is directly responsible to Direktur Jenderal Bina Pelayanan Medik of the Medical Department of

Republic Indonesia. RSHS is a class A referral hospital which is the best of health services for the

people of West Java.

RSHS is serves as an education hospital for medical workers and also as a national center of

excellence in the field of nuclear medicine. More specifically, RSHS serves as the only nuclear

medicine specialist education provider in Indonesia.

1.1.1 Brief History of Dr. Hasan Sadikin Hospital (RSHS)

RSHS was built by the Dutch government in 1920 and inaugurated on 15 October 1923

under the name of ‘Het Ziekenhuis Algemeene Bandoengche’. On 30 April 1927 its name was

changed to Het GemeenteZiekenhuis Juliana with a capacity of 300 beds. During the Japanese

occupation, the hospital was used as a military hospital by the name Rigukun Byoin, and in 1948 the

hospital's function returned to general hospital with the name “Ranca Badak Hospital”, whose

management is under the township of Bandung.

In 1954, Ranca Badak Hospital served as a provincial hospital. Two years later, in 1956, it

was established as a general hospital center. This coincided with the establishment of the Faculty of

Medicine, University of Padjadjaran. RSHS started working with the Medicine Faculty of

Padjadjaran University for a medical education.

On October 8, 1967, the name of Ranca Badak Hospital changed to General Hospital Dr.

HasanSadikin as a tribute to Dr. Hasan Sadikin who passed away while holding the position of

director of the hospital. Dr Hasan Sadikin was one of the founders of the Faculty of Medicine,

University of Padjadjaran (FKUP) and also served as the second Dean of FKUP.

Since itsestablishment in 1923, RSHS has developed into a large hospital in West Java which

serves as a referral hospitaland Pinnacle Peak of the West-Java province. Moreover, RSHS is a

teaching hospital for FKUP and other educational institutions for medical workers. Because of its

capability of providing specialist services and offering a broad range of sub-specialty services,

RSHS was set as a Class A Hospital in accordance with the PP No. 23 of 2003by the Department of

Health and by SK Menkes RI No. 861/Menkes/VI/2005 on October 18, 2004. RSHS has changed

the status of the Company Bureau (Perjan) into an institution that applies to Financial Management

of Public Service Agency (BLU-PPK).

1.2 Industry, Government and Society

In carrying out its functions, Hasan Sadikin Hospital cannot be separated from its Politic,

Economic, Technology, and Social Culture conditions and environment. These conditions could

impact the HS Hospital strategies positively, causing the hospital to improve their competency to

provide healthcare services quality to their customers/patient.

1.2.1 PEST Analysis

Start from their foundation until now, HS hospital has experienced some changes in their

status.Starting in the form of Swadana, Pendapatan Negara Bukan Pajak, Perusahaan Jawatan it

now is a Hospital for Public Service. This change is due to government policy. As a Government-

run Hospital, there are some policies which create opportunities for the hospital and also some

policies that limit the hospital’s activity and reduces the flexibility of managing the hospital.

The growth of the economic rate also impacted the Hasan Sadikin hospital. The purchasing

power of people and inflation rate affect operational and planning system of the hospital.

Moreover, the technology development influences the development of doctor’s technological

knowledge, the improvement of the quality of service and an increase in the costs that hospitals and

patients have to pay. The development of supporting technology systems has to be followed

significantly with the capability of hospital’s human resources to match this development and

increase the positive value of the hospital.

1.2.2 Indonesia Demographic and Economic Conditions

The population of Indonesia is around 242,3 Million on 2011, and is dominated by the

middle-income segment as the largest and fastest growing segment of Indonesia’s population, with

GDP growth in Indonesia being around 6,5%.

Based on BPS Statistic Data, the middle income consumer segment in Indonesia spends

17,8% of their expenses on Goods & Services that include toiletries & personal care, books &

stationeries, medical & healthcare, education, transportation and recreation. Around 51% of their

expenses is spend on Food and Beverages.

Figure 1.1. Indonesia Demographic by Income, 2012 (in Million) (Source: The World Bank,

Ministry of Health, BPS)

Based on BPS Data Statistic, the total population in West Java Province is around 44 million

people, and that makes West Java having the largest population in Indonesia in 2011. Bandung has

the 3rd

largest population in West Java Province, which is around 2,5 million people.

The Ministry of Health of the Republic Indonesia has allocated a budget for health in West

Java Province which is only Rp 2,3 Trillion for the whole of 2011. However, the realization budget

that was actually allocated on thehealth areaby the Government of West Java Province was only Rp

743 Million. This budget is for running the Jamkesmas/Jamkesda program, Puskesmas facilities,

Health Research, Health Development Program for mother care and baby birth, and Medicine

(Generics).

To provide the Health Care Facilities in West Java Province, there are Hospitals and

Puskesmas in West Java Province.The total number of Hospitals is 251, which includes 32 hospitals

in Bandung area. There are 1.050 Puskesmas in the West Java Province, with 62 Puskesmas in

Bandung area to serve citizens with low-level economic conditions. 95,2% of the population has

already rights to have a very low-payment of health care facilities provided by ASKES Insurance,

Jamkesmas, and Jamkesda from the Government.

High income segment (19.4 Mn) Monthly income per household: >USD 1,000

Mid-high income segment (29.1 Mn) Monthly income per household: USD 550–1,000

Mid-low income segment (126 Mn) Monthly income per household: USD 150–550

Low income segment (67.8 Mn) Monthly income per household: <USD 150

8%100%

2011

28%

52%

12%

242.3 Mn

Figure 1.2. Proportion of Health Insurance for Indonesian People, 2011 (Source: P2JK)

Some customers that have ASKES, Jamkesmas, and Jamkesda feel that there is a gap

between the services supplied to them and the customers that are using non-governmental insurance,

such as long queuing time, Health Care Equipment, room facilities, and capability of the doctors.

With the big total population and just a small number of Health Care Services in the West

Java Province, the government still needs a bigger number of Hospitals and Puskesmas to satisfy the

demands of patients which increases every year, especially for the sub-urban areas in the West Java

Province.

1.2.3 Political-Legal environment for Government Health Industry

With the issuance of Law No. 20 of 1997, in 1998 the revenue status of a government

hospital like RSHS is one of the Non-Tax Revenue (PNBP) of the Indonesian country, meaning that

all income and expenses must be recorded into the government within 24 hours. It was felt that this

condition strongly inhibits smooth operations, leading to delays in the provision of laboratory

reagents which were compounded by rising U.S. dollar exchange rates sharply, almost causing the

Clinical Pathology Laboratory services to collapse in 1998.

In the next period, the limitation of the government in financing hospital services has

declined, because the hospital was required to improve the quality of service. It made a big change

in paradigm of the government to act more as a catalyst by removing operations that can be done by

the hospital itself (steering rather than rowing). Thus, the Government issued a new Law No.

.119/2000 that made RSHS a Bureau Company (Perjan).

With having autonomy and greater flexibility in managing the hospital because of this new

status, RSHS perceived performance improved. The status of Perjan hospitals was constrained by

new legislation, so that since 2005RSHS, with the other 12 hospitals in Indonesia, transformed into

the new status of Financial Management of Public Service Agency (BLU-PPK).

1.2.4 Five Porter Analysis

1. Threat of new entrants (High)

Nowadays, hospital/ healthcare business are becoming more promising. Growth of new hospital

increases rapidly either privately or foreign company owned, increasing competition between

government hospitals, especially for HS Hospital. Threats in this business do not only consist of

how to get and retain customers by excellent quality and services but also of how to protect

human resources - physician, therapist, and expert - that HS hospital already has, so that it can

give the competitive advantage to company itself.

2. Rivalry among existing firms (High)

The competition intensity among hospitals in Indonesia is very aggressive in order to get more

customers, especially in middle up customer segment. For this segment, the competition is

comes from both local and foreign firms. Each competitor serves the target market with service

differentiation through high standard quality, reliability and time service delivery.

3. Bargaining power of customers (High)

People are more conscious about the quality of healthcare so that bargaining power of customer

has increased to a high level. In addition, the rapid new hospital growth give customers

increasing options to choose from.

4. Bargaining power of suppliers (Medium)

Government policies about the procurement of productscan directly influence the conditionsfor

bargaining suppliers. That process must be done through one committee. Procurement in larger

orderscan influence the moderation of the bargaining power of the suppliers.

5. Threat of substitute product or services (High)

There is a high threat of substitute services, since the demand for traditional/ alternative

healthcare increasesrapidly. The substitute of services is possible since customers (low to

middle) are more price sensitive. If hospitals charge at higher prices, or if the “quality” does not

satisfy the patient, then consumers are able to choose a substitute from the many alternativesthat

are present in the market environment. Government awareness of this situation sometimes could

lead to disadvantages to society.

1.2.5 EFAS and IFAS

In order to get a picture of the market and competitors, the SWOT method will be used to

define the information from internal and external sides of Hasan Sadikin Hospital. The internal

information captures strengths and weaknesses that Hasan Sadikin Hospital has, where the external

information provides the opportunities and threats Hasan Sadikin Hospital might face.

Strengths

Tabel 1.1 Internal Strengths Analysis (Source : Renstra 2007 until 2011)

No Description Factor Sub-Factor Rating Value Total

a

Services

0,35

1,30

Sub specialis services increase both quantity and

quality aspect 0,25 4 0,35

Class A Hospital as top recommendation, full

acreditation with full sixteen services 0,2 4 0,28

As hospital for education always update with

IPTEKDOK and education model development in

Indonesia 0,15 3 0,16

Service competency and ability to develop new

product 0,25 4 0,35

Medical committee performs as their roles 0,15 3 0,16

b

Financial

0,2

0,78

Government subsidy 0,2 4 0,16

Increasing of cost recovery 0,4 4 0,32

Financial management assisted by banking services 0,1 3 0,06

Using system development central service

admnistration (PPTARS) with SIMRS 0,1 4 0,08

Hospital rate including unit cost 0,2 4 0,16

c

Human Resources and Organization

0,3

1,09

Appropriate quantity and quality of medical

employee 0,24 4 0,29

Variability of education background in human

resources to support serbices, education and

research requirement 0,28 4 0,34

The ability of paramedic, functional employee , and

administration non functional increase 0,13 3 0,12

The attitude, loyality and motivation of specialist

physican increase 0,13 3 0,12

Organization structure inline with BLU concept 0,12 4 0,14

Corporation between HasanSadikin Hospitaland

medical faculty of Padjajaran University about

health resarch 0,1 3 0,09

d

Facilities, Infrastructure and equipment

0,15

0,64

Strategic location 0,25 5 0,19

Has prospectif master plan, already implemented 0,2 4 0,12

Sufficient building and equipment 0,3 4 0,18

Compututerized SIMRS continue to develop 0,25 4 0,15

Total 3,80

Weaknesses

Tabel 1. 2. Internal Weaknesses Analysis (Source : Renstra 2007 until 2011)

No Description Factor Sub-Factor Rating Value Total

a

Services

0,35

1,16

Service procedures not yet oriented with customer

satisfaction 0,3 4 0,42

Long time of delivery 0,25 3 0,26

Marketing not fully utilized 0,25 3 0,26

Intergration of service and education not fully

optimized 0,2 3 0,21

b

Financial

0,2

0,65 Deficit in particular unit services 0,4 3 0,24

Rate applied not as final cost 0,35 3 0,21

HS HOSPITAL's Employee contract payment

financed under hospital 0,25 4 0,20

c

Human resources and organization

0,3

0,90 Number of nurse not sufficient with requirement 0,5 3 0,45

No relation between reward and achievement 0,5 3 0,45

d

Facilities, Infrastructure and equipment

0,15

0,51 Low budget for maintenance cost 0,35 3 0,16

Lack of layout compare to room requirement 0,25 3 0,11

Lack of sophisticated facility and equipment 0,4 4 0,24

Total 3,22

Opportunities

Tabel 1.3. Market Opportunity Analysis (Source : Renstra 2007 until 2011)

No Description Factor Sub-Factor Rating Value Total

a

Law

0,18

0,90 Law No.1 year 2004 about country treasury 0,5 5 0,45

Law No.29 year 2004 abour medical practice

encourage spesialist physicians fully contributed to

HS Hospital

0,5 5 0,45

b

Government Policy

0,18

0,57

Political will, government support the development

of organization performance with PP No.23 year

2005, including possibility of Operational

Corperation (KSO)

0,35 5 0,32

PMK and Kepmekes availability as Juknis PP No.

23 years 2005 0,35 4 0,25

Gakin's patient will be funded by Government under

Askesin program 0,3 4 0,22

c

Competitor

0,16

0,58 Opportunity to have an agreement with other

hospital, both domestic and foreign. 0,6 4 0,38

Tabel 1.3. Market Opportunity Analysis (Source : Renstra 2007 until 2011)

No Description Factor Sub-Factor Rating Value Total

Strategy alliances to share facility and equipment

0,4 3 0,19

d Economy

0,16

0,08

Economic growth in Indonesia 0,16 3 0,08

e

Social and Culture

0,16

0,56

Society tends to push hospital to give best quality 0,5 4 0,32

Society more conscious about quality of health

service especially promotif and preventive health 0,25 3 0,12

Life expectancy rising in line with increasing of

people health awareness 0,25 3 0,12

f

Technology

0,16

0,58

IPTEKDOK as based to develop new

services/products 0,4 3 0,19

Submission for cooperation in services and

sophisticated technology increasing 0,6 4 0,38

Total 3,26

Threats

Tabel 1.4. Threat Analysis (Source : Renstra 2007 until 2011)

No Description Factor Sub-Factor Rating Value Total

a Law

0,18

Taxes regulation increasing hospital expenditure 1 3 0,54 0,54

b

Government Policy

0,18

Complaint for product and service under Kepperes

no.80 year 2003 impacted to long and less flexible

process

1 3 0,54 0,54

c Competitor

0,16

Marketing of private/ Foreign hospital more

aggressive than HS Hospital 1 4 0,64 0,64

d

Economy

0,16

0,72 Increasing of not so unfortunate people in Indonesia

whose not have health assurance from government 0,5 3 0,24

Rupiah depreciation compare to dollar 1 3 0,48

e Social and culture

0,16

People tend to get health service alternatives from

overseas 1 3 0,48 0,48

f Technology

0,16

High investment and maintenance for sophisticated

technology 1 3 0,48 0,48

Total 3,4

Based on the matrix showed below, Hasan Sadikin Hospital strategic position is a growth strategy to

face hospital market in Indonesia.

Figure 1.3. SWOT Analysis Result

1.2.6 Business Issues faced by Hasan Sadikin Hospital

Fierce competitive levels in every business sectorlead tothe critical response of people to

products of goods and services.Furthermore, the threat of new entrants pressures the current

provider to improve their service quality in order to gain trust from their customers.

In order to anticipate to these problems, some companies started to revise their vision,

mission, company strategies and made improvements on their operational activities, which improved

the corporate performance. Also companies are researching and learning from other strategies of

companies that have the best performance. To reach the goal of a company’s vision HS hospital

wants to gain global recognition and to position the hospitals as a world class hospital. HS has to

compete with other hospitals both nationally and internationally and has to answer the challenges

with providing health service quality.

Until this moment tools called “Standar Akreditasi Rumah Sakit”, that are nationally

applicable but not yet usedfor international standardized performance measurement, are usedto

measure the performance of HS Hospital. In order to fulfill the needs, HS Hospital needs to apply

international standard performance measurement tools such as Malcolm Balridge. Malcolm Balridge

provides a special assessment system when applied to the hospital can determine the strategy to win

the competition, adopting structural changes to improve the performance and aim for awardssuch as

the Indonesia Quality Award (IQA).

IFAS = 7,02

EFAS = 6,66

Growth strategy

By using international standard tools to measure the corporate performance, HS Hospitals

might be able to recognize their position within their business environment, particularly with other

hospitals in the regional sectors around Southeast Asia.

1.2.7 Business Solution

In this research an Integrated Performance Management System (IPMS) is used as a system

to develop the business solution that relates to the topic of how the HS Hospital is to achieve and

improve their performance.

1.3 Market and Competitor

Zairi (1992) explain that there are multiple ways to analyze market and competitors

1. Analyze Competitor by using product as starting point to identify strength, weakness, design

capability and technology exploitation.

2. Financial analysis, which gives an indication against competitor, source allocation, business

results, etc.

3. Business environment change.

4. Market dynamic to understand consumer behavior, buying power, etc.

One of the methodologies to gather information regarding the business environment is

environmental scanning. Environmental scanning usesexternal factors information coming from

annual report, books and others to benchmark its capabilities against competitors.

The Ministry of Health divides Indonesian healthcare into public healthcare and private

healthcare, and Hasan Sadikin Hospital provides public healthcare represented by the west java

government.

General hospitals make up for almost 80 percent of the total hospitals in the country. Despite

the rapid increase in non-communicable diseases, specialist hospitals targeting cardiac care and

cancer are considerably low at less than one percent of all hospitals. Conversely, hospitals

specialising in paediatric care, maternity care, and mental health are most common.

The health system in Indonesia relies heavily on the private sector and this should be given

proper importance by the government, deciding which health indicators (infant mortality, maternal

mortality and others) will and will not be improved. Due to lack of infrastructure and skilled

workforce in the public sector, most of the population (even the poor) seek private sector treatment

for critical services as childbirth, paediatric diarrhoea, and acute respiratory diseases.

With globalization, competition is really tight in the hospital industry, not only a national

scale, but also internationally. Hospitals in other countries also effectively become competitors of

Indonesian hospitals. When asurvey was held amongst customers, the main reason why Indonesian

people prefer to take medical treatment abroad than domestically is because they assume hospitals in

another country are more convenient and have more reliable service than hospitals in the Indonesia.

Nevertheless, we can see the number of JCI certified hospitals (Joint Commission

International - an international hospital standards bodies) accredited in Indonesia is only 9 hospitals.

In comparison with Singapore, that already has 22 hospitals that have this accreditation. So, the

customers’ perception is really important, and Indonesian hospitals havethe ability to compete and

to be in the forefront to improve patient care and confidence.

Although RSHS is the only hospital that has a BLU status in West Java Province, RSHS still

competes with other hospitals, especially in Bandung area.

Table 1.5. Hospital in West Java Province (Source: Ministry of Health)

Figure 1.4. Percentage of Hospitals in Indonesia, 2010

In term of financial analysis, public healthcare and private healthcare have increasing trends

for their expenditures, based on research by Frost and Sullivan.

Figure 1.5. Hospital Expenditure in Indonesia

Figure 1.6. Hospital Expenditure Projection in Indonesia

In the past decade, the significant growth of the public health sector underpinned the

majority of the healthcare sector development. In response to the financial and economic crisis, new

emphasis was placed on pro-poor financing, whereby the public sector was bestowed as the primary

sector for delivering accessible and affordable healthcare services to the poor.

Industry competition assessment for Hasan Sadikin Hospital will be done through

comparison with the strongest competitor in Indonesia, which is representedby private healthcare.

According to Frost & Sullivan, PT Siloam International Hospitals is the largest private hospital

group in Indonesia in terms of number of hospital beds as of December 31, 2012. Over the last 17

5,1 5,7 7,8

10,3 12,1 13,6 4,3 4,7

7,3

9,5

11,3 12,8

0,00

5,00

10,00

15,00

20,00

25,00

30,00

2007 2008 2009 2010e 2011e 2012e

Exp

end

itu

re

($ B

illi

on

)

Private Government

2013F 2014F 2015F

Private Expenditure 14,66 16,96 19,95

Government

Expenditure 15,44 17,44 19,95

0,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

45,00

Gover

nm

en

t vs

Pri

vate

Hea

lth

Ex

pen

dit

ure

(U

SD

bil

lion

)

years, Siloam Hospital has been a pioneer and been a part of many significant milestones in the

development of healthcare in Indonesia. They received an “excellence” award from the Asian

Hospital Management Award in 2011.

There are some critical success factors that contribute to the success of Siloam Hospital compared to

Hasan Sadikin Hospital such as

1. Infrastructure

2. Finance

3. Technology

4. Services

5. Education

This could be mapped into the following table

Tabel 1.6. Comparison

Aspect Hasan Sadikin Hospital Position compare to Siloam Hospital

Below Average Average Above Average

Infrastructure

Finance

Technology

Service

Education

Base on table above, there are 4 weakness factors that make HasanSadikin Hospital

performance below Siloam Hospital; Infrastructure, Finance, Technology and Service.

As of April 30, 2013, Siloam operated 13 hospitals, providing a comprehensive range of

specialist medical services such as complex surgical procedures, as well as laboratory services,

radiology and imaging services, fertility treatment, general healthcare services and diagnostic and

emergency services. As of April 30, 2013, Siloam has a total bed capacity of 3,436 beds, 1,178

doctors (including 930 specialists) who provided services to patients at the hospitals, and employed

2,607 nurses and other allied health personnel. Siloam plans to further expand their operations and

presence through building new hospitals, expanding their existing hospitals and opportunistic

acquisitions, with the goal of increasing their total bed capacity to 10,000 beds over the next five

years.

In the yearsended December 31, 2010, 2011 and 2012 and the four months ended April 30,

2012 and 2013, Siloam Hospital recorded revenues of Rp.1,030.5 billion, Rp.1,259.3 billion,

Rp.1,788.1 billion (US$183.9 million)2, Rp.534.3 billion (US$55.0 million) and Rp.789.5 billion

(US$81.2 million), respectively, and net operating revenues of Rp.702.0 billion, Rp.881.1 billion,

Rp.1,272.7 billion(US$130.9 million), Rp.380.4 billion (US$39.1 million) and Rp.577.8 billion

(US$59.4 million).

There is one factor that Hasan Sadikin Hospital can compete with Siloam Hospital, which is

Education. Hasan Sadikin Hospital works closely with Pajajaran University, while Siloam Hospital

with Pelita Harapan University. Most of the students from both universities join internships and do

research before they become full time doctors, nurses and any medical health personnel in the

future. HasanSadikinHospitaland Siloam Hospital cooperation with education organization make

them have the same position.

1.4 Product and Services

RSHS has a scope of business that organizes relief and recovery efforts which are

implemented in a harmonious, integrated and continuous environment with health promotion and

prevention efforts as well as efforts to implement the referral, education and research and other

efforts needed.

Hasan Sadikin Hospital is a “Class A” which is the central reference rate of West Java

province, and has facilities adequate to support highly qualified human resource excellence, as a

commitment to always improve quality of service.

Infrastructure is meant as a means of building, medical and non-medical equipment. RSHS

has 715 patient rooms and has emergency room that are divided into 3 rooms of Actions (R.

Surgical, R. Medical, and R. Children), 1 room Resuscitation, 1 Triage Room, 1 Observation

Lounge for class II (RIS B), 1 Observation Lounge for class I (A RIS KLS I), Room 5 Intermediate

Ward (RIS A VIP), 1 room and Perinatology Obgyn action for class I.

In the field of medical services RSHS provides twenty specialist medical services, 127 sub

specialty services and specialized media services.

a) EmergencyDepartment Room, facilitated with Resuscitation Room, Room Triage, Room

Observation, Examination Room and Room of Join Together.

b) Installation of Outpatient

c) RSHS has 13 specialist clinics and 63 clinics for 99 sub specialty, also 10 specialty clinics

for executive class located in the emergency department.

d) HospitalizationDepartment, provided 1,100 bed consists of

121 VIP beds

107 Class I beds

137 Class II beds

650 Class III beds

85 beds for Intensive Care, High Care, Isolated Room, etc.

RSHS assets, which are the property of State (BMN), is managed by a computerized Account

Management Information System (BMN). RSHS assets consist of 130,000 items which are

distributed to 715 rooms.

Ambulances are available 24 hours and equipped with medical equipment that meet the ISO

standards, supported by medical and paramedical professionals according to the needs of the patient.

Currently, RSHS has 12 unit ambulances and 2 hearses. Other common features include lounge,

banks, mosque and cafeteria and these are scattered in several locations in RSHS. Parking area is

equipped with a security system using CCTV 24-hour and supported by 92 security guards. Security

guard officers are divided over the five service areas, covering 27 points guard.

Furthermore, RSHS has services activities that are supported by non-medical services such as

Installation of Laundry, Nutrition Installation, Installation of Maintenance Facility Hospital,

Pharmacy Installation, Installation of Environmental Health Hospital, Hospital Information System

Installation, Installation of Supply, Central Sterile Supply Department (CSSD).

In the process leading to become a superior hospital, RSHS established flagship service, namely:

1. Nuclear Medicine services

- Gamma Camera

Plane gamma camera for nuclear medicine is a system to process the gamma radiation from the

human body to be made in the form of images for purposes of a diagnostic.

- PET CT

PET / CT is a medical imaging diagnostic tool most advanced in the world today, is the only

technology that uses an anatomical way to perform imaging examinations of the function, the

body's metabolism and receptors, can detect correctly without injuring the body, capable of

differentiation and sensitive high to examine the presence of even a small cancerous lesions and

early detection of cancer at an early stage, the level of diagnosis accuracy reached above 90%.

The PET/CT has an important role in determining the subsequent treatment plan.

2. Radiology services

- CT Scan

CT Scan is one radio diagnostic equipment using x-rays. The resulting image is basically a

mapping of objects to the absorption of x-ray.

- MRI

Magnetic Resonance Imaging (MRI) is a technique used to produce a picture of internal organs

in living organisms, as well as to find the amount of water content in the geological structure.

Usually used to describe a pathological or physiological changes in living muscle. On

treatment, MRI is used to distinguish muscle pathologies such as brain tumors compared to

normal muscle

- MSCT 128 Slices Dual - Sources

The latest technology MSCT 128 Dual Sources Slices technology is the most advanced

diagnostic radiology imaging. MSCT has a variety of features to speed up the scan time,

minimize radiation dose, and minimize artifacts .

Faster imaging capabilities as well as the results of image quality make it easier for medical

personnel to get a more accurate diagnostic results. Moreover, in terms of radiation protection ,

this tool is able to reduce the radiation exposure of patients and operators because it has features

that improve the effectiveness of air to the maximum and to minimize radiation exposure

without compromising image quality .

3. Cardiac services

- ESMR

Sophisticated equipment to detect heart blockages

4. Surgical Services Urology

- ESWL

Extracorporeal shock wave lithotripsy (ESWL) is a non - invasive therapy , because it does not

require surgery or infusion device into the patient's body . As the name implies, Extracorporeal

means outside the body , whereas the mean crushing stones Lithotripsy , ESWL literally means

destruction of urinary tract stones using shock waves ( shock wave ) is transmitted from outside

the body .

5. Radiotherapy services

- Linac

This tool helps the process of radiation treatment with radiation source has a distance to the

intended target or are outside the body . Sources used are X-rays or photons that are emitted

electromagnetic waves released by aircraft liner accelerator ( linac ) .

- COBALT 60

Treatment machines include gamma sources for the purposes of external beam radiotherapy

machine called teletherapy . Most of the frequently made isosentris , let the file rotates around

the patient with SAD were determined .

1.4.1 Company Resources

According to the data on December 2008, Human Resources at HasanSadikin Hospital,

consist of a total 3623 of employees, which have different professions. The doctors ratio, including

specialist doctors, with beds are 1,2:1. And ratio of nurses with beds are 1:1, which is considered to

be less than the ideal ratio (1,5:1). Thecurrentnursing shortage problemishandled byusinginterns,

then theratio is increased to1,13:1.

In order to response and to manage their condition in a fierce business, the shortage of number of

employees is continually handled by opening vacancies through Selection of CPNS, internship and

temporary-contracts. To response to their qualifications training programs are established.

1.4.2 Supporting resources

There are several supporting resources which support the activities of HasanSadikin Hospital.

a. Medical instrument

To support the operational activities, HS Hospital provides various medical tools that are

supported by modernized and newly-developed technology calibrated by Authorized Agency of

HealthFacilities. Internationally standardized surgical tools, comprehensive monitoring tools, and

other medical tools that help the hospital create a service system that can be carried out fastly,

quickly and accurately which considers on handling patient safety. There are several high-

technological medical tools provided by Hasan Sadikin Hospital which are; Digital Angiography

machine, CT scan, MRI, Linac, Cobalt, Camet CT, Densitometer, etc. According to the inventory

data of HS Hospital, the value of medical instruments is 45% of the Hospital total assets.

b. Non-medical tools

The tools such as steam sterilizer, medical gas installation, Un-interupted Power Supply (UPS),

boiler, etc. are available supporting tools to enhance healthcare service. These tools are valued as

12% of total assets. Maintenanceprograms that are conducted are important to support the success

of services provided by HS Hospital.

c. Hospital Information System

Master plan applications of the Hospital Information System which reached stage V supports the

integrated patient data, service givens, and cost of services. The continuous program Case Mix/

INA DRG and the development of Bridging Systems between Hospital IS with PT Askes to

support online access will help to easier the current process.

d. Land and building

The Land that usedfor HS Hospital operational activities is 87.000 m2

wide, and buildings take

101.802 m2

. These buildings are used for health care facility, office, warehouse, patient room

building, etc.

Stage 2

Formulation

In the previous stage, basic information is explained about the internal and external

conditions related to the RSHS. This information is an important factor as a base for formulating

the performance management system in RSHS. In the formulation stage, the first step is

identifying RSHS’s vision and mission in order to understand whether RSHS comply with the

performance vision and mission criteria (Wibisono, 2007).

2.1 Formulate Vision and Mission

2.1.1 Vision

RSHS’s vision is to be the Indonesian World Class Hospital that shows Excellence in

Services, Education, and Research. To identify and align with the performance framework,

RSHS vision should be analyzed using vision criteria (Wibisono, 2007), which consists of the

following 11 as mentioned in table 2.1.

Table 2.1 Criteria of Great Vision

A great vision should be Yes No

1. is a single sentence Y

2. Inspire-making employees feel comfortable working in an organization N

3. Written in a good and true without empty words N

4. Easily understood by all employees Y

5. Focus on one or two aspects of the performance only. Not too much N

6. The result can be tested Y

7. Developed by the CEO or leader, not by committee N

8. Once a year, be re-examined its validity Y

9. Realistically, said the company's current position and the limited

resources available N

10. Can be changed, so it should not be carved in the stele Y

11. Employees can easily remember without having to look at a cheat sheet

or brochure Y

Score 54.5%

There are five criteria of RSHS’s vision that are not complying with the vision criteria

(Wibisono, 2007), and therefore the total score is 54.5%. There are multiple problems that can be

improved for RSHS’s vision. The first problem is that RSHS is a government hospital; they

should prioritize and focus on regional services, which is West-Java. The second problem is that

RSHS’s vision have three performance indicators, while based on vision criteria no.5 of

(Wibisono, 2007), there should only be one or two performance indicator(s). The third subject to

improve is that the vision of world class leader seems to be unrealistic; while the RSHS is not

even a public listed company which is registered in Indonesian stock exchange.

Based on the previous analysis, the recommendation for RSHS vision is

“To be the Indonesian Regional Class Hospital that shows Excellence in Services”

2.1.2 Mission

Based on the current RSHS website, RSHS has the mission to Held Comprehensive

Health Excellence and to be Integrated with Education and Research. To identify and align with

the performance framework, RSHS mission should be analyzed using the mission criteria

(Wibisono, 2007), which consists of the following 16 criteria, listed in table 2.2.

Table 2.2 Criteria of Great Mission

A great mission should be Yes No

1. Clearly distinguish between your organization with competitors N

2. Defining what organization doing and, more importantly, what is not doing N

3. Identify the key skills and competencies Y

4. Encourage organizations to make better decisions, which involve

opportunities in the future Y

5. Define the product or service without being too narrow N

6. No longer than one paragraph Y

7. Can be clearly understood by employees Y

8. Written in a good and correct sentence without including the blank sentences Y

9. Focus on current conditions and are not mixed / combined with a vision

statement for the future N

10. Reviewed and rewritten if the scope of organizational change Y

Table 2.2 Criteria of Great Mission

A great mission should be Yes No

11. Specific to influence the behavior of individuals within the company Y

12. Reflects the company's real excellence and recognition based on the

strengths and weaknesses of the company N

13. Realistic and achievable Y

14. Flexible enough so that it can respond to changes in the environment Y

15. Referring to the competitive advantage N

16. Includes some logical statements and the values behind the statement, to

evoke the spirit of and facilitating communication within and outside the

organization / company

Y

Score 62.5%

There are six criteria of RSHS’s mission that are not complying with the mission criteria

(Wibisono, 2007), and therefore it has a total score of 62.5%. There are several options to

improve RSHS’s mission analysis, the first is that RSHS is a government hospital, they should

prioritize and focus on public services in West-Java instead of mention Health Excellence. The

second, RSHS’s mission does not focus on their competitive advantages such as nuclear

technology, meanwhile they focus more on the integration of operational processes; education

and research. The hospital should have a core competence in services with advanced technology

to get the more customer satisfaction.

Based on the previous analysis, the recommendation for RSHS mission is

“To Held Comprehensive Service Health Excellence for Public, combined with an

advanced Hospital technology and to be Integrated with Education and Research.”

2.2 Formulate RSHS Strategy

After the organization’s vision and mission is determined, the next stage is the

completion of strategies. It is essential for organizational strategies to be current and relevant

based on EFAS and IFAS results, which are discussed in the previous stage. The strategic plan is

reviewed to determine where they fit within the four Balanced Scorecard perspectives: Learning

and Growth, Internal Processes, Customers, and Financial. In this section, our team made a

Kaplan and Norton’s strategy map. A strategy map represents how the organization creates value

and visually shows the detailed objectives in each of the four perspectives required for success as

figure 2.1 shows. See next page because of landscape mode.

Figure 2.1 Balanced Scorecard Strategy Map

2.3 Performance Management Framework

2.3.1 Performance Variable

Table 2.3 Organisational Results

Perspective Strategy Aspect Variable

Grouping

Performance

Variable Measurement

Organisational

Result

1

Financial

Hospital

cost

recovery

Net revenue increase Net revenue increase compare to previous year

2 Operating profit

margin Operating results as a percent of total operating revenue

3,4 Salary and benefit

expense Total RSHS earned comparing to employee costs

3,4 Debtors Patient debtor days

6,7,8,9

Non

Financial

Health

Excellence

Patient satisfaction

rate

Patients' overall rating of their physician and services by

using survey questionnaire

10,11,15,

17 Patient Treatment Number of patients on the elective surgery waiting list

10,11,15,

16 Patient safety RSHS concern to maximizee patient safety

9 Patient control Patient engagement ratio in decision making process

5,

6,7,8,9,13

,14

Patience loyalty Number of loyal patients interacts with RSHS across

multiple service lines

10,11,15,

17

Emergency

treatment

Percentage of patients treat immediately based on triage

category

6,10,13,1

5

Completeness of

health care type

provided

Number of services that RSHS provided

6 Community quality

image

Community view of RSHS's service quality by using

survey questionnaire or awards

7

Service

Excellence

Patients complaints

and resolution rate

Percentage of number of complaints resolved per total

complaints

20 Regulatory and legal

goals

RSHS concern to government's regulation i.e Gakin's

patients funded by Askesin Prog

12,13 Laboratory service Services related to laboratory activities

Table 2.3 Organisational Result

Perspective Strategy Aspect Variable

Grouping

Performance

Variable Measurement

Organisational

Result

14

Non

Financial

Service

Excellence

Patient related

administrative

failures

Number of incidents/failures related to services

12,21,22

Education

Excellence

Research based

hospital

Number of significant medical and non medical research

held by RSHS

18,19 Model teaching

hospital Role model Hospital especially for teaching method

19 Recognition in

education hospital Number of recognition received by RSHS

Table 2.4 Internal Processes

Perspective Aspect Performance Variable Measurement

Internal

Processes

Innovation

Employees participation in professional

association and community events Percentage of employees participation

Number of research Total number of significant medical and non medical

research held by RSHS

Operation

Processes

Employee productivity Ratio of personel/ hospital stay

Medical error rate Ratio that measure errors in medical treatment

Patient waiting time

Length of time since patient comes and get medical

treatment

Denials time due to no authorization

Emergency waiting time Length of time to get immediate treatment for each

triage category

Completeness of health care type provided Number of services that RSHS provided

Courtesy and respect Care and respect shown by employee

Physicians competency Competency assessment and performance appraisal for

physicans

Nurses responsiveness Responsiveness given by nurses include

communication,empathy and efficiency

Table 2.4 Internal Processes

Perspective Aspect Performance Variable Measurement

Internal

Processes

Operation

Processes

Patient Engagement ratio Engage patient in decision making process

Ratio physicans and nurses Ratio number of medical staff (physicans/nurses) for

each bed

Prudent relationship with pharmaceutical supplier Degree of dependency RSHS for its pharmaceutical

supplier

Staff engagement Engage staff to build cultivate environment of

improvement

Payment process Number of condition discharged but not final billed

Askesin process for Gaskin's patient

Debtors Patient debtor days

Optimized Regional government budget Optimized budget for research and development

Infrastructure effectivity

Effectivity of layout compare to room requirement

Budget for facility maintenance cost

Utilization of parking area

Recognition from patient and independent rating

organization

Number of recognition received by RSHS in providing

services

After

services Customer care services

Percentage of number of complaints resolved per total

complaints

Marketing Marketing effectivity Percentage effectiveness of marketing budget and

benefit

Table 2.5 Resource Availability

Perspective Aspect Performance Variable

Resources

Availability Human Resources

Physician

Nurse and medical staff reliability

Employee participation in R&D

Training and development

Nurse turn over

Table 2.5 Resource Availability

Perspective Aspect Performance Variable

Resources

Availability

Human Resources

Intern from Padjajaran University

Employee Absenteeism

Employee well trained with technology

Nurse productivity

Organisational Resources

Bureaucratic culture

Conventional thingking

Government subsidy

Technology Resources

Nuclear technology

Central administration with SIMRS

Modernized medical technology

2.3.2 Variable Linkage

Variable linkage from the organizational output perspective; internal process and resource capabilities are described on the

next page. From figure 2.6, we can see that increasing the performance of an organization will be done much easier if we already

know which variables contribute to the output of the organization itself.

In order to find the variable linkages, we brainstormed with the fishbone diagram using the secondary data that was already

collected before due to limited research time and bureaucratic research process in RSHS. As a result we found 21 variables in internal

process that may significantly affect the organization’s results. Let us take one example to show a linkage, if RSHS want to improve in

health excellence, then first of all RSHS have to see the current condition of the medical error rate, i.e. number of patient falls in bed.

Moreover, medical process also shows linkage in resource availability like physicians and nurses that need to be improved by RSHS.

Fishbone is a team-brainstorming tool used to identify potential root causes to the problem, which may disturb RSHS to reach

the desired goals. Because of its function it may be referred to as a cause and effect diagram. The main goal why we used the fishbone

diagram is to illustrate the relationship between a given outcome and all the factors that influence that certain outcome. Unfortunately,

our team could not determine the factor that influence outcome more quantitatively since there is no primary data or questionnaire

collected.

Figure 2.2 Fishbone of Hospital Cost Increase Causes

Figure 2.3 Fishbone of Medical Quality Decrease

Figure 2.4 Fishbone of Education not well developed

Figure 2.5 Fishbone of Service and administration failure

Figure 2.6 Variable Linkage

2.3.3 Benchmark

External Benchmark with Indonesian Hospital

Basu and Wright (1007) define benchmarking as a measurement of business practice of a

company against competitor or the industry leader. As RSHS business is in the healthcare and

hospital industry, it is better for RSHS to compare their own performance with the industry

leader. In Indonesia According to Frost & Sullivan, the largest hospital is PT Siloam

International Hospitals.

In order for RSHS to pursue its vision and mission “To be the Indonesian Regional Class

Hospital that Excellence in Services” and “To Held Comprehensive Service Health Excellence

for Public, combine with advanced Hospital technology and Integrated with Education and

Research.”, RSHS needs to benchmark their performance to meet standard of the industry leader,

which in this case are Siloam hospital as private hospital and RSCM as government hospital.

There are some aspects that RSHS could benchmark against Siloam hospital, such as;

infrastructure, technology, service and education as below table

Table 2.18 External Benchmark

Aspect Measurement Siloam RSHS

Infrastructure - Number of hospital 13 1

- Number of bed 3436 1100

Technology

- Number of speciality

service 8 4

Service - Number of employee 3785 3623

- Employee/Bed 1.1 3.3

Education

- Number of collaboration

with medical and nursing

school

13 1

In table above, Siloam has operated 13 hospitals with a total bed of 3436. Meanwhile

RSHS only operate 1 hospital with 1100 number of bed. RSHS has more employee utilization

per bed as they have 3623 employees, which consist of different positions (doctors, nurses, etc.)

that results in that on average 3.3 employees handle 1 bed. Compare with Siloam that run more

effective by having 1.1 employees on average to handle 1 bed. Siloam has 1,178 doctors

(including 930 specialists) and employed 2,607 nurses and other allied health personnel. In the

number of collaboration with medical and nursing school, Siloam has actively collaborate with

suitable local, regional universities and research institute such as Universitas Pelita Harapan

School of Medicine, Mochtar Riady Institute of nanotechnology, Universitas Hasanuddin School

of Medicine and 10 others. Meanwhile RSHS only collaborate with Universitas Pajajaran in

Bandung.

Siloam has twice more than RSHS in speciality services, which includes several

technologies such as cardiology, urology, radiology, orthopedics, fertility treatment,

endocrinology, gastroenterology, cancer and liver. RSHS has nuclear medicine services that

Siloam does not have it in either of their hospitals. Based on figure 2.43, we could identify the

standard that RSHS could measure as their competitive priorities.

Figure 2.43 External Benchmark

We minimize into 3 categories only, as RSHS only have 1 hospital to be operated.

Table 2.19 Standard of Performance

Competitive Priorities Standard of Performance

Employee/Bed Poor Average Excellent

> 3 2 1

Collaboration with

medical and nursing

school

Poor Average Excellent

< 5 5 - 10 > 10

Speciality Service Poor Average Excellent

1 2 - 5 > 5

0

2

4

6

8

10

12

14

#hospital #speciality

service

#collaboration

w/school

#(employee/bed)

Am

ou

nt

Measurement Aspect

Benchmark

Siloam

RSHS

In the employee/bed and collaboration with medical and nursing school, RSHS

performance is poor as RSHS has a score of only 3.3 for employee/bed and they collaboration

only with 1 university. RSHS has average performance in speciality services, by having 4

technologies such as cardiology, urology, radiology and nuclear medicine.

As RSHS is government hospital, it need also to be compared with other government

hospital in Indonesia. For this case, Rumah Sakit Cipto Mangunkusumo (RSCM) in Jakarta is

used as comparison (see table below).

Figure 2.44 Comparisons with RSCM

RSHS and RSCM typically similar in term of number collaboration and number of

hospital, as RSCM collaborate with Universitas Indonesia and they only have one hospital in

Jakarta. RSCM is one point better in the number of speciality services, but due as RSCM

employee number is higher of 3708 people, compare to RSHS of 3623 employee, the ratio of

employee per bed is 3.7, about 0.4 higher.

External Benchmark with Foreign Hospital

Siloam seems to be the best hospital in Indonesia. So for benchmarking, Siloam is 100%

or 1, while other hospitals have a score between 0%-100% or a score between 0 and 1. The

number of beds Siloam has is 3436, divided over 13 hospitals. While the Hasan Sadikin Hospital

0

1

2

3

4

5

6

Am

ou

nt

Measurement Aspect

Comparison with RSCM

RSCM

RSHS

has 1100 beds and there is only 1 hospital. The main difference is that there are government

(public) and private hospitals in Indonesia.

The usual hospitals in the Netherlands are like a medical specialist center that is (partly)

funded by the government. There are university hospitals (for example the UMCG, University

Medical Centre Groningen), general hospitals and specialized hospitals (for example the

Rotterdam Eye Hospital or the Sofia Child hospital, which focuses only on children).

However, when we look at the UMCG, the main hospital in Groningen (where all foreign

students come from) in particular, which is one of the biggest hospitals in the Netherlands, we

can see that they have around 1300 beds and more than 10000 employees.

In Indonesia there seems to be an increase in hospitals, where in the Netherlands the

number of hospitals are actually decreasing. An example is Admiral the Ruyter hospital, which

had 3 full-running hospitals but almost fully shut down one because of the cuts in costs, so the

third hospital is only policlinic, which means that you cannot stay there for the night, since the

hospital is only open during normal opening hours (monday-saturday 9:00 am - 17:00 pm).

Furthermore, benchmarking with the number 1 ranked medical facilitator in the US will

be done. This provider is the Johns Hopkins Hospital. This hospital is part of Johns Hopkins

Medicines, which covers an entire medical enterprise consisting of 4 hospitals, 1 children’s

hospital, 1 medical center and 5 health care and surgery centers and Johns Hopkins Schools such

as the University School of Medicine or University School of Nursing. However, for the

benchmarking we will focus upon the one hospital itself. The hospital opened in 1889 and after

four years opened the School of Medicine, which would lead to the concept of combining

research, teaching and patient care. This model would earn the hospital a national and

international reputation for excellence and discovery.

JHH=Johns Hopkins Hospital

JHM=Johns Hopkins Medicine

Table 2.20 External Benchmark with US Hospital

Aspect Measurement JHH JHM

Medicines

Infrastructure

- Number of hospital 1 6

- Number of bed 1059 2677

Technology - Number of speciality service 15 15

Table 2.20 External Benchmark with US Hospital

Aspect Measurement JHH JHM

Medicines

Service

- Number of employee 9704 19436

- Employee/Bed efficiency rate 9.2 7.3

Education - Number of collaboration with

medical and nursing school 5 5

Stage 3

Implementation

3.1 Measurement / Variable Score Card

RSHS executives must perform the complex task of keeping pace with the dynamic

government healthcare environment such as changing patient volumes, stringent government

policy, employee shortages, etc .To take the informed decisions that help the RSHS maintain a

competitive advantage, the executives need real time actionable information at their finger tips.

Team present our point of view on the information and features hospital that executives need to

help them make informed decisions.

a. Key Result Indicator

Table 3.1 Key Result Indicator

KRI How does it help a executives

Hospital

cost

recovery

Revenue Revenue and expense control would provide real time snap shot of the RSHS

performance

Debtor days would provide insight into how payor are performing and which

one needs re-negotiations

Cost/bed

Employee cost/

Rev

Debtor days

Health

Excellence

Hospital

incidents or

safety

An executive gets a quick snapshot on how the hospital is performing with

regard the quality of care. The drill down will linkage with KPI and PI to

provide insight on factors that need immidiate corrective actions

Patient satisfaction data provide valuable insights into making adjustment in

areas that need improvement

Patient wait time directly influences the patient satisfaction level. Such

insight allows directors to target for improvement areas with higher wait

times. Thus, staff can be added, training conducted to increase efficiency,

and technology support provided for enhanced productivity

Patient

satisfaction

Patient wait

time

Emergency

room treatment

Service

Excellence

Average process

time Average process time and complain resolved have a very high impact to

maintain customer satisfaction. Effort should be made to maintain these

area.

Percentage

complaint rate

resolved

Bed Occupancy

Education

Excellence

Number of

research Number of research and its budget provide details on how RSHS performing

in education sector based on their Vission and mission. This insight will help

an executive to allocate the budget in order to provide the employee involved

in education Budget

Research

b. Key Performance Indicator

In this section, team explore the variables that represent a set of measures focusing on

organizational performance that are the most critical for the current and future success of the

organization :

Table 3.2 Key Performance Indicator

No

Key

Performance

Indicator

Formula Units Source Time

Frame PIC Target

1 Actual

Revenue

(Actual Revenue current

year - Revenue from

previous year) / Revenue

from previous year x 100

Percentage Historical

Data

Update

quartely Finance >20 %

2 Average Total

cost per bed

Total hospital costs/ Total

number of hospital beds Number

Historical

Data

Update

monthly Finance N/A

3

Salary and

benefit

expense

Total Revenue / Total

Employee Cost Percentage

Historical

Data

Update

quartely

Finance &

HR 30%

4 Debtors Patient debtor days Days Historical

Data

Update

monthly Finance 30 days

5

Patient

satisfaction

rate

Patients' overall rating of

their physician and

services

Rate Survey Update

yearly

Operational

& CS 90%

6 Patient

Treatment

a.Number of patients on

the elective surgery*

waiting list who were

treated within the

clinically recommended

timeframe for their

urgency category

Number

Historical

Data

Update

daily

Medical and

Nursing

See

table 3.3

b.Average long of stay Days Update

quartely

6 – 9

days

c.Bed occupancy rate Percentage 85%

d. Death Rate Percentage 1%

7 Patient safety

a. Number of patients get

minor accident (i.e fall

from bed)

Number

Historical

Data

Update

daily

Medical and

Nursing

Zero

accident

b. Number of patient get

moderate accident (i.e

infection, transfusion

reaction)

Number Zero

accident

c. Number of patient get

malpractice Number

Zero

accident

d. Length time responding

to emergency calls from

patient room

Time 10

minutes

8 Patient control

Total patient signing the

surgery contract / total

number of surgery x 100

Percentage Historical

Data

Update

quartely Operational 100%

Table 3.2 Key Performance Indicator

No

Key

Performance

Indicator

Formula Units Source Time

Frame PIC Target

9 Patience loyalty

Number of loyal

patients interacts with

HSGH across

multiple service lines

Number Survey Update

yearly

Operational

& CS

> 1.5

times

10 Emergency

treatment

Number of patients

treat immediately /

Number of patients in

Emergency Treatment

based on triage

category* x 100

Percentage Historical

Data

Update

daily

Medical

and Nursing

See table

3.4

11

Completeness

of health care

type provided

Number of services

that HSGH provided

comparing to Number

of average hospital

provided

Number Benchmark Update

quartely Operational 1

12 Community

quality image

Community view of

HSGH’s service

quality

Rank Survey Update

yearly CS Excellence

13

Patients

complaints and

resolution rate

Number of complaints

resolved per total

complaints based by

complaint category x

100

Percentage Historical

Data

Update

weekly CS 0,9

14 Regulatory and

legal goals

Number of Gakin’s

Patients funded by

Askesis Prog get

services / Number of

Gakin’s Patient x 100

Percentage Historical

Data

Update

monthly Finance 0,99

15 Laboratory

service

Laboratory test

accuracy / Desired

Test accuracy x 100

Percentage Historical

Data

Update

quartely

Medical

and Nursing 0,99

16 Administrative

process time

Average patient wait

due to administration

process

Number Historical

Data

Update

daily Operational 20 minutes

17

Patient related

administrative

failures

Number of

incidents/failures

related to services

based on failures

category

Number Historical

Data

Update

weekly Operational 0,2

18 Research based

hospital

Number of significant

medical and non

medical research held

by HSGH

Number Research Update

yearly DIKLAT > 5 / years

19 Model teaching

hospital

Number of

collaboration with

medical and nursing

school

Number Partnership Update

yearly DIKLAT > 1

Table 3.2 Key Performance Indicator

No Key Performance

Indicator Formula Units Source

Time

Frame PIC Target

20 Recognition in

education hospital

Number of recognition

received by HSGH Number Award

Update

yearly DIKLAT

>5 /

years

*Table 3.3 KPI for Elective Surgery

Key

Performance

Indicator

Category Formula Units Target

Elective

Surgery

Cat 1 admit % of urgency category 1 elective surgery patients admitted

within 30 days Percentage 100%

Cat 2 admit % of urgency category 2 elective surgery patients admitted

within 90 days Percentage 80%

Cat 3 admit % of urgency category 2 elective surgery patients admitted

within 365 days Percentage 95%

Number of

patients on the

elective surgery

waiting list

% of triage category minimal seen within clinically

recommended times Number N/A

*Table 3.4 KPI for Emergency Room

Key

Performance

Indicator

Category Formula Units Target

Emergency

Care

Bypass % of operating time on hospital bypass Percentage 3%

Red Triage % of triage category 1 patients seen immediately Percentage 100%

Yellow Triage % of triage category delayed seen within clinically

recommended times Percentage 80%

Green Triage % of triage category minimal seen within clinically

recommended times Percentage 80%

Black Triage % of triage category expextant seen with clinically

treatment Percentage 100%

24 hours Number of patients with a length of stay in the ER greater

than 24 hours Number 0

3.2 Evaluation

a. Current Condition

With purpose for evaluation , we evaluated RSHS’s effort by using the Malcolm Baldrige

National Quality Award. In this framework we conducted a self-assessment from a business

results perspective based on data of 2006 up to 2008.

1. Product Outcomes

How does the level and trend looks like, base on measurement and key performance indicator

that are important for a customer?

a. Outpatient visits, figure 2.7:

Outpatient numbers in year 2007 increase with 26,5% compared to 2006. In 2008 it increased

with 34,6% compared to 2007, but if it is compared to the yearly target in 2008, it was decreased

with 1,7%.

Figure 3.1 Outpatient trend from year 2006 to 2008

b. Outpatient visits based on payments, see table 2.6:

Visitor for outpatient were categorized into six types based on how visitors made the payment to

the RSHS hospital. The type of patient that is increasing is public, askes (government insurance

protected) and honorary. Meanwhile the decreasing group of patients are the ones that are not

capable to pay, the contractor and the foundation.

Table 3.5 Outpatient visits based on their payment

No

Type of

Payment 2007 2008 %

1 Public 118367 146215 24%

2 Askes 213581 220740 3%

3 Honorary 432 689 59%

4 Not capable 155597 142781 -8%

Table 3.5 Outpatient visits based on their payment

No

Type of

Payment 2007 2008 %

5 Contractor 19560 15376 -21%

6 Foundation 2560 1970 -23%

Total 510097 527771 3%

c. Number of outpatient referrals in percentages, figure 2.8:

Number of outpatient referrals in year 2007 and 2008 were above RSHS’s targets, which were

47,8% and 26,03% more, respectively.

Figure 3.2 Number of Outpatient Referrals

d. Polyclinic Specialist and Medical Check Up visits, see figure 2.9 for more information:

Number of Polyclinic specialist has increase to 36,34% and Medical Check Up (MCU) visits

increased to 28,64%.

Figure 3.3 Number of Polyclinic Specialist and MCU visit

41 43 45 48 50 60

55

0

20

40

60

80

2007 2008 2009 2010 2011

Ou

tpati

ent

Ref

erra

ls

Year

Number of Outpatient Referrals

Target

Actual

26084 27032

4281 5507

0

10000

20000

30000

2007 2008

Vis

its

Year

Polyclinic and MCU visitor

Polyclinic Specialist

Medical Check Up

e. Emergency patients, figure 2.10:

Number of emergency patients in 2008 decreased to 5,38% compared to 2007 and if compared to

the target it a decrease of 25,57%.

Figure 3.4 Number of Emergency Patient

f. Bed Occupancy Rate (BOR), figure 2.11:

Bed Occupancy Rate (BOR) from year 2006 to 2008 was within the ideal BOR target, which

currently is around 70%. Ideal upper BOR is 85% and ideal bottom BOR is 60%.

Figure 3.5 Bed Occupancy Rates (BOR) from year 2006 to 2008

g. Average Long of Stay (ALOS), for more information see figure 2.12:

Average Long of Stay (ALOS) overall seen is already between the ideal targets, in actual it was 7

to 8 days (Ideal target is 6-9 days). Meanwhile for ALOS in class 3, it has an average of 11 days

of stay.

44500 50003

61963 45350 48678 46059

0

20000

40000

60000

80000

2006 2007 2008 Nu

mb

er o

f P

ati

ent

Year

Emergency Patient

Target

Actual

80 82

78 78

74 73

65

70

75

80

85

2006 2007 2008

BO

R (

%)

Year

Bed Occupancy Rate

Target

Actual

Figure 3.6 Average Long of Stay (ALOS) from year 2006 to 2008

h. Turn Over Interval (TOI), figure 2.13:

Turn Over Interval (TOI) ideally should be between 1 to 3 days. In 2008, TOR increased from

previously 2,47 days to 2,51 days. However, this is still below the target of 2,87 days.

Figure 3.7 Turn Over Interval (TOI) from year 2007 to 2008

i. Gross Date Rate (GDR), figure 2.14 provides us more information:

Gross Date Rate in 2007 and 2008 was above ideal standards of 4,5%.

Figure 3.8 Gross Date Rate (GDR) from year 2007 to 2008

11 11 10 8 8 7

0

5

10

15

2006 2007 2008 D

ay

s

Year

Average Long of Stay

ALOS class 3

Actual

2,87 2,87

2,47 2,51

2,00

2,50

3,00

2007 2008

Days

Year

Turn Over Interval

Target

Actual

4,50 4,50

4,90 5,10

4,00

4,50

5,00

5,50

2007 2008

Per

cen

tag

e (

%)

Year

Gross Date Rate

Ideal

Actual

j. Delivery Time in Emergency Room, see figure 2.15:

Delivery time in Emergency Room for year 2008 was 10.5 hours, which was below the target of

10.53 hours.

Figure 3.9 Delivery Time for Emergency Room from year 2007 to 2008

k. Net Death Rate (NDR), figure 2.16:

Net Death Rate (NDR) was above standard for year 2007 as well as for year 2008.

Figure 3.10 Net Death Rate from year 2007 to 2008

l. Surgery Service, also figure 2.17:

Number of surgeries done in 2008 increased to 7,45% compared to 2007 and almost met the

targets of 2008.

Figure 3.11 Number of Surgery from year 2007 to 2008

12,00 10,53 9,96 7,59 6,00 11,33 10,50

0,00

20,00

2007 2008 2009 2010 2011

Ho

urs

Year

Delivery Time for Emergency Room

Target

Actual

4,28 3,98 3,68 3,34 3,00 4,12 4,43

2,50 2,50 2,50 2,50 2,50

0,00

5,00

2007 2008 2009 2010 2011

Rate

Year

Net Death Rate

Target

Actual

Standard

14417 15480 15320 17100 18000

14352 15421

0

10000

20000

2007 2008 2009 2010 2011

Nu

mb

er o

f S

urg

ery

Year

Surgery Service

Target

Actual

m. Hemodialysis Action, showed in figure 2.18:

Number of Hemodialysis actions increased every year with 7,34% and 8,29% for year 2007 and

2008 respectively, which was an increase of 5,11% from the RSHS target.

Figure 3.12 Number of Hemodialysis Action from year 2006 to 2008

n. Radiology and Radiotherapy Services, shown in figure 2.19:

Number of radiology services decreased in 2008 with 4,18% and it was 24,02% below RSHS’s

target for that year. Meanwhile radiotherapy service was increasing continuously 55,25% and

7,59% over the year 2007 and 2008 compared to the previous year.

Figure 3.13 Number of Radiology and Radiotherapy Service from year 2006 to 2008

o. Pathology Anatomy Service, figure 2.20:

Number of pathology anatomy service has an increasing trend from year 2006 to 2008

continuously. However, it was still 2,63% below year 2008’s target.

11930 10788 11580 12540

8000 10000 12000 14000

2006 2007 2008

Nu

mb

er o

f

Act

ion

s

Year

Hemodialysis Action

Target

Actual

129815 156421

94652 124035 118849

16407 25471 27403

0

50000

100000

150000

200000

2006 2007 2008

Nu

mb

er o

f S

ervic

es

Year

Radiology and Radiotherapy Service

Target Radiology

Radiology

Radiotherapy

Figure 3.14 Number of Pathology Anatomy Service from year 2006 to 2008

p. Examination of Clinical Psychology

Number of Clinical Pathology Examination of 6.86% below target in 2008

Figure 3.15. Number of Anatomy Pathology Examination 2006 – 2008

q. Forensic Medicine

Number of bodies received Forensic Medicine in 2008 has decreased by 0.12% and 4.05% below

the 2008 target.

Figure 3.16. Number of Corpses Examination 2006 – 2008

r. Nuclear Medicine

Number of Nuclear Medicine examinations from 2006 to 2008 successively decreased

6.03% and increased 6.11% but 14.78% below the 2007 and 0.07% below the 2008 target.

9813 12036

9289 10954 11719

0

5000

10000

15000

2006 2007 2008

Nu

mb

er o

f S

erv

ices

Year

Pathology Anatomy Service

Target

Actual

Figure 3.17 Number of Nuclear Medicine Examination 2006 – 2008

s. Pharmacy

Number of prescription items were served in 2006 and 2008 increased 17.45% and 4.62%

and 2.41% above the target in 2008.

Figure 3.18. Number of prescription items were served 2006 – 2008

t. Assisted Reproductive Technology

Number of IVF examination in 2007 decreased 18.17% and increased 7.25% in 2008

Figure 3.19. Number of examinations with assisted reproductive technology 2006 – 2008

u. Surgery Room Utilization

In 2008 the surgery room utilization was 15.24% above the target of Strategic Plan

Figure 3.20 . The surgery room utilization compared to the target of Strategic Plan

How do these results compare with the performance of your competitors and other companies

that offer similar products?

Performance comparisons with competitors yet done.

2. Customer Outcomes

a. Focus Results to Customers

How’s it like the current level and trend of the main indicators of the size or customer

satisfaction and dissatisfaction?

1. Based on the results of measurements obtained in 2009 IKM data is as follows:

Table 3.6. Customer Satisfaction based on IKM Measurement on 2009

Work Unit

Performance Services Unit

Very

Bad Not Good Good Very Good

25 -

43,75

43,76 -

62,50

62,51 -

81,25

81,26 -

100,00

IRJ 74,05

IGD 71,06

OBG 75,95

IPD 75,28

Anak 74,53

Surgery 76,12

2. Customer satisfaction per room on 2008

Highest patient satisfaction in Intensive Room, High Care and Child Care and the lowest in the

RIK Room and Orchids Room

Figure 3.21. Patient Satisfaction Per Room in 2008

3. SMS Hot Line

SMS is 69.7% which followed the rest in the form of suggestions and awards

Figure 3.22. Number of SMS Hot Line per month

How does this compare with the results of the customer satisfaction level competitors and other

companies that offer similar products?

RSHS for this item has not yet implemented.

3. Financial and Market Outcomes

a. Financial Result

How does the current level and trend of size or financial key indicators including measures of

aggregate returns, activity / financial activities (financial viability) or the performance of the

budget?

Indicator, target and financial realisation are:

Table 3.7. Financial Indicator 2007 - 2008

Indicator 2007 2008

Target Realisation Target Realisation

LIKUIDITY

Cash Ratio (%) 98.62 364.92 109.09 39.58

Acid Test Ratio (Quick Ratio) 290.02 979.3 77.08 35.2

Current Ratio (%) 423.08 1221.14 436.36 284.08

Net Working Capital of Sales 7.9 27.2 9.1 32.47

RATIO LEVERAGE

Debt to Total asset (%) 1.49 1.74 1.51 9.13

RATIO SOLVABILITY

Solvability (%) 6730.8 5731.5 6006.47 194.69

Debt to Equity Ratio (%) 1.5 1.78 1.68 10.05

RATIO RENTABILITY

Gross Profit Margin (%) 2.92 2.5 -4.56 -3.98

Base Cost Productivity (Base Pro) (%) 91.46 93.19 98.3 99.25

Net Profit Margin (%) 2.92 2.5 -4.56 -3.98

Net Return on Investment(%) 2.19 1.89 -3.64 -3.03

Return on Capital Employed (%) 2.9 1.89 -50.12 -3.03

Net Return on Equity (%) 0.22 1.92 -3.7 3.34

Based on the level of health in 2007 and 2008, RSHS are in the AA category or

HEALTHY. Total score of 2008 decreased 3.2 compared to 2007 as shown in Table 2:9 below:

Table 3.8. Health Rate of RSHS 2007 – 2008

No Performance Indicator Value

2007 2008

1 Finance 17.5 16.1

2 Operational 34.65 32.35

3 Quality and Benefits 32.5 33

Total 84.65 81.45

Based on graph below, RSHS actual revenue compared with Renstra target show a good

signal within period shown ,however RSHS revenue in 2008 decreased about 43% than previous

year. This is the case when RSHS can control the cost until 40,3% of cost in 2007, it shows in

figures below :

b. Market Result

RSHS using indicator number of new health service provided to the community in order

to determine the level and trend from size and indicator of health hospitality market, including

market share, positioning in market, market growth , and market conditions to penentrate the

new market.

In 2007, RSHS conform Renstra target with introduce five new health service in on year,

but this number decreased in 2008

4. Workforce Outcomes

In order to increase the employee satisfaction for RSHS’s employee, some policies of

workforce that have been implemented by RSHS are :

Figure 3.23 Actual Revenue compared with

Renstra Target

Figure 3.24 Cost Control compared with

Renstra Target

Figure 3.25 Number of New Health Service

Table 3.9 Workforce Result

Description 2007 2008

Target Actual Target Actual

DUPAK settlement 2370 2551 2401 2552

SK PAK completion 325 340 330 407

Promotion proposal 429 429 398 364

Realization promotion 414 380 419 388

Salary increase periodically 1168 1168 1180 1212

Improving civil servants status 139 109 228 82

ID Card production 619 668 778 606

Reward from Presiden and health ministry 255 222 510 467

Pension 82 91

Recruitment for non civil servants 83 84

Recruitment for civil servant candidates 77 77

a. Recruitment and Promotion

In 2007 was a year when RSHS hired the highest number of employee through

promotion from employee honorers become civil servant candidates, while nurses, computer

operator, medical record staff, parmacist assistant and accounting staff comes from employee

contract.

b. Employee Transfer

Employee transfer commonly due to employees follow the placement of their spouse.

Figure 3.27 Number of Employee Transfer

Figure 3.26 Recruitment

and Promotion

c.Employee Sanction

Employee guidance because of santions given in form of verbal and writtern warnings

Figure 3.28 Number of Employee due to Saction

d. Accumlated Salary Payment

Accumlated salary payment are below the target due to constraints of new regulations

Table 3.10 Accumulated Salary Payment

Accumlated Salary Type 2008

Remarks Target Actual

Adjustment of functional

position 1075 222

Remains 79,34% from target, need to

complete the document ie Inpassion decision

letter and SPMT conform with allowance

Promotions 896 422 Remains 53% from target, need to adjust

based on decision letter and base salary

Salary adjustment 2068 2068 As target

e. Employee Composition based on Education

Table 3.11 Employee Composition based on Education

Education 2007 2008

Target Actual Target Actual

Formal Education

Diploma Nursing 33 0 30 29

Midwifery Diploma 3 3 3 3

Others Diplome 0 0 0 5

Analyst& Radiotherapy scholars 0 0 0 8

Health scholars 0 0 2 1

Midwifery scholars 0 0 1 0

Bachelor of Nursing 4 4 8 10

Table 3.11 Employee Composition based on Education

Education 2007 2008

Target Actual Target Actual

Others Bachelor 0 0 0 10

Master of Nursing 1 0 2 2

Master of Management 0 0 3 2

Others Master 0 0 3 4

Master of Specialization of medical 0 0 2 2

Doctoral 0 0 1 1

Certificate of adjustment 6 4 4 1

Pre-service, Category 1, 2 and 3 111 28 0 0

Total 158 39 59 78

f. Employee Training and Development

Training and development for employee in 2007 reached 42.5% of the target, while the

year 2008 was 9.25% above the target. For clinical training in 2007 was not specified a target

while in 2008 it reached 59.64% above the target. The setting of target in 2008 better than the

target of 2007. Education and training tables are listed in the table below

Table 3.12 Employee Training and Development

Training and Development

Activities

2007 2008

Target Actual Target Actual

RSHS Training

a Management 635 participants 270 Participants 530 participants 579 participants

b Clinical - 306 Participants 425 participants 667 participants

Research 1 title - 11 titles 9 titles

Research Socialization - - 11 titles 9 titles

Library 1 Package - - -

Seminar and Workshop - - - -

a in-house 12 activities 7 Activities - 185 participants

b out-house (domestic and abroad)

- - 80 participants

Training outside RSHS - - -

a Management 1 participant - 44 participants 16 participants

b Clinical - - 21 participants 4 participants

Seminar and Workshop - - 45 participants 20 participants

a Case mix - - - -

b IRSPI - - - -

c PERSI - - - -

Comparative study - - 36 participants 12 participants

g. Accidents

2007: 22 peoples got needle stick

2008: 5 peoples got needle stick

h. Health checks

2006: all of the employees

2007: staff of nuclear specialist doctor, radiologic, pharmacy, nutrists, and laundry

2008: medical check-up for all of the employees

i. K3 training : 100 peoples/year based on target

Fire-accident training: 100 peoples/year based on target

Yearly inspection tools by fire department

Fire-simulation: from 2004 to 2008, including 300 employees

5. Process Outcomes

Forecasting the current level and trend at this period from the size and important

performance indicator work system, including the readiness of work system and work

environment in emergency moment.

a. Nutrition services

The number of patient’s portion is decreasing to 0,6%, the doctor increasing 23%, and

employee increasing 17,6%

Figure 3.29 nutrition services for the patient, doctor, and employee

0

200000

400000

600000

800000

1000000

2007 2008

834071 879071

92271 113488

258.192 303527

Patient

Doctor

Employee

b. Food budgets for the year 2008 increasing at 23,22% compared to 2007. 77,93% percent of the

food are distributed for the patient.

c. Nutrition care service

Nutrition care service hospitalization were increases in a row from 52.95% to 22.3% ,

and for outpatient decrease 4,28% and increases 7,55%

Figure 3.30 Number of Nutrition Care Service

d. Survey of customer satisfaction to food quality and food acceptance shows 86,44% of

respondents says that the food quality is good, and 42,22% respondents says that the food can be

spent off.

e. Maintenance of infrastructure and equipment

In 2007, 83.02% numbers of proposals were realized, and in 2008 increases to 89,06%.

Compared to 2007 numbers of maintenance proposals were increased to 19,46%.

Figure 3.31 Number of Infrastructure and Maintenance

2381 2279 2451

8004

12242

14792

0

5000

10000

15000

20000

2006 2007 2008

Outpatient

Hospitalization

0

1000

2000

3000

4000

2007 2008

3145

3757

2611

3346

proposal

realization

f. Usage of electricity and telephone

The level of electricity usage is increases 22,2%, but the usage of telephone is decrease at

16,27%

Figure 3.32 Level of electricity & telephone usage

g. The usage of diesel and water

The level of diesel usage is increases at 13,45%, and water is increases at 19,54%

Figure 3.33 level of diesel and water usage

h. The performance valuation of cleaning service

The performance of cleaning service staff from 2007 to 2008 was relatively stable. Since

the pathology building (IPD) started the operation in 2008, there’s no data collected in 2007

Figure 3.34 Performance of cleaning service 2007-2008

0

2000

4000

6000

2007 2008

4522,4 4622,9

189,3 158,5

Electricity

Telephone

0

500000

Diesel (Lt) Water (m3)

237949 269985 385579

460922

2007

2008

0

20

40

60

80

100

Old EU-COT IPD RIK IRJ

79,79 74,9 73,12 75,58 83,4

76,35 79,3

64,14

80,59

2007

2008

i. Control level of wild animals

The controlling process of wild animal routinely per month with the following data:

Table 3.13 data of wild animals controlled in 2007-2008

activity standard 2007 2008

Wiggler 0 0 0

Cats 115 27

Roach 4273 2523

j.Measurement of environment quality

The water quality sourced from PDAM, commonly were under the determined threshold,

whereas the environmental quality were at the bottom of the determined threshold. Table 3.53

shows the data of environment quality

Table 3.14 measurement of environment quality 2007-2008

activity standard 2007 2008

Clean water Once a month 9 times, 72

points, fulfill the

NAB

12 times, 108

point, fulfill the

NAB

Environment Quality:

- Noise

- Temperature

- Humidity

- Lightning

- Dusty

- Number of bacterium

< 45 Dba

22 - 26 C

35 – 60%

100 – 200 lux

1200 CFU/m3

50 mcg

100% > Dba

17.46% > NAB

48.57% > NAB

51.52% > NAB

5.71% > NAB

40% > NAB

Swab of eating utensils Once a month 9 times, 19 points

< NAB

12 times, 36

points < NAB

Waste of medic 2500 kg/month 63933 kg 62368 Kg

Waste of non-medic 3642 m3 3606 m3

Quality of wasting water 10 times, < NAB

k. Linen

In 2008 the production of linen were decreases because were forced to allocate in reparation.

Figure 3.35 Laundry performance 2007-2008

l. The development of SIMRS phase V according to Master Plan SIMRS (%)

Figure 3.36 Development of SIMRS phase V 2007-2008

9958

13642

9741

6395

9209

16071

364

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

2006 2007 2008

linen

reparation

depreciation

20

40

60

80

100

25

38

0

20

40

60

80

100

120

2007 2008 2009 2010 2011

target

realization

m. Procurement

Procurement conducted by RSHS were operated from RBA and DIPA

Figure 3.37 Procurement financed by RBA and DIPA

n. Income from ambulance were increased 113.03% compared than in 2007

6. Leadership and Social Responsibility Outcomes

6.1 The result of important indicator from strategy achievement and organization plan work

a. Arranging bed utilization and improving the composition of the third class beds. Bed

composition improvement from 962 to 1100 with composition shown in table below:

Table 3.15. Bed Capacity per Treatment Class

Treatment Class Bed Capacity %

VIP Class 121 11,00

First Class 107 9,73

Second Class 137 12,45

Third Class 650 59,09

Intensive Care Unit 31 2,82

High Care Unit 41 3,73

Isolation Room 13 1,18

Total 1100 100

In addition it is also being done Gakin Building construction that has reached the final stage

with a capacity of 440 beds.

0

10

20

30

40

50

60

70

2007 2008

RBA Gd Gakin

RBA Routine

DIPA

b. NDR lowered from 4.28% to 3.0% with the strategy of increasing professionalism and

integrity through education and training along with maintenance and development of SPA in

particular special care unit.

Education and training are listed in Table 2.12 and 2.13 , while for the maintenance and

development of the SPA:

- Realization of the proposed maintenance increased from 83.02% to 89.06%

- Total maintenance costs increased 12.6%

- Total maintenance cost is 2.88% of the total revenue

c. ALOS lowering surgical services from 13 days to 8 days to fix the strategy of preoperative

and administrative procedures through the development of pre-surgical clinical and

administrative system improvements. The results of this are:

- Enforcement of operating standards Installation Central Surgical

- The implementation of guidelines for implementation of the central sterilization of

operating room

- Enforcement of quality of nursing care

- Operating room utilization increased from 2.55 to 2.69 over the target set. (Figure 3.29)

- Number of surgeries increased by 7.45% compared to 2007

d. Lowering the delivery time of 13 hours in the ER to 6 hours with strategies to increase the

professionalism and integrity as well as improve the management of services in the ED

through education, training and professional development as well as the improvement of

coordination arrangement service management system in the ER. The results of this are:

- Delivery time in the ER has decreased, ie 11.33 hours in 2007 to 10.5 hours in 2008

- In 2008, all employees have been trained PPGD ER

6.2 The result of significant size or indicators of ethical behavior and stakeholder confidence in

senior leadership and governance of the organization

In 2008, RSHS expressed as:

a. Hospital with the title 'Accredited Full Full Rate' for the second time with 16 services and

include patient safety program.

b. Expressed as a hospital that provides excellent service to its customers. It is characterized by

Prima Citra exerts from the President.

c. Pilot Project bridging program with PT Askes.

6.3 The result of an important indicator of the size or customer behavior?

For this item, the indicators are:

- Informed consent incomplete

- Negligence or fault of the clerk of the patient information

- Number misconduct or drug delivery

- Public complaints against the services provided RSHS associated with mal

practice

For it can not be obtained because the data is confidential.

6.4 The result of an important indicator of the size or the fulfillment of social responsibility and

organizational support to the main community

Indicators of compliance responsibilities to the community:

a. The establishment of Hospital Patient Safety Committee as a major form of support to the

patient and the hospital.

b. Print and electronic media visits typically served greatly influenced by the cases that are

being handled or health news that are happening in the community crowded. The mass

media visits that occurred in 2007 and 2008 are:

Table 2.16 Print and Electronic Media visits in 2007 and 2008

Uraian 2007 2008

Print Media 615 419

Electronic Media

and Radio 1193 498

Radio Media 1808 917

c. Community outreach programs conducted by extension in the internal part RSHS was 390

times in 2007 and 400 times in 2008. A similar extension activities carried out separately

by uni-related units and integrated yet unreported.

d. Social Activity program, conducted in 2007 RSHS is 10 times and in 2008 as many as 9

times. Including not including the amount of social assistance and disaster conducted by

units working separately and never reported to the Public Relations Section.

b. Process Modification

To achieve the target emergency department’s KPI, team employed DMAIC

methodology and engaged key stakeholders throughout the hospital, including ED physicians,

ED nursing, unit nursing, Transportation and nurse Administrative section.

Team only focus on improving emergency department (ED) process after define and

measure why the variable of patient satisfaction in emergency department is below 60 %. This

fact was the impetus to examine how to reduce the time between an admission order and the time

the patient was transported to get immidiate treatment. Moreove low of satisfaction rate resulting

from misdiagnosis and a delay in physician intervention. By using Lean Six Sigma, Hasan

Sadikan can improve patient satisfaction as target, reduced emergency department length of

service, and recovered cost.

Figure 3.38 Emergency Process (Current Process)

Figure 3.39 Emergency Process (Proposed)

Based on figure 3.39 , there are some improvement for new triage system :

1. Quick Registration Process

2. Medical Doctor is the 1st person a patient sees

3. Physician, Registration Associate and Nurse assess patient together in triage area

4. Ability to discharge non-emergent patients from triage

5. Bed- side registration

6. Registration is now back end of process

By changing the emergency process in ED it is expected that new process minimize wait

times to treatment, elimited initial waiting since registration completed at bedside. As the result,

new conditions could lead better services to patient and improve patient satisfaction scores. In

service excellence perspective result, new process can increase volume 10 – 12%.

3.3 Diagnosis

a. Training

Training at RSHS needs to be provided include a general understanding of the issue

management system with all the attributes that related to the hospital, especially with the regard

of handling issue performance management systems, and an introduction to how to use the

application management issue itself. Special training will be given to the Head of Hospital which

is the highest decision-maker in the system, and general training will be given to the employees

who will probably be PL and PIC on project management issues. At the training, participants

will be given a lesson on how to use the management system issues .

b. Allocation of resources

Issue management system is a tool for RSHS to do their job. As for daily routine work –

day employees including doctor, nurse, and other staff have the pile of work to be done. For the

existence of this system does not interfere with the existing jobs, the allocation of time to get

used to the employees in the use is depending on their work hours per week. While that will be

responsible for measuring, analyzing, and evaluating fund performance results is the head of the

RSHS to make a decision.

3.4 Display

a. Reporting Key Results Indicators in a “Dashboard” to the board

SWOT Analysis of Current Balance Score Card RSHS

Strength Weaknesses

1. Trend highlighted against monthly, quarterly,

yearly performance

2. Represented by departement

3. Report and chart should be easy to e-mail and

print.

4. Capability to access data feeds from other devices

5. Anytime anywhere access by allowing users to

access screens over mobile

1. Hard to evaluate and make program focus

strategy from the problem of RSHS to have

more improvement next year

2. KPIs that available to evaluate less than 5

measurement

3. Only indicator from balance score card that

using for the performance tools

Opportunities Threats

Update the performance tools that can be integrated

with the system and more capable for RSHS needed

New system cannot be applied immediately

because of HR capability and cost to re-update

the performance tools

The dashboard as shown in figures below will help RSHS dramatically accelerate the

speed and quality decision making cycle

Figure 3.40 Current Dashboard BSC RSHS

b. IPMS Tools Suggested

Based on the new vision and mision, we can build the variable measurement for each

department, so we can have the problem that needed to improve by RSHS through program

focus strategy by having a good synergy in each department. To create this tools, we

combine KPI Measurement from BSC, IPMS, MBNQA as potrait, and Six Sigma.

Figure 3.41 Display new tools

Figure 3.42 KPI Measurement and Responsibilities

Figure 3.43 Result IPMS Map for RSHS

Figure 3.44 RSHS Organizational Output

Based on the result, RSHS still needed improvement on operational and high quality of

their facilities and hospitality to achieve higher organizational result in finance and non-finance

such as, patient satisfaction.

Stage 4

Review and Update

In developing Performance Management System, there are four principles that could be use as a

foundation guideline; (1) Partnership, (2) Empowerment, (3) Integrated performance

improvement and (4) Independent. Here are the analyses for each principle, base on their

previous or existing condition and then compare with proposed condition

No. Principles Previous or Existing Proposed

1. Partnership Only within RSHS

organization

Linkage between

RSHS, customer

and supplier

2. Empowerment Management level Management top

down to employee

level

3. Integrated performance improvement Administration division Linkage between

division

4. Independent Internal RSHS Outside RSHS (use

consultant)

After understanding the four principles, there are five rules that need to be highlighted in

formulation of performance management system

No. Rules Previous Proposed

1. Ease of understanding ISO 9001:2008 Integrated

Performance

Management System

2. Long term orientation Mainly focus on financial

performance

Performance on

finance, customers,

internal process and

learning & growth

3. Time base Yearly to quarterly Weekly to real time

(online)

4. Focus in continuous improvement Internal benchmark External benchmark

5. Quantitative approach Performance variable related

mostly on financial aspect

side

Detail performance

variable and KPI