TESIS. (STUDI PADA POLI PIPI RSUD Dr. SOETOMO SURABAYA)

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TESIS

ANALISIS PENGARUH THREE ELEMENTS TO IMPROVEMENT QUALITY DAN RESPONSIVENESS TERHADAP WAKTU TUNGGU

PELAYANAN

(STUDI PADA POLI PIPI RSUD Dr. SOETOMO SURABAYA)

POPY ARIZONA

UNIVERSITAS AIRLANGGA

FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER

PROGRAM STUDI ADMINISTRASI DAN KEBIJAKAN KESEHATAN SURABAYA

2015

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TESIS

PELAYANAN

POPY ARIZONA NIM 101214453057

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iii

PELAYANAN

TESIS

Untuk memperoleh gelar Magister Kesehatan Minat Studi Manajemen Kesehatan

Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat

Universitas Airlangga

Oleh: POPY ARIZONA NIM 101214453057

2015

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PENGESAHAN

Dipertahankan di depan Tim Penguji Tesis Minat Studi Manajemen Kesehatan

Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat Universitas Airlangga dan diterima untuk memenuhi persyaratan guna memperoleh gelar

Magister Kesehatan (M.Kes.) pada tanggal 2 November 2015

Mengesahkan

Universitas Airlangga Fakultas Kesehatan Masyarakat

Dekan,

Prof. Dr. Tri Martiana, dr., M.S. NIP 195603031987012001

Tim Penguji: Ketua : Dr. Setya Haksama, drg., M.Kes

Anggota : 1. Dr. Nyoman Anita Damayanti, drg., M.S. 2. Dr. M. Bagus Qomaruddin, Drs., M.Sc. 3. Dr. Rachmat Hargono, dr., M.S., M.PH. 4. Erwin Astha Triyono, dr., Sp.PD.KPTI 5. Ansarul Fahrudda, drg., M.Kes.

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v

PERSETUJUAN

TESIS

Diajukan sebagai salah satu syarat untuk memperoleh gelar Magister Kesehatan (M.Kes.)

Minat Studi Manajemen Kesehatan

Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat

Universitas Airlangga Oleh : POPY ARIZONA NIM 101214453057 Menyetujui, Surabaya, 2 November 2015

Pembimbing Ketua Pembimbing

Dr. Nyoman Anita Damayanti, drg., M.S. Dr. M. Bagus Qomaruddin, Drs., M.Sc.

NIP 196202281989112001 NIP 196502161990021001

Mengetahui,

Ketua Program Studi Administrasi dan Kebijakan Kesehatan

Dr. Thinni Nurul Rochmah, Dra.Ec., M.Kes. NIP 196502111991032002

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PERNYATAAN TENTANG ORISINALITAS

Yang bertanda tangan di bawah ini, saya:

Nama : Popy arizona

NIM : 101214453057

Program Studi : Administrasi dan Kebijakan Kesehatan Minat Studi : Manajemen Kesehatan

Angkatan : 2012

Jenjang : Magister

menyatakan bahwa saya tidak melakukan kegiatan plagiat dalam penulisan tesis saya yang berjudul:

ANALISIS PENGARUH THREE ELEMENTS TO IMPROVEMENT QUALITY DAN RESPONSIVENESS TERHADAP WAKTU TUNGGU

PELAYANAN

Apabila suatu saat nanti terbukti saya melakukan tindakan plagiat, maka saya akan menerima sanksi yang telah ditetapkan.

Demikian surat pernyataan ini saya buat dengan sebenar-benarnya.

Surabaya,2 November2015

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vii

KATA PENGANTAR

Puji syukur kehadirat Allah SWT atas segala Karunia dan Hidayah-Nya penyusunan tesis dengan judul “Analisis Pengaruh Three Elements to Improvement Quality dan Responsiveness Terhadap Waktu Tunggu Pelayanan (Studi Pada Poli PIPI RSUD Dr. Soetomo Surabaya)” ini dapat

diselesaikan.

Tesis ini berisikan mengenai pengaruh Three elements to improvement

quality dan responsiveness terhadap waktu tunggu pelayanan di RSUD Dr.

Soetomo Surabaya.

Ucapan terima kasih yang tak terhingga saya sampaikan kepada Ibu Dr. Nyoman Anita Damayanti, drg., M.S.dan Bapak Dr. M. Bagus Qomaruddin, Drs., M.Sc. selaku dosen pembimbing yang dengan penuh kesabaran dan perhatiannya dalam memberikan bimbingan, semangat dan saran hingga tesis tersebut bisa diselesaikan dengan baik.

Dengan terselesainya tesis ini, perkenankan saya mengucapkan terima kasih yang sebesar-besarnya kepada :

1. Prof. Dr. Moh. Nasih, S.E., M.T., Ak., selaku Rektor Universitas Airlangga Surabaya.

2. Prof. Dr. Tri Martiana, dr., M.S. selaku Dekan Fakultas Kesehatan Masyarakat Universitas Airlangga.

3. Dr. Thinni Nurul Rochmah, Dra.Ec., M.Kes. selaku Ketua Program Studi Administrasi dan Kebijakan Kesehatan dan Ketua Minat Studi Manajemen Kesehatan, Fakultas Kesehatan Masyarakat, Universitas Airlangga.

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4. Ketua penguji Dr. Setya Haksama, drg., M.Kes., Dr. Rachmat Hargono, dr., M.S., M.PH., Erwin Astha Triyono, Sp.PD.KPTI., dan Ansarul Fahrudda, drg., M.Kes., atas kesediaan menguji dan membimbing dalam perbaikan tesis ini.

5. Bapak dr. Harsono selaku Plt. Direktur RSUD. Dr. Soetomo Surabaya.

6. Seluruh staf karyawan dan pasien Poli Perawatan Intermediate Penyakit Infeksi (PIPI) Surabaya yang telah membantu dan mendukung pelaksanaan penelitian ini.

7. Kepada kedua orang tua, H.Didik Mashudi dan Hj. Emmy Budi Purwanti dan saudara-saudara penulis (Novie Budi SH.,Mkn., Berlino Askandar Tjokroprawiro SH.,Mkn., Deddy Mashudi SH., Novi Eka Yunita ST.,) yang selalu memberikan doa tulus dan motivasi tiada henti terhadap penulisan tesis.Suami dan anak ku tercinta, Dr. Wisudanto,SE.,MM., Maylova Queena yang senantiasa memberikan doa, bantuan dan semangat tiada henti sehingga penulis dapat menyelesaikan tesis ini.

8. Putu Ayu yang selalu bersama mulai bimbingan, proposal, seminar hasil dan sidang tesis serta rekan seangkatan yang telah berjuang bersama selama ini. Demikian, semoga tesis ini bisa memberi manfaat bagi diri kami sendiri dan pihak yang menggunakan.

Surabaya, 2 November 2015

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SUMMARY

Analysis of Three Elements to Improvement of Quality and Responsiveness of the Waiting Time Service (Studies in polyclinic PIPI RSUD Dr. Soetomo

Surabaya)

Leadership as one indicator of the quality of human resources is a factor determining the success of an organization such as a hospital. Leadership is one of the most influential factor in improving the quality of health services so that can become a reference to improve the quality leadership, quality technology, organizational commitment and human resources. Dr. SoetomoGeneral Hospital is a government hospital to the classification of types A, teaching Hospital, referral hospitals and the largest in eastern Indonesia. Number of Human Resources as many as 6685 people. The problems in the installation of intermediate care outpatient infectious diseases (polyclinic PIPI) was the waiting time of patients ≥ 60 minutes. The general objective of this research was to analyze the Influence of quality leadership, quality technology, organizational commitment and human resource factors (responsiveness) on quality of care in nursing intermediate polyclinic infectious diseases (polyclinic PIPI RSUD Dr. Soetomo Surabaya).

This research was quantitative descriptive study. The design of this study using cross sectional design, the measurements or observations made simultaneously at a time or all the time. Data collection was conducted over two (2) months in April 2014 until May 2014. The unit of analysis in this study was the employees in polyclinic PIPI RSUD Dr. Soetomo Surabaya. The sample size for the employees is 20 people and a large sample of patients was 93 patients.

The results showed that (1) Quality leadership in polyclinic PIPI RSUD Dr. Soetomo Surabaya at the high category; (2) Quality technology in most of the employees are in the low category. (3) Organizational commitment in polyclinic PIPI RSU Dr. Soetomo Surabaya mostly in the high category. (4) All the variables quality leadership (altruistic calling, emotional healing, wisdom, organizational stewardship) did not significantly affect the service quality at polyclinic PIPI RSU Dr. Soetomo Surabaya. (5) There is no significant relationship between quality technology (perceived ease of use of the waiting time at polyclinic PIPI RSU Dr. Soetomo Surabaya. No significant influence of quality technology (perceived usefullness) to the waiting time at the service of in polyclinic PIPI RSUD Dr. Soetomo Surabaya. (6) There is no significant relationship between organizational commitment (commitment affective, continuance commitment, normative commitment) on quality of care in polyclinic PIPI RSUD Dr. Soetomo Surabaya. (7) There is a significant relationship between Human Resources in this

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responsiveness (Responsiveness) to the waiting time at the service of in polyclinic PIPI RSU Dr. Soetomo Surabaya

The recommendation to improving the quality of services at polyclinic PIPI RSUD Dr. Soetomo Surabaya are: (1) Improving attachment to the organization to carry out activities such as outbound or team work involving all members of the organization; (2) The routine supervise and evaluated observance. (3) Conduct training in the use of technology so everyone facility or organization members really understand the benefits and its use. (4) Socializing since the beginning of the technology to be used so that all members of the organization feel ownership. Suggestions study are (1) The need for the addition of a general practitioner to be placed in polyclinic PIPI RSUD Dr. Soetomo Surabaya and (2) Rolling the employees to further enhance the emotional attachment to all members of the organization in polyclinic PIPI RSUD Dr. Soetomo Surabaya.

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ABSTRACT

Analysis of Three Elements to Improvement of Quality and Responsiveness of the Waiting Time Service (Studies in polyclinic PIPI RSUD Dr. Soetomo

Surabaya)

Leadership is one of the most influential factor in improving the quality of health services. Leadership can become a reference to improve the quality leadership, quality technology, organizational commitment and human resources. The problems in polyclinic PIPI RSUD Dr. Soetomo Surabaya was the waiting time of patients ≥ 60 minutes. The Aim of this research was to analyze the influence of quality leadership, quality technology, organizational commitment and human resource factors (responsiveness) on quality of care in polyclinic PIPI RSUD Dr. Soetomo Surabaya. This research was quantitative descriptive study. Data collection was conducted over two (2) months in April 2014 until May 2014. The unit of analysis in this study was the employees in polyclinic PIPI RSUD Dr. Soetomo Surabaya. The sample size for the employees is 20 people and a large sample of patients was 93 patients.

The results showed that (1) Quality leadership in polyclinic PIPI RSUD Dr. Soetomo Surabaya at the high category; (2) Quality technology in most of the employees are in the low category. (3) Organizational commitment mostly in the high category. (4) All the variables quality leadership (altruistic calling, emotional healing, wisdom, organizational stewardship) did not significantly affect the waiting time at polyclinic PIPI RSUD Dr. Soetomo Surabaya. (5) There is no significant relationship between quality technology (perceived ease of use of the waiting time at polyclinic PIPI RSUD Dr. Soetomo Surabaya. No significant influence of quality technology (perceived usefullness) to the waiting time at the service of in polyclinic PIPI RSUD Dr. Soetomo Surabaya. (6) There is no significant relationship between organizational commitment (commitment affective, continuance commitment, normative commitment) on quality of care in polyclinic PIPI RSUD Dr. Soetomo Surabaya. (7) There is a significant relationship between Human Resources in this responsiveness (Responsiveness) to the waiting time at the service of in polyclinic PIPI RSUD Dr. Soetomo Surabaya

Key Words: Improvement Quality, Quality leadership, Quality technology,

Organizational commitment

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DAFTAR ISI

Halaman

SAMPUL DEPAN ... i

SAMPUL DALAM ... ii

HALAMAN PRASYARAT GELAR ... iii

HALAMAN PENGESAHAN ... iv

HALAMAN PERSETUJUAN ... v

PERNYATAAN TENTANG ORISINALITAS ... vi

KATA PENGANTAR ... vii

SUMMARY ... ix

ABSTRACT ... xi

DAFTAR ISI ... xii

DAFTAR TABEL ... xv

DAFTAR GAMBAR ... xvii

DAFTAR LAMPIRAN ... xviii

DAFTAR ARTI LAMBANG, SINGKATAN DAN ISTILAH... xix

BAB 1 PENDAHULUAN ... 1

1.1 Latar Belakang dan Identifikasi Masalah ... 1

1.2 Kajian Masalah ... 8 1.3 Rumusan Masalah ... 14 1.4 Tujuan Penelitian ... 15 1.4.1 Tujuan Umum ... 15 1.4.2 Tujuan Khusus ... 15 1.5 Manfaat Penelitian ... 16

BAB 2 TINJAUAN PUSTAKA ... 18

2.1 Pengertian Mutu pelayanan kesehatan ... 18

2.2 Manajemen Mutu... 20

2.3 Faktor sumber daya manusia dan perbaikan mutu ... 33

2.4 Dimensi mutu ... 34

2.5 Faktor kunci sukses dalam mutu pelayanan ... 36

2.6 Waktu tunggu sebagai ukuran mutu pelayanan ... 39

2.7 Penentuan isu strategis dengan konsep paretto ... 46

BAB 3 KERANGKA KONSEPTUAL PENELITIAN... 49

3.1 Kerangka Konseptual Penelitian ... 49

3.2 Penjelasan Kerangka Konsep Penelitian ... 50

3.3 Hipotesis Penelitian ... 50

BAB 4 METODE PENELITIAN... 52

4.1 Jenis dan rancang bangun Penelitian ... 52

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xiii

4.4 Populasi dan Sampel... 53

4.5 Kerangka Operasional ... 54

4.6 Variabel Penelitian ... 56

4.7 Definisi operasional………67

4.8 Instrumen penelitian………...76

4.9 Validitas dan Reliabilitas………76

4.10 Tehnik pengumpulan data………..77

4.11 Analisis data………...78

4.11.1 Proses pengolahan data………...78

4.11.2 Prosedur analisis data………..78

BAB 5 HASIL DAN ANALISIS DATA ... 80

5.1 Gambaran Umum RSUD Dr. Soetomo Surabaya ... 80

5.1.1 Gambaran umum RSUD Dr. Soetomo Surabaya ... 80

5.1.1.1 Sejarah ... 80

5.1.1.2 Visi dan Misi ... 81

5.1.1.3 Kebijakan dasar ... 82

5.1.2 Gambaran umum Poli PIPI ... 82

5.2 Analisis Quality Leadership di Poli PIP………84

5.3 Analisis Quality Technology di Poli PIPI………..90

5.4 Analisis Organisational Commitment di Poli PIPI………94

5.5 Analisis Responsiveness di Poli PIPI……….98

5.6 Pengaruh Quality Leadership terhadap waktu tunggu pelayanan di Poli PIPI………..102

5.7 Pengaruh Quality Technology terhadap waktu tunggu Pelayanan di Poli PIPI………..102

5.8 Pengaruh Organitaional Commitment terhadap waktu tunggu Pelayanan di Poli PIPI………..103

5.9 Pengaruh Responsiveness terhadap waktu tunggu Pelayanan di Poli PIPI………..103

5.10 Isu strategis………...104

BAB 6 PEMBAHASAN.………...106

6.1 Analisis Quality leadership di Poli PIPI………..109

6.2 Analisis Quality technology di Poli PIPI………..113

6.3 Analisis Organitational commitment di Poli PIPI………115

6.4 Analisis Responsiveness di Poli PIPI………119

BAB 7 PENUTUP ... 123

7.1 Kesimpulan ... 123

7.2 Saran ... 124

DAFTAR PUSTAKA ... 125 LAMPIRAN

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DAFTAR TABEL

Nomor Judul Tabel Halaman

Tabel 1.1 Waktu tunggu pasien di Poli PIPI RSUD Dr. Soetomo

Surabaya ...5

Tabel 1.2 Kunjungan pasien di Poli PIPI ...6

Tabel 1.3 Waktu tunggu pasien mulai bulan Juni – Desember 2012...7

Tabel 1.4 Perbandingan Waktu tunggu di Poli PIPI dan semua Poli Sub Spesialis ...7

Tabel 4.1 Variabel Penelitian, Definisi Operasional dan Alat Ukur...57

Tabel 5.1 Distribusi jawaban karyawan terhadap pernyataan Variabel Quality Leadership...84

Tabel 5.2 Kesimpulan dari Indikator Quality Leadership di Poli PIPI....88

Tabel 5.3 Kesimpulan tentang Quality Leadership di Poli PIPI ...90

Tabel 5.4 Distribusi Dimensi Qualty Technology...91

Tabel 5.5 Distribusi dimensi Perceived Ease of Use dan Perceived Usefulness ...92

Tabel 5.6 Kesimpulan tentang Quality Technology di Poli PIPI……….. 93

Tabel 5.7 Distribusi dimensi Organizational Commitment……….94

Tabel 5.8 Distribusi dimensi Organisational Commitment……….96

Tabel 5.9 Kesimpulan tentang Organitational Commitment………. 98

Tabel 5.10 Distribusi waktu tunggu pelayanandi Poli PIPI……… .98

Tabel 5.11 Distribusi Responsiveness………...99

Table 5.12 Hasil Tabulasi Silang Quality LeadershipTerhadap Waktu Tunggu Pelayanan…….………...99

Tabel 5.13 Hasil Tabulasi Silang Quality Technology Terhadap Waktu Tunggu Pelayanan……….100

Tabel 5.14 Hasil Tabulasi Silang Organitational Commitment Terhadap Waktu Tunggu Pelayanan ...101

Tabel 5.15 Hasil uji regresi linier Quality Leadership Terhadap Waktu Tunggu Pelayanan ...102

Tabel 5.16 Hasil uji regresi linier Quality TechnologyTerhadap Waktu Tunggu Pelayanan ...102

Tabel 5.17 Hasil uji regresi linierOrganitational commitmentTerhadap Waktu Tunggu Pelayanan ...103

Tabel 5.18 Hasil uji regresi linier Responsiveness terhadap Waktu tunggu pelayanan ...103

Tabel 5.19 Isu strategis, penyebab dan rekomendasi penelitian Waktu tunggu pelayanan di Poli PIPI ...104

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DAFTAR GAMBAR

Nomor Judul Gambar Halaman

Gambar 1.1 Faktor kemungkinan penyebab waktu tunggu yang lama ... 8

Gambar 2.1 Model penerimaan teknologi /TAM ... 30

Gambar 3.1 Kerangka Konseptual Penelitian ... 49

Gambar 4.1 Kerangka Operasional Penelitian ... 54

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DAFTAR LAMPIRAN

Nomor Judul Lampiran Halaman

Lampiran 1 Informed Consent ... 130

Lampiran 2 Kuesioner Penelitian Pada Karyawan Poli PIPI ... 137

Lampiran 3 Kuesionar Penelitian Pada Pasien Poli PIPI ... 142

Lampiran 4 Hasil Uji Validitas dan Reliabilitas Karyawan ... 145

Lampiran 5 Hasil Uji Validitas dan Reliabilitas Pasien... 164

Lampiran 6 Hasil Regresi Linier Karyawan dan Crosstab ... 166

Lampiran 7 Hasil Regresi Linier Pasien ... 176

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xvii

DAFTAR ARTI LAMBANG, SINGKATAN DAN ISTILAH

UPIPI : Unit Perawatan Intermediate Penyakit Infeksi PIPI : Poli Perawatan Intermediate Penyakit Infeksi

RSUD : Rumah Sakit Umum Daerah

SPM : Standar Pelayanan Minimal

PPDS : Program Pendidikan Dokter Spesialis

SDM : Sumber Daya Manusia

IOM : Institute Of Medicine WHO : World Health Organisation NHS : National Health Service

MAQ :Maximizing Access and Quality COPE :Client Oriented, Provider Efficient TAM : Technology Acceptance Model

HIV : Human Immune Virus

AIDS : Acquired Immuno Deficiency Syndrome

ODHA : Orang dengan HIV / AIDS

EMR : Electronic Medical Record