Pengantar
Pengantar Mata
Mata Kuliah
Kuliah::
Kebijakan
Kebijakan dan
dan Manajemen
Manajemen Mutu
Mutu (Safety and Quality)
(Safety and Quality)
Peminatan
Peminatan HPM
HPM--2017
2017
Adi Utarini (adiutarini@ugm.ac.id)
Tujuan pembelajaran umum:
Menggunakan kerangka berpikir untuk
menganalisis masalah keselamatan
pasien, kebijakan dan mutu pelayanan kesehatan
serta mengidentifikasi intervensi perbaikan
keselamatan pasien dan mutu pelayanan
Memahami sistem manajemen mutu dan memilih
pendekatan-piranti peningkatan mutu
Menyusun program kegiatan untuk melakukan
perbaikan mutu yang berkesinambungan
Menggunakan kerangka berpikir untuk
menganalisis masalah keselamatan
pasien, kebijakan dan mutu pelayanan kesehatan
serta mengidentifikasi intervensi perbaikan
keselamatan pasien dan mutu pelayanan
Memahami sistem manajemen mutu dan memilih
pendekatan-piranti peningkatan mutu
Menyusun program kegiatan untuk melakukan
Tujuan pembelajaran khusus
Menganalisis masalah keselamatan pasien dan mutu
pelayanan menggunakan kerangka Berwick
Melakukan analisis risiko dalam pemberian pelayanan
kesehatan
Menganalisis kerangka kerja mutu dan indikator mutu
pelayanan kesehatan
Memahami sistem manajemen mutu dalam pelayanan
kesehatan
Merencanakan peningkatan mutu yang berkesinambungan
dalam pelayanan kesehatan
Melakukan analisis kebijakan mutu dan fraud dalam era
jaminan kesehatan nasional
Menganalisis masalah keselamatan pasien dan mutu
pelayanan menggunakan kerangka Berwick
Melakukan analisis risiko dalam pemberian pelayanan
kesehatan
Menganalisis kerangka kerja mutu dan indikator mutu
pelayanan kesehatan
Memahami sistem manajemen mutu dalam pelayanan
kesehatan
Merencanakan peningkatan mutu yang berkesinambungan
dalam pelayanan kesehatan
Melakukan analisis kebijakan mutu dan fraud dalam era
Struktur Sesi Perkuliahan
Pasien dan masyarakat
Pengantar: Safety and Quality serta Model Berwick
Pemberdayaan pasien dan masyarakat
Sistem mikro pelayanan
Manajemen risiko dan safety FMEA, RCA
Standar dan indikator mutu
Sistem makro organisasi
Sistem manajemen mutu Kepemimpinan mutu
Komitmen dan budaya mutu CQI, UR
Model-piranti QI dan metode statistik Program Safety and Quality
Lingkungan
Kebijakan Kemenkes
Mutu dan fraud di era JKN Kerangka kerja mutu
Kebijakan -regulasi layanan primer dan sekunder
Evaluasi Mata Kuliah
Penugasan: @ 10%
1. Menemukan artikel yang terkait dengan masalah safety dan
mutu pelayanan kesehatan: lessons learnt dan analisis dengan Kerangka Berwick (Individu)
2. Berpartisipasi dalam pembelajaran mutu yang diselenggarakan
oleh pihak internasional (kelompok)
3. Menyusun rangkuman bab dalam buku (kelompok)
4. Berpartisipasi menulis di website mutupelayanankesehatan
(individu)
Ujian: 60%
Tengah semester: 20% (bentuk tertulis) Akhir semester: 40% (penugasan utama)
Presensi:
Memenuhi 75% sebagai syarat mata kuliah
Penugasan: @ 10%
1. Menemukan artikel yang terkait dengan masalah safety dan
mutu pelayanan kesehatan: lessons learnt dan analisis dengan Kerangka Berwick (Individu)
2. Berpartisipasi dalam pembelajaran mutu yang diselenggarakan
oleh pihak internasional (kelompok)
3. Menyusun rangkuman bab dalam buku (kelompok)
4. Berpartisipasi menulis di website mutupelayanankesehatan
(individu)
Ujian: 60%
Tengah semester: 20% (bentuk tertulis) Akhir semester: 40% (penugasan utama)
Presensi:
It was later revealed that a chain of errors before the surgery culminated in the wrong leg being prepped for the procedure. While the surgeon’s team realized in the middle of the procedure that they were operating on the wrong leg, it was already too late, and the leg was removed. As a result of the error, the surgeon’s medical license was suspended for six months and he was fined $10,000. University Community Hospital in Tampa, paid
New Jersey. Seorang pasien telah menjalani operasi paru kanan yang tidak diperlukan. Dr. Perera, menyampaikan ke pasiennya bahwa paru kanannya ditemukan tumor yang life-threatening, meskipun sama sekali tidak ada. Ia juga mengubah Catatan Medik pasien yang memberi kesan bahwa operasi pada paru kanan memang diperlukan. Komite
Surgical site infections (SSI) di RS
Insidensi: 49,1%
Insidensi: 49,1%
Ernest A. Codman (1869
Ernest A. Codman (1869--1940)
1940)
5 tahun (1911-1916), 337 pasien
Error 36% Error 36%
Studi Prevalensi Kejadian yang Tidak Diharapkan
25 32 10,5 USA-2010 USA-2011 Amerika Latin2010 – 2011
3,9 2,7
11,7
16,6 7,5
0 10 20 30 40
USA-1 USA-2 Inggris Australia Canada %
Harvard School of Public Health
Harvard School of Public Health--Survey
Survey
(2002)
(2002)
1 dari 3 dokter mengaku 1 dari 3 dokter mengaku
Pada keluarga atau pribadi Pada keluarga atau pribadi
Patient safety, definition
• “the prevention of harm to patients
The
The
IOM
IOM
• “freedom from accidental or preventable
injuries produced by medical care.
the
the
AHRQ
AHRQ
injuries produced by medical care.
AHRQ
AHRQ
Emphasis is placed on the system of care delivery
Emphasis is placed on the system of care delivery
that
that
• (1) prevents errors;
• (2) learns from the errors that do occur;
The origins of the patient safety problem are
classified in terms of
type
type ofof errorerror
communication
communication patientpatient clinicalclinical communication
communication
(failures between patient (failures between patient
or patient proxy or patient proxy && practitioners, practitioner practitioners, practitioner
&
& nonmedical staff, ornonmedical staff, or among practitioners), among practitioners), patient patient management management (improper (improper
delegation, failure in delegation, failure in
tracking, wrong tracking, wrong referral, or wrong referral, or wrong
U
Untowardntoward incidents, therapeutic misadventures, iatrogenicincidents, therapeutic misadventures, iatrogenic injuries or other adverse occurrences directly associated injuries or other adverse occurrences directly associated with care or services provided within the jurisdiction of a with care or services provided within the jurisdiction of a
medical center, outpatient clinic or other facility. medical center, outpatient clinic or other facility.
May result from acts of commission or omission May result from acts of commission or omission
(e.g., administration of the wrong medication, failure to (e.g., administration of the wrong medication, failure to
make a timely diagnosis or institute the appropriate make a timely diagnosis or institute the appropriate therapeutic intervention, adverse reactions or negative therapeutic intervention, adverse reactions or negative
Adverse drug events
Adverse drug events in in
in inp
patient
atient
((Classen
Classen et al., 1997).
et al., 1997).
Extra cost
Extra cost ProlongProlong
hospitalization hospitalization Increase Increase mortality mortality
(Bates et al., 1997)
$8.4 million/year for teaching hospital
with 700-beds (Phillips, Christenfeld, and
McGlynn, 1998)
Failure of a planned
action to be completed
as intended
ERROR, Definition (IOM, 1999)
ERROR, Definition (IOM, 1999)
the use of a wrong
plan to achieve an
aim
Errors include product, procedures, system
error which occurs as a
result of an action not
Omission
Omission
Eror which occurs as
Eror which occurs as
a result of an action
a result of an action
Commission
Commission
ERROR
ERROR
result of an action not
taken
a result of an action
a result of an action
taken incorrectly
taken incorrectly
•• misdiagnosis
misdiagnosis
•• delayed evaluation
delayed evaluation
•• failure to prescribe
failure to prescribe
•• Incorrect action
Incorrect action
•• wrong medication
wrong medication
Severe 0s
Near Misses
Death 1
Prevented/No harm incidents
000s
SLIP
SLIP is
is observeable
observeable,, LAPSE is not
LAPSE is not
• turning the wrong knob on a
piece of equipment
Slip
Slip
• not being able to recall
something from memory
Active error:
An error that occurs at the level of the frontline
operator and whose effects are felt almost
immediately.
Defining, Identifying, and Measuring Error in Emergency Medicine
Latent error:
Errors in the design organization, training, or
maintenance that lead to operator errors and whose
effects typically lie dormant in the system for lengthy
• The capacity to cause error
A
A
• Did not reach the patient
B
B
• Did not cause the patient harm
C
C
• Required monitoring to confirm it resulted in no harm to the patient and/or required intervention to preclude harm
D
E
E
• Required InterventionE
E
• Required Hospitalization
F
F
• Permanent Patient Harm
G
• Sustain Life
H
H
• Patient’s Death
10 12 14 16 18 16,6 12,9 11 10,8 9 Australia
Australia New ZealandNew Zealand JapanJapan BritainBritain DenmarkDenmark CanadaCanada USAUSA
Adverse event in Health Care System
Adverse event in Health Care System
%
0 2 4 6 8 10 9 7,5 3,7Human error is a symptom of trouble deeper
Human error is a symptom of trouble deeper
in the system (it is the starting point, not the
in the system (it is the starting point, not the
end)
end)
To explain failure, do NOT try to find where
To explain failure, do NOT try to find where
To explain failure, do NOT try to find where
To explain failure, do NOT try to find where
people went wrong
people went wrong
Find how people’s assessment and action
Find how people’s assessment and action
made sense at the time, given the
Patient safety
Patient safety
avoiding injuries or harm to patients from care that is
avoiding injuries or harm to patients from care that is
intended to help them
intended to help them
Freedom from accidental injury
1.
1. Build aBuild a SAFETYSAFETY CULTURECULTURE
2.
2. Build aBuild a ccomommmitmenitmentt && fofoccusus on patient safetyon patient safety
3.
3. Develop integrated risk management programmeDevelop integrated risk management programme 3.
3. Develop integrated risk management programmeDevelop integrated risk management programme
4.
4. DevelopDevelop record and report on patientrecord and report on patient safetysafety
5.
5. Actively involve patients in communicatingActively involve patients in communicating safetysafety issuesissues
6.
6. Learn from error and set up a more safety procedureLearn from error and set up a more safety procedure
7.
o
o
Think Safety
Think Safety
o
o
Talk Safety
Talk Safety
Jadi...
o
o
Work Safety
Work Safety
o
o
BREATHE … SAFETY
BREATHE … SAFETY
Is Quality important?
In Hospital 6, less than 5% of TB suspects receive
sputum smear examination according to standards
(Ref)
In Medan, less than 20% of private practitioners
have heard of International Standards for TB Care
(ISTC) (Ref)
1 dissatisfied patient will tell their experiences to
more than 3 persons
I have to sell the only piece of land I have for TB
treatment [which is free at the health centre]
In Hospital 6, less than 5% of TB suspects receive
sputum smear examination according to standards
(Ref)
In Medan, less than 20% of private practitioners
have heard of International Standards for TB Care
(ISTC) (Ref)
1 dissatisfied patient will tell their experiences to
more than 3 persons
I have to sell the only piece of land I have for TB
UU Praktek
Kedokteran
UU
UU
SJSN
Indikator SPM
dll..
Perijinan
UU Rumah sakit
UU
Kesehatan
UU
Konsumen
Permenkes
The degree or grade of excellence
The Oxford English Dictionary (1988)
the degree to which health care services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional
knowledge.
Agency for health care research and quality
QUALITY: Definitions
The degree or grade of excellence
The Oxford English Dictionary (1988)
the degree to which health care services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional
knowledge.
QUALITY: Definitions
Carrying out interventions correctly
according to pre-established standards and
procedures, with an aim of satisfying the
customers of the health system and
maximizing results without generating
health risks or unnecessary costs.
Carrying out interventions correctly
according to pre-established standards and
procedures, with an aim of satisfying the
customers of the health system and
maximizing results without generating
health risks or unnecessary costs.
QUALITY: Definitions
degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and
are consistent with current
professional knowledge
IOM, 1990
Definitions
National Association of Quality Assurance
Professionals described quality as
“the level of
excellence produced and documented in the
process of patient care, based on the best
knowledge available and achievable at a particular
knowledge available and achievable at a particular
facility.”
the Community Health Accreditation Program
QUALITY: Definitions
Conformance to standards ….
Exceeding customer expectations ….
Consists of
Consists of
Quality
Physician
Payers Patients
and families
Whose
perspectives?
Quality
PayersRegulator
1. Quality
1. Quality
Awareness
Awareness
2.
2.
Quality
Quality
Measurement
Measurement
Suara pasien
Suara pasien
“Dua jam sebelum operasi saya tidak melihat adanya penanda operasi pada ekstremitas yang akan dioperasi. Terdapat
perbedaan informasi mengenai
perbedaan informasi mengenai jenis tindakan anestesi antara dokter bedah dan dokter
anestesi. Padahal pasien adalah dokter spesialis, dirawat di VVIP. Alhamdulillah operasi berhasil baik dan pasien terhindari dari
Penugasan 1: Individu (10%)
Menemukan artikel (empirical research atau systematic
review) tentang safety dan quality di jurnal internasional
Artikel harus berbeda antar mahasiswa
Dari artikel tersebut ditulis:
Artikel tersebut terkait dengan rantai peningkatan mutu Berwick yang mana
Apa pembelajaran penting atau hal menarik dari artikel tersebut
Deadline: Rabu, 1 Maret, dikumpulkan file menggunakan
Gamel (fasilitas Forum)
Menemukan artikel (empirical research atau systematic
review) tentang safety dan quality di jurnal internasional
Artikel harus berbeda antar mahasiswa
Dari artikel tersebut ditulis:
Artikel tersebut terkait dengan rantai peningkatan mutu Berwick yang mana
Apa pembelajaran penting atau hal menarik dari artikel tersebut
