Memimpin Peningkatan Mutu dengan Pendekatan Sistem Mikro Klinik

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  • Memimpin Peningkatan Mutu dengan Pendekatan Sistem Mikro Klinik dr. Robertus Arian Datusanantyo, M.P.H.

    Koleksi Pribadi Skrining Katarak di Puskesmas Ngulak, Kab. Musi Banyuasin, Sumsel

  • Ilustrasi Kasus Tn. M (18) dan Ny. F (18) adalah pasangan

    suami istri yang menantikan kelahiran anak kembar.

    Saat usia cukup bulan, Ny. F. kejang di rumah.

    Tn. M. membawa istrinya ke bidan praktek. Bidan membawa Ny. F. ke Puskesmas. IGD Puskesmas memberikan obat anti

    kejang dan pasien distabilkan, 30 menit kemudian pasien dirujuk ke RSUD.

    RSUD tahu bahwa ada ibu hamil cukup bulan dengan kejang sedang dalam perjalanan.

  • Ilustrasi Kasus (lanj.) Ny. F. datang diantar tim Puskesmas di IGD

    RSUD.

    IGD RSUD segera menyiapkan operasi, melakukan informed-consent, dan membereskan syarat Jampersal.

    Ny. F dioperasi dan anak kembarnya lahir sehat walau BBLR (2300 dan 1800 gram).

    Ny. F. pulih kesehatannya dalam perawatan di RSUD dan pulang dengan kedua anak dan suaminya.

    Kisah diinspirasi dari:http://klinik-gratis.blogspot.com/2012/09/hampir-saja-tak-tertolong-kasus-near.html

    http://mentaloss.com/sites/default/les/styles/article_640x430/public/95921224.jpg

  • Pasien Kejang di rumah

    Pasien dibawa ke bidan praktek

    Pasien dibawa ke Puskesmas

    Pasien distabilisasi

    di Puskesmas

    Pasien dikirim ke

    RSUD

    Pasien distabilisasi

    di IGD RSUD

    Pasien dioperasi di

    kamar bedah RSUD

    Pasien dirawat di bangsal RSUD

    Pasien pulang

    Pelayanan kepada pasien dikerjakan pada sistem mikro klinik (clinical microsystem) yang secara bersama-sama membentuk sistem pelayanan kesehatan yang paripurna dan lengkap. Lalu, apakah sistem mikro klinik itu?

  • (Berwick 2002)

  • Sistem Mikro Klinik 1. Tempat pertemuan pasien (& keluarga) dengan

    tim pelayanan kesehatan. 2. Garda depan pelayanan kesehatan. 3. Tempat dilakukannya pelayanan, sekaligus:

    1. Tempat keajaiban pelayanan terjadi, 2. Tempat kesalahan tragis terjadi.

    4. Melibatkan: 1. Pasien, keluarga, pemberi layanan, 2. Proses, pola: budaya kerja, aliran informasi,

    hasil pelayanan. (Nelson et al 2007)

  • Clinical Microsystem A clinical microsystem is a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients. It has clinical and business aims, linked processes, and a shared information environment, and it produces performance outcomes. Microsystems evolve over time and are often embedded in larger organizations. They are complex adaptive systems, and as such they must do the primary work associated with core aims, meet the needs of their members, and maintain themselves over time as clinical units.

    (Nelson et al 2007)

  • Fisiologi Sistem Mikro Klinik

    (Nelson et al 2008)

  • (Nelson et al 2002)

    Leadership. Roles: 1. Maintain constancy

    of purpose; 2. Establish clear goals; 3. Foster positive

    culture; 4. Advocate for the

    microsystem in the larger organization.

    Process Improvement. 1. Continuous

    monitoring of care; 2. Use of

    benchmarking; 3. Frequent test of

    change; 4. Sta empowerement

    to innovation.

  • Memimpin Sistem Mikro Klinik

    Building Knowledge Basic structural characteristic of clinical microsystem;

    Processes, unwanted variation & method.

    Taking Action Having specic processes for making things happen; Involves taking action

    on the patterns of work to promote the cooperative functioning of the whole group of people and to recognize members interdependence.

    Reviewing and Reecting Creating a structure for reection; Having a process for honestly asking Is the work getting done? and Is there a good match between the needs of

    the beneciaries and our work outputs?

    (Batalden et al 2003)

  • Plan Do Study Act Cycle

    Plan Objective; Questions and predictions; Plan to carry out the cycle.

    Do Carry out the plan; Document problems & unexpected observations; Begin data analysis.

    Study Complete data

    analysis; Compare data to predictions;

    Summarize what was learned.

    Act What changes are to be made;

    Next cycle?

    (Nelson et al 2007)

  • Standardize Do Study Act Cycle

    Standar- dize How shall we standardize the process & embed it in daily work?; What type of environment can support standardization?

    Do What are we learning as we do the standardization?; Any problem or surprises?

    Study What have we

    learned?; What do the measures show?; Are there needs for

    change?

    Act Do we need to

    modify the standardization?;

    Design new PDSA.

    (Nelson et al 2007)

  • Menulis Reeksi 1. Deskripsi

    1. Apa yang terjadi? 2. Apa yang diperiksa / diselidiki?

    2. Interpretasi 1. Apa yang penting/relevan/

    bermanfaat? 2. Bagaimana menjelaskannya

    dengan teori? 3. Apa yang sama dan berbeda?

    3. Luaran 1. Apa yang telah dipelajari? 2. Apa kepentingannya untuk masa

    depan? (Hampton 2010)

    http://th09.deviantart.net/fs70/PRE/i/2009/352/b/b/Black_Mirror_girl_by_JeDavid.jpg

  • Kesimpulan 1. Penting untuk mengenali tempat pelayanan

    kesehatan sebagai mikro sistem klinik.

    2. Pendekatan mikro sistem klinik dapat digunakan untuk peningkatan mutu.

    3. Memimpin peningkatan mutu di sistem mikro klinik memerlukan strategi.

    4. Siklus PDCA eksperimen. 5. Siklus SDSA standarisasi.

    http://w

    ww.ledn

    eonsolutions.co.uk

  • Referensi Batalden, P.B., Nelson, E.C., Mohr, J.J., Godfrey M.M., Huber, T.P.,

    Kosnik, L., Ashling, K., 2003. Microsystems in Health Care: Part 5. How Leaders Are Leading. The Joint Commission Journal on Quality and Patient Safety, 29(6), pp.297-308.

    Berwick, D., 2002. A users manual for the IOM's Quality Chasmreport. Health Aairs, 21(3), pp.8090.

    Hampton M. 2010. Reective Writing: A Basic Introduction. Available at: http://www.port.ac.uk/media/contacts-and-departments/student-support-services/ask/downloads/Reective-writing---a-basic-introduction.pdf

    Nelson, E.C., Batalden, P.B., Huber, T.P., Mohr, J.J., Godfrey M.M., Headrick, L.A., Wasson, J.H., 2002. Microsystems in Health Care: Part 1. Learning from High-Performing Front-Line Clinical Units. The Joint Commission Journal on Quality and Patient Safety, 28(9), pp.472-493.

  • Referensi Nelson EC, Batalden PB, Godfrey MM (Ed.). 2007. Quality By Design,

    A Clinical Microsystem Approach. San Fransisco: Jossey-Bass.

    Nelson, E.C., Godfrey, M.M., Batalden, P.B., Berry, S.A., Bothe, A.E., McKinley, K.E., Melin, C.N., Muething, S.E., Moore, G., Wasson, J.H., Nolan, T.W., 2008. Clinical Microsystems, Part 1. The Building Blocks of Health Systems. The Joint Commission Journal on Quality and Patient Safety, 34(7), pp.367-378.

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    Terima Kasih atas Perhatiannya!