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PM-PSLP PPSUB Maret 2012 Koleksi: Soemarno KOMPENDIUM LINGKUNGAN DAN PEMBANGUNAN GREEN HOSPITAL A Green Hospital is defined according to Physicians for.

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Presentasi berjudul: "PM-PSLP PPSUB Maret 2012 Koleksi: Soemarno KOMPENDIUM LINGKUNGAN DAN PEMBANGUNAN GREEN HOSPITAL A Green Hospital is defined according to Physicians for."— Transcript presentasi:

1 PM-PSLP PPSUB Maret 2012 Koleksi: Soemarno KOMPENDIUM LINGKUNGAN DAN PEMBANGUNAN GREEN HOSPITAL A Green Hospital is defined according to Physicians for Social Responsibility as a hospital that has taken the initiative to do the one or more of the following: 1.Choose an environmentally friendly site, 2.Utilizes sustainable and efficient designs, 3.Uses green building materials and products, 4.Thinks green during construction and keeps the greening process going. A Green Hospital is constructed around a hospital that recycles, reuses materials, reduces waste, and produces cleaner air.

2 RUMAH SAKIT A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays. Hospitals are usually funded by the public sector, by health organizations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. General Hospital The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service. health SPECIALIZED HOSPITALS Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. There are however a few exceptions, e.g. China, where government funding only constitutes 10% of income of hospitals.nonprofit Sumber: ….. Diunduh 6/4/2012

3 RUMAH SAKIT HUJAU “SUATU PENDEKATAN GLOBAL" According to Physicians for Social Responsibility, The green hospital movement began a few years ago following the U.S. Green Building Council (USGBC)’s release of their Leadership in Energy and Environmental Design (LEED) standards for building construction. Although initial construction costs are higher, green hospitals have been shown to reduce long-term energy costs. In addition, there is a growing consensus among the health care profession that pollutants generated by medical facilities must be reduced. Moreover, green hospital design has been linked to better patient outcomes and staff retention. In the past few years, a number of newly constructed and renovated hospital buildings have strived for and received LEED certification. A Green Hospital is defined according to Physicians for Social Responsibility as a hospital that has taken the initiative to do the one or more of the following: choose an environmentally friendly site, utilizes sustainable and efficient designs, uses green building materials and products, thinks green during construction and keeps the greening process going. A Green Hospital is constructed around a hospital that recycles, reuses materials, reduces waste, and produces cleaner air. Green Hospital Intitive is ready to launch A Green Hospital “A global Approach” Conference through Hospital 2020 Partnership that will be held in January 2011 as part of an integrated campaign to promote the best practices in the future hospital. TUJUAN KONFERENSI: To accelerate the development, use, and diffusion of environmentally preferable products and practices, and the construction of green buildings in future hospital projects around the world by disseminating examples of best practices and convening health care professionals, university researchers, designers of professional buildings, and vendors of cleaner and safer products and services. To provide examples of best practices in environmentally preferable purchasing from the U.S., Canada, and Europe. To address environmentally sustainable design practices and construction materials in healthcare. To discuss and evaluate initiatives to incorporate environmentally preferable purchasing in health care and group purchasing organizations. To showcase environmentally preferable and occupationally safer products and practices. To evaluate alternatives to medical waste incineration. Sumber: ….. Diunduh 6/4/2012

4 Issues of concern and focus: 1.Mercury 2.Lead 3.PVC & DEHP (Polyvinyl Chloride) 4.Medical Waste 5.Green hospital building 6.Food 7.BFRs (Brominated Flame Retardants) 8.E-waste ( Electronic Waste) 9.VOCs ( Volatile Organic Compounds) 10.EPP (Environmentally Preferable Purchasing) 11.Chemical policy Interested parties or companies in the Conference: 1.Sustainable building materials 2.Products free of mercury, latex, PVC, and DEHP 3.Energy and water conservation 4.Tools and resources for environmentally preferable purchasing 5.Greener cleaners 6.Integrated pest management 7.Waste Reduction and Recycling 8.Green Electronics 9.Managing pharmaceuticals 10.Environmentally Preferable Medical Waste Treatment and Disposal 11.Safer alternatives to PBDEs: products in health care settings 12.Nutritious, Sustainable Foods and Food Systems.. RUMAH SAKIT HUJAU “SUATU PENDEKATAN GLOBAL"

5 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST Memilih Lokasi yang ramah lingkungan bagi RSH 1.Avoid farmland, wetlands, flood plains, environmentally sensitive lands, and hazardous substance sites. 2.Rehabilitate vacant areas as necessary. 3.Share existing parking/transportation infrastructure. 4.Minimize heat island (thermal gradient differences between developed and undeveloped areas). 5.Take advantage of existing transit, water, and energy infrastructure in the community. 6.Preserve local habitat, green fields, and natural resources.. Sumber: Diunduh 6/4/2012 Lokasi berada di tempat yang cukup strategis dan mudah dijangkau dari segala arah, Rumah sakit yang nyaman, dengan lingkungan yang asri, kawasan sekitar yang sejuk, bebas dari gangguan bising kendaraan, bebas polusi serta kenyamanan untuk beristirahat bagi setiap penderita yang dirawat. RSU PINDAD BANDUNG

6 DISAIN BANGUNAN YANG EFISIEN DAN RAMAH LINGKUNGAN 1.Prioritize parks, greenways, and bikeways throughout the new hospital area. Plan sufficient shade. 2.Investigate incentives available from the U.S. Department of Energy. 3.Consider (re)use of existing buildings, including structure, shell, etc. 4.Identify opportunities to incorporate recycled materials into the building, such as beams and posts, flooring, paneling, bricks, doors, frames, cabinetry, furniture, trim, etc. 5.Provide suitable means of securing bicycles with convenient change/shower facilities for those who cycle to work. 6.Design for durability-life cycle costing/value engineering strategy for finishes and systems to reduce waste. 7.Maximize day lighting and view opportunities (building orientation, exterior/interior shading devices, high-performance glazing, photo- integrated light sensors, shallow floor plates, increased building perimeter, etc.). 8.Designate an area for recyclable collection and storage that is appropriate and convenient with consideration given to using cardboard balers, aluminum can crushers, recycling chutes, and other waste management technologies to enhance recycling program. 9.Consider the installation of an on-site compost vessel. 10.Design for adaptability of building design as user needs change. 11.Establish a project goal for locally sourced materials and identify materials and material suppliers that can help achieve this goal; this reduces environmental impact due to transportation and supports the local economy. 12.Provide capacity for indoor air quality monitoring to sustain long- term occupant health and comfort (carbon dioxide sensors integrated into building automation system). Sumber: Diunduh 6/4/2012 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

7 ENERGI 1.Orient building to take advantage of solar energy for heating and daylighting, and to encourage natural ventilation and passive cooling. 2.Consider heat recovery systems where appropriate. 3.Use computer-simulation model to assist in maximizing energy performance. 4.Install mechanical ventilation equipment. 5.Install high-efficiency heating and cooling equipment. 6.Install a lighting control system. 7.Install high-efficiency lights, appliances, and fixtures with motion/occupancy sensors where appropriate. 8.Consider heating/cooling and energy from renewable sources (e.g., solar, wind, biomass, geothermal, bio-gas, etc.). 9.Minimize light pollution by proper and judicious illumination. 10.Design the building with equipment to measure water and energy performance. 11.Consider task lighting "opening window" technology, and underfloor HVAC systems with individual diffusers. 12.Exceed minimum insulation requirements for walls, ceilings, etc., as prescribed by the U.S. Department of Energy. 13.Install and maintain a temperature/humidity monitoring system to automatically adjust to building conditions and link system to building automation system. 14.Consider the use of Energy Star and Environmental Choice products wherever possible. 15.Deploy a monitoring and tracking system for all energy inputs with scheduled reviews to ensure efficiencies are being met.. Sumber: Diunduh 6/4/2012 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

8 AIR 1.Evaluate safe strategies to recycle wastewater/gray water for other purposes on the site. 2.Limit disruption of storm water flows by minimizing runoff, increase on-site infiltration, and reduce containments through constructed wetlands, bioswales, etc. 3.Consider collecting storm water runoff for other purposes (irrigation) on the site. 4.Consider use of reverse osmosis feed water to feed steam boilers in power plant to reduce chemicals required, produce cleaner steam, increase cycles, and reduce boiler blowdown to the environment. 5.Landscape with drought-resistant native plants and perennial ground covers. Situate building to take advantage of existing vegetation. 6.Use low-flow taps, nozzles, and toilets. Sumber: Diunduh 6/4/2012 STUDI ANALISIS SISTEM PENYEDIAAN AIR BERSIH DAN KUALITAS BAKTERIOLOGIS AIR BERSIH DI RSUD BLAMBANGAN BANYUWANGI TAHUN 2011 MEIHANA NURUL H Skripsi, FKM UNAIR Sistem penyediaan air bersih di rumah sakit merupakan bagian dari sanitasi. Sehingga, air bersih mempunyai peranan penting dalam upaya pencegahan penyakit atau kejadian infeksi di rumah sakit. Hasil penelitian menunjukkan adanya peningkatan yang cukup bagus sistem penyediaan air bersih dan kualitas bakteriologis air bersih di RSUD Banyuwangi pada tahun Berdasarkan penilaian observasi di RSUD Blambangan Banyuwangi terhadap sistem penyediaan air bersih didapatkan total skor 605 dari 800 (75,625%) memenuhi syarat Kepmenkes 1204 Tahun 2004 dan kualitas bakteriologis air bersih di RSUD Blambangan Banyuwangi dari hasil pemeriksaan laboratorium terhadap 11 titik sampel air memenuhi syarat ditinjau dari Permenkes RI No. 416/Menkes/Per/IX/1990. Saran bagi RSUD Blambangan Banyuwangi perlu memperbaiki sistem penyediaan air bersih meliputi pengurasan reservoir, kegiatan desinfeksi serta pemeriksaan kualitas air seharusnya dilakukan secara secara rutin dan konsisten, selain itu perlu dilakukan analisis pencatatan hasil laboratorium kualitas bakteriolgis air bersih secara berkesinambungan untuk perbaikan ke depan. (sumber: meihananur-2063) MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

9 EVALUASI 1.Ensure that building elements are installed and calibrated properly to meet the project's environmental health goals in addition to mechanical, electrical, and plumbing system requirements. 2.Perform a two-week building flushout or test contaminant levels in building before occupancy. Sumber: Diunduh 6/4/2012 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

10 BAHAN KIMIA / KUALITAS UDARA INDOOR 1.Avoid ozone-depleting chemicals in mechanical equipment and insulation (zero tolerance for CFC-based refrigerant). 2.Avoid materials that will offgass pollutants, such as solvent-based finishes and adhesives, carpeting, and particleboards that release formaldehyde. 3.Audit existing building systems using refrigerant and fire suppression chemicals and remove HCFCs and halons. 4.Specify refrigeration/fire-suppression systems that use no HCFCs or halons. 5.Specify materials free from toxic chemicals and that do not release toxic byproducts throughout their life cycle, and avoid those toxins that are carcinogenic, persistent, or bio-accumulative. Key materials to avoid include mercury (switching equipment), arsenic (pressure-treated wood), urea formaldehyde (engineered wood), PVC (floors, wall coverings, furniture, roof membranes, plumbing pipe, electrical wire), and asbestos. 6.Place air intakes away from vehicles and other such sources of pollution to prevent indoor air contamination. 7.Adopt an indoor air quality management plan to protect the HVAC system during construction, control pollutant sources, and interrupt pathways for contamination. Sumber: Diunduh 6/4/2012 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST Pelayanan rumah sakit untuk pasien sangat diprioritaskan. Peralatan canggih dalam dunia medika sangat diperlukan untuk melancarkan proses penyembuhan pasien. Tingkat kenyamanan pasien mencerminkan kuwalitas rumah sakit yang profesional. Kondisi tersebut memicu rumah sakit untuk mendapatkan kepercayaan dari pasien yang mengharapkan sembuh dari penyakit yang diderita. Salah satu kenyamanan yang diberikan rumah sakit adalah tempat tidur transport pasien. Pada saat ini rumah sakit diseluruh wilayah Indonesia umumnya memperhatikan standart kenyamanan pasien khususnya saat berada di tempat tidur. Saat pasien dipindahkan ketempat pemeriksaan lain dimana bidang yang akan dilalui tidak selalu datar. Untuk itu dibutuhkan tempat tidur transport pasien yang mampu mengkondisikan tempat tidur tersebut agar tetap datar secara otomatis.

11 LIMBAH 1.Encourage environmentally responsible forest management by using woodbased materials certified in accordance with the Forest Stewardship Council Principles and Criteria. 2.Incorporate materials that are designed for disassembly and recycle/reuse at the end of functional life. 3.Ensure adequate space for storage of hazardous waste (e.g., biomedical, chemical, radioactive, etc.).. Sumber: Diunduh 6/4/2012 Ir. Nusa Idaman Said, M.Eng Kelompok Pengkajian Teknologi Pengelolaan Air Bersih dan Limbah Cair, Direktorat Teknologi Lingkungan, Kedeputian Bidang Informatika, Energi dan Material. Badan Pengkajian dan Penerapan Teknologi Air limbah rumah sakit merupakan salah satu sumber pencemaran lingkungan yang sangat potensial. Oleh karena itu air limbah tersebut perlu diolah terlebih dahulu sebelum dibuang ke saluran umum. Masalah yang sering muncul dalam hal pengelolaan limbah rumah sakit adalah terbatasnya dana yang ada untuk membangun fasilitas pengolahan limbah serta operasinya, khususnya untuk rumah sakit tipe kecil dan menengah. Untuk mengatasi hal tersebut maka perlu dikembangkan teknologi pengolahan air limbah rumah sakit yang murah, mudah operasinya serta harganya terjangkau, khususnya untuk rumah sakit dengan kapasitas kecil sampai sedang. Selain itu perlu menyebar-luaskan informasi teknologi khususnya untuk pengolahan air limbah rumah sakit, sehingga dalam memilih teknologi pihak pengelola rumah sakit mendapatkan hasil yang optimal. Salah satu cara pengolahan air limbah rumah sakit yang murah, sederhana dan hemat energi adalah proses pengolahan dengan sistem biofilter anaerob-aerob. Dengan sistem kombinasi biofilter "Anaerob-Aerob" diperoleh hasil air olahan yang cukup baik, serta proses pengolahannya sangat stabil walaupun konsentrasi maupun debit air limbah berfluktuasi Sumber: MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

12 Use Green Building Materials and Products 1.Minimize the use of carpets and other such materials that have the potential to absorb and release indoor pollutants. 2.Use high-reflectant roofing. 3.Use high-performance windows (double-glazed, argon, etc.). 4.Use rapidly renewable building materials, such as bamboo flooring, wool carpet, strawboard, linoleum, poplar OSB, sunflower seed board, wheatgrass cabinetry, hemp fabrics, etc. 5.Use durable products and materials that require low maintenance. Think Green During Construction 1.Establish landfill diversion plan (or site and building elements (land clearing debris, cardboard, metals, brick, concrete, plastic, clean wood, glass gypsum wallboard, carpet insulation) and track efforts to comply with recycling/diversion plan. 2.Protect trees and topsoil during site work. 3.Centralize cutting operations to reduce job site waste and simplify sorting. 4.Minimize construction packaging material or return such waste to suppliers for reuse/recycling. 5.Educate and seek feedback from crews, including subcontractors, about the environmental vision and the importance of green design and construction practices.. Sumber: ….. Diunduh 6/4/2012 BUILDING A GREEN HOSPITAL CHECKLIST

13 Keep Greening 1.Establish a waste separation and recycling program, and educate staff as to the benefits. 2.Educate and engage staff in all departments in current environmental initiatives and about opportunities to get involved. 3.Establish a "Green Team" of staff from all departments to monitor progress toward environmental goals. 4.Draft a measurements and verification plan to compare predicted savings (water, electricity) with those actually achieved once built. 5.Create a staff environmental coordinator position. 6.Phase out the use of chemical pesticides on greenspace in favor of organic horticultural approaches. 7.Adopt green procurement protocols to screen all products for environmental benefits and alternatives. 8.Develop an environmental management system. 9.Engage in a "green power" contract with a local utility. 10.Identify local recyclers/buyers of glass, plastic, organic waste, office paper, cardboard, etc. 11.Identify and support waste haulers/recyclers who share a green philosophy. 12.Initiate a policy of purchasing only fairly traded coffee and chocolate products in cafeterias/vending machines. 13.Develop a wellness initiative to improve the quality of the employee's work life.. Sumber: ….. Diunduh 6/4/2012 MEMBANGUN RUMAH SAKIT HIJAU: CHECKLIST

14 Green + Hospitals Sustainable Healthcare Infrastructure. More than just Green. Hospitals need to cope with various challenges in order to be sustainably profitable and thus fulfill economic as well as ecological requirements. To address these challenges, being a green hospital is not enough. Therefore a program called Green + Hospitals was set up by Siemens. It encompasses the following critical success factors for sustainable healthcare infrastructure: 1.Green 2.Efficiency 3.Quality A Green + Hospital designed by Siemens addresses these three success factors comprising products and solutions from different application areas: energy generation and distribution, building automation, IT and communications infrastructure, green IT, and medical technology. Green: The green effects include:The green effects include: reduction of energy consumption; sustainable and careful use of resourceS pollution reduction. Quality. The quality effects include:The quality effects include: patient identification and safety; convenient and healthy procedures; health supporting environmental conditions. Efficiency. The efficiency effects include:The efficiency effects include: optimized clinical, non-clinical, and support workflows; efficient assignment of time; efficient assignment of costs. Sumber: 11~a_categoryId~e_ ~a_catTree~e_ , ~a_langId~e_- 11~a_storeId~e_10001.htm….. Diunduh 6/4/2012

15 Green Ecological Aspects for Sustainable Healthcare Infrastructure One success factor of Green + Hospitals deals with ecological aspects, which can be summarized under green technologies concerning environmental care. Besides the reduction of energy consumption, we turn our attention to sustainable and careful use of resources and pollution reduction. This leads to better environmental care, lower costs, and increased quality. A broad portfolio in the areas Infrastructure, IT and Medical Technology supports you in reaching green goals. Please follow the links to find more detailed information and significant examples. Infrastructure: 1.Cost savings up to 40%* thanks to optimized and modernized heating, ventilation and cooling 2.Optimized illumination control systems for more comfort and energy savings 3.Enhanced customized solutions, services, products, and technologies optimize the life-cycle performance for hospitals to achieve maximum energy savings, performance and sustainability without compromising comfort and life safety 4.Reduced travel efforts through optimized communications systems, e.g. video conferencing 5.Green patient multimedia infotainment 6.Desktop phones with reduced energy consumption IT: 1.Transformational data center (consolidation and virtualization technologies) 2.Data center energy efficiency (file server storage reduction, and usage of ground water for air cooling in DC) 3.Green IC architectures = desktop and server virtualization (including hosted architectures) Medical Technology: 1.Energy efficient medical technologies 2.Environmentally friendly operation of medical technologies 3.Careful use of resources in production and recycling of medical technologies Sumber: ….. Diunduh 6/4/2012

16 Quality: ASPEK MUTU INFRASTRUKTUR LAYANAN KESEHATAN YANG BERKELANJUTAN Ecological and economical efforts are important for a hospital. But as essential as they are, the most important aspect for a sustainable hospital is the quality of patient care. Therefore, we pay special attention to patient identification and safety, reliable and secure storage, access to data, convenient and healthy procedures, enhanced quality of diagnosis and treatment, and also to health- supporting environmental conditions. A broad portfolio in the areas Infrastructure, IT and Medical Technology supports you in reaching quality goals. Please follow the links to find more detailed information and significant examples. Infrastructure: 1.People and asset tracing – maximum safety and comfort for patients and elderly people, protection of babies 2.Compact monitoring technology (clean rooms) – to protect patients reliably and fulfill regulatory requirements 3.Efficient e-health infrastructure 4.Intrusion detection, video surveillance, access control – for more security and enhanced comfort for staff, patients and visitors 5.Patient terminal – for the highest possible independence of patients and more comfort for staff 6.Tailored fire-safety solutions to protect patients, staff, visitors, and assets reliably IT: 1.Enhanced quality of diagnosis and treatment, e.g. e-prescription, e- medication, and e-health record 2.Reliable storage and access to health data 3.Optimized diagnostic time and less waiting time thanks to state-of-the-art IT 4.Ubiquitous access to patient data Medical Technology: 1.Optimized diagnostic time and less waiting time thanks to state-of-the-art imaging systems 2.Dose reduction, low-dose imaging 3.Implementation of clinical processes aligned with Standard-of-Care classification.

17 EFFICIENCY: ASPEK EFISIENSI INFRASTRUKTUR LAYANAN KESEHATAN YANG BERKELANJUTAN Green + Hospitals are more than just ecologically efficient buildings. A holistic view on efficiency as well as processes is essential, including planning, equipment, system integration, IT, and operation. Optimized workflows and medical and support processes are required to leverage the full potential of efficiency. Besides the optimization of clinical, non-clinical, and support workflows, we care about the efficient assignment of time and costs. A broad portfolio in the areas Infrastructure, IT and Medical Technology supports you in reaching efficiency goals. Please follow the links to find more detailed information and significant examples. Infrastructure: 1.Demand-based heating, ventilation and cooling systems ensure optimal room conditions and avoid unnecessary energy costs 2.Energy Performance Contracting guarantees costs savings up to 40% to finance other measures, e.g. building modernization work 3.Life safety and security systems ensure business continuity, and efficient resource allocations and reduce losses 4.Integrated power distribution for optimal patient care 5.Unified communications and seamless media integration 6.Mobile voice and data communications 7.Reduced reaction time to patients’ needs IT: 1.Enhanced data quality through archive and document solutions (enterprise content management for hospitals) 2.System integration for hospital information systems 3.Workflow optimization by workflow-oriented medical IT 4.Efficient care processes through unified IT and communication processes 5.Fixed-mobile convergence with integrated networks and user interfaces Medical Technology: Time saving state-of-the-art imaging systems Consulting for efficient clinical paths, efficient planning of room concepts, and efficient radiology concepts.

18 GREEN + HOSPITALS REFERENCES Infrastruktur Layanan Kesehatan yang Berkelanjutan Sustainable healthcare infrastructure means the big challenge to unify ecological and economical demands in healthcare. Siemens supports you in meeting these challenging demands and prepares you for the future — with Green + Hospitals. With a variety of levers that lead to sustainable healthcare infrastructure. First “Green + Hospital” in Germany Open since mid-2010, the Ethianum in Heidelberg, Germany is a clinic specializing in plastic surgery, aesthetic surgery and preventive medicine. It is one of the first hospitals in Germany to rigorously focus on sustainability criteria. Based on an innovative solution concept from Siemens, the Ethianum combines the latest diagnostic procedures and treatments with the use of natural resources – for example, in the area of power supply. Significant characteristics Intelligent building management system using geothermal energy as a source of energy-efficient heating, ventilation and air-conditioning Resource-saving, patient-friendly medical systems and lighting technology to make examinations as pleasant and efficient as possible Energy-saving, multifunctional communications network that gives physicians reliable access to treatment data from patient rooms, provides patients with multimedia and telephone access, and allows them to control the heating and cooling in their room Consistent use of communications technology to support more efficient workflows Environmental value Intelligent planning ensures a high recycling quota – during construction, operation, and in the event the building is ever taken down* No carbon emissions from heating, air-conditioning or water heating thanks to geothermal energy* Sustainable energy savings of up to 50 percent through the use of efficient medical technology* Customer and patient value Reduced energy and operating costs thanks to consistent energy management* Excellent patient care with the aid of the latest medical technology Friendly, healing atmosphere and hotel-like comfort, for example through innovative lighting concepts and use of daylight Enhanced image thanks to focus on sustainability and environmental protection

19 MENUJU RUMAH SAKIT HIJAU: DARI GRAY HOSPITAL St. Joseph Hospital in Berlin-Tempelhof, Germany is an advanced care hospital with 475 beds and around 1,100 staff. It has entrusted Gegenbauer Health Care Services (GHC) with operating its building technology facilities. In 2007, when GHC determined the hospital needed renovations totaling approximately €3 million, it started looking around for an innovative financing concept. To take the pressure off the budget, the hospital’s supporting organization Katholische Wohltätigkeitsanstalt zur heiligen Elisabeth (St. Elizabeth Catholic charitable foundation) chose Siemens’ energy management performance contracting as its modernization and financing strategy. Using this approach, the hospital’s facilities will be modernized within the framework of a 15-year contract. Significant characteristics Modernize the drinking water heating system and the heat networks; install highly efficient circulating pumps and mini combi-valves with pressure differential regulation Set up a decentralized electric steam system Upgrade the existing heat recovery system and optimize the ventilation systems by installing a high-efficiency heat recovery register Optimize and make flexible the refrigeration supply, chilled water distribution net, and recooling system by adapting temperatures and flow rates as needed Set up the new DESIGO building automation system with around 2,500 data points; nearly all cables, sensors, and actuators of the old system will be reused Retrofit or replace the conventional ballasts and T8 bulbs with highly efficient T5 technology from Osram Environmental value Active climate protection by reducing CO2 emissions by approx. 1,300 tons per year* Ongoing process optimization through joint continuous consumption monitoring by Siemens and GHC Customer and patient value Contractually fixed energy-saving goal: €325,000 or 23.8 percent below the 2007 energy consumption level* Guaranteed energy savings over €4.8 million within contract period related to energy pricing 2008 (heating oil) and 2009 (electricity)* Sumber: ….. Diunduh 6/4/2012

20 AN IMPRESSIVE EXAMPLE FOR ENERGY EFFICIENCY IN HOSPITALS When the Bremerhaven/Reinkenheide Clinical Center with more than 700 beds opened its doors in 1976, it was the most modern hospital of its kind in the state of Bremen. It has continued to extend its leading position as a therapy and diagnostic center right up to the present day. By contrast, the productivity and efficiency of its building services installations have declined over the years, especially with regard to energy consumption. Primary energy costs amounted to some two million euros in There was an urgent need for extensive refurbishment and upgrading. Thanks to an Energy Management Performance Contract with Siemens, the Clinical Center is now achieving enormous savings. Significant characteristics A total of 120 separate measures taken which affect the building infrastructure (such as heating and cooling equipment, medical compressed-air supply, main low-voltage supply, steam sterilizers and the entire building automation facilities including the management system). Annual cost savings for energy: 520,000 €* For instance, the power required to generate steam for air conditioning, cooking and sterilization has been reduced by 6,200 MWh* or 72%*. The air conditioning systems outside of the operating or intensive care areas now only start heating when outdoor temperatures drop to 2°C. Load-demand heat supply to the building represents an additional major source of potential savings. The use of highly efficient circulating pumps enables some 50 MWh* of electricity to be saved annually. Upgrading the heating circuit control system enables room temperatures in certain parts of the building to be reduced during the night, i.e. outside their hours of use. The energy savings on room heating amounts to 5,000 MWh* or 50%*. The Bremerhaven/Reinkenheide Clinical Center has achieved a milestone in terms of installation quality, sustained cost economies and energy optimization. Environmental value Reduced energy consumption by more than 25%*. Reduced CO 2 emissions by 4,100 tons* annually. Customer value The Clinical Center is saving 520,000 €* in energy costs annually. Siemens Energy Savings Performance Contracting guarantees annual energy savings of 25%*. Increases building value and patient comfort Klinikum Bremerhaven Reinkenheide The extensive modernization activities lead to more comfort for patients and staff, reduced the energy costs, and lead to tremendous cost reductions.

21 LABORATORIUM HIJAU The Laboratório Dr. Joaquim Chaves in Miraflores near Lisbon, Portugal is a main pillar of the Joaquim Chaves Group – which also includes Imaging and Oncology Centers – and one of the leading private laboratories operating in Portugal. Due to its size, high levels of specialization, and superior-quality work, the facility is also considered a reference laboratory for the region. In view of increasing cost pressures triggered by market consolidation, the economic crisis, and increasing wastewater and solid-waste disposal costs, in December 2007 the Laboratório invested in a Siemens laboratory automation solution. This investment boosted the company’s competitiveness and environmental friendliness. Significant characteristics Implementation of customized Siemens Automation Solutions including clinical chemistry, immunoassay, and haematology complemented with haemostasis, urinalysis and blood gas instruments Installation of kPCR technology for molecular testing Consolidation of departments in one core lab with 40 percent reduction in space required* Relocation of 10 percent of lab personnel to manual testing sections in the laboratory* Environmental value 30 tons less material waste annually – thanks to eliminating the use of nearly a million sample tubes each year* 74 percent reduction of liquid waste* 40 percent savings in water consumption* Customer and patient value Higher profitability and increased competitiveness, thanks to 30 percent lower lab costs* Acceleration of analysis periods by 59 percent without affecting quality* Reduction of 50 percent in volume of blood samples* Sumber: 11~a_categoryId~e_ ~a_catTree~e_ , , , ~a_langId~e_- 11~a_storeId~e_10001.htm….. Diunduh 6/4/2012

22 Why are hospitals associated with the colour green? By Thomas Söderqvist On 15 Jul 2009 · 7 Comments · In displays/exhibits, history of medicine, visual studiesThomas Söderqvist7 Commentsdisplays/exhibitshistory of medicinevisual studies Ever wondered why hospitals are associated with the colour green? Green surgery scrubs, green operating theatres, green-painted instruments, and so on and so forth. A temporary exhibition called ‘Artifact Spotlight: The Colour of Medicine’ at the Canada Science and Technology Museum in Ottawa shows how the colour green conquered the hospital world during the 20th century:‘Artifact Spotlight: The Colour of Medicine’ Canada Science and Technology Museum Green was a popular choice. Surgeons first added “spinach-leaf green” to their clothing in 1914 to reduce glare from traditional hospital whites. In the 1930s, hospital decorators used green to influence patient moods. It carried associations with nature, growth and recovery. Tiled surgical suites, patient rooms, clothing and instruments all went green in the post World War Two era. The exhibition curator, David Pantalony, is currently exploring the history of the colour green in medical instruments in the period 1950 to 1975 and in medicine in general. Look out for his forthcoming article in the Canadian Medical Association Journal this summer. Green is a color of peace.Hospitals must maintain a peaceful environment.Patients in hospitals must be peaceful so that they will recover faster. Sumber: colour-green/….. Diunduh 6/4/2012

23 GERAKAN RUMAH SAKIT HIJAU Sometimes called the "healthy hospital movement," this is a worldwide effort of over 440 organizations in over 55 nations to "green" health care facilities and to ensure that medical care does not further contribute to diseases caused by environmental contaminants. Typical projects include stopping the manufacture and use of mercury- based thermometers (U.S.), eliminating hospital incinerators that emitted toxic dioxin, improving hospital food quality, green purchasing of materials, green building to save energy and water and eliminate volatile pollutants, and elimination of PVC in hospital equipment. The movement has been spearheaded by nurses, doctors, and concerned NGOs. Keywords Sustainable health care systems, green health care, PVC, waste incineration, medical waste disposal, dioxin, environmental health, ecologically sustainable health care, sustainable health care, sustainable medicine, disease prevention, raising awareness, health literacy, health promotion, health care, medical facilities, clinics, emergency care, public health, green building, green purchasing, food ingredients, food safety, hazardous substances, persistent organic pollutants, volatile organic pollutants, body burden, biomonitoring, ecotoxicology, nutrition, mercury pollution, public health, epidemiology, workplace safety, food safety, product safety, toxicology, food web, dose, exposure, risk management, risk assessment, toxic pollution, pollution source, bioaccumulation, biomagnification, pesticides, fungicides, plasticizers, solvents, polychlorinated biphenyls, halogenated aryl hydrocarbons (HAH), endocrine disruptors, environmental estrogens, polynuclear aromatic hydrocarbons (PAH), petroleum hydrocarbons, precautionary principle, environmental pharmaceuticals. Sumber: ….. Diunduh 6/4/2012

24 A GREEN HOSPITAL IS A COMFORTABLE HOSPITAL By: Jonathan HiskesJonathan Hiskes Published: Jun :34am Hospitals use more energy per square foot than any other type of commercial building, so they’re a prime target for greener design. But nobody cares about energy efficiency when they’re rushing to the hospital, right? The builders of the new Swedish Issaquah hospital and medical center, opening next month 18 miles east of Seattle, hope to convince patients and visitors that greener design doesn’t just save money and carbon emissions – it also makes for a more comfortable treatment environment. I toured the 550,000-square-foot facility this week and found a host of smart design features to back up that claim. The building is oriented around a large courtyard garden, reducing lighting loads and providing natural light and views of greenery to all inpatient rooms. Heating comes from a network of steam pipes, forgoing energy- intensive electric baseboards and recapturing excess heat that otherwise would be vented out. The steam-based heating system also keeps surfaces warmer, making for more comfortable rooms. And a high-efficiency ventilation system will provide fresher, higher-quality air than conventional setups. The goal is to use less than 150 kBTU (British thermal units) per square foot per year, which would make Swedish Issaquah the most energy efficient hospital in Washington and well below the national average of 246 kBTU, according to Kevin Brown, chief strategic office at Swedish. If it can get usage below 100 kBTU, it’ll be the most efficient hospital in the nation, he said. Building a new hospital isn’t cheap – the latest reported cost for the project is $365 million (which includes the 18-acre land purchase). The nonprofit Swedish network has help from Puget Sound Energy, which is offering between $2 million and $4 million in grants and rebates for hitting efficiency targets. The utility also gave input on the design, suggesting, for example, larger ducts that would require less energy for ventilation.reported costSwedish Sumber: ….. Diunduh 6/4/2012 RSH = RUMAH SAKIT YANG NYAMAN

25 A GREEN HOSPITAL IS A COMFORTABLE HOSPITAL By: Jonathan HiskesJonathan Hiskes Published: Jun :34am The hospital uses Energy Star lighting fixtures and appliances, though it’s still limited by the offerings of medical equipment makers, according to Chuck Salmon, Swedish’s executive director for Issaquah operations and development. “Energy efficient equipment has not really caught on in the medical equipment industry,” he said. “They just want to make sure things work.” But what about the number one factor in green building – location? The site near Interstate 90 gets a paltry Walk Score of 28 out of 100, compared to 78 for downtown Issaquah, a Seattle exurb tucked into the Cascade foothills. There weren’t any 18-acre sites available in the town center, Brown said. And because the hospital will serve a large area, from Lake Washington to the west to Cle Elum, over the mountain pass to the east, quick access from the highway was more important than a walkable location, he said. Fair enough.of 28 When I toured the facility, I was struck that hospital executives talk about time efficiency in much the same way that environmental wonks talk about energy efficiency. In the emergency room, there is no waiting area or triage area. Instead, patients will be brought directly to one of 28 treatment rooms where they can receive diagnoses and treatment in one location. “Any time in which a patient is not getting value-added treatment is wasted time,” said ER physician John Milne. One more thing: Hospital chef Eric Eisenberg hopes nearby residents will stop by the hospital even when they don’t have medical issues to address – for the food. Seriously. It may sound like a bad joke, but the facility includes a stylish Café 1910 that offers local organic fare like Alki Bakery bread. He knows that convincing people to stop by a hospital café, even one with a separate outside entrance, is a tall order. The location will help, positioned between the highway and a profusion of new housing subdivisions without many businesses to serve them. Whether or not outsiders stop by for the food, I’m sure patients, their families, and hospital staff will appreciate the non-cafeteria-style offerings. Chef Eisenberg said the approach fits the effort to see diet and medicine as part of a broader understanding of community wellness. The same holds true for energy – these things can’t be separated. Sumber: ….. Diunduh 6/4/2012 RSH = RUMAH SAKIT YANG NYAMAN

26 DEFINISI RUMAH SAKIT Let us examine a few definitions of the term ‘hospital’. The word ‘hospital’ is derived from the Latin word hospitalis which comes from hospes, meaning a host. The English word ‘hospital’ comes from the French word hospitale, as do the words ‘hostel’ and ‘hotel’, all originally derived from Latin. The three words, hospital, hostel and hotel, although derived from the same source, are used with different meanings. The term ‘hospital’ means an establishment for temporary occupation by the sick and the injured. Today hospital means an institution in which sick or injured persons are treated.. Dorland’s Illustrated Medical Dictionary defines a hospital as: An institution suitably located, constructed, organized, staffed to supply scientifically, economically, efficiently and unhindered, all or any recognized part of the complex requirements for the prevention, diagnosis and treatment of physical, mental and the medical aspects of social ills; with functioning facilities for training new workers in many special professional, technical and economical fields, essential to the discharge of its proper functions and with adequate contacts with physicians, other hospitals, medical schools and all accredited health agencies engaged in the better-health programme. Sumber: ….. Diunduh 6/4/2012

27 DEFINISI RUMAH SAKIT Blackiston’s New Gould Medical Dictionary (McGraw-Hill, New York, 1959, p. 560) describes a hospital as an institution for medical treatment facility primarily intended, appropriately staffed and equipped to provide diagnostic and therapeutic services in general medicine and surgery or in some circumscribed field or fields of restorative medical care, together with bed care, nursing care and dietetic service to patients requiring such care and treatment. According to the Directory of Hospitals in India, 1988, a hospital is an institution which is operated for the medical, surgical and/or obstetrical care of in-patients and which is treated as a hospital by the Central/state/government/local body/private and licensed by the appropriate authority. Sumber: ….. Diunduh 6/4/2012 A hospital in Steadman’s Medical Dictionary is defined as an institution for the care, cure and treatment of the sick and wounded, for the study of diseases and for the training of doctors and nurses..

28 KONSEP RUMAH SAKIT A modern hospital is an institution which possesses adequate accommodation and well-qualified and experienced personnel to provide services of curative, restorative and preventive character of the highest quality possible to all people regardless of race, colour, creed or economic status; which conducts educational and training programmes for the personnel particularly required for efficacious medical care and hospital service; which conducts research assisting the advancement of medical service and hospital services and which conducts programmes in health education. Modern hospitals are open 24 hours a day. Their personnel render services for the cure and comfort of patients. In the operation theatre, skilled surgeons perform life-saving surgery. In the nursery, new-borns receive the tender care of trained nurses. In the laboratory, expert technicians conduct urine, stool and blood tests, vital to the battle against disease. In the kitchen, cooks and dieticians prepare balanced meals that contribute to the patient’s speedy recovery. A hospital aims at the speedy recovery of patients. That is why its rooms are equipped with air-conditioners, call-bells and other devices. Several hospitals have libraries which provide books for the patients. The telephone keeps the sick in touch with their friends and relatives. In most of the hospitals today, patients have newspaper and barber services in their rooms. Many hospitals, keeping in view the recreation needs of their patients, have provided televisions and radio sets in their rooms/wards. To save the precious time of the medical staff, secondary duties, like explaining the diagnosis and line of treatment to the patients and their attendants, are entrusted to another section of the staff called ‘medical social workers’. In hospitals, therefore, the endeavour is to provide the best possible facilities to the patients within the hospital’s resources. Sumber: ….. Diunduh 6/4/2012

29 TIPE MANAJEMEN RUMAH-SAKIT Types of hospital management 1.Federal Government of Nigeria: All hospitals administered by the Government of India, viz. hospitals run by the railways, military/defence, mining, or public sector undertakings of the Federal Government such as teaching/specialist hospital. 2.State government: All hospitals administered by the state government authorities and public sector undertakings operated by state such as state university teaching hospitals, specialist hospitals, general hospitals, comprehensive health centres. 3.Local bodies: All hospitals administered by local governments, viz. the rural and basic health centres (Primary Health Care Centres), dispensaries. 4.Private: All private hospitals owned by an individual or by a private organization. 5.Voluntary organization: All hospitals operated by a voluntary body/a trust/charitable society registered or recognized by the appropriate authority under federal/state government laws. This includes hospitals run by missionary bodies and co-operatives. 6.Corporate body: A hospital ran by a public limited company. Its shares can be purchased by the public and dividend distributed among its shareholders.. Sumber: ….. Diunduh 6/4/2012

30 APA ITU MANAJEMEN RUMAH SAKIT? Hospital Management provides a direct link between healthcare facilities and those supplying the services they need. This procurement and reference resource provides a one-stop-shop for professionals and decision makers within the hospital management, healthcare and patient care industries. Hospital Management is a new theory in management faculty. Earlier a senior doctor used to perform the role of a hospital manager. However, nowadays everything demands a specialist. Almost all the things related to hospital have changed. Many categories concerning medical sciences and hospital have altered totally. There are various types of hospitals today, including ordinary hospitals, specialty hospitals and super specialty hospitals. The categories are regarding to the types of facilities they offer to the people. Eligible professionals are needed for the smooth operating of a hospital. Various courses and training programs have been developed to find out eligible hospital managers. Such professionals are well trained to solve the rising challenges and specific necessities of modern day hospitals. The Hospital Management courses are open to non-medical background graduates also. A hospital manager is in a way responsible for administrative dealings of the hospital. He accepts the charge of various aspects of hospital management and health administration reverencing to the patients and healthcare.. Sumber: ….. Diunduh 6/4/2012

31 Hospital Management Information System (HMIS) (An electronic Management) An electronic management in a Hospital or a Nursing Home would require to very precise and must result into cost cutting and efficient management. We have developed this revolutionary product” Electra” is very accurate in its approach and suit all environments including large, medium or small sites. The crucial points that “Electra” emphasis on are listed in the following paragraphs which in turn justify your purchase. You will require less number of Staff to cater more patients in same time or even less. You would have the choice to re-deploy them at other suitable locations. Hospital Management System not only provides an opportunity to the hospital to enhance their patient care but also can increase the profitability of the organization. Electra would enable hospitals or Nursing Homes to serve the rapidly growing number of health care consumers in a cost-effective manner. Electra can also save extra money on your current computer hardware shopping. Check up with our executive to more on this. Hospital administrators would be able to significantly improve the operational control and thus streamline operations. This would enable to improve the response time to the demands of patient care because it automates the process of collecting, collating and retrieving patient information. The senior Doctors would spend his precious time more in clinical activities than to put in clerical activities otherwise. This software interface would also save them a lot of time for special jobs only. Accounting sometimes becomes awfully pathetic and complex. This product will eliminate any such complexity, since the retrieval of information through its MIS will become virtually on the tip of your fingers. Very important for some, the reduced cost of the manpower would pay for the cost of this product with in a short time after its implementation.. Sumber: ….. Diunduh 6/4/2012

32 ELECTRA Hospital Management System (HMS)(An electronic Management) Hospital Management System (HMS) (An electronic Management) ELECTRA is a software product suite designed to improve the quality and management of clinical care and hospital health care management in the areas of clinical process analysis and activity-based costing. ELECTRA enables you to develop your organization and improve its effectiveness and quality of work. Managing the key processes efficiently is critical to the success of the hospital. ELECTRA helps you manage your processes. ELECTRA provides all process management tool elements: modeling, analysis, and simulation. Documentation though an important part of a Hospital, is a non-productive exercise for the intellectual human being, whose ability lies in core areas of excellence. Hence a systematic approach to the way documents are managed, can transform your Hospital resources to its highest utility and advantage. HMS Benefits: Electra enables hospitals and doctors to better serve their patients. Improved quality of patient care Increased nursing productivity Reducing the time spent by staff filling out forms, freeing resources for more critical tasks Better quality of care, procedures and service to Patients. Control over the costs incurred by diagnosis-related groups. Sumber: Diunduh 6/4/2012

33 MODULES OF HOSPITAL MANAGEMENT SYSTEM 1.Registration and Enquiry Management 2.Appointment & Queue Management 3.EMR (Electronic Medical Record) 4.Casualty & Emergency Management 5.In-patient A-D-T (Admission-Discharge-Transfer) 6.Pharmacy Management 7.Laboratory Information System 8.Radiology and Nuclear Medicine 9.PACS Radiology 10.Operation Theatres Management 11.Nursing & Ward Management 12.Blood Bank Management 13.Service Order Processing 14.Ambulance Services Management 15.Bed Census Management 16.Quality Assurance 17.Stores and Inventory Management 18.Billing and Financial Accounting 19.TPA and Insurance Management 20.Patient Referral System 21.HR and Payroll Management 22.Duty Roster Management 23.Physiotherapy and Rehabilitation 24.Dietary Management 25.CSSD (Central Sterile and Supply Department) 26.House Keeping and Laundry Management 27.Bio-Medical Waste Management 28.MIS (Management Information System) 29.Telemedicine Sumber: Diunduh 6/4/2012

34 MANAJEMEN RUMAH SAKIT : Pendahuluan In recent times, health care concept of the people have undergone a tremendous change which has lead to higher expectations and an increased demand for high quality medical care and facilities. Here comes the importance of Health/ Hospital Management. It is the latest concept in the field of management and one of the most lucrative and important careers in the health sector. According to a recent US survey, Hospital management is one among the top ten millennium professions which provides a direct link between healthcare facilities and those supplying the services they need. A career in Hospital Management involves ensuring effective utilization of physical and financial resources of the hospital as well as creating an organizational climate beneficial to the growth and development of the personnel. It is a difficult, challenging, responsible and more over, a demanding job. Professional services of trained manpower namely Hospital administrators/ managers have now become essential to manage hospitals and medical facilities. It is the hospital administrators/ managers who manage hospitals, outpatient clinics, hospices, drug-abuse treatment centers etc. They would be responsible for overall patient care, education, research and community health care associated with the organization, and make sure that they conform to the rules of the Hospital. These people with the help of a team of assistants, look after the administrative affairs i.e plan, coordinate and direct the delivery of health services within a hospital. In early days, senior doctors used to perform the role of a hospital manager. But now things have changed and the services of these qualified professionals are required for the smooth functioning of hospitals. The services of these professionals go a long way in making the hospital more productive, profitable and comfortable for the patients. Career opportunities in the field of Hospital Management are increasing very rapidly not only because of the growing importance of hospital industry, but also with the difference in the nature of work in hospitals. It is an apt career for those who have an empathic nature along with a flair for organising, and an eye for detail. A Hospital Manager requires good knowledge of finance and information systems, interpretation of data, and must be able to keep up good communication with the staff of various departments, and patients. They can work as Deans and Directors of medical colleges, Hospital superintendents, Deputy superintendents, Medical directors, Nursing directors, Heads of departments and as Administrators with substantial managerial responsibilities. Hospital manager will be responsible for the overall organization and management of the hospital to ensure its smooth functioning with the objective of ensuring complete satisfaction.. Sumber: htm….. Diunduh 6/4/2012

35 FUNGSI RUMAH SAKIT To provide care for the sick and injured: This can be done by accommodating them according to their physical condition and financial status. When we talk of physical condition, we mean that some patients are seriously ill and require admission in Intensive Care Unit while others are not seriously ill and can be accommodated elsewhere (e.g. in deluxe room, single room with AC and without AC, semi-private room and general ward) according to their financial status. There may be some patients who may require isolation. In that case, they should be kept in isolated rooms, but the building should be kept always in a good state of repair, pleasing appearance and providing the patient every mental and physical comfort. In every hospital, there should be sufficient diagnostic and treatment facilities available such as medical laboratory, X-ray, ultrasound, MRI and CT scan for diagnosis and operation theatre for surgery, labour rooms for delivery, nursery for children, physical therapy for rehabilitation of patients, so that they may be properly treated. Training of physicians, nurses and other personnel: They receive their training in both theory and practice in approved schools and colleges. Therefore, a hospital being a complex and specialized organization must employ highly trained personnel so that they may train others. Particularly in the branch of medical and paramedical education, different associations/councils play very important roles. They make surveys of hospitals and accord their approval. Only these approved hospitals can provide training in medicine, nursing, dietetics, pharmacy, physiotherapy, administration, medical social work, medical record library, X-ray and medical record technology, etc. Capable boys and girls should be attracted to such courses as a career which offers them fair remuneration, opportunities for self-development and reasonable security.

36 Prevention of disease and promotion of health: It is the duty of the hospitals to cooperate with the government agencies. They can treat patients of communicable and non- communicable diseases, notify to the recognized authorities of any communicable disease of which it has knowledge, assist in vaccination programmes of the government, etc. Sumber: ….. Diunduh 6/4/2012 Advancement of research in scientific medicine: In light of the broad social responsibility for maintaining and restoring the health, it is an important function, but no hospital is permitted to do direct experiments on patients. It must resort to necessary tests in laboratories and on animals. They can do so by making observation of functions of the body in health and in disease but they will have to maintain clinical record of patients accurately for which they have to engage qualified and trained medical record technicians who will preserve the record in such a manner that it can be made available for study at any time to physicians and surgeons.

37 ‘GREEN’ HOSPITALS: EFFECTIVE SOLUTION TO SAVE POWER ‘Green’ healthcare is set to be the upcoming buzz in the construction industry. To ensure sterile and clean environment to patients, hospitals in India tend to consume large amount of electricity and end up spending exorbitant amount of money in this segment. Therefore, experts are increasingly recommending green healthcare operations. “Energy is a significant expense in a hospital, apart from manpower and consumables expenses. This clearly indicates that there is an opportunity for hospitals to cut costs and thereby contribute to reducing the ecological carbon foot print,” says Dr Vivek Desai, managing director of Hosmac India Pvt. Ltd, a leading hospital planning and management consultancy firm based in Mumbai. Green hospitals: The concept Green hospitals are buildings that tend to make maximum use of natural light and solar energy. Therefore, these buildings are constructed in a specific angle of alignment with the sun to maximise the use of natural light. Apart from this, these buildings aid in establishing a passive cooling system for the interiors. Windows are also located at particular angles to ensure ventilation, increase access to natural light and reduce heat. Using simple operational measures such as installing unitary air conditioning systems and sensors, among others also facilitate in electricity conservation in various departments of the hospitals. Survey reveals To understand the consumption of electricity per bed across hospitals, Hosmac recently conducted a survey among various healthcare facilities across metros. According to the survey, the expenditure on electricity varies from 2-4% of the total expenditure of a hospital, thereby making power a significant expense head. Besides, note the following three striking revelations that came out of the survey: High-end tertiary hospitals with 300 beds and above spend around 60% of their power expenditure on services directly related to patient care (comprising OPD, IPD, ICU, radiology, diagnostic services etc) Hospitals with higher level of technology spend four times more than hospitals with basic technology infrastructure Hospitals with high dependence on artificial lighting spend three times more, when compared with hospitals depending on natural lighting systems Sumber: 8Green%E2%80%99-hospitals-Effective-solution-to-save-power.html ….. Diunduh 6/4/2012

38 ‘GREEN’ HOSPITALS: EFFECTIVE SOLUTION TO SAVE POWER Survey recommendation The survey therefore recommends green hospitals to reduce electricity consumption and slash operational costs considerably. Furthermore, the survey points out that hospitals can undertake initiatives to educate their staff about the various effective measures to save power. “Hospitals can undertake simple measures like switching off the air conditioners when not in use, and if it is a centrally air-conditioned building then the management can go for effective maintenance of the filters, which eventually reduce chilled water pumping requirement and in turn cuts electricity costs considerably,” says Sameer Mehta, COO of Hosmac Projects, the infrastructure division of Hosmac India Pvt. Ltd. Mr Mehta further added that the demand for green hospitals is going strong currently and he went on to cite examples such as Kohinoor Hospital, Kurla; Savla Hospital, Seawood etc. Documented evidences There are hospitals in India that have managed to reduce electricity consumption by 27% and save up to Rs 40 lakh annually by greening healthcare operations. In this regard, mention may be made of Pune- based Jehangir Hospital and Kovai Medical Centre and Hospital in Coimbatore. Jehangir Hospital saved Rs lakh with an investment of mere Rs lakh. The hospital through its innovative strategies reduced electrical energy consumption by 12.66%, water energy consumption by 53.9%, specific energy consumption for air conditioning by 17.9% and lighting by 5.99%. Similarly, Kovai Medical Centre and Hospital through its initiatives—monitoring energy utilisation, technology upgradation and emphasis on the use of renewable energy resources—considerably reduced its energy spending. Sumber: 8Green%E2%80%99-hospitals-Effective-solution-to-save-power.html ….. Diunduh 6/4/2012

39 Green Hospitals Author: Nicole Wong Published: April 11, 2011 at 12:54 pmNicole WongApril 11, 2011 at 12:54 pm Read more: It would never occur to us that hospitals are sites that generate a great deal of polluting waste, but think of all the gauze, intravenous bags, paper, disposable syringes, disposable paper gowns, plastic and glass bottles that contain medications, and suddenly, hospitals look like major contributors of landfill mass. With the increasing consciousness in eco-friendliness, some hospitals have proactively chosen to minimize the waste they produce by recycling and also by ordering medical supplies in kits that minimize packaging as well as ordering adequate rather than excessive amounts of perishable supplies. St. Joseph Medical CenterSt. Joseph Medical Center is an example of how a hospital can earn recognition and improve its image by practicing better waste management systems. Up to 2010, it has successfully kept 217 tons of "waste" out of landfills. The recognition comes from Practice Greenhealth, a national organization for health- care facilities committed to promoting environmentally responsible operations in the medical field.Practice Greenhealth The award is significant in that it recognizes any healthcare facilities that have achieved improvements in their mercury elimination, waste reduction, and pollution prevention programs and show leadership in the local community and in the health- care sector for recycling efforts and waste reduction. Few people realize that hospitals without a safe and efficient waste management system become a source of mercury pollution. It's a tad ironic that the very place that people go to in order to receive health care is also a place that potentially sickens both the environment and people. So long as a hospital is without any form of explicit pollution prevention program, it is, by default, a polluter. Which clinic or hospital do you and your loved ones visit? Does that facility have a streamlined and monitored waste disposal system? These are important questions to ask in order to ensure that our hospitals and clinics don't end up being the source of our health concerns. Read more: hospitals/#ixzz1rEB4wF2C hospitals/#ixzz1rEB4wF2C Sumber: Diunduh 6/4/2012

40 The green hospital movement began a few years ago following the U.S. Green Building Council (USGBC)’s release of their Leadership in Energy and Environmental Design (LEED) standards for building construction. Although initial construction costs are higher, green hospitals have been shown to reduce long-term energy costs. In addition, there is a growing consensus among the health care profession that pollutants generated by medical facilities must be reduced. Moreover, green hospital design has been linked to better patient outcomes and staff retention. In the past few years, a number of newly constructed and renovated hospital buildings have strived for and received LEED certification. Boulder Community Hospital (CO), the Children’s Hospital of Pittsburgh (PA), and Providence Newberg Medical Center (OR) are among the nation’s hospitals that have already achieved LEED certification. Many other hospitals will be striving for LEED certification for their newly constructed facilities. Sumber:….. Diunduh 6/4/2012 PROJECT: GREEN HOSPITALS How to get started: 1.Find out if any hospitals in your community are planning to remodel or construct new facilities. Find out which individuals and/or hospital board members are planning/overseeing the new construction/remodeling. 2.Meet with local environment leaders, e.g. local green building coalition, to ask for suggestions, collaboration, and other assistance. 3.Meet with members of the hospital board of trustees, including the CEO if possible, to discuss the benefits of green hospitals. If the hospital administrators appear receptive to the idea of green hospital construction, tell them about LEED certification. If appropriate, try to secure their commitment to a certain level of LEED certification for the new building.

41 KRITERIA BANGUNAN HIJAU The Gold LEED certification building requirements include specific commitments to minimize the use of resources, maximize energy efficiency and release minimal waste into the surrounding environment. The specifications to be met include criteria that fall under the following categories: 1.Sustainability of the Site 2.Water Efficiency 3.Energy and Atmosphere 4.Materials and Resources 5.Indoor Environmental Quality 6.Innovation in Design Designing our cancer center according to these requirements would not only fulfill our obligation to the Cleveland area as an environmentally friendly neighbor, but would also offer many economic advantages that would serve the hospital well into the future. With reduced expenditures on energy, water, and waste production the hospital would have great potential to reduce our operating costs. Sumber:….. Diunduh 6/4/2012

42 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Efficiency and Cost-Effectiveness 1.An efficient hospital layout should: 2.Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces 3.Allow easy visual supervision of patients by limited staff 4.Include all needed spaces, but no redundant ones. This requires careful pre-design programming.programming 5.Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material 6.Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces 7.Consolidate outpatient functions for more efficient operation—on first floor, if possible—for direct access by outpatients 8.Group or combine functional areas with similar system requirements 9.Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients, staff, and supplies. Sumber: Diunduh 6/4/2012

43 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Flexibility and Expandability Since medical needs and modes of treatment will continue to change, hospitals should: Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible, rather than highly specific ones Be served by modular, easily accessed, and easily modified mechanical and electrical systems Where size and program allow, be designed on a modular system basis, such as the VA Hospital Building System. This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first- cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below.VA Hospital Building System Be open-ended, with well planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories. Sumber: Diunduh 6/4/2012

44 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Therapeutic Environment Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. (See VA Interior Design Manual.) Some important aspects of creating a therapeutic interior are:interior designertherapeutic environmentVA Interior Design Manual 1.Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs 2.Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients. 3.Admitting ample natural light wherever feasible and using color- corrected lighting in interior spaces which closely approximates natural daylightdaylight 4.Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not availableviews 5.Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage. Sumber: Diunduh 6/4/2012

45 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Cleanliness and Sanitation Hospitals must be easy to clean and maintain. This is facilitated by: 1.Appropriate, durable finishes for each functional space 2.Careful detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints 3.Adequate and appropriately located housekeeping spaces 4.Special materials, finishes, and details for spaces which are to be kept sterile, such as integral cove base. The new antimicrobial surfaces might be considered for appropriate locations. 5.Incorporating O&M practices that stress indoor environmental quality (IEQ)O&M practicesIEQ Sumber: Diunduh 6/4/2012 SANITASI RUMAH SAKIT Dalam lingkup Rumah Sakit (RS), sanitasi berarti upaya pengawasan berbagai faktor lingkungan fisik, kimiawi dan biologik di RS yang menimbulkan atau mungkin dapat mengakibatkan pengaruh buruk terhadap kesehatan petugas, penderita, pengunjung maupun bagi masyarakat di sekitar RS. Dari pengertian di atas maka sanitasi RS merupakan upaya dan bagian yang tidak terpisahkan dari sistem pelayanan kesehatan di RS dalam memberikan layanan dan asuhan pasien yang sebaik-baiknya, )(arena tujuan dari sanitasi RS tersebut adalah menciptakan kondisi lingkungan RS agar tetap bersih, nyaman, dan dapat mencegah terjadinya infeksi silang serta tidak mencemari lingkungan. Dalam pelaksanaannya sanitasi RS seringkali ditafsirkan secara sempit, yakni hanya aspek kerumahtanggaan (housekeeping) seperti kebersihan gedung, kamar mandi dan WC, pelayanan makanan minuman. Ada juga kalangan yang menganggap bahwa sanitasi RS hanyalah merupakan upaya pemborosan dan tidak berkaitan langsung dengan pelayanan kesehatan di RS. Sumber:

46 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Accessibility All areas, both inside and out, should: 1.Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if federally funded or owned, the GSA's ABA Accessibility StandardsADAGSA's ABA Accessibility Standards 2.In addition to meeting minimum requirements of ADA and/or GSA's ABA Accessibility Standards, be designed so as to be easy to use by the many patients with temporary or permanent handicaps 3.Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for two wheelchairs to pass easily 4.Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious Sumber: Diunduh 6/4/2012 Principles and a process that support accessible design include: Laws, Codes, and Standards Know what laws apply and which standards they reference: Project developer (government vs. private entity) Project use (residential, retail, office, etc.) Funding sources (public vs. private) Building type (new construction vs. renovation) Housing type (Single family vs. multifamily) Housing ownership (Condo vs. rental) Planning for Access Consider access early in the process and throughout all phases of the project.project Identify conflicts and synergies in context with other design objectivesdesign objectives Examples might include: 1.bollards as a way to address safety/security and its impact on access and aestheticsbollardssafety/security 2.ramps vs. stairs for functional and access and aesthetics, etc.aesthetics 3.retrofitting a historic building to meet access and historic preservation issues at the same timehistoric preservation 4.choosing sustainable materials, such as pervious pavers, consider the type of paver selected. Those which must be installed with gaps or spaces between them may not be suitable for use on accessible routes.

47 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Controlled Circulation A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled. 1.Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients 2.Typical outpatient routes should be simple and clearly defined 3.Visitors should have a simple and direct route to each patient nursing unit without penetrating other functional areas 4.Separate patients and visitors from industrial/logistical areas or floors 5.Outflow of trash, recyclables, and soiled materials should be separated from movement of food and clean supplies, and both should be separated from routes of patients and visitors 6.Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors 7.Dedicated service elevators for deliveries, food and building maintenance services Sumber: Diunduh 6/4/2012

48 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Aesthetics Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include: 1.Increased use of natural light, natural materials, and texturesnatural light 2.Use of artwork 3.Attention to proportions, color, scale, and detail 4.Bright, open, generously-scaled public spaces 5.Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices 6.Compatibility of exterior design with its physical surroundings Sumber: Diunduh 6/4/2012 Aesthetics is a branch of philosophy devoted to beauty. It dissects the visual compositional elements like proportion and line, as well as other formal qualities—auditory, tactile, olfactory, thermal, and even kinesthetic—that achieve beauty. Moreover, aesthetics involves studying concepts that may underlie the stamp of beauty, such as political context or expression of status. In the case of architecture, underlying concepts may also include imageable form, a sense of place, and interpretation of available technology. Not surprisingly, then, theories of beauty vary to reflect currents of thought in societies. It is free of specific values.

49 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: One way to become acquainted with the possibilities of an architectural commission is to become familiar with a number of buildings of the same type. In addition, this branch of the WBDG is designed primarily to help those not familiar with architectural design terminology to understand the basic process, techniques, and language by which architectural concepts become reality. Toward that end, the following strategies are recommended: 1.Understanding the Appropriate Language and Elements of Design Architects use specific terminology to describe fundamental elements of a building, and to assess its design quality. A client's fluency with this vocabulary improves the architect's application of the elements it represents.Understanding the Appropriate Language and Elements of Design 2.Engage the Integrated Design Process An integrated design process interlaces the multiple design disciplines that inform a building. A series of steps can provide an orderly flow to this dialogue, and the full and constructive participation of all members of the design and delivery team will help assure the best results. Sumber: Diunduh 6/4/2012

50 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Security and Safety In addition to the general safety concerns of all buildings, hospitals have several particular security concerns: 1.Protection of hospital property and assets, including drugs 2.Protection of patients, including incapacitated patients, and staff 3.Safe control of violent or unstable patients 4.Vulnerability to damage from terrorism because of proximity to high- vulnerability targets, or because they may be highly visible public buildings with an important role in the public health system. Sumber: Diunduh 6/4/2012 The design and construction of secure and safe buildings (free from danger or risk of harm) continues to be the primary goal for owners, architects, engineers, project managers, and other stakeholders.architectsengineers In addition to those listed, other stakeholders include: construction managers, developers, facilities managers, code officials, fire marshals, building inspectors, city/county/state officials, emergency managers, law enforcement agencies, lenders, insurers, and product manufacturers. Realizing this goal is often a challenge due to funding limitations, resistance from the occupants due to impacts on operations, productivity and accessibility, and the impacts on the surrounding environment and building architecture due to perimeter security, hardening, and standoff requirements. Understanding the impact site security has on the overall security of the building is important as well. A balance between the security and safety goals and the other design objectives and needs of the facility can be attained. The establishment of an integrated design process where all of the design team members understand each other's goals can aid in overcoming these challenges and will lead to the development of a solution which addresses all of the requirements. Understanding the interrelationship with the other WBDG design objectives (i.e., Sustainable, Aesthetics, Cost-Effective, Historic Preservation, Accessible, Functional / Operational and Productive), early in the design process, is an essential step in overcoming the obstacles commonly encountered in the achievement of a secure and safe building.integrated design processSustainableAestheticsCost-EffectiveHistoric PreservationAccessibleFunctional / OperationalProductive

51 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Sustainability Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design.energywatersustainable design Sumber: Diunduh 6/4/2012 Building construction and operation have extensive direct and indirect impacts on the environment. Buildings use resources such as energy, water and raw materials, generate waste (occupant, construction and demolition) and emit potentially harmful atmospheric emissions. Building owners, designers and builders face a unique challenge to meet demands for new and renovated facilities that are accessible, secure, healthy, and productive while minimizing their impact on the environment.accessiblesecurehealthyproductive Considering the current economic challenges, retrofitting an existing building can be more cost effective than building a new facility. Designing major renovations and retrofits for existing buildings to include sustainability initiatives reduces operation costs and environmental impacts, and can increase building resiliency.cost effective The main objectives of sustainable design are to avoid resource depletion of energy, water, and raw materials; prevent environmental degradation caused by facilities and infrastructure throughout their life cycle; and create built environments that are livable, comfortable, safe, and productive.comfortablesafeproductive

52 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: While the definition of sustainable building design is constantly changing, six fundamental principles persist. Optimasi Tapak / Struktur yang ada Creating sustainable buildings starts with proper site selection, including consideration of the reuse or rehabilitation of existing buildings. The location, orientation, and landscaping of a building affect the local ecosystems, transportation methods, and energy use. Incorporate Smart growth principles in the project development process, whether it be a single building, campus or military base. Siting for physical security is a critical issue in optimizing site design, including locations of access roads, parking, vehicle barriers, and perimeter lighting. Whether designing a new building or retrofitting an existing building, site design must integrate with sustainable design to achieve a successful project. The site of a sustainable building should reduce, control, and/or treat stormwater runoff. Optimasi Penggunaan Energi With America's supply of fossil fuel dwindling, concerns for energy independence and security increasing, and the impacts of global climate change arising, it is essential to find ways to reduce load, increase efficiency, and utilize renewable energy resources in federal facilities. Improving the energy performance of existing buildings is important to increasing our energy independence. Government and private sector organizations are committing to net zero energy buildings in the next decade or so as a way to significantly reduce our dependence on fossil zero energy buildings Konservasi Air In many parts of the country, fresh water is an increasingly scarce resource. A sustainable building should use water efficiently, and reuse or recycle water for on-site use, when feasible. Sumber: Diunduh 6/4/2012

53 Building Attributes OF GREEN HOSPITAL by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee NIKA Technologies, Inc.VA Office of Construction & Facility Management (CFM) Last updated: Use Environmentally Preferable Products Use Environmentally Preferable Products A sustainable building is constructed of materials that minimize life- cycle environmental impacts such as global warming, resource depletion, and human toxicity. Environmentally preferable materials have a reduced effect on human health and the environment and contribute to improved worker safety and health, reduced liabilities, reduced disposal costs, and achievement of environmental goals. Enhance Indoor Environmental Quality (IEQ) Enhance Indoor Environmental Quality (IEQ) The indoor environmental quality (IEQ) of a building has a significant impact on occupant health, comfort, and productivity. Among other attributes, a sustainable building maximizes daylighting; has appropriate ventilation and moisture control; and avoids the use of materials with high-VOC emissions. Additionally, consider ventilation and filtration to mitigate chemical, biological, and radiological attack. Optimize Operational and Maintenance Practices Optimize Operational and Maintenance Practices Considering a building's operating and maintenance issues during the preliminary design phase of a facility will contribute to improved working environments, higher productivity, reduced energy and resource costs, and prevented system failures. Encourage building operators and maintenance personnel to participate in the design and development phases to ensure optimal operations and maintenance of the building. Designers can specify materials and systems that simplify and reduce maintenance requirements; require less water, energy, and toxic chemicals and cleaners to maintain; and are cost- effective and reduce life-cycle costs. Additionally, design facilities to include meters in order to track the progress of sustainability initiatives, including reductions in energy and water use and waste generation, in the facility and on site. Sumber: Diunduh 6/4/2012

54 . Even Hospitals are Going Green Published: Monday, February 23, 2009, 2:40 PM Updated: Thursday, January 14, 2010, 3:19 PM By Carol Ann Campbell The Star-LedgerCarol Ann Campbell Jersey hospitals are creating healthier environments, inside and out. Vegetative rooftop, solar panels, cogeneration units, giant sun-deflecting louvers, nontoxic paints. Could this be the latest headquarters for a high-tech start-up? Well, not exactly. There is one other item -- the biodegradable bed pan -- that tells you right away this is a "green" hospital. New Jersey medical centers, some saddled with the country's oldest buildings, are making efforts big and small to be kinder to the environment. Hospital executives say measures to go green fit well with their mission to heal, and often make economic sense. "The health of our patients and the health of our environment are both important to us," said Barry S. Rabner, president and CEO of Princeton HealthCare System, one of two new hospitals being built with technology that will make them among the greenest in the nation. Rabner is overseeing creation of the new University Medical Center at Princeton, a $442 million hospital in Plainsboro with all the latest environmentally conscious bells and whistles. For example: The building will face south to let natural light into hospital rooms. Sensors will reduce artificial light in each room based on how much natural light is present. A system of giant louvers will regulate how much sun comes into the building and reduce the amount of energy needed. Carbon dioxide sensors will adjust temperatures based on the number of people in a room. The hospital system will create a 32-acre park that will restore the shoreline of Millstone River, create a bike path and plant indigenous, low-maintenance shrubs. There will be no vast lawns in need of insecticide and fertilizer. The hospital, which should be completed by 2011, will have a rainwater collection system and solar panels. No wonder other hospital executives with tight budgets and old buildings may be, well, green with envy. "When we set out to build this project in 2002, we developed a series of guiding principles, and one was a commitment to creating an environmentally responsible and sustainable building," Rabner said. Virtua Health, with headquarters in Marlton, also is building a new hospital from the ground up to replace the system's facility in Voorhees, Camden County. Sumber: Diunduh 6/4/2012

55 KONSEP GREEN HOSPITAL Sustainable healthcare – for patients and the environment Healthcare too has witnessed a paradigm shift regarding the use of energy and raw materials. Both ecological and economical requirements exacerbate the challenge of creating sustainable infrastructure solutions for cities as well as rural areas. Siemens helps hospitals to pave the way into a sustainable future – with Green + Hospitals. The modular Green + Hospitals concept offers means to address both economical and ecological demands in healthcare. This helps hospitals reduce energy costs through energy optimization, building automation and the use of energy-saving equipment, while simultaneously ensuring more comfort for patients. In parts this can be achieved by low dose technology in computed tomography. Over the years, Siemens has been highly successful in integrating many innovations into its scanners that significantly reduce radiation dose in comparison to other systems available on the CT market. In addition Siemens has issued a “Guide to Low Dose” that gives a detailed explanation of the functions currently available to reduce the dose in radiological imaging from Siemens. A smooth and safe workflow with structured clinical pathways, short examination times and the comprehensive use of IT are also key to the economic efficiency of a hospital. In February 2010, the China Hospital Association and Siemens agreed on a strategic paper on Green Hospital development. The aim is to implement a Green Standard for China’s hospitals. Furthermore, Siemens Healthcare and Huashan Hospital in Shanghai agreed to develop integrated approaches combining in vivo and in vitro diagnostic solutions. Doctors also plan to combine the advantages of traditional Chinese medicine with those of Western science. To keep medical technology at the forefront of these changes, Siemens is working with Chinese partners to develop new treatment methods. Sumber: ….. Diunduh 6/4/2012

56 Green plus Efficiency plus Quality: with Green + Hospitals, each step toward one success factor also impacts the other success factors – to achieve a sustainable healthcare infrastructure.. Sumber: ….. Diunduh 6/4/2012 Konsep Green+ Hospital Efisiensi HijauKualitas Sustainable Healthcare Infrastructure

57 Green Hospital of The Future Efficiency, quality and innovation are landmarks in this process.“Influence the influencers“ was an internal Intel philosophy some years ago. According to Rick Fedrizzi, President, CEO and founding chairman of the U.S. Green Building Council: “The health care industry can benefit from the practice of Green Building design and construction.“ The reason why was clear: The health care sector and especially the hospital, accounts for almost one tenth of the country´s carbon-dioxide emissions. It needs to reduce its carbon footprint, its volume of waste output, non-recycled water usage and energy consumption, among other things. It was one of the best kept secrets in the past but it’s out now: Hospitals present an even greater ecological hazard than office buildings. Sumber: Diunduh 6/4/2012

58 Future Scenarios for the Green Hospital of the Future The most important drivers for the proposed-future scenario: 1.The consequences of global climate change will pose daunting challenges, combined with a confluence of geopolitical hostilities over the exhaustion of oil and fresh water reserves. 2.The downsizing and redeployment of healthcare accelerates the functional deconstruction of the hospital. Medical care will be widely dispersed across an increasing number of small-scale micro-hospitals and clinics. 3.By 2050, the home and not the hospital, will become the center of the healthcare universe. Health promotion (sickness prevention) will be limited only by global discrepancies between high-tech versus low-tech societies. 4.The physical space at present separating the individual from contact with the natural environment, will gradually diminish. Buildings for Health will increasingly express anthropomorphic and organic forms … 5.The digital divide will continue to separate the haves from the have-nots in the global healthcare landscape. The internet can significantly advance patient-centred care and sickness prevention but by 2050 the expert, empowered patient may exist only in cultures wealthy enough to afford sophisticated technology. 6.Progressive architecture for health will express the compatible values of both human and ecological health. Conservation will need to find new uses for abandoned hospitals and to create carbon-neutral healing environments. 7.A multifaceted discipline will merge design with the health sciences. 8.Eco-humanist hospitals will advocate for quality of life issues and sickness prevention. Sumber: ….. Diunduh 6/4/2012

59 TOGETHER FOR A GREEN HOSPITAL OF THE FUTURE These networks serve to address all questions concerning the challenges of the future. A hospital is not an island, it has to consider hundreds maybe thousands of aspects in the creation of a Green Hospital. This can only be achieved together. No hospital, no political initiative, no industrial corporation, no organisation or health insurance company can achieve this alone. What is required is the active support and a sustained commitment by all, for a Green Hospital of the Future to be realised. The Asklepios Hospital Group initiated the Green Hospital Program for this reason. The Green Hospital Program is an initiative that would like to present hospitals and healthcare facilities with innovative models of efficiency and quality, as well as relevant solution scenarios, that contribute towards achieving the following objectives in new hospital construction, renovation or modernisation measures: 1.Significant environmental benefits through economically and ecologically sensitive handling of natural resources in a Green Hospital. 2.Protection and promotion of the health and wellbeing of the people in the Green Hospital. Prevention in medical care. 3.Future-proof design and thus a more careful handling of natural resources through environmentally responsible and sustainable construction methods, based on energy-efficient technologies and use of environmentally-friendly and ‘healthy’ building materials. Sumber: Diunduh 6/4/2012

60 GREEN HOSPITAL PROGRAM Everyone, however, who would like to play a role in significantly shaping the future will need to approach, at greatly differing levels, the complex relationships within the environmental system and the healthcare system. Similar to a giant puzzle are the direct and indirect effects of the construction and operation of a Green Hospital of the Future in relation to its environmental impact, its medical and health-promoting facilities and quality, and its social responsibilities that we have to analyse and then implement when the time comes. Here we have an overview of the key aspects and action levels of the Green Hospital Program in each division: Green Health & Care, Green Patient, Green Building und Green Healthcare IT. Sumber: Diunduh 6/4/2012

61 Hospitals, in fact the entire health sector would lose the opportunity to assume the leadership role I described earlier. We must not only focus on a Green Building and its lifecycle, we need to see the big picture here, a picture that places the Green Hospital in a meaningful context with environmental changes, with social changes, with new ecological challenges.. Sumber: ….. Diunduh 6/4/2012 GREEN HOSPITAL PROGRAM

62 RUMAH SAKIT HIJAU DI MASA DEPAN For a Green Hospital of the Future, for ecological sustainability and a qualitative responsibility for the future of healthcare, for the protection and wellbeing of the patient, and the environment. That is our objective, that is our vision. And we are already making a start on it today – we have commenced the Green Hospital Program in many of our hospitals. In this context, GREEN can also be a part of the service mission of the healthcare industry of tomorrow. If we accept that we are at the beginning of a long and at times difficult journey, the aim of which is to change a great many areas of our contemporary health care system that need to change. Sumber: Diunduh 6/4/2012 RUMAH SAKIT HIJAU Adanya berbagai laporan mengenai dampak kerusakan lingkungan dan ekosistem dunia pada dekade belakangan, seperti peningkatan suhu global dan efek rumah kaca, banjir tahunan, gempa, dsb. akhirnya menyadarkan manusia untuk lebih memperhatikan lingkungan dan keseimbangan ekosistem. Hal ini tidak luput dari perhatian para pimpinan dan profesional di RSUP Persahabatan. Pihak manajemen periode Direktur Utama Dr. Agung Sutiyoso mulai mengakomodir prinsip “ramah lingkungan dan ekosistem” melalui pencanangan strategi pelayanan rumah sakit berbasis kenyamanan dan keamanan lingkungan dengan tipologi masyarakat perkotaan. Pendekatan mutu pelayanan paripurna yang telah dilaksanakan di Rumah Sakit Persahabatan, dikembangkan lebih jauh menjadi rumah sakit yang berwawasan ekologis, yaitu menjadikan lingkungan hijau rumah sakit menjadi kekuatan (strength) untuk mendukung peningkatan mutu pelayanan rumah sakit. Diharapkan dengan menciptakan lingkungan rumah sakit yang lebih hijau, natural, alami, dan dekat dengan alam; dapat memberikan rasa nyaman dan aman bagi pasien yang berkunjung dan yang dirawat, sehingga mempercepat proses penyembuhan sekaligus sebagai sarana relaksasi tidak hanya bagi pasien, tetapi juga untuk keluarga, pengunjung, dan pegawai RSUP Persahabatan sendiri. (SUMBER: emid=517)

63 04/11/ :07:41 AM PERSI (PERHIMPUNAN RUMAHSAKIT INDONESIA) Komite Green Hospital Keberadaan rumah sakit di suatu wilayah dengan daya dukung lingkungan yang terbatas sering tidak menjadi perhatian manajemen rumah sakit, padahal paradigma terkini mengajarkan bahwa pengelola rumah sakit wajib menempatkan aspek keseimbangan ekologi, sosial dan estetika menjadi dasar pada setiap perumusan kebijakan melalui optimalisasi pengelolaan lingkungan hidup dan pemberdayaan, sehingga keberadaan rumah sakit dengan kompleksitas kegiatannya tidak menambah beban negatif berupa pencemaran lingkungan, bahkan memberikan manfaat positif bagi kelestarian lingkungan masyarakat sekitar. Disisi lain pola tuntutan kebutuhan masyarakat modern akan layanan rumah sakit juga telah bergeser kepada tuntutan pelayanan kesehatan yang berbasis prinsip ramah lingkungan, karena masyarakat menyadari bahwa jaminan kenyamanan dan keamanan lingkungan selama berinteraksi di lingkungan rumah sakit merupakan bagian pelayanan yang akan mereka peroleh sebagai satu kesatuan pelayanan prima di rumah sakit. Rumah sakit ramah lingkungan saat ini menjadi salah satu kebutuhan dalam manajemen perubahan yang sedang dikembangkan dibanyak rumah sakit. Penerapan rumah sakit ramah lingkungan merupakan bagian dari alasan mengapa rumah sakit perlu berubah menuju pada pemenuhan konsep industri pelayanan kesehatan sesuai kebutuhan pasar dan masyarakat. Kebutuhan pasar dan masyarakat terkini akan industri pelayanan kesehatan telah bergeser menuju industri dengan pelayanan yang memuaskan, aman, nyaman dan menjamin pengguna tidak menerima akibat negatif dari kegiatan pelayanannya. Perhimpunan Rumah Sakit Indonesia sangat perduli dengan masalah-masalah yang berkaitan dengan mutu pelayanan, keselamatan pasien, maupun masalah lingkungan. Sebagai wujud dari keperdulian dan komitmen PERSI dengan masalah lingkungan, maka sejak tahun 2009 dibentuklah komite Green Hospital yang memiliki visi dan misi sebagai berikut :. Sumber: Diunduh 6/4/2012

64 INTEGRATED HOSPITAL MANAGEMENT SYSTEM The Integrated Hospital Management System handles the day-to-day, and budgetary activities of the hospital. The purpose of the software is to manage the hospital and its patients. This relates to managing patient information, managing the administration of the hospital, managing doctor itineraries, providing the management with MIS information, etc. The module description, and the workflows that are illustrated in this document serve to assist in making an assessment, and to gain a rudimentary understanding of the solution deliverables. Module List - Registration Management - Appointments Management - OPD Management - Emergency Services Management - Floor (Ward) Management - IO Billing Module - Laboratory Management - Investigations Management - Diet Management - Operation Theatre Management - Medical Records Maintenance - Packages Management - Pharmacy Management - Blood Bank Management - Central Sterile Supply Management - Financial Accounts Management - Accounts Receivables Module - Accounts Payables Module - Stores And Inventory Management - Personnel And Payroll Management - Time Attendance Module - Gate Pass Management - Statistical Analysis And Statutory Reports - MIS Reports And Graphs. Sumber: Diunduh 6/4/2012

65 HOSPITAL MANAGEMENT SYSTEM. Sumber: Diunduh 6/4/2012

66 BEBERAPA KONSEP DASAR TENTANG MANAJEMEN RUMAH SAKIT A.Rumah Sakit 1.Pengertian Rumah Sakit Beberapa pengertian rumah sakit adalah: a.Menurut Assosiation of Hospital Care (1947) Rumah sakit adalah pusatdimana pelayanan kesehatan masyarakat, pendidikan serta penelitiankedokteran diselenggarakan b.Menurut American Hospital Assosiation (1974) rumah sakit adalah suatualat organisasi yang terdiri tenaga medis professional yang terorganisir serta sarana kedokteran yang permanen menyelenggarakan pelayanankedokteran, asuhan keperawatan yang berkesinambungan, diagnosis sertapengobatan penyakit yang diderita oleh pasien. c.menurut Wolper dan Pena (1997) rumah sakit adalah tempat dimanaorang sakit mencari dan menerima pelayanan kedokteran serta tempatdimana pendidikan klinik untuk mahasiswa kedokteran, perawat dantenaga profesi kesehatan lainya diselenggarakan (Sumber: Azwar, Azrul Pengantar Administrasi Kesehatan. Edisi III PT Bina Rupa Aksara,Jakarta). 2.Fungsi rumah sakit Permenkes RI No. 159b/Men kes/Per/1998, fungsi rumah sakit adalah : a.Menyediakan dan menyelenggarakan pelayanan medik, penunjang medik.rehabilitasi, pencegahan dan peningkatan kesehatan.. b.Menyediakan tempat pendidikan dan atau latihan tenaga medik danparamedik.] c.sebagai tempat penelitian dan pengembangan ilmu dan teknologi bidangkesehatan. Fungsi-fungsi ini dilaksanakan dalam kegiatan intramural (didalam rumah sakit)dan ekstramural (di luar rumah sakit). kegiatan intramural dibagi menjadi 2 kelompok besar yaitu pelayanan rawat inap dan pelayanan rawat jalan Sumber: Sakit….. Diunduh 6/4/2012

67 DEFINISI RUMAH SAKIT Rumah sakit itu sebuah tempat, tetapi juga sebuah fasilitas, sebuah institusi, sebuah organisasi. Untuk dapat mengatur rumah sakit dengan baik maka seseorang tentu harus dapat mendefinisikannya dengan tepat pula. Definisi yang paling klasik hanya menyatakan bahwa rumah sakit adalah institusi (fasilitas) yang menyediakan pelayanan pasien rawat inap, ditambah dengan beberapa penjelasan lain. American Hospital Association tahun 1978 menyatakan bahwa rumah sakit adalah suatu institusi yang fungsi utamanya adalah memberikan pelayanan kepada pasien, diagnostik dan terapeutik untuk berbagai penyakit dan masalah kesehatan, baik yang bersifat bedah maupun non bedah. SK menteri Kesehatan RI No. 983/Menkes/SK/XI/1992 menyebutkan bahwa rumah sakit umum adalah rumah sakit yang memberikan pelayanan kesehatan yang bersifat dasar, spesialistik dan sub spesialistik. Sumber: Diunduh 6/4/2012 Manajemen Rumah Sakit Manajemen rumah sakit adalah koordinasi antara berbagai sumber daya (unsur manajemen) melalui proses perencanaan, pengorganisasian, ada kemampuan pengendalian untuk mencapai tujuan rumah sakit seperti : Menyiapkan sumber daya, mengevaluasi efektivitas, mengatur pemakaian pelayanan, Efisiensi, Kualitas.sumber daya Banyak definisi manajemen yang ada, dan masing-masing akan menunjukkan penekanan tertentu, yang penting diambil pada pokok fungsi manajemen dan unsur dari manajemen.definisi manajemen

68 MUTU PELAYANAN RUMAH SAKIT Mutu pelayanan rumah sakit adalah derajat kesempurnaan rumah sakituntuk memenuhi permintaan konsumen akan pelayanan kesehatan yang sesuaidengan standart profesi dan standart pelayanan dengan menggunakan potensisumber daya yang tersedia di rumah sakit dengan wajar, efisien dan efektif serta diberikan secara aman dan memuaskan sesuai dengan norma, etika,hukum dan sosio budaya dengan memperhatikan keterbatasan dan kemampuanpemerintah dan masyarakat konsumen. Faktor - faktor yang menentukan mutu pelayanan rumah sakit yaitu: 1.Kehandalan yang mencakup dua hal pokok, yaitu konsistensi kerja dankemampuan untuk dipercaya. 2.Daya tangkap, yaitu sikap tanggap para karyawan melayani saat dibutuhkanpasien. 3.Kemampuan, yaitu memiliki keterampilan dan pengetahuan yang dibutuhkanagar dapat memberikan jasa tertentu. 4.Mudah untuk dihubungi dan ditemui. 5.Sikap sopan santun, respek dan keramahan para pegawai. 6.Komunikasi, yaitu memberikan informasi kepada pelanggan dalam bahasayang dapat mereka pahami, serta selalu mendengarkan saran dan keluhanpelanggan. 7.Dapat dipercaya dan jujur. 8.Jaminan keamanan 9.Usaha untuk mengerti dan memahami kebutuhan pelanggan. 10.Bukti langsung yaitu bukti fisik dari jasa, bisa berupa fasilitas fisik, peralatanyang digunakan, representasi fisik dan jasa. (Sumber: Depkes RI Standar Pelayanan Rumah Sakit, Dirjen Yanmed, Depkes RI,Jakarta). Sumber: Sakit….. Diunduh 6/4/2012

69 FAKTOR POKOK YANG MEMPENGARUHI MUTU Parasuraman mengemukakan bahwa 10 faktor yang mempengaruhi mutu yang ada dapat dirangkum menjadi 5 faktor pokok yaitu: 1.Tangibles; bukti langsung meliputi fasilitas fisik, perlengkapan, sarana danpenampilan pegawai. 2.Realibility; kehandalan yaitu kemampuan memberikan pelayanan yang dijanjikan dengan segera, akurat dan memuaskan. 3.Responsiveness; daya tanggap yaitu keinginan para karyawan dalammemberikan pelayanan dengan tanggap. 4. Assurance; jaminan mencakup pengetahuan, keterampilan, kemampuan,kesopanan dan sikap dapat dipercaya dari para karyawan, bebas daribahaya, resiko dan keragu-raguan. 5.Empathy; yaitu kemudahan dalam melakukan hubungan komunikasi yangbaik, perhatian pribadi dan memahami kebutuhan pelanggan. (Parasuraman. A, Zeithhaml, Lavenia A, and Berry, Leonard L Serqual ItemScale for Measuring Consumer Perception of Servive Quality, Journal of Retailing,64). Sumber: Sakit ….. Diunduh 6/4/2012

70 PELAYANAN RAWAT INAP Pelayanan rawat inap adalah suatu kelompok pelayanan kesehatan yangterdapat di rumah sakit yng merupakan gabungan dari beberapa fungsipelayanan. Kategori pasien yang masuk rawat inap adalah pasien yang perluperawatan intensif atau observasi ketat karena penyakitnya. Menurut Revans (1986 ) bahwa pasien yang masuk pada pelayanan rawat inap akan mengalami tingkat proses transformasi, yaitu: 1.Tahap Admission, yaitu pasien dengan penuh kesabaran dan keyakinandirawat tinggal di rumah sakit. 2.Tahap Diagnosis, yaitu pasien diperiksa dan ditegakan diagnosisnya. 3.Tahap treatment, yaitu berdasarkan diagnosis pasien dimasukan dalamprogram perawatan dan therapi. 4.Tahap Inspection, yaitu secara continue diobservasi dan dibandingkanpengaruh serta respon pasien atas pengobatan. 5.Tahap Control, yaitu setelah dianalisa kondisinya, pasien dipulangkan.pengobatan diubah atau diteruskan, namun dapat juga kembali ke prosesuntuk didiagnosa ulang. (Tim Dep. Kes RI Konsep dan Proses Keperawatan, Cetakan I, Jakarta). Sumber: Sakit….. Diunduh 6/4/2012

71 KUALITAS PELAYANAN RAWAT INAP Menurut Jacobalis ( 1990 ) kualitas pelayanan kesehatan di ruang rawat inap rumah sakit dapat diuraikan dari beberapa aspek, diantaranya adalah: 1.Penampilan keprofesian atau aspek klinis. Aspek ini menyangkut pengetahuan, sikap dan perilaku dokter dan perawatdan tenaga profesi lainya. 2.Efisiensi dan efektifitas. Aspek ini menyangkut pemanfaatan semua sumber daya di rumah sakit agar dapat berdaya guna dan berhasil guna. 3.Keselamatan Pasien. Aspek ini menyangkut keselamatan dan keamanan pasien. 4.Kepuasan Pasien. Aspek ini menyangkut kepuasan fisik, mental, dan sosial pasien terhadaplingkungan rumah sakit, kebersihan, kenyamanan, kecepatan pelayanan,keramahan, perhatian, biaya yang diperlukan dan sebagainya. (Sumber: Jacobalis Samsi Kumpulan Tulisan terpilih tentang Rumah Sakit Indonesiadalam Dinamika Sejarah, Transformasi, Globalisasi dan Krisis Nasional, penerbit IDI, Jakarta). Sumber: Sakit….. Diunduh 6/4/2012

72 MUTU LAYANAN RAWAT INAP Menurut Adji Muslihuddin (1996), Mutu asuhan pelayanan rawat inap dikatakan baik apabila : 1.Memberikan rasa tentram kepada pasienya yang biasanya orang sakit. 2.Menyediakan pelayanan yang benar benar profesional dari setiap stratapengelola rumah sakit. Pelayanan ini bermula sejak masuknya pasien kerumah sakit sampai pulangnya pasien. Dari kedua aspek ini dapat diartikan sebagai berikut: 1.Petugas penerima pasien dalam melakukan pelayanan terhadap pasienharus mampu melayani dengan cepat karena mungkin pasien memerlukanpenanganan segera. 2.Penanganan pertama dari perawat harus mampu membuat pasien menaruhkepercayaan bahwa pengobatan yang diterima dimulai secara benar. 3.Penanganan oleh para dokter yang profesional akan menimbulkankepercayaan pasien bahwa mereka tidak salah memilih rumah sakit. 4.Ruangan yang bersih dan nyaman, memberikan nilai tambah kepada rumahsakit. 5.Peralatan yang memadai dengan operator yang profesional. 6.Lingkungan rumah sakit yang nyaman. Sumber: Sakit….. Diunduh 6/4/2012

73 PELAYANAN TENAGA MEDIS Tenaga medis merupakan unsur yang memberikan pengaruh palingbesar dalam menentukan kualitas dari pelayanan yang diberikan kepada pasiendi rumah sakit. Fungsi utamanya adalah memberikan pelayanan medik kepadapasien dengan mutu sebaik baiknya, menggunakan tata cara dan teknikberdasarkan ilmu kedokteran dan etik yang berlaku serta dapatdipertanggungjawabkan kepada pasien dan rumah sakit. Donabedian (1980), mengatakan bahwa perilaku dokter dalam aspekteknis manajemen, manajemen lingkungan sosial, manajemen psikologi danmanajemen terpadu, manajemen kontinuitas, dan koordinasi kesehatan danpenyakit harus mencakup beberapa hal, yaitu: 1.Ketepatan diagnosis 2.Ketepatan dan kecukupan therapi 3.Catatan dan dokumen pasien yang lengkap 4.Koordinasi perawatan secara kontinuitas bagi semua anggota keluarga. (Sumber: Donabedian, A.V Exploration In Quality Assesment and Monitoring, Michigan,USA). Sumber: ….. Diunduh 6/4/2012

74 PELAYANAN TENAGA PERAWAT / PARAMEDIS. Pelayanan perawatan di rumah sakit merupakan bagian integral daripelayanan rumah sakit secara menyeluruh, yang sekaligus merupakan tolokukur keberhasilan pencapaian tujuan rumah sakit, bahkan sering menjadi faktor penentu citra rumah sakit di mata masyarakat. Keperawatan sebagai suatu profesi di rumah sakit yang cukup potensialdalam menyelenggarakan upaya mutu, karena selain jumlahnya yang dominan juga pelayananya menggunakan pendekatan metode pemecahan masalahsecara ilmiah melalui proses keperawatan. Asuhan Keperawat meliputi: 1.Pelayanan keperawatan (Nursing Service) adalah seluruh fungsi, tugas,kegiatan dan tanggung jawab yang dilaksanakan oleh seorang perawatdalam praktek profesinya. 2.Asuhan keperawatan ( Nursing Care ) adalh suatu pelayanan keperawatanlangsung berupa bantuan, bimbingan, penyuluhan, pengawalan atauperlindungan yang diberikan seorang perawat untuk memenuhi kebutuhan pasien. (Sumber: Tim Dep. Kes RI, Konsep dan Proses Keperawatan, Cetakan I, Jakarta). Sumber: Sakit….. Diunduh 6/4/2012

75 PENYEDIAAN SARANA MEDIK, NON MEDIK, DAN OBAT OBATAN Standart peralatan yang harus dimiliki oleh rumah sakit sebagaipenunjang untuk melakukan diagnosis, pengobatan, perawatan dan sebagainyatergantung dari tipe rumah sakit, disamping tersedianya sarana penunjangmedik juga perlu tersedia alat alat keperawatan. Dalam rumah sakit, obat merupakan sarana yang mutlak diperlukan, bagian farmasi bertanggung jawab atas pengawasan dan kualitas obat. Persediaan obat harus cukup, penyimpanan efektif, diperhatikan tanggal kadaluarsanya, dan sebagainya. (Bouwhuizen,M Ilmu Keparawatan, Bagian I, EGC Penerbit Buku Kedokteran,Jakarta). Sumber: Sakit ….. Diunduh 6/4/2012 LAYANAN RUMAH SAKIT Salah satu yang sangat dekat dengan masyarakat adalah pelayanan Rumah sakit yang saat ini sedang menjamur diberbagai tempat. Bahkan banyak Rumah sakit dibangun dan berlomba-lomba untuk meningkatkan mutu pelayanan di Rumah sakit, dikarenakan persaingan yang kuat di tiap-tiap Rumah sakit. Hal-hal yang perlu diketahui adalah : Sesungguhnya Rumah sakit dikota Jakarta saja sudah mulai menjamur dan Rumah sakit harus memperhatikan didalam peningkatkan mutu pelayanan yang ada. Masyarakat bukan saja membutuhkan sebuah kesembuhan, tetapi juga sebuah pelayanan yang sangat diharapkan oleh masyarakat, sehingga pada saat masyarakat ke Rumah sakit untuk berobat maka masyarakat merasa nyaman dan tidak takut atau curiga dikarenakan pihak Rumahsakit melayani sungguh-sungguh. Ada 2 hal yang saling berkaitan didalam pelayanan peningkatan dan mutu pelayanan RS yaitu : pelayanan medik dan penunjang medik. Pelayanan medik menyangkut sebuah pelayanan medis dimana yang terlibat adalah dokter dan pasien bagaimana membangun dan meningkatkan kepercayaan masyarakat tehadap dokter. Sedangkan penunjang medis adalah hal-hal yang menyangkut diatas seperti Apotik, Radiologi, Laboratorium, Front office, Rekam Medis atau didalam penyimpanan data. (SUMBER:

76 PERSEPSI DAN HARAPAN PELANGGAN RUMAH SAKIT Menurut Gilson, dkk (1994), yang menjadi elemen penting dalam menentukan harapan masyarakat terhadap pelayanan kesehatan: 1.Kemanjuran obat, keterjangkauan biaya, tidak membutuhkan waktu yanglama dalam proses perawatan. 2.Memperoleh obat merupakan faktor yang terpenting yang mendasari polapemanfaatan pelayanan kesehatan. 3.Pandangan yang menyeluruh mengenai penampilan, seperti sikap petugasyang baik, kecakapan petugas, dan hubungan petugas dengan pasien. 4.Persepsi masyarakat terhadap kualitas sarana dan prasarana yang meliputi jarak yang dapat dicapai, keadaan gedung, ruang tunggu, privasi, dankelengkapan peralatan medis. 5.Persepsi masyarakat terhadap kualitas proses yang meliputi keterampilanpetugas, kecukupan staf, biaya perawatan, dan penjelasan pengobatan Sumber: Sakit….. Diunduh 6/4/2012 Dalam konsep model kualitas yang dikemukakan oleh Parasuraman, Zeithmal dan Berry (1990) yang dikenal dengan servqual model menyatakanada empat faktor yang mempengaruhi persepsi dan harapan pasien terhadap jasa pelayanan, yaitu: 1.Pengalaman dari teman (word of mouth) 2.Kebutuhan atau keinginan ( personal need ) 3.Pengalaman masa lalu saat menerima jasa pelayanan ( past experience) 4.Komunikasi melalui iklan/ pemasaran (external communications tocustomer). (Parasuraman. A, Zeithhaml, Lavenia A, and Berry, Leonard L Serqual Item Scale for Measuring Consumer Perception of Servive Quality, Journal of Retailing,64).

77 FAKTOR-FAKTOR KEPUTUSAN PELANGGAN RUMAH SAKIT Di dalam masyarakat terdapat bermacam macam kelompok yangmempunyai perbedaan yang menggambarkan nilai dan kekuatan kelompoktersebut. Perbedaan ini akan mempengaruhi persepsi dan harapan pasien. Menurut Anderson (1974) dalam buku Notoatmodjo dkk (1989) terdapat tiga kategori utama yang mempengaruhi pelayanan kesehatan, yaitu: 1.Karakteristik PredisposisiMenggambarkan bahwa setiap individu individu mempunyai kecenderunganyang berbeda beda dalam menggunakan pelayanan kesehatan. Hal inikarena ada ciri ciri demografi seperti jenis kelamin, umur, dan status marital,karena struktur sosial, seperti tingkat pendidikan, pekerjaan, kesukuan danlain lain serta keyakinan bahwa pelayanan dapat menolong proseskesembuhan penyakit. 2.Karakteristik PendukungPenggunaan fasilitas pelayanan kesehatan yang ada sangat tergantungpada kemampuan konsumen untuk membayar. 3.Karakteristik KebutuhanTeori pemanfaatan pelayanan kesehatan berkaitan erat dengan permintaanakan pelayanan kesehatan oleh konsumen. Permintaan akan pelayanan kesehatan justru selama ini yang meningkat. Hal ini dikarenakan penduduksudah benar benar mengeluh sakit serta mencari pengobatan. Faktor faktor yang mempengaruhi permintaan pelayanan kesehatan diantaranya adalahpengetahuan tentang kesehatan, sikap terhadap fasilitas kesehatan danpengalaman terhadap kemampuan fasilitas kesehatan tersebut. (Notoatmodjo Soekidjo Metodologi Penelitian Kesehatan, Rineke cipta,Jakarta). Sumber: Sakit….. Diunduh 6/4/2012

78 PEMENUHAN PERMINTAAN PELANGGAN RUMAH SAKIT Seringkali para manager lebih suka mengukur kepuasan pelangganuntuk menaksir penampilan organisasinya dari pada merencanakan strateginilai, mempelajari kebutuhan dan keinginan pelanggan atau mengukur mutuproduk. Tingkat kepuasan pelanggan dapat diukur dengan membandingkankesesuaian antara harapan/ keinginan dan pengalaman yang didapat merekaseperti dalam teori The Expectancy Disconfirmation Model yang dikemukakanoleh Supranto (1997), sebagai berikut: Tki = Xi/Yi x 100% Keterangan: Tki = Tingkat Kesesuaian; Xi = Skor Nilai Pengalaman; Yi = Skor Nilai Harapan. Bila Skor nilai pengalaman mendekati atau bahkan melebihi skor nilai harapan/keinginan, maka pasien dapat dianggap puas terhadap mutu pelayanan yang diterimanya. Sebaliknya, apabila skor nilai pengalaman berada di bawah skor nilai haparan, berarti pasien tidak puas terhadap mutu pelayanan yang diterimanya. (Supranto, J Pengukuran Tingkat Kepuasan Pelanggan untuk Menaikan PangsaPasar, Rineka Cipta Cetakan II, Jakarta). Sumber: Sakit ….. Diunduh 6/4/2012

79 PEMANFAATAN RUMAH SAKIT 1. Tahap Proses Memilih Rumah Sakit Proses membeli dari konsumen ada beberapa tahap, yaitu: a.Keinginan dan kebutuhan apa yang mendorong pelanggan untukmenggunakan suatu jasa. (need arousal) b.Apakah pelanggan mengumpulkan informasi berkaitan dengan kebutuhanyang dirasakan. (information Gathering ) c.Bagaimana pelanggan mengevaluasi alternatif (decision evaluation) d.Bagaimana pelanggan memanfaatkan jasa rumah sakit. (decision execution) e.Bagaimana sikap pelanggan setelah memanfaatkan jasa rumah sakit. ( post decision assessment ) (Sumber: Novi Syahrial, Drg, MARS. Mata Kuliah Manajemen Pemasaran: AnalisisPeluang Pasar Rumah Sakit, Universitas Indonesia, Sumber: Sakit ….. Diunduh 6/4/2012

80 Keputusan Setelah memanfaatkan jasa rumah sakit Dampak setelah memanfaatkan fasilitas rumah sakit dapat berupa : 1.Adanya kepuasan penuh 2.Adanya kepuasan sebagian 3.Sama sekali tidak puas terhadap fasilitas rumah sakit. Kepuasan dikemukakan sebagai rasa lega atau senang karenaharapan atau hasrat tentang sesuatu terpenuhi. Kepuasan mempunyaidimensi fisik, mental dan sosial. Kepuasan pasien merupakan persepsimultidimensional yang terkait dengan struktur proses dan outcome layanan. Sedangkan ketidakpuasan merupakan kesenjangan anatara harapan/keinginan dan kenyataan layanan yang diterima oleh pasien (Jacobalis. S Beberapa Teknis dalam Manajemen Mutu, Universitas GadjahMada, Yogyakarta). Sumber: Sakit….. Diunduh 6/4/2012 KEPUASAN PASIEN Kepuasan pasien dapat dipengaruhi oleh mutu pelayanan kesehatan yang diberikan oleh rumah sakit sebagai provider, dimana mutu pelayanan kesehatan bagi pasien berarti empati, respek dan tanggap akan kebutuhannya, dalam hal ini kebutuhan pelayanan yang diberikan oleh petugas kesahatan. Sedangkan mutu pelayanan kesehatan bagi petugas berarti bebas melakukan segala sesuatu secara professional. untuk meningkatkan derajad kesehatan pasien dan masyarakat sesuai dengan ilmu pengetahuan dan ketrampilan yang memadai serta terlindungi aleh atuaran perundang-undangan yang berlaku. Menurut Lori Di Prete Brown, dalam bukunya Quality Assurance of Health Care in Developing Countries, mutu pelayanan kesehatan merupakan fonomena yang komprehensip dan multi facet. Kegiatan menjaga mutu dapat menyangkut satu atau beberapa dimensi mutu baik untuk pelayanan klinis maupun managemen dalam pelayanan kesehatan. Adapun dimensi mutu yang dimaksud adalah: kompentensi teknis (technical competence), akses terhadap pelayanan (acces to service), efektivitas (effectiveness), efisiensi (efficiency), kontinuitas (continuity), keamanan (safety), hubungan antar manusia (interpersonal) dan kenyamanan (amenities) yang disebut dengan delapan demensi mutu. (SUMBER: terhadap.html)

81 KONSEP KEPUASAN PELANGGAN / PASIEN Ketidakpuasan adalah kekecewaan. Ketidakpuasan terhadap layanan kesehatan diungkapkan dalam bentuk keluhan, protes, kemarahan,surat terbuka dalam media masa, pengaduan kepada ikatan profesi sampaipengaduan di pengadilan dengan tuduhan malpraktek. Kepuasan/ketidakpuasan layanan rumah sakit erat kaitanya dengan: 1.Dokter, perawat atau petugas lain di rumah sakit. 2.Aspek hubungan antar manusia. 3.Kemanusiaan. 4.Kenyamanan/ kemudahan fasilitas dan lingkungan 5.Peralatan dan perlengkapan. 6.Biaya pengobatan. Dalam pengalaman sehari hari, ketidakpuasan pasien yang palingsering dikemukakan ialah ketidakpuasan terhadap: 1.Sikap dan perilaku petugas rumah sakit atau karyawan. 2.Keterlambatan layanan oleh dokter/ perawat. 3.Dokter tertentu susah ditemukan. 4.Dokter kurang informatif dan komunikatif. 5.Lamanya proses masuk rawat. 6.Ketertiban dan kenyamanan lingkungan. (Jacobalis. S Beberapa Teknis dalam Manajemen Mutu, Universitas GadjahMada, Yogyakarta). Sumber: Sakit….. Diunduh 6/4/2012

82 PENERAPAN MANAJEMEN RUMAH SAKIT Rumah sakit perlu menerapkan sistem manajemen yang berorientasi pada kepuasan pelanggan. Untuk itu rumah sakit di Indonesia harus menciptakan kinerja yang unggul. Kinerja yang unggul atau Performance Excellence merupakan salah satu faktor utama yang harus diupayakan oleh setiap organisasi untuk memenangkan persaingan global, begitu juga oleh perusahaan penyedia jasa pelayanan kesehatan. Banyak cara yang dapat dilakukan oleh para pengelola rumah sakit untuk menciptakan kinerja yang unggul diantaranya melalui pemberian pelayanan yang bagus serta tindakan medis yang akurat dan mekanisme pengelolaan mutu tentunya. Salah satu strategi yang dilakukan oleh pengelola rumah sakit swasta dalam mempertahankan atau meningkatkan jumlah konsumen adalah pelayanan. Tuntutan untuk mendapatkan pelayanan yang berkualitas dan nyaman semakin meningkat, sesuai dengan meningkatnya kesadaran arti hidup sehat. Keadaan ini dipengaruhi oleh tingkat pendidikan, sosial budaya dan sosial ekonomi masyarakat yang perlu mendapat perhatian dari pengelola rumah sakit. Untuk memenuhi tuntutan masyarakat tersebut, di setiap kota besar seperti Jakarta banyak sekali usaha rumah sakit dengan kualitas pelayanan dan peralatan medis yang prima dapat kita temukan di setiap sudut kota, sehingga masyarakat konsumen yang tadinya harus ke luar negeri demi servis dan kualitas dokter yang prima, sekarang tidak perlu lagi ke luar negeri. Dalam usaha peningkatan kualitas pelayanan terhadap konsumen, rumah sakit berusaha untuk mempunyai tenaga dokter ahli yang tetap, sekaligus memperkerjakan dokter waktu dan dokter kontrak. Bahkan di beberapa rumah sakit di kota besar seperti Jakarta dapat kita jumpai pelayanan Unit Gawat Darurat (UGD) yang ditangani oleh dokter tetap maupun dokter kontrak. Sumber: ….. Diunduh 6/4/2012

83 PENERAPAN MANAJEMEN RUMAH SAKIT Bahkan ada rumah sakit yang menyediakan tempat dan sarana lengkap seperti laboratorium dengan tenaga analis, radiologi dan tempat perawatan yang serba lengkap. Sedangkan untuk tenaga dokternya mereka mengambil dokter-dokter spesialis yang terkenal dan pengelola rumah sakit menganggap dokter spesialis dan pasiennya sebagai “customer” mereka Untuk menjaga agar dokter spesialis ternama tersebut tetap menjadi customer mereka, maka pihak rumah sakit melakukan strategi sedemikian rupa. Diantaranya dengan menyediakan peralatan medis yang dikehendaki oleh para dokter tersebut Sedangkan untuk menghasilkan mekanisme pengelolaan mutu yang bagus, perusahaan dalam hal ini rumah sakit perlu menerapkan metode pengukuran yang efektif untuk dapat menganalisis dan menemukan dimensi mutu 0 yang perlu diperbaiki atau ditingkatkan untuk mencapai mutu yang tinggi. Salah satu model pengukuran yang sudah dikenal luas dan terbukti secara efektif membantu keberhasilan penerapan sistem manajemen mutu adalah sistem Malcolm Baldrige National Quality Award. Malcolm Baldrige National Quality Awards (MBNQA) merupakan sistem manajemen yang sangat efektif untuk menghasilkan loyalitas pelanggan dan kinerja tinggi bila diterapkan dengan tepat. Kriteria penilaian/pengukuran kinerja yang dimiliki oleh MBNQA juga dapat digunakan oleh industri jasa pelayanan kesehatan, yang disebut dengan Performance Excellence for Health Care based on MBNQA. Kriteria Performance Excellence for Health Care based on MBNQA terdiri dari 7 kategori, yaitu: Health Care Results, Patient -and Other Customer- Focused Results, Financial and Market Results, Staff and Work System Results, Organizational Effectiveness Results, Governance and Social Responsibility Results. Dengan penerapan sistem manajemen mutu secara menyeluruh dan model pengukuran tepat maka perusahaan akan menjadi perusahaan kelas dunia yang siap memenangkan persaingan. Dalam penerapannya, manajemen di rumah sakit dapat dilihat dari fungsi perencanaan rumah sakit dan fungsi pergerakan dan pelaksanaan rumah sakit. Sumber: ….. Diunduh 6/4/2012

84 INDIKATOR PENILAIAN MUTU ASUHAN KESEHATAN Mutu asuhan kesehatan sebuah RS akan selalu terkait dengan struktur, proses, outcome sistem pelayanan RS yersebut. Mutu asuhan pelayanan RS juga dapat dikaji dari tingkat pemanfaatan sarana pelayanan oleh masyarakat, mutu pelayanan dan tingkat efisiensi RS. Aspek struktur Struktur adalah semua masukan (input) untuk system pelayanan sebuah RS yang meliputi tenaga, peralatan, dana dan sebagainya. Ada sebuah asuransi yang mengatakan bahwa jika struktur sistem RS tertata dengan baik, akan lebih menjamin mutu asuhannya. Baik tidaknya struktur RS diukur dari tingkat kewajaran, kuantitas, biaya, efisiensi, mutu dari masing – masing komponen struktur. Proses Proses adalah semua kegiatan dokter dan tenaga professional lainnya yang mengadakan interaksi secara profesional dengan pasiennya. Interaksi ini diukur antara lain dalam bentuk penilaian tentang pasien, penegakan diagnosa, rencana tindakan pengobatan, indikasi tindakan, penanganan penyakit, dan prosedur pengobatan. Dalam hal ini juga dianut asumsi bahwa semakin patuh tenaga profesi menjalankan ”standards of good practice” yang telah diterima dan diakui oleh masing – masing ikatan profesi, akan semakin tinggi pula mutu asuhan terhadap pasien. Baik tidaknya pelaksanaan proses pelayanan di RS dapat diukur dari tiga aspek yaitu relevan tidaknya proses itu bagi pasien, efektivitas prosesnya, dan kualitas interaksi asuhan terhadap pasien. Sumber: Diunduh 6/4/2012

85 INDIKATOR PENILAIAN MUTU ASUHAN KESEHATAN Outcome Outcome adalah hasil akhir kegiatan dokter dan tenaga profesi lainnya di RS terhadap pasien. Di sini diperlukan pedoman untuk mengukur mutu asuhan pelayanan kesehatan. Indikator mutu pelayanan medis meliputi : 1. Angka infeksi nosokomial 2. Angka kematian kasar (Gross Death Rate) 3. Kematian pasca bedah 4. Kematian ibu melahirkan ( Maternal Death Rate-MDR) 5. Kematian bayi baru lahir (Infant Death Rate-IDR) 6. NDR (Net Death Rate di atas 48 jam) 7. ADR (Anasthesia Death Rate) 8. PODR (Post Operation Death Rate) 9. POIR (Post Operative Infection Rate) Indikator mutu pelayanan untuk mengukur tingkat efisiensi RS : 1. Unit cost untuk rawat jalan 2. Jumlah penderita yang mengalami dekubitus 3. Jumlah penderita yang jatuh dari tempat tidur 4. BOR (Bed Occupancy Rate) 5. BTO (Bed Turn Over) 6. TOI (Turn Over Interval) 7. ALOS (Average Length of Stay) 8. Normal Tissue Removal Rate Sumber: Diunduh 6/4/2012

86 INDIKATOR PENILAIAN MUTU ASUHAN KESEHATAN Indikator mutu yang berkaitan dengan tingkat kepuasan pasien dapat diukur dengan : 1.Jumlah keluhan dari pasien/keluarganya 2.Surat pembaca di koran 3.Surat kaleng 4.Surat masuk dari kotak saran, dan sebagainya 5.Survei tingkat kepuasan pengguna pelayanan kesehatan RS. Indikator cakupan pelayanan sebuah RS terdiri dari : 1.Jumlah dan pesentase kunjungan rawat jalan/inap menurut jarak PS dengan asal pasien 2.Jumlah pelayanan dan tindakan medik 3.Jumlah tindakan pembedahan 4.Jumlah kunjungan SMF spesialis 5.Pemfaatan oleh masyarakat 6.Contact rate 7.Hospitalization rate 8.Out patient rate 9.Emergency out patient rate. Untuk mengukur mutu pelayanan sebuah RS, angka-angka standar tersebut di atas dibandingkan dengan standar (indikator) nasional. Jika tidak ada angka standar nasional, penilaian dialkukan dengan menggunakan hasil pencatatan mutu pada tahun sebelumnya di RS yang sama setelah dikembangkan kesepakatan pihak manajemen / direksi RS yang bersangkutan dengan masing-masing SMF dan staf lainnya yang terkait. Sumber: Diunduh 6/4/2012

87 INDIKATOR PENILAIAN MUTU ASUHAN KESEHATAN Indikator mutu yang mengacu pada keselamatan pasien: 1. Pasien terjatuh dari tempat tidur/kamar mandi 2. Pasien diberi obat yang salah 3. Tidak ada obat/alat emergensi 4. Tidak ada oksigen 5. Tidak ada alat penyedot lendir 6. Tidak tersedia alat pemadam kebakaran 7. Pemakaian obat tidak sesuai standar 8. Pemakaian air, listrik, gas, dan sebagainya. Mutu pelayanan medis dan kesehatan di RS sangat erat kaitannya dengan manajemen RS (quality of services) dan keprofesionalan kinerja SMF dan staf lainnya di RS (quality of care). Keduanya merupakan oucome dari manajemen manjaga mutu di RS (quality assurance) yang dilaksanakan oleh gugus kendali mutu RS. Dalam hal ini, gugus kendali mutu dapat ditugaskan kepada komite medik RS karena mereka adalah staf fungsional (nonstruktural) yang membantu direktur RS dengan melibatkan semua staf SMF RS. Sumber: Diunduh 6/4/2012 Human resource management is an approach to the management of people based on the following fundamental principles: 1.Human resource management is concerned with integration by getting all the members of the organization involved so that they may work together with a sense of common purpose. 2.Human resource policies of the organization should be fair to all. They should make a major contribution to the achievement of an organization’s objectives as well as provide conducive atmosphere of working to the employees so that their output is maximum. 3.Human resources are the most important assets and their tactful management is the key to success of an organization. 4.The culture and values of an organization exert enormous influence on the organization. Therefore, organizational values and culture should be accepted and acted upon by one and all in the organization.

88 RSU Daya Akan Dijadikan Rumah Sakit Hijau Tribun Timur - Kamis, 29 September :03 WIT Rumah Sakit Umum Daya akan dijadikan sebagai rumah sakit hijau (green hospital) berbasis kenyamanan dan keamanan lingkungan. Di rumah sakit milik pemerintah ini akan diperbanyak pepohonan, AC hanya digunakan di ruang tertentu, mengurangi bola lampu, jendela diperbanyak, dan atap diganti dengan tanaman yang menjalar. "Rumah sakit ini akan dijadikan rumah sakit hijau pertama di Makassar. Saat ini dalam tahap persiapan menuju rumah sakit hijau," kata Direktur RS Umum Daya, dr St Sainab (Kamis 29/9/2011). Saat ini manajemen rumah sakit mulai memperbanyak tanaman. Tanaman yang berdaun lebat akan ditanam di sekeliling rumah sakit. Tanaman ini sebagian dibeli di Pulau Jawa. Penulis : Edi Sumardi Editor : Ridwan Putra Sumber:….. Diunduh 6/4/2012 RSMM, Menuju RS Hijau & Asri Upaya yang paling sering dilakukan yaitu dengan menanam pohon. Seperti yang dilakukan pihak Rumah Sakit Marzoeki Mahdi (RSMM), bekerja sama dengan Koramil Bogor Barat, RSMM melakukan penanaman ratusan pohon. Pada kegiatan yang dihadiri unsur Kecamatan, Koramil, Polsek serta manajemen RSMM ini, ditanam berbagai jenis pohon. Diantaranya pohon jambu merah yang bermanfaat untuk mengatasi penyakit DBD. Selain itu juga berbagai tanaman keras yang bisa jadi pelindung dan penahan air dari jenis ketapang. Ditanam pula pohon bunga seperti bougenville, aglonema dan bunga merah. Untuk penanaman kali ini dilakukan di depan bangsal Dewi Ambar. “Penanaman ini dilakukan dalam rangka mendukung program dunia untuk menjaga bumi serta program pemerintah menanam satu juta pohon”. Hal ini sekaligus program Rumah Sakit Hijau dan Asri, yang dicanangkan Kementerian Kesehatan. Sejak awal 2012 ini, RS yang berlokasi di jalan Dr. Semeru kota Bogor- Jawa Barat ini, memang telah mencanangkan program Rumah Sakit Hijau & Asri. “Agar pasien merasa nyaman, apalagi ini Rumah Sakit, butuh kenyamanan”. Keseriusan pihak RS dibuktikan juga dengan membentuk tim khusus untuk menangani program penghijauan ini. Maka terciptalah taman-taman yang indah dan pepohonan yang asri di RS ini (sumber: menuju-rs-hijau-a-asri&catid=69:info-bogoraya&Itemid=116)

89 Rumah Sakit ‘Hijau’ Masih Langka di Indonesia 7 Februari 2012 oleh Redaksi Sudah seharusnya Rumah Sakit yang dibangun ramah lingkungan. Namun di Indonesia, masih banyak rumah sakit yang tidak memperdulikan keselamatan lingkungan, misalnya pembuangan limbah. "Hampir semua rumah sakit menuju 'green hospital' tapi belum ideal sekali" ujar dr. Supriyantoro, Sp.P MARS, Dirjen Bina Upaya Kesehatan saat konferensi pers peresmian ruang isolasi di Rumah Sakit Umum Pusat Persahabatan, Rawamangun, Jakarta Timur. Jum’at (3/2). Kendala dari 'green hospital' ini ada pada proses. Hal utama yakni perubahan dari teknologi dan budaya kerja yang ada. Dari data yang ada, beberapa rumah sakit dikatakan 'merah', artinya masih tidak memenuhi standar rumah sakit dalam mengolah limbah. Beberapa rumah sakit yang masuk dalam daftar merah kebanyakan rumah sakit yang tidak di bawah Kementerian Kesehatan. Rumah sakit tersebut berada dibawah pemerintahan daerah. ‘Green hospital' bukan hanya bangunan rumah sakit yang dicat hijau atau biru. Bukan juga yang asri dan banyak pepohonan, tetapi juga harus tidak memiliki limbah yang merugikan masyarakat. Selain itu, rumah sakit juga harus hemat energi dan air. Sumber daya yang ada harus dikelola dengan efisien dan baik. Rata-rata setiap rumah sakit sudah menerapkan sistem 'green hospital' ini, namun ada beberapa yang belum. Syaratnya saat ini bangunan rumah sakit tidak boleh menghadap ke timur, tapi harus ke utara. Hal ini agar bangunan tidak banyak menggunakan pendingin ruangan. Sumber: %E2%80%98hijau%E2%80%99-masih-langka-di-indonesia….. Diunduh 6/4/2012

90 RS DIDORONG TERAPKAN KONSEP HIJAU | Sabtu, 4 Februari 2012 | 04:00 WIB Rumah sakit didorong menerapkan konsep hijau dalam mengelola gedung dan lingkungannya. Ini dilakukan agar tak menimbulkan kerugian kepada warga sekitar akibat limbah yang dihasilkan. Direktur Bina Upaya Kesehatan Kementerian Kesehatan Supriyantoro, Jumat (3/2), di Jakarta, mengatakan, rumah sakit (RS) yang dikelola baik tidak akan menimbulkan kerugian bagi masyarakat. Rumah sakit yang berkonsep hijau tidak hanya banyak pohon, tetapi juga tidak punya limbah yang berdampak kepada masyarakat. Menurut Supriyantoro, konsep hijau juga terkait efisiensi penggunaan listrik dan air. Dengan demikian, ongkos operasional RS menjadi hemat dan berkelanjutan. Terkait Program Penilaian Peringkat Kinerja Perusahaan dalam Pengelolaan Lingkungan Hidup (Proper), akhir November 2011, Kementerian Lingkungan Hidup mengumumkan 14 RS berkategori biru, 27 RS merah, dan 1 RS hitam. Kategori biru berarti RS menjalankan standar pengelolaan lingkungan. Kategori merah dan hitam berarti RS dinilai masih abai mengelola lingkungan. Sumber: ….. Diunduh 6/4/2012 Human resource management in hospitals has now become a necessity and it has to achieve : 1.effective utilization of human resources; 2.desirable working relationships among all employees; 3.maximum employee development; 4.high morale in the organization; and 5.continuous development and appreciation of human assets.

91 GREEN HOSPITAL by Solikah Sriningsih - Wednesday, 25 May 2011, 11:54 PMSolikah Sriningsih Prinsip Dasar Rumah Sakit Hijau 1.Protecting the immediate health of building occupants The health of patients, staff, and visitors can be profoundly affected by the quality of the indoor air which in turn is dependent upon physical and mechanical design (such as ventilation and location of wastes and toxics), the choice of building materials, the management of construction emissions, and building operations and maintenance. Additionally, access to daylighting has been found to favorably affect staff productivity and patient outcomes. 2.Protecting the health of the surrounding community Local air and water quality is also significantly affected by building design choices. Off-gassing building materials and finishes, construction equipment and HVAC systems directly emit VOCs, particulates and other materials that can result in the formation of ground level ozone (smog), and cause allergic attacks, respiratory problems and other illnesses. Land use and transportation planning, landscape and water management on the grounds and water conservation efforts within the building will influence the amount of toxic emissions released to the water and air throughout the life of the building. 3.Protecting the health of the global community and natural resources The health impact of a building stretches far beyond its immediate community. The production of building materials can result in the release of persistent bioaccumulative toxic compounds, carcinogens, endocrine disruptors and other toxic substances. These compounds threaten communities where the materials are manufactured, and, because of the long life of some of these compounds, can risk the health of communities and ecosystems far from their release.. Sumber: Diunduh 6/4/2012

92 BEBERAPA INDIKATOR KEBERHASILAN GREEN HOSPITAL. Mengurangi KONSUMSI LISTRIK 1.pemanfaatan cahaya alami 2.menggunakan switch timer 3.menggunakan jenis lampu hemat enersi 4.menggunakan AC automatic control 5.membuat ventilasi alami berfungsi pada ruang tertentu dan saat tertentu Hemat Konsumsi AIR BERSIH -menggunakan kran otomatis -menggunakan air bekas untuk flushing dan siram taman, cuci mobil PENCEMARAN LINGKUNGAN 1.mengurangi penggunaan material polutant 2.mengubah perilaku manusia terhadap lingkungan 3.mengusahakan Ruang Terbuka Hijau 4.memperbanyak tanam pohon 5.membuat sumur resapan, biopori, kolam penampungan air hujan EKSPLOITASI SUMBER ALAM -menghemat penggunaan kertas dengan menggunakan teknologi informasi -menghemat penggunaan bahan bakar AIR BUANGAN CUCI DAN MANDI + AIR HUJAN DARI TALANG ATAP digunakan untuk flushing toilet digunakan untuk siram taman cuci mobil sebagai cadangan air pompa kebakaran ENERSI PANAS YANG KELUAR DARI GENSET / TRAFO / BOILER dimanfaatkan sebagai sumber enersi lain KERTAS BEKAS FOTO COPY digunakan kembali pada sisi belakangnya digunakan untuk keperluan lainnya MENGUBAH PERILAKU MANUSIA TERHADAP LINGKUNGAN 1.Stop penggunaan bahan mengandung mercury dan PVC 2.Tidak menggunakan incenerator yg menghasilkan racun/polusi udara 3.Hemat penggunaan enersi (lampu, AC) 4.Hemat penggunaan air dan kertas 5.Memilah sampah di tempat pembuangan Sumber: ….. Diunduh 6/4/2012


94 RUMAH SAKIT PENDIDIKAN UNILA GUNAKAN KONSEP TEKNOLOGI HIJAU “Selain ramah lingkungan, bangunan RSP ini juga hemat energi karena untuk pencahayaannya didesain agar optimal menyerap cahaya matahari sehingga hemat listrik (Sulastri, pembantu rektor UNILA). RSP ini memiliki fungsi pendidikan, penelitian, dan pengabdian pada masyarakat. Sehingga penggunaannya tidak untuk tujuan komersil. Pada saat ini proyek pembangunan RSP pada lahan seluas 10,8 hektar tersebut sudah memasuki tahap pertama, yakni land clearing dan pembangunan struktur bangunan. “Pada tahap pertama, biayanya sudah mencapai Rp. 52, 8Milyar. Bangunan ini diperkirakan akan menelan biaya untuk bangunan fisik hingga Rp. 400 Milyar. Sumber: sakit-pendidikan-unila-gunakan-konsep-teknologi-hijau ….. Diunduh 6/4/2012 RS PENDIDIKAN Rumah sakit pendidikan merupakan fasilitas yang sangat krusial dalam pendidikan kedokteran. Di rumah sakit pendidikanlah mahasiswa kedokteran langsung terjun untuk mendapatkan pengalaman dalam menangani berbagai macam penyakit. Misalnya, FKUI telah menjalin kerjasama dengan berbagai rumah sakit yang dinilai layak untuk tempat penyelenggaraan kegiatan akademik bagi para mahasiswa untuk semua jenjang program pendidikan FKUI. Selain itu juga diharapkan agar dapat terjalin kerja sama yang aktif dan efektif dalam meningkatkan mutu pelayanan, pendidikan, penelitian kedokteran dan ilmu terkait lainnya. (sumber:

95 Lampung, Pelita ; Senin, 12 Desember 2011 Pemkab Meminta RSUD Menambah Ruang Hijau di Area Rumah Sakit Pemerintah Kabupaten Lampung Selatan (Pemkab) meminta Rumah Sakit Umum Daerah (RSUD) untuk menambah ruang terbuka hijau di area rumah sakit. Hal ini berkaitan dengan upaya mempertahankan predikat Adipura mendatang. Berdasarkan evaluasi tahap pertama yang dilakukan Badan Lingkungan Hidup (BLH) dan Dinas pasar, Kebersihan dan Keindahan (DKK), di RSUD Kalianda penghijauan di tempat itu masih rendah. Kami berharap penghijauan di RSUD Kalianda dapat ditambah, hal ini dilakukan selain dapat menambah keindahan, penghijauan juga berguna untuk menyerap karbondioksida di lingkungan rumah sakit. Berbagai item penilaian di RSUD Kalianda sebetulnya sudah cukup baik, misalnya dari segi kebersihan, pengelola IPAL dan Uji Laboratorium sudah mendukung. Evaluasi penilaian Adipura ini juga dilakukan di sekolah-sekolah yang ada di Kalianda, evaluasi yang kita laksanakan agar dalam penilaian Sumber: ruang-hijau-di-area-rumah-sakit/ ….. Diunduh 6/4/2012 Ruang Terbuka Hijau Secara umum ruang terbuka publik (open spaces) di perkotaan terdiri dari ruang terbuka hijau dan ruang terbuka nonhijau. Ruang Terbuka Hijau (RTH) perkotaan adalah bagian dari ruang-ruang terbuka (open spaces) suatu wilayah perkotaan yang diisi oleh tumbuhan, tanaman dan vegetasi (endemik maupun introduksi) guna mendukung manfaat ekologis, sosial-budaya dan arsitektural yang dapat memberikan manfaat ekonomi (kesejahteraan) bagi masyarakatnya. Ruang terbuka nonhijau dapat berupa ruang terbuka yang diperkeras (paved) maupun ruang terbuka biru (RTB) yang berupa permukaan sungai, danau, maupun areal-areal yang diperuntukkan sebagai genangan retensi. Secara fisik RTH dapat dibedakan menjadi RTH alami yang berupa habitat liar alami, kawasan lindung dan taman-taman nasional, maupun RTH nonalami atau binaan yang seperti taman, lapangan olah raga, dan kebun bunga.

96 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis PENGERTIAN KEPUASAN Kepuasan menurut Kamus Bahasa Indonesia adalah puas; merasa senang; perihal (hal yang bersifat puas, kesenangan, kelegaan dan sebagainya). Kepuasan dapat diartikan sebagai perasaan puas, rasa senang dan kelegaan seseorang dikarenakan mengkonsumsi suatu produk atau jasa untuk mendapatkan pelayanan suatu jasa. Menurut Oliver (dalam Supranto, 2001) mendefinisikan kepuasan sebagai tingkat perasaan seseorang setelah membandingkan kinerja atau hasil yang dirasakannya dengan harapannya. Tingkat kepuasan merupakan fungsi dari perbedaan antara kinerja yang dirasakan dengan harapan. Apabila kinerja dibawah harapan, maka pelanggan akan sangat kecewa. Bila kinerja sesuai harapan, maka pelanggan akan sangat puas. Sedangkan bila kinerja melebihi harapan pelanggan akan sangat puas harapan pelanggan dapat dibentuk oleh pengalaman masa lampau, komentar dari kerabatnya serta janji dan informasi dari berbagai media. Pelanggan yang puas akan setia lebih lama, kurang sensitive terhadap harga dan memberi komentar yang baik tentang perusahaan tersebut. Menurut Kotler (1988) kepuasan adalah tingkat kepuasan seseorang setelah membandingkan kinerja atau hasil yang dirasakan dibandingkan dengan harapannya. Jadi kepuasan atau ketidakpuasan adalah kesimpulan dari interaksi antara harapan dan pengalaman sesudah memakai jasa atau pelayanan yang diberikan. Upaya untuk mewujudkan kepuasan pelanggan total bukanlah hal yang mudah, Mudie dan Cottom menyatakan bahwa kepuasan pelanggan total tidak mungkin tercapai, sekalipun hanya untuk sementara waktu (Tjiptono, 1997). Berdasarkan uraian dari beberapa ahli tersebut diatas, maka dapat disimpulkan bahwa kepuasan adalah perasaan senang, puas individu karena antara harapan dan kenyataan dalam memakai dan pelayanan yang diberikan terpenuhi. Sumber: rumah-sakit/ ….. Diunduh 6/4/2012

97 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis Memahami kebutuhan dan keinginan pasien adalah hal penting yang mempengaruhi kepuasan pasien. Pasien yang puas merupakan aset yang sangat berharga karena apabila pasien puas mereka akan terus melakukan pemakaian terhadap jasa pilihannya, tetapi jika pasien merasa tidak puas mereka akan memberitahukan dua kali lebih hebat kepada orang lain tentang pengalaman buruknya. Untuk menciptakan kepuasan pasien suatu perusahaan atau rumah sakit harus menciptakan dan mengelola suatu system untuk memperoleh pasien yang lebih banyak dan kemampuan untuk mempertahankan pasiennya. Upaya untuk meningkatkan kepuasan konsumen dapat dilakukan dengan berbagai strategi untuk dapat merebut pelanggan. Junaidi (2002) berpendapat bahwa kepuasan konsumen atas suatu produk berhubungan erat dengan kinerja yang dirasakan konsumen atas poduk tersebut. Jika kinerja produk lebih tinggi dari harapan konsumen maka konsumen akan mengalami kepuasan. Hal yang hampir serupa dikemukakan oleh Indarjati (2001) yang menyebutkan adanya tiga macam kondisi kepuasan yang bisa dirasakan oleh konsumen berkaitan dengan perbandingan antara harapan dan kenyataan, yaitu jika harapan atau kebutuhan sama dengan layanan yang diberikan maka konsumen akan merasa puas. Jika layanan yang diberikan pada konsumen kurang atau tidak sesuai dengan kebutuhan atau harapan konsumen maka konsumen menjadi tidak puas. Kepuasan konsumen merupakan perbandingan antara harapan yang dimiliki oleh konsumen dengan kenyataan yang diterima oleh konsumen dengan kenyataan yang diterima oleh konsumen dengan kenyataan yang diterima oleh konsumen pada saat mengkonsumsi produk atau jasa. Konsumen yang merasa puas atas suatu produk atau jasa dapat dikategorikan ke dalam konsumen masyarakat, konsumen instansi dan konsumen individu. Pasien adalah orang yang karena kelemahan fisik atau mentalnya menyerahkan pengawasan dan perawatannya, menerima dan mengikuti pengobatan yang ditetapkan oleh tenaga kesehatan (Prabowo, 1999). Sedangkan Aditama (2002) berpendapat bahwa pasien adalah mereka yang di obati dirumah sakit. Berdasarkan uraian diatas, maka dapat disimpulkan bahwa kepuasan pasien adalah perasaan senang, puas individu karena terpenuhinya harapan atau keinginan dalam menerima jasa pelayanan kesehatan. Sumber: rumah-sakit/ ….. Diunduh 6/4/2012 Pengertian kepuasan pasien

98 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis Menurut Budiastuti (2002), pasien dalam mengevaluasi kepuasan terhadap jasa pelayanan yang diterimanya mengacu pada beberapa faktor, antara lain : 1.Kualitas produk atau jasa. Pasien akan merasa puas bila hasil evaluasi mereka menunjukkan bahwa produk atau jasa yang digunakan berkualitas. Persepsi konsumen terhadap kualitas poduk atau jasa dipengaruhi oleh dua hal yaitu kenyataan kualitas poduk atau jasa yang sesungguhnya dan komunikasi perusahaan terutama iklan dalam mempromosikan rumah sakitnya. 2.Kualitas pelayanan. Memegang peranan penting dalam industri jasa. Pelanggan dalam hal ini pasien akan merasa puas jika mereka memperoleh pelayanan yang baik atau sesuai dengan yang diharapkan. 3.Faktor emosional. Pasien yang merasa bangga dan yakin bahwa orang lain kagum terhadap konsumen bila dalam hal ini pasien memilih rumah sakit yang sudah mempunyai pandangan “rumah sakit mahal”, cenderung memiliki tingkat kepuasan yang lebih tinggi. 4.Harga. Harga merupakan aspek penting, namun yang terpenting dalam penentuan kualitas guna mencapai kepuasan pasien. Meskipun demikian elemen ini mempengaruhi pasien dari segi biaya yang dikeluarkan, biasanya semakin mahal harga perawatan maka pasien mempunyai harapan yang lebih besar. Sedangkan rumah sakit yang berkualitas sama tetapi berharga murah, memberi nilai yang lebih tinggi pada pasien. 5.Biaya. Mendapatkan produk atau jasa, pasien yang tidak perlu mengeluarkan biaya tambahan atau tidak perlu membuang waktu untuk mendapatkan jasa pelayanan, cenderung puas terhadap jasa pelayanan tersebut. Sumber: rumah-sakit/ ….. Diunduh 6/4/2012 Faktor yang mempengaruhi kepuasan pasien

99 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis 1.Kinerja (performance), berpendapat pasien terhadap karakteristik operasi dari pelayanan inti yang telah diterima sangat berpengaruh pada kepuasan yang dirasakan. Wujud dari kinerja ini misalnya : kecepatan, kemudahan, dan kenyamanan bagaimana perawat dalam memberikan jasa pengobatan terutama keperawatan pada waktu penyembuhan yang relatif cepat, kemudahan dalam memenuhi kebutuhan pasien dan kenyamanan yang diberikan yaitu dengan memperhatikan kebersihan, keramahan dan kelengkapan peralatan rumah sakit. 2.Ciri-ciri atau keistimewaan tambahan (features), merupakan karakteristik sekunder atau karakteristik pelengkap yang dimiliki oleh jasa pelayanan, misalnya : kelengkapan interior dan eksterior seperti televisi, AC, sound system, dan sebagainya. 3.Keandalan (reliability), sejauhmana kemungkinan kecil akan mengalami ketidakpuasan atau ketidaksesuaian dengan harapan atas pelayanan yang diberikan. Hal ini dipengaruhi oleh kemampuan yang dimiliki oleh perawat didalam memberikan jasa keperawatannya yaitu dengan kemampuan dan pengalaman yang baik terhadap memberikan pelayanan keperawatan dirumah sakit. 4.Kesesuaian dengan spesifikasi (conformance to spesification), yaitu sejauh mana karakteristik pelayanan memenuhi standart-standart yang telah ditetapkan sebelumnya. Misalnya : standar keamanan dan emisi terpenuhi seperti peralatan pengobatan. 5.Daya tahan (durability), berkaitan dengan beberapa lama produk tersebut digunakan. Dimensi ini mencakup umur teknis maupun umur ekonomis dalam penggunaan peralatan rumah sakit, misalnya : peralatan bedah, alat transportasi, dan sebagainya. 6.Service ability, meliputi kecepatan, kompetensi, serta penanganan keluhan yang memuaskan. Pelayanan yang diberikan oleh perawat dengan memberikan penanganan yang cepat dan kompetensi yang tinggi terhadap keluhan pasien sewaktu-waktu. 7.Estetika, merupakan daya tarik rumah sakit yang dapat ditangkap oleh panca indera. Misalnya : keramahan perawat, peralatan rumah sakit yang lengkap dan modern, desain arsitektur rumah sakit, dekorasi kamar, kenyamanan ruang tunggu, taman yang indah dan sejuk, dan sebagainya. 8.Kualitas yang dipersepsikan (perceived quality), citra dan reputasi rumah sakit serta tanggung jawab rumah sakit. Bagaimana kesan yang diterima pasien terhadap rumah sakit tersebut terhadap prestasi dan keunggulan rumah sakit daripada rumah sakit lainnya dan tangggung jawab rumah sakit selama proses penyembuhan baik dari pasien masuk sampai pasien keluar rumah sakit dalam keadaan sehat. Sumber: sakit/ ….. Diunduh 6/4/2012 Tjiptono (1997) kepuasan pasien ditentukan oleh faktor :

100 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis Menurut Moison, Walter dan White (dalam Haryanti, 2000), faktor yang mempengaruhi kepuasan konsumen, yaitu : 1.Karakteristik produk, produk ini merupakan kepemilikan rumah sakit yang bersifat fisik antara lain gedung dan dekorasi. Karakteristik produk rumah sakit meliputi penampilan bangunan rumah sakit, kebersihan dan tipe kelas kamar yang disediakan beserta kelengkapannya. 2.Harga, yang termasuk didalamnya adalah harga produk atau jasa. Harga merupakan aspek penting, namun yang terpenting dalam penentuan kualitas guna mencapai kepuasan pasien. Meskipun demikian elemen ini mempengaruhi pasien dari segi biaya yang dikeluarkan, biasanya semakin mahal harga perawatan maka pasien mempunyai harapan yang lebih besar. 3.Pelayanan, yaitu pelayanan keramahan petugas rumah sakit, kecepatan dalam pelayanan. Rumah sakit dianggap baik apabila dalam memberikan pelayanan lebih memperhatikan kebutuhan pasien maupun orang lain yang berkunjung di rumah sakit. kepuasan muncul dari kesan pertama masuk pasien terhadap pelayanan keperawatan yang diberikan. Misalnya : pelayanan yang cepat, tanggap dan keramahan dalam memberikan pelayanan keperawatan. 4.Lokasi, meliputi letak rumah sakit, letak kamar dan lingkungannya. Merupakan salah satu aspek yang menentukan pertimbangan dalam memilih rumah sakit. Umumnya semakin dekat rumah sakit dengan pusat perkotaan atau yang mudah dijangkau, mudahnya transportasi dan lingkungan yang baik akan semakin menjadi pilihan bagi pasien yang membutuhkan rumah sakit tersebut. 5.Fasilitas, kelengkapan fasilitas rumah sakit turut menentukan penilaian kepuasan pasien, misalnya fasilitas kesehatan baik sarana dan prasarana, tempat parkir, ruang tunggu yang nyaman dan ruang kamar rawat inap. Walaupun hal ini tidak vital menentukan penilaian kepuasan pasien, namun rumah sakit perlu memberikan perhatian pada fasilitas rumah sakit dalam penyusunan strategi untuk menarik konsumen. Sumber: rumah-sakit/ ….. Diunduh 6/4/2012

101 1.Image, yaitu citra, reputasi dan kepedulian rumah sakit terhadap lingkungan. Image juga memegang peranan penting terhadap kepuasan pasien dimana pasien memandang rumah sakit mana yang akan dibutuhkan untuk proses penyembuhan. Pasien dalam menginterpretasikan rumah sakit berawal dari cara pandang melalui panca indera dari informasi-informasi yang didapatkan dan pengalaman baik dari orang lain maupun diri sendiri sehingga menghasilkan anggapan yang positif terhadap rumah sakit tersebut, meskipun dengan harga yang tinggi. Pasien akan tetap setia menggunakan jasa rumah sakit tersebut dengan harapan-harapan yang diinginkan pasien. 2.Desain visual, meliputi dekorasi ruangan, bangunan dan desain jalan yang tidak rumit. Tata ruang dan dekorasi rumah sakit ikut menentukan kenyamanan suatu rumah sakit, oleh karena itu desain dan visual harus diikutsertakan dalam penyusunan strategi terhadap kepuasan pasien atau konsumen. 3.Suasana, meliputi keamanan, keakraban dan tata lampu. Suasana rumah sakit yang tenang, nyaman, sejuk dan indah akan sangat mempengaruhi kepuasan pasien dalam proses penyembuhannya. Selain itu tidak hanya bagi pasien saja yang menikmati itu akan tetapi orang lain yang berkunjung ke rumah sakit akan sangat senang dan memberikan pendapat yang positif sehingga akan terkesan bagi pengunjung rumah sakit tersebut. 4.Komunikasi, yaitu tata cara informasi yang diberikan pihak penyedia jasa dan keluhan-keluhan dari pasien. Bagaimana keluhan-keluhan dari pasien dengan cepat diterima oleh penyedia jasa terutama perawat dalam memberikan bantuan terhadap keluhan pasien. Misalnya adanya tombol panggilan didalam ruang rawat inap, adanya ruang informasi yang memadai terhadap informasi yang akan dibutuhkan pemakai jasa rumah sakit seperti keluarga pasien maupun orang yang bekunjung di rumah sakit. aka dapat ditarik kesimpulan bahwa faktor-faktor kepuasan pasien adalah : kualitas jasa, harga, emosional, kinerja, estetika, karakteristik produk, pelayanan, lokasi, fasilitas, komunikasi, suasana, dan desain visual. Sumber: ….. Diunduh 6/4/2012 KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis Faktor kepuasan konsumen (lanjutan):

102 Aspek – aspek yang mempengaruhi kepuasan pasien (Griffith, 1987): 1.Sikap pendekatan staf pada pasien yaitu sikap staf terhadap pasien ketika pertama kali datang di rumah sakit. 2.Kualitas perawatan yang diterima oleh pasien yaitu apa saja yang telah dilakukan oleh pemberi layanan kepada pasien, seberapa pelayanan perawatan yang berkaitan dengan proses kesembuhan penyakit yang diderita pasien dan kelangsungan perawatan pasien selama berada dirumah sakit. 3.Prosedur administrasi yaitu berkaitan dengan pelayanan administrasi pasien dimulai masuk rumah sakit selama perawatan berlangsung sampai keluar dari rumah sakit. 4.Waktu menunggu yaitu berkaitan dengan waktu yang diperbolehkan untuk berkunjung maupun untuk menjaga dari keluarga maupun orang lain dengan memperhatikan ruang tunggu yang memenuhi standar-standar rumah sakit antara lain : ruang tunggu yang nyaman, tenang, fasilitas yang memadai misalnya televisi, kursi, air minum dan sebagainya. 5.Fasilitas umum yang lain seperti kualitas pelayanan berupa makanan dan minuman, privasi dan kunjungan. Fasilitas ini berupa bagaimana pelayanan terhadap pemenuhan kebutuhan pasien seperti makanan dan minuman yang disediakan dan privasi ruang tunggu sebagai sarana bagi orang-orang yang berkunjung di rumah sakit. 6.Fasilitas ruang inap untuk pasien yang harus rawat. Fasilitas ruang inap ini disediakan berdasarkan permintaan pasien mengenai ruang rawat inap yang dikehendakinya. 7.Hasil treatment atau hasil perawatan yang diterima oleh pasien yaitu perawatan yang berkaitan dengan kesembuhan penyakit pasien baik berapa operasi, kunjungan dokter atau perawat. 8.Tingkat kepuasan antar individu satu dengan individu lain berbeda. Hal ini terjadi karena adanya pengaruh dari faktor jabatan, umur, kedudukan sosial, tingkat ekonomi, pendidikan, jenis kelamin, sikap mental dan kepribadian. 9.Kepuasan pasien atau konsumen berdasarkan teori-teori diatas tidak hanya dipengaruhi oleh jasa yang dihasilkan oleh suatu rumah sakit semata, tetapi juga dipengaruhi oleh pelayanan yang diberikan oleh petugas rumah sakit baik dokter, perawat, dan karyawan-karyawan lainnya. KEPUASAN PASIEN TERHADAP PELAYANAN RUMAH SAKIT Posted on December 28, 2007 by klinis Sumber: rumah-sakit/ ….. Diunduh 6/4/2012

103 ASPEK-ASPEK KEPUASAN PASIEN RUMAH SAKIT Aspek-aspek yang mempengaruhi kepuasan pasien adalah : 1.Sikap pendekatan staf pada pasien yaitu sikap staf terhadap pasien ketika pertama kali datang di rumah sakit. 2.Kualitas perawatan yang diterima oleh pasien yaitu apa saja yang telah dilakukan oleh pemberi layanan kepada pasien, seberapa pelayanan perawatan yang berkaitan dengan proses kesembuhan penyakit yang diderita pasien dan kelangsungan perawatan pasien selama berada dirumah sakit. 3.Prosedur administrasi yaitu berkaitan dengan pelayanan administrasi pasien dimulai masuk rumah sakit selama perawatan berlangsung sampai keluar dari rumah sakit. 4.Fasilitas – fasilitas yang disediakan rumah sakit yaitu fasilitas ruang inap, kualitas makanan atau kios-kios penjual makanan yang terjamin kesehatannya, privasi dan waktu kunjungan pasien. Sumber: rumah-sakit/ ….. Diunduh 6/4/2012 Ada lima gap yang memungkinkan kegagalan penyampaian layanan jasa : 1.Gap antara harapan konsumen dan persepsi manejemen. 2.Gap antara persepsi menejemen dan spesifikasi kualitas jasa 3.Gap antara spesifikasi kualitas penyampaian jasa. 4.Gap antara penyampaian jasa dan komunikasi eksternal. 5.Gap antara jasa yang dipersepsikan dan jasa yang diharapkan. Untuk mewujudkan dan mempertahankan kepuasan pelanggan organisasi jasa harus melakukan empat hal (Fandi Tjiptono, 2006). 1. Mengidentifikasi siapa pelanggannya. 2. Memahami tingkat harapan pelanggan atas kualitas. 3. Memahami strategi kualitas pelayanan pelanggan. 4. Memahami siklus pengukuran umpan balik dari kepuasan pelanggan. (sumber: -)

104 Towards a Green Hospital Subtitle: The hospital as a concept and as a type of building, warrants reconsideration. Challenges and considerations in planning Green Hospitals of the future. Speaker: Dr. Wolfgang Sittel, Head of Architecture and Design at Asklepios Hospital Group and initiator of the Asklepios Green Hospital Program Location: Asia-Pacific Weeks Berlin Date: 8. September 2011 The key topic of this session is „Towards a Green Hospital“. And in line with this, we’ve just enjoyed a presentation on some very interesting facts and figures detailing solution scenarios, economic aspects and the value of Green Hospitals. Now, as you know, the Asklepios Hospital Group, with its more than one hundred and eleven hospitals and welfare institutions, employing over thirty six thousand staff is one of the largest and most successful group of hospitals in Europe. I’m also here today because I would like to create a greater understanding of why this initiative was created, why we actively support it and why Asklepios, from the perspective of a Hospital Group, considers the Green Hospital concept to be eminently important for the German hospital and healthcare market. Furthermore, I’d also like to provide answers to questions such as: How do we achieve a ‘Green Hospital of the Future’ together? What is needed here? And: What is important? In preparing for this presentation I did some research on the internet, among other sources of information. There I found that many hospitals are described as ‚Green Hospitals’, “Energy-Saving Hospitals”, as “Climate-Friendly Hospitals”. Sumber: Diunduh 6/4/2012

105 "GREEN HOSPITAL" PROJECT SETTING STANDARDS IN HEALTHCARE Customer Challenge Worldwide, the healthcare sector is faced with new challenges when it comes to the planning of hospitals and healthcare institutions. As natural resources dwindle and costs rise, ways to minimise the impact that healthcare delivery has on the environment are in greater demand than ever. Solution The "Green Hospital" project is based on a multi-dimensional approach: the combination of ecology, economy and well-being of people in a hospital. GE will provide the necessary innovative solutions from its different businesses, optimising the efficiencies of the design. The GE technologies involved in this project are Power-Heat-Cooling co-generation, solar heat, and cold, energy efficient medical equipment and lighting as well as systems for water purification reuse. As part of the implementation of the project, the aim is to increase energy efficiency by 30 percent while at the same time reducing energy consumption by 30 percent and expanding the proportion of renewable energies in the energy mix by up to 30 percent. This model is geared towards the European Union's target for the expansion of renewable energies. The energy efficiency principles will be employed both in the conversion of existing buildings and the construction of new facilities with an expected finalisation of the project planned for Sumber: ….. Diunduh 6/4/2012

106 April 07, 2009 HOSPITALS: SETTING A GREEN STANDARD by Eileen Weber Hospitals are recycling light bulbs and batteries. They are using green cleaning products. Even choosing to switch from cotton mop heads to microfiber saves thousands of gallons of water every year. They are even incorporating nature as part of the healing process with rooftop gardens and balconies open for fresh air. Studies have shown that patients who have some connection to nature have lower stress levels and recover more quickly. But it doesn’t stop there. Practicing a healthy green business is great. But it’s even better in a green building. According to an article dated March 27th in The Boston Globe, more hospitals are seeing the long-term benefit of renovating in an environmentally friendly way. They have included everything from LED lighting to high efficiency glass to low VOC paints and adhesives to roof top solar panels.The Boston Globe Here in Connecticut, there are a few hospitals in particular that stand out in their quest to be green. Yale-New Haven and Bridgeport Hospitals have either renovated their space to be energy efficient and LEED-certified or changed their daily routines to be more environmentally-friendly. According to their December 2007 press release, Yale-New Haven Hospital was the first in the state to register for LEED certification. Smilow Cancer Hospital, the hospital’s latest addition slated to open at the end of this year, boasts local building materials, enhanced ventilation systems, low VOC paints and adhesives, as well as a healing rooftop garden, to name a few. Yale-New Haven has long been associated with environmentally friendly practices. Bridgeport Hospital has been no slouch either when it comes to the environment. According to an article dated August 20, 2008 in The Connecticut Post, the hospital started going green about 10 years ago. The hospital is a member of Practice Greenhealth, a non-profit organization geared toward sustainable health care. They have focused on reducing their toxic waste as well as recycling equipment and using eco-friendly products.The Connecticut Post “We’ve taken a number of steps toward a green initiative,” said John Cappiello, Media Relations Coordinator for Bridgeport Hospital. “We’ve done everything from saving on electrical costs to recycling literally tons of stuff.” “It is made up of staff from all over the hospital: nursing, operations, food and nutrition, laboratory, radiology, etc. It is a very passionate and dynamic group of staff who all are committed to providing a green environment.” Brunetti also said the hospital reprocesses certain types of used surgical supplies. They also return any unopened or unused pharmaceuticals. They even use green cleaning products and have reduced the amount of chemicals used to clean the floors by 85%. Sumber: green-standard.html ….. Diunduh 6/4/2012

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