HOSPITAL ORGANIZATION Present by FAROUK ILMID DAVIKNIM KRISBIANTONIM

Legal Basis The order of laws and regulations governing the organization of hospitals in the Unitary State of the Republic of Indonesia: 2 Undang-Undang Nomor 44 Tahun 2009 tentang Rumah Sakit, dan Peraturan Presiden Nomor 77 Tahun 2015 tentang Pedoman Organisasi Rumah Sakit. Keputusan Presiden Nomor 40 Tahun 2001 tentang Pedoman Kelembagaan dan Pengelolaan Rumah Sakit Daerah

Legal Basis 3 Pedoman Pengorganisasian Komite Etik Rumah Sakit dan Majelis Kehormatan Etik Rumah Sakit Indonesia PERSI-MAKERSI, 2009 Peraturan Menteri Kesehatan Nomor 755/MENKES/PER/IV/2011 Tentang Penyelenggaraan Komite Medik di Rumah Sakit Peraturan Menteri Kesehatan Nomor 1691/MENKES/PER/VIII/2011 tentang Keselamatan Pasien Rumah Sakit Peraturan Menteri Kesehatan Nomor 49 Tahun 2013 tentang Komite Keperawatan Rumah Sakit Peraturan Menteri Kesehatan Republik Indonesia Nomor 10 Tahun 2014 Tentang Dewan Pengawas Rumah Sakit Peraturan Menteri Kesehatan Nomor 58 Tahun 2014 tentang Standar Pelayanan Kefarmasian di Rumah Sakit Peraturan Menteri Kesehatan Nomor 8 Tahun 2015 tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit Peraturan Pemerintah Nomor 93 Tahun 2015 tentang Rumah Sakit Pendidikan

Hospital Overview Hospitals are health service institutions that provide full-scale personal health services that provide inpatient, outpatient, and emergency services (UU No. 44 tahun 2009 tentang Rumah Sakit ) 4

Tasks and Functions of hospitals (UU No. 44 tahun 2009 tentang Rumah Sakit) Hospital Tasks: Hospitals have the duty to provide personal health services in a plenary. Hospital Functions: 1)Health care and medical recovery services in accordance with hospital service standards; 2)Maintenance and improvement of individual health through health services that are second to third level in accordance with the medical needs; 3)Organizing education and training of human resources in the context of capacity building in the provision of health services; and 4)The implementation of research and development and screening of health technology in the framework of improving health services by taking into account the ethics of health sciences 5

General Terms of Hospital Organization (PP No.77 Tahun 2015 tentang Pedoman Organisasi RS) Hospital organization was established in order to realize an effective, efficient and accountable hospital in order to achieve the vision and mission of the hospital in accordance with good corporate governance and good clinical governance Hospital organization is made by adjusting to the amount of activity and workload of hospital. This adjustment is made by dividing up all the duties and functions of the organization structure The compulsory principles that must be applied by the organization's leaders in the hospital are coordination, integration, simplification, synchronization and mechanization within their respective environments and with other units 6

General Terms of Hospital Organization (PP No.77 Tahun 2015 tentang Pedoman Organisasi RS) Organization of the hospital consists of several organizational elements that can be a directorate, department, division, installation, work unit, committee and / or unit. The principle of establishment element of hospital organization adjusted with requirement, work load, and / or classification of hospital. The organization of the hospital consists of at least: 1)head of hospital or hospital director; 2)elements of medical services; 3)elements of nursing; 4)medical supporting elements; 5)elements of general administration and finance; 6)medical committee; and 7)internal audit unit 7

General Terms of Hospital Organization (PP No.77 Tahun 2015 tentang Pedoman Organisasi RS) In additional to the Medical Committee, hospitals may establish other committees for the organization of certain functions in hospitals according to the needs and development of science and technology in order to improve the quality of patient care and safety. Other committees may be committees on : 1)nursing; 2)pharmacy and therapy; 3)infection prevention and control; 4)control of antimicrobial resistance; 5)ethics and law; 6)education coordination; and 7)risk management and patient safety 8

Example of Hospital Organization Structure 9

RSUD Soetomo 10

RSAL Ramelan Surabaya 11

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RS Pendidikan UNAIR 13

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RSU HAJI Surabaya 15

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Struktur Organisasi RS Khusus 18

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RSIA Soerya 21

Hospital Organization Elements The structural sub organization that exists within the hospital environment: 1)head of hospital or hospital director; 2)elements of medical services; 3)elements of nursing; 4)medical supporting element; 5)elements of general administration and finance; 6)committees: the Medical Committee; Nursing Committee, Infection Prevention and Control Committee (PPI), Pharmaceutical and Therapeutic Committee (KFT), Antimicrobial Resistance Control Committee (KPRA), Hospital Ethics and Law Committee, Education Coordination Committee, Risk Management and Patient Safety Committee. 7)internal check unit 22

Hospital Director (UU. No.44 Tahun 2009 tentang Rumah Sakit) the director of the hospital is the supreme leader with the name of the chief office, the president director, or the director. The head of the hospital or director of the hospital should be a medical practitioner who has the skills and expertise in the field of hospitalization. Structural personnel who occupy the position as head of the hospital must be Indonesian citizenship. The head of the hospital should not be a concurrent owner of a hospital 23

The task of the hospital director is to lead the organization of the hospital, with the function of: 1)coordination of duties and functions of organizational elements; 2)stipulation of the policy of organization of the hospital in accordance with its authority; 3)organization of duties and functions of the hospital; 4)guidance, supervision, and controlling the execution of duties and functions of organizational elements; and 5)evaluation, recording, and reporting 24

The medical service element The medical service element is one of the elements of hospital organization in the field of medical services that is under and responsible to the head of hospital or hospital director. Medical service units include outpatient, inpatient, and emergency services. The medical service elements are led by directors, deputy directors, chiefs, or managers. Elements of this medical service in charge of performing medical services by organizing functions: 1)preparation of plans for the provision of medical services; 2)coordination and implementation of medical services; 3)implementation of quality control, cost control, and patient safety in the field of medical services; and 4)monitoring and evaluation of medical services 25

The Nursing service elements (PP No.77 Tahun 2015 Tentang Pedoman Organisasi Rumah Sakit) The element of nursing is one element of the organization of hospitals in the field of nursing services that are under and responsible to the head of the hospital or hospital director. The nursing element is led by the director, deputy director, head of field, or manager. This nursing element is in charge of performing nursing services by performing the functions of: 1)preparation of a plan for the delivery of nursing services; 2)coordination and implementation of nursing services; 3)implementation of quality control, cost control, and patient safety in the field of nursing services; and 4)monitoring and evaluation of nursing services 26

The medical support element (PP No.77 Tahun 2015 Tentang Pedoman Organisasi Rumah Sakit)  The medical support element is one of the elements of the organization of the hospital in the field of medical support services under and responsible to the head of the hospital or the director of the hospital.  The medical support element is led by the director, deputy director, head of field, or manager.  This medical support element is in charge of performing medical support services by performing the functions of: 1)preparation of plans to provide medical support services; 2)coordination and implementation of medical support services; 3)implementation of quality control, cost control, and patient safety in the field of medical support services; and 4)monitoring and evaluation of medical support services 27

General administrative (PP No.77 Tahun 2015 Tentang Pedoman Organisasi Rumah Sakit)  General administrative and financial elements are led by directors, deputy directors, chiefs, or managers. This general and financial administration element is tasked with carrying out general and financial administration.  In carrying out general administrative tasks, general administrative elements by organizing management functions: 1)administration; 2)housekeeping; 3)legal services and partnerships; 4)marketing; 5)public relations; 6)recording, reporting, and evaluation; 7)research and development; 8)human Resources; and 9)education and training. 28

Task of Finance Element 29

HRD and Marketing 30

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Medical Record 32

BPJS in Hospital 33

The Medical Committee (Permenkes No.755 tahun 2011 tentang Penyelenggaraan Komite Medik di Rumah Sakit) (PP No.77 Tahun 2015 Tentang Pedoman Organisasi Rumah Sakit)  The Medical Committee is an organizational element that has the responsibility to apply good clinical governance.  The Medical Committee is established by and responsible to the head of the Hospital or the director of the Hospital  The Medical Committee is in charge of improving the professionalism of medical staff working in hospitals by: 1)Conduct credentials for all medical staff who will perform medical services at the hospital; 2)Maintaining professional quality of medical staff; and 3)Maintain discipline, ethics, and professional behavior of medical staff. 34

Nursing Committee PP No.77 Tahun 2015 Tentang Pedoman Organisasi RS PMK. No.49 Tahun 2013 Tentang Komite Keperawatan Rumah Sakit  Committee of Nursing is an organizational element of the hospital that has the main function of maintaining and improving the professionalism of nursing personnel through credential mechanisms,, and maintenance of ethics and professional discipline.  The implementation of the Nursing Committee aims to improve the professionalism of nursing personnel (nurses and midwives) and to manage good clinical governance so that the quality of nursing services and obstetric care oriented to patient safety in hospitals is more secure and protected. 35

Structure Nursing Committee PMK. No.49 Tahun 2013 Tentang Komite Keperawatan Rumah Sakit 36

The infection prevention and control committee PMK. No Tahun 2011 Tentang Keselamatan Pasien di RS  The infection prevention and control committee is an organizational element established by hospitals to perform infection prevention and control functions in hospitals.  The PPI committee plays a role in preventing the spread of resistant microbes through: 1)application of standard precautions, 2)surveillance of infection cases caused by multiresisten microbes, 3)cohorting / isolation for infection patients caused by multiresisten microbes, 4)drafting guidelines for handling extraordinary microbe multiresisten events 37

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The Pharmacy and Therapy Committee (KFT) PMK No.58 Tahun 2014 Tentang Standar Pelayanan Kefarmasian di Rumah Sakit  The Pharmacy Therapy Team (TFT) is an organizational element that provides recommendations to hospital leaders regarding drug use policies in hospitals.  The members of this team consist of doctors representing all the specialties in hospitals, pharmacists, and other health workers.  KFT / TFT has the primary duty of developing a policy on medication use in hospitals 39

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The antimicrobial resistance control committee PMK. No.8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit  The antimicrobial resistance control committee is an organizational element established by hospitals in order to control the widespread use of antimicrobials both in health care facilities and in society  In its implementation, KPRA is a team of implementing antimicrobial resistance control program which at least consists of: 1)SMF representative clinician / section; 2)nursing; 3)pharmaceutical installation; 4)clinical microbiology laboratory; 5)committee / team of Prevention of Infection Control (PPI); and 6)Committee / team of Pharmacy and Therapy (KFT) (Article 8 PMK 8/2015). 41

The Hospital Ethics Committee Pedoman Pengorganisasian Komite Etik Rumah Sakit dan Majelis Kehormatan Etik Rumah Sakit Indonesia, PERSI-MAKERSI, 2009  The Hospital Ethics Committee (KERS) is an organizational unit of hospitals established in order to help hospital leaders apply Hospital's Code of Conduct.  The main duties and functions of KERS are to help hospital managers apply Hospital Code of Ethics throughout the hospital environment 42

The education coordination committee PP No.93 Tahun 2015 Tentang Rumah Sakit Pendidikan  The education coordination committee is an organizational element based in the Education Hospital. In order to coordinate all clinical learning processes at the Education Hospital, an education coordination committee was established.  The education coordination committee is formed by the director / head of the main Education Hospital along with the head of the Education Institution and responsible to the director / head of the Education Hospital.  The education coordination committee has the main duty to provide administrative support of clinical learning process at the Education Hospital 43

The patient risk and safety management committee PMK. No Tahun 2011 Tentang Keselamatan Pasien di RS  The patient risk and safety management committee is an organizational element established to improve patient safety and hospital service quality.  This committee has a duty: 1)Developing patient safety programs in hospitals according to the specificity of the hospital; 2)to formulate policies and procedures related to the patient's hospital safety program; 3)carrying out the roles to conduct motivation, education, consultation, monitoring (monitoring) and assessment (evaluation) on applied (implementation) of patient hospital safety program; 4)working with hospital education and training sections to conduct internal hospital patient safety training; 5)recording, incident reporting, incident analysis, and developing solutions for learning; 6)provide input and consideration to the head of the hospital in the framework of policy making Patient Hospital Safety; and 7)report activity to the head of the hospital. 44

Internal audit unit (SPI) Internal audit unit is an organizational element in charge of conducting internal audit performance audit of the hospital. The internal examination unit is under and responsible to the head or director of the hospital. In carrying out the task of the internal examination unit perform the functions: 1)Monitoring and evaluation of risk management implementation in hospital work unit; 2)Assessment of the system of controlling, managing and monitoring the effectiveness and efficiency of systems and procedures in the field of service administration, as well as general and financial administration; 3)The execution of special duties within the scope of internal control assigned by the head of the hospital or the director of the hospital; 4)Monitoring of the implementation and promptness of the implementation of follow-up on audit report; and 5)Provision of consultation, advocacy, guidance and assistance in the implementation of hospital operations (Article PP 77/2015). 45

Supervisory Board (Dewan Pengawas) PMK. No.10 Tahun 2014 Tentang Dewan Pengawas Rumah Sakit The Hospital may establish a Board of Trustees of the Hospital in accordance with the provisions of legislation. The Board of Trustees of the Hospital is a nonstructural unit that is independent, established, and responsible to the Hospital owner Hospital Board of Supervisors in PMK 10/2014, hereinafter referred to as Supervisory Board is a nonstructural unit at a hospital conducting internal hospital nontechnical coaching and supervision involving community elements. The Board of Supervisors serves as the governing body of the Hospital in conducting internal nontechnical coaching and supervision of hospitals in the Hospital and the Decision of the Collective Board is collective collegial. Supervisory Board established in hospitals implementing KDP BLU / BLUD also carries out supervision on the financial management of the Public Service Board or the Regional Public Service Board in accordance with the laws and regulations by reporting the execution of the duties to the Hospital owner at least 1 (one) time in one semester and at any time upon request of the owner of the Hospital. 46

Hospital Information System (HIS) 47

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Summary 1.The principle of establishment of organization element of organization adjusted with requirement, work load, and / or classification of hospital. 2.The organization of the hospital consists of at least: 1)head of hospital or hospital director; 2)elements of medical services; 3)elements of nursing; 4)medical supporting element; 5)elements of general administration and finance; 6)medical committee; and 7)internal audit unit. 3.In addition to the Medical Committee, hospitals may establish other committees for the administration of certain functions in hospitals according to the needs and development of science and technology. 4.Hospital may establish a Board of Trustees of the Hospital which is a nonstructural unit that is independent, established, and responsible to the owner of the Hospital 5.The Hospital Supervisory Board conducts internal and non-technical hospital nursing supervision of hospitals that involve unity elements. 49

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Perbedaan Organisasi Vs Enterprise Vs Corporation Bagaimana bisnis punya kemampuan untuk menghadapi tantangan hari ini dan masa depan Isu organisasi saat ini : INOVASI (Perlu ada unit INOVASI) Tim inovasi ini yang akan terus memberikan pembaharuan pelayanan,strategi, dan pengembangan pelayanan 51