IMPROVEMENT IN RSHS EMERGENCY DEPARTMENT TRANSIT-1 SERVICES TO INCREASE CLAIM CONFORMITY TO BPJS KESEHATAN

• Main Author: Alfonso Hutajulu, Rudy
• Format: Theses
• Language: Indonesia
• Subjects: Manajemen umum
• Online Access: https://digilib.itb.ac.id/gdl/view/75604
• Institution: Institut Teknologi Bandung

In January-November 2022, there were 923 Transit-1 patients in the Emergency Department (ED) of Dr. Hasan Sadikin Hospital Bandung who could not be claimed as inpatients because of not fulfilling one of the requirements from BPJS Kesehatan. This research seeks to find the root cause of this problems and provide suggestions for solutions using the Root Cause Analysis method. Observation and interviews are used to collect data in the first two step of the methode which are Problem Understanding and Problem Cause Brainstorming to identify the research problem. The emerged research problem is that Transit-1 service are not fulfilling 6-hours inpatient requirements from BPJS Kesehatan. In the Problem Cause Data Collection step using the Pareto principle, four causes were identified that contributed to almost 80 percent of the problems. The four problems are: The patient's clinical condition improves; No indication for inpatient services; Inappropriate indications for hospitalization to Transit-1; and Patients refused treatment. In the Root Cause Identification step, the first three causes are then analyzed to find the root causes of the problem using the 5 Whys method. In the Root Cause Identification step, The patient's clinical condition improves has one root cause namely the absence of a Model Of Care (MoC) in the ED which can facilitate the service of patients who require short length of care and require a broad range of diagnostic tests and medical procedures. No indication for inpatients service has one root cause identified which is ineffective leadership from the hospital’s director. And the inappropriate indication for hospitalization to Transit1, has two root causes which are : the absence of a MoC in the ED which can facilitate the service of patients who require short length of care but require a broad range of diagnostic tests and medical procedures, and ineffective leadership from the hospital’s director. Suggested solutions for the root causes that have been identified are: holding a Short Stay Unit MoC in the and conduct a leadership improvement program that is designed to respond to : organizational structure challenges, human resources challenges, work nature challenges, and challenges related to leaders.