ACADEMIC HEALTH CENTER IN UNIVERSITAS INDONESIA DR.dr.Ratna Sitompul, Sp.M(K)
• The process • How we do it • Jakarta Sehat (collaboration with secondary and primary health care) • The evidence how AHC-AHS UI will give us benefit
FMUI AND CMGH PARTNERSHIP • Established since colonial era two side of a coin • FMUI is under the ministry of research technology and higher education through Universitas Indonesia and CMGH is a technical implementation unit under the ministry of health • All the medical staff in Cipto Mangunkusumo General Hospital (CMGH) were the teaching staff for clinical education in FMUI • Collaboration of FMUI and CMGH are implemented through a joint strategic planning (Renstra) 2010-2014 and continue 2015-2019
FKUI and RSCM problems in achieving the mission • FKUI and RSCM are separate institution, but functionally interdependent • less coordination in planning, organizing and controlling services, education and research activities • less efficient in resources management • the relation between institution depend on the human relation between CEO and the Dean • sub-optimal achievement in all three mission
• Difficulties in align vision, strategy across school of medicine and hospital
4
4
FKUI and RSCM commitment • “FKUI and RSCM need to support each other to achieve both vision” • Medical student and residency in training should be assigned in the best performed quality of care patient safety • Need variety place of work (primary, secondary or tertiary teaching hospital), RSCM role is critical • Faculty as a role model, excellence clinical teacher and excellence clinical leadership • FKUI need to increase volume and quality of international publication
The first periods of collaboration • Year 2010 to 2014 • Without any support (policy or financial) from university nor government, we developed: • • • • • •
strategic planning, shared key performance indicator, design program and person in charge from FKUI and RSCM Fit and proper test for Head of Department Patient safety and quality of care Apply for JCI acrreditation
FKUI-RSCM JOINT FINANCIAL PERSPECTIVE
FKUI-RSCM’S VISION, MISSIONs
CUSTOMER PERSPECTIVE
FINANCIAL PERSPECTIVE
To become the best teaching hospital To achieve stakeholder satisfaction
To optimize net income
IBP PERSPECTIVE To raise medical education, research and development fund
To achieve holistic comprehensive healthcare services To achieve excellent excellent healthcare services
To develop translational research To achieve integrated healthcare services, medical education and research through the use of information-technology system
To achieve cost-effective healthcare services, medical education and research
To develop network system in healthcare services and medical education
To achieve re-engineering through operational research
L&G PERSPECTIVE To develop caring and performancebased culture
To develop excellent staffs with comprehensive
competency
To develop excellent facilities and technology according to best practice
To develop hospital information technology system
To develop hospital management system according to best practice
To expand segment for private customer
FMUI-CMH: HOW DO WE WORK? Vision & Mission Common Strategic objectives
Shared Key Performance Indicator (KPI)
Programs Monitoring and evaluation
Department KPI Department programs Department activities
Strategic and policy FMUI– CMH
Strategic planning and shared KPI Integration Remuneration system Policy of Human resources management Policy of faculty recruitment
Structure/Operation al
Indonesian Clinical Training and Education Center Center for Clinical Epidemiology & Evidence-Based Medicine Supervisor in charge and clinical teacher Jakarta Urban health studies Leadership training for young staff Joint Ethic Committee for Health Research Coordinating Committee or Medical Education Integrated research and healthcare services • Reproduction and Infertility • Stem Cell •Virology and Cancer Pathobiology
FKUI
Stem Cell Therapy for End Stage Heart Disease
NOGA Prof. Teguh Santoso, MD
INDONESIAN CLINICAL TRAINING AND EDUCATION CENTER 2010 FKUI
FKUI – RSCM – UNIVERSITY OF WESTERN AUSTRALIA
• Facilitate medical students, general practitioners, residents and specialists in achieving and maintaining skills to perform low to high end procedures.
• Training and education teaching of trainer for 10 other medical faculties all over Indonesia.
Training of the Trainers on Teaching Procedural and Surgical Skills Workshop on Basic Suturing Techniques Workshop on Basic Surgical Skill Part-1 Workshop on emergency and Anesthesia Crisis Management
The Role of Mesenchymal Stem Cell in Non-union Fracture Treatment and Fracture Reconstruction
FKUI
1 Male, 23 years old Neglected, non union shaft femur
2
fracture
4
5
3
6
• We have a monitoring and an evaluation team • Routinely meeting of Dean and CEO to discuss problem, obstacle and decide action for improvement program (AVI) • The idea of Dean FKUI and CEO RSCM as a team is across department, university of Indonesia and Ministry.
Achievement of Collaboration • Kontrak Kinerja Departemen dan individu • JCI accreditation • Asean University network review • Increase of international publication • QS Ranking 301-400 Life science and medicine
FKUI-RSCM still have difficulty BACKGROUND OF AHS UI • Limitation of human resource as Faculty, funding, and coordination in health service, education, and research • Integration of major teaching hospital similar to AHC model is essential • Implemented in the second Strategic Plan FMUI-CMGH (2015-2019)
The second period of FMUI AND CMGH PARTNERSHIP 2015-2019 To Fortify Integration of patient care, education and research
Vision: To create infinite experience for all through academic health system
Mision: • Provide comprehensive, high quality and affordable health care for all levels of society. • Conduct education that produce the excellent graduates, based on research in the international standard hospital.
• Carry out medical research and medical education research with international standard, cross-discipline to solve and anticipate future health problems. • Actively assist the central government and local governments in health care, education and health research. • Perform integrated, effective, efficient, and accountable organizational governance, to realize financial growth and reliable management
VISION 2020 “ To create infinite experience for all through Academic Health system”
AHS Institution
SASARAN STRATEGIS
Terwujudnya Kepuasan Stakeholder
Terwujudnya Pelayanan, Pendidikan dan Riset yang ekselen
KEY PERFORMANCE INDIKATOR
INDIKATOR KINERJA
1 Tingkat Kepuasan Peserta Didik
2
Jumlah Translational/operational research yang diterapkan dalam layanan
3
Persentase lulusan tepat waktu yang mendapatkan pengalaman lebih
TARGET 2015
CAPAIAN 2015
TARGET 2016
60%
69,60%
70%
11
11
11
23
Masih diolah Bagian Penelitian
12%
62,15%
BL
30%
Masih diolah Tim Renstra
1. Terbentuknya tim 1. Terbentuknya tim advokasi advokasi 4 Terbitnya dasar hukum pembentukan AHC 2. Terbentuknya 2. Terbentuknya Terwujudnya Kelembagaan kebijakan dan SPO kebijakan dan SPO AHC 3. Renstra bersama 3. Renstra bersama
5
Persenatse proses bisnis terintegrasi yang dikelola AHC
CAPAIAN 2016
KET
Data masih diolah bagian Bakordik
Terbentuknya Terbentuknya struktur struktur organisasi organisasi resmi resmi
Bukti data pendukung : Manual Book
5 ∕ 11
5 ∕ 11
5 ∕ 11
5 ∕ 11
Tercapai
Persiapan
S1 telah terakreditasi sedangkan untuk Sp1 tidak ada akreditasi AUN yang ada akreditasi LAMPT-Kes
Persiapan
Persiapan
FKUI
Terwujudnya pusat unggulan Jumlah pusat unggulan riset, pelayanan riset, pelayanan dan 7 dan pendidikan yang terintegrasi dengan pendidikan yang terintegrasi kinerja ekselen
1
3
3
4
Tercapai
Terwujudnya sistem jaringan pelayanan dan pendidikan Jumlah program pendidikan pelatihan RS 8 menuju RSCM FKUI sebagai Jejaring kesehatan primer RSCM FKUI acute academic tertiary care
7
12
12
16
Tercapai
Terwujudnya Pendidikan Dokter Spesialis dalam rangka 9 Jumlah dokter spesialis baru lulusan FKUI menunjang layanan primer yang bekerja di RSUD
5
5
BL
6
Tercapai (data capaian belum FIX, masih akan diolah kembali)
Terwujudnya budaya menolong dan berkinerja
BL
53,16%
Di ukur tahun 2017
6 Akreditasi LAMPT-Kes
AHS Terakreditasi International
Jakarta Sehat Program
10
Indeks Budaya Kinerja AHC RSCM FKUI
Diklat dan FKUI
Defining Values, Meaning, Main Behaviors FMUI-CMGH Values
Meaning
Main Behaviors
Integrity
Harmony between words and deeds in accordance Faithful and Cautious ethical, moral, and humanitarian Honest and Consistent Persistent with Ethics
Professionalism
Competent and responsible in duty
Collaboration
Cooperate in an integrated manner and equality in Proactively Team Work order to achieve the common goal Help Each Other & Synergy Integration in Equality
Awareness
Serve with empathy, sincere and caring
Care and Empathy Quick Response Mutual Respect
Excellence
Provide the best with creative, innovative, and sustainable way
Highest Standard Oriented Innovative, Creative & Advanced Open Minded and Visionary
Competent & Continuous Learning Responsible & Dedicated Discipline & Obey the Rules
JAKARTA SEHAT PROGRAM
JAKARTA SEHAT PROGRAM Mutual collaboration among FKUI, RSCM and Jakarta local government • To improve the quality of health of urban community (Jakarta population) through the development of 4 main programs: • • • • •
Effective referral system Improvement of primary care service quality Improvement of financing system Emergency respond plan To involve Jakarta government in health education and
Jumlah Pasien Rujukan Dewasa di Puskesmas Kecamatan Tahun 2014 (Rencana Vs Realisasi) 2000
Penurunan Angka Rujukan di PKM:
1874
1800
1643
1600 1400
1281 1102
1200 936
1000 800 600 400
200
325 181
2014
Cilincing
83%
82%
Koja
71%
82%
Tambora
66%
91%
414
345
166
2013
156
31
Tanah Abang 73
25
68%
0
PKM Cilincing
PKM Koja
PKM Tambora
PKM Tanah Abang
Jumlah pasien rujukan yang direncanakan 2013
Jumlah pasien rujukan yang direalisasikan 2013
Jumlah pasien rujukan yang direncanakan 2014
Jumlah pasien rujukan yang direalisasikan 2014
Angka rujukan kumulatif dapat ditekan hingga 72% (2013) 81% (2014)
Jumlah Pasien Rujukan Anak di Puskesmas Kecamatan Tahun 2014 (Rencana Vs Realisasi) Penurunan Angka Rujukan di PKM: 2013
2014
Cilincing
78%
82%
Koja
65%
89%
Tambora
Tanah Abang
78% 66%
70%
Angka rujukan kumulatif dapat ditekan hingga 2013 : 72% 2014 : 81%
PRESTASI FKUI-RSCM-AHS UI DR.dr.Ratna Sitompul, Sp.M(K)
Pendidikan di FKUI
Total Student body • undergraduate • postgraduate • • • •
27
Residency Fellowship Magister PhD
1200
1600 350 50 100
27
SURVEI KEPUASAN
PESERTA PENDIDIKAN DOKTER SPESIALIS di R S C M-
FAKULTAS KEDOKTERAN UNIVERSITAS INDONESIA PHEEM (Postgraduate Hospital Educational Environment Measure)
RSCM
40 item pernyataan
14 item pernyataan
Indeks Kepuasan Keseluruhan Valid n = 1102 Berdasarkan kuesioner PHEEM, rerata (SD) tingkat kepuasan peserta didik pada keseluruhan item adalah sebesar 73,0% (0.12). Berdasarkan kuesioner RSCM, rerata (SD) tingkat kepuasan peserta didik pada keseluruhan item adalah sebesar 60,5% (0.16). Bila kedua kuesioner tersebut digabungkan, maka rerata tingkat kepuasan peserta didik adalah sebesar 69,6% (0.15).
100% Tinggi 75%
50%
Cukup
25% Rendah
0%
73% PHEEM
60.5%
RSCM
PROFIL
STAF FKUI
Data Dosen Berdasarkan Jabatan Fungsional 2014 - 2016 176 180
135
160 140 120 100
80
60
76
87
95 59
74 76
47 34 35 37
60 40 20 0
Asisten Ahli
Lektor 2014
Lektor Kepala 2015
2016
Guru Besar
Jabatan Fungsional Berdasarkan Status Kepegawaian September 2016 350 300 250
200 150 100 50 0
Pengajar Akademik CPNS UI Akademik PNS UI Akademik UI-BHMN Akademik PNS DEPKES Total
12 24 22 274 332
Asisten Ahli
Lektor
Lektor Kepala
Guru Besar
51 23 13 87
69 26 81 176
28 1 47 76
24 13 37
FACULTY EVALUATION BY RESIDENCE IN TRAINING
Kedokteran Penerbangan Radiologi Patologi Anatomi Pulmonologi Bedah Saraf Bedah Plastik Kardiologi Bedah Obsgyn BTKV Akupuntur Psikiatri THT Mata Rehabilitasi Medik IPD Patologi Klinik Anak Anestesi Kulit Farmakologi Klinik Urologi Onkologi Radiasi Neurologi Gizi Klinik Forensik Kedokteran Olahraga Mikrobiologi Klinik Kedokteran Okupasi Orthopaedi
0%
Membaik Menurun Menetap
20%
40%
60%
80%
100%
Hasil Tingkat Kepuasan PHEEM >80%
82.5%
1.
Terdapatnya masa pendidikan yang jelas.
85.9%
2.
Memiliki tanggung jawab yang sesuai.
80.1%
3.
Pengajar klinis memiliki keterampilan komunikasi yang baik.
89.1%
4.
Dapat berpartisipasi aktif dalam kegiatan pendidikan.
81.8%
5.
(Tidak) ada diskriminasi gender.
90.1%
6.
Menjalin kerja sama yang baik dengan dokter sejawat lain.
80.9%
7.
Mendapat kesempatan memberikan pelayanan berkelanjutan.
80.8%
8.
Keamanan secara fisik saat berada di lingkungan rumah sakit.
81%
9.
Mendapat pengalaman belajar klinis yang dibutuhkan secara cukup.
84.2%
10. Pengajar klinis memiliki keterampilan mengajar yang baik.
84.5%
11. Menjadi bagian dari tim yang bekerja di sini.
86.7%
12. Pelatihan membuat peserta didik siap menjadi seorang spesialis/konsultan.
85.3%
13. Pengajar klinis memotivasi menjadi pelajar yang mandiri.
Area for improvement Hasil Tingkat Kepuasan
PHEEM <60%
58.6%
1. Harus melakukan tugas yang tidak semestinya.
59.5%
2. Terdapat buku panduan pengajaran yang informatif bagi residen.
58.5%
3. Jam kerja sesuai dengan peraturan yang ada.
47%
4. Rumah sakit menyediakan akomodasi (kamar jaga) yang baik.
50.3%
5. Tidak ada budaya menyalahkan.
36.5%
6. Ketersediaan konsumsi (makanan dan minuman) yang cukup saat jaga.
RISET FKUI
Empat strategi FKUI-RSCM untuk mengembangkan riset kedokteran 1. Penguatan sumber daya penelitian 2. Pengembangan riset interdisiplin
3. Penguatan riset klinik 4. Public-private-partnership
UI INNOVATION for Health
Indonesian Medical Education & Research Institute (IMERI)
Academic Health System UI
RSCM
RSUI
RSP
RSF RSUD
RSPI RSUD
RSJP
RSUD
PUSKESMAS
CLINICAL RESEARCH COMMUNITY RESEARCH MEDICAL TECHNOLOGY
DRUG DEVELOPMENT
RSAB
RSPON
RSKD
PUBLIKASI TAHUN 2016
DEPARTEMEN BIOMEDIK No 1 2 3 4 5 6 7 8 9 10 11 12
Departemen Anatomi Biokimia & Biologi Molekuler Biologi Kedokteran Farmakologi & Terapeutik Farmasi Fisika Kedokteran Fisiologi Kedokteran Forensik & Medikolegal Histologi Mikrobiologi Parasitologi Kimia kedokteran TOTAL
Jumlah staf
2009 0 2 0 0 0 0 0 1 1 3 6 0 13 / 86
2010 0 2 0 5 0 0 0 0 1 2 7 1 17 / 95
Jumlah Artikel berdasarkan penulis pertama/terdepan 2011 2012 2013 2014 0 0 0 1 2 0 0 3 4 1 4 1 10 9 6 3 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 4 3 4 5 3 3 5 4 4 5 11 2 0 1 0 0 27 / 113 22 / 120 31 / 134 19 / 126
2015 4 0 0 3 0 0 2 0 3 5 4 1 21 / 127
2016 3 5 5 7 3 0 5 0 2 6 4 2 42 / 274
PUBLIKASI TAHUN 2016
No
Departemen
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Anestesiologi & Intensive Care Gigi dan Mulut Ilmu Bedah Urologi Ortopedi Ilmu Bedah Saraf Ilmu Kedokteran Komunitas Ilmu Kesehatan Anak Ilmu Kesehatan Kulit & Kelamin Ilmu Kesehatan Mata Ilmu Penyakit Dalam Ilmu Penyakit THT Ilmu Gizi Kebidanan & Kandungan Kardiologi Neurologi Patologi Anatomi Patologi Klinik Pendidikan Kedokteran Psikiatri Pulmonologi Radiologi Radioterapi Rehabilitasi Medik TOTAL
DEPARTEMEN KLINIK Jumlah staf
2009 0 0 5
0 4 5 1 2 31 1 3 7 2 3 2 1 0 2 3 0 1 0 73 / 86
2010 2 0 12
0 2 6 0 0 30 1 2 4 1 0 6 0 1 3 6 1 0 0 78 / 95
Jumlah Artikel berdasarkan penulis pertama/terdepan 2011 2012 2013 2014 1 0 0 1 0 0 0 0 10 14 12 15
0 3 7 0 2 36 1 4 8 5 1 2 1 0 1 4 0 0 0 86 / 113
0 2 8 1 3 31 5 0 7 10 3 3 1 0 4 3 1 0 1 98 / 120
0 6 21 1 3 32 1 3 4 6 1 1 0 0 3 6 2 0 1 103 / 134
0 4 19 1 2 29 2 3 4 13 3 1 0 1 3 3 2 0 1 107 / 126
2015 0 0 21
0 3 18 0 2 18 1 10 5 11 3 1 0 1 0 11 0 0 0 106 / 127
2016 3 1 3 15 14 0 3 38 5 5 44 1 4 14 22 1 2 3 1 1 4 0 1 4 188 / 274
CAPAIAN PUBLIKASI INTERNASIONAL DAN IMPACT FACTOR No
Jumlah Publikasi Internasional
2016
2009
2010
2011
2012
2013
2014
2015
1
Pre-klinik
19
29
36
33
50
35
21
42
2
Klinik
76
72
91
99
120
129
106
232
3
Impact Factor Per Artikel
160,209
198,281
447,339
201,494
341,788
273,127
Increase 30% from targeted by the UI
PENGABDIAN MASYARAKAT FKUI ( 47 Kegiatan)
PEROKONDA, SUMBA
Hasil Kepuasan PPDS
Survey on Faculty’s Opinion of Residency in Training
Developed by FKUI and RSCM but Funded by RSCM
HASIL AUDIT KEPATUHAN KEBERSIHAN TANGAN PERIODE JANAPR 2015 MHS KEDOKTERAN 85% 80% 75% 70% 65% 60%
81%
80%
79%
77%
68% MHS KEDOKTERAN
AHS UI MEMBER 1. Faculty of Medicine Universitas Indonesia 2. Cipto Mangunkusumo General Hospital 3. Fatmawati Hospital 4. Persahabatan Hospital 5. National Cancer Center Dharmais Hospital 6. Sulianti Saroso Infectious Diseases Hospital 7. National Mother and Child Center Harapan Kita 8. National Cardiovascular Center Harapan Kita 9. Universitas Indonesia Teaching Hospital * 10. National Brain Center
HOSPITAL
MoU
Strategic Plan
Departement
Self Assesment
Cipto Mangunkusumo General Hospital
+
+
+
4.1
+
+
+
Not Available
National Cardiovascular Center Harapan Kita
+
+
+
Not Available
Fatmawati Hospital
+
+
-
Not Available
National Cancer Center Dharmais Hospital
+
+
-
Not Available
National Mother and Child Center Harapan Kita
+
+
-
Not Available
Sulianti Saroso Infectious Disease Hospital
+
-
-
Not Available
Universitas Indonesia Teaching Hospital
-
-
-
Not Available
National Brain Center
-
-
-
Not Available
Persahabatan Hospital
AHS UI MEMBER Self assesment of aligment with FMUI
ACADEMIC HEALTH SYSTEM UNIVERSITAS INDONESIA (AHS-UI)
• Joint Decree Ministry of Health and Ministry of Education
Academic Health System UI (AHS UI)
VISION
Academic innovation through collaborative outstanding health care for people and communities
MISION
• Implementing excellent health care through evidence-based innovation • Conducting new state of the art medical and health education which uphold moral and ethics • Conducting innovative research to improve science mastery and medical technology in healthcare services • Performing good governance for every member of Academic Health System and cultivating other healthcare facilities • Supporting and providing input for the formulation of government policy
Academic Health System UI (AHS UI) Strategic Value Integrated health center as a result of collaboration among teaching hospital and health science clusters Diminishing the institutional borders effective and efficient collaboration Integrated research and medical education
Creating holistic health service
How is our integration observed by external party? • Apply AIM program of AAHCI • How other can learn from our experience?
AAHCI • The Association of Academic Health Centers International (AAHCI) is a member-based association founded in 2008 as a subsidiary to the U.S.-based AAHC • FMUI is the member of AAHCI since 2010
AIM Tools AAHCI Completion by AHS UI
Five topics of AIM Tools 1. 2. 3. 4. 5.
Mission alignment Internal accountability External accountability Interprofessional education and practice Knowledge generation and dissemination
Continue: there are four section each topic 1. 2. 3. 4.
Leadership Workforce Infrastructure Practice
Mission Allignment • The governance structure of institution is designed to optimize integration of its program areas (research, education, clinical care) • Defined leadership roles, scopes of authority and accountability • Leadership from each mission area interacts with other mission areas • Alignment of education, research, and clinical practice is a major component of the work plan of the AHC leader and the deans of AHC schools • Leadership has worked across departments to develop, implement, review and update a strategic plan • Strategic Plan is linked with the institution’s budget cycle
Mission Allignment • Alignment of education, research, and clinical practice is a major component of the strategic plan • Alignment of education, research and clinical practice is resourced, e.g. line item in the budget of AHC and AHC Schools
AIM tools form Translation from topic
Description of measurable element based on indicator
Description of topics
Elaboration stage of collaboration (what we have done)
List of evidence to support current stage
AIM tools form (continue) Hope of next level of collaboration
Self assessment
Benefit of AHC-AHS UI: • UKMPPD • 30% have competency beyond expectation • Increase of nternasional publication • JCI Acrreditated ( Academic medical center- Human subject program) • Pusat penelitian berbasis pelayanan (12 pusat) • QS ranking 301-400 • Jakarta Sehat budget 3-5M from Jakarta goverment
TARGET AREAS Fully alignment of health service, education, and research in AHS UI
CURRENT STAGE
• • • •
No alignment Minimal alignment Partial alignment Substantial alignment
Will tis be sustain? What is the next challenges? How to serve better?
THANK YOU
