ACADEMIC HEALTH SYSTEM AS STRATEGY FOR INCREASING ACCESS AND QUALITY OF HEALTH CARE. Prof. Dr. dr. Akmal Taher, SpU (K)

ACADEMIC HEALTH SYSTEM AS STRATEGY FOR INCREASING ACCESS AND QUALITY OF HEALTH CARE Prof. Dr. dr. Akmal Taher, SpU (K)

Yogyakarta, January 12 2017

MINISTRY OF HEALTH REPUBLIC OF INDONESIA

DEFINITION OF AHC An Academic Health Center is defined as an accredited, degree-granting institution of higher education that consist of :  



A Medical school One or more other health professional schools or programs (e.g., cluster of health sciences, dentistry, nursing, pharmacy, public health, veterinary medicine) An owned or affiliated relationship with a teaching hospital, health system, or other organized health care provider. Source : AAHC


INTEGRATION

Functional Integration

• Coordination and collaboration in planning, implementation and evaluation in education, service, research, and community service.

Structural Integration

• represents the union of Educational Institutions and Teaching Hospital into a single unit of work in performing the functions of education, service, research, and community service.

Source : PP 93/2015

Health Challenges 



  

st 21

century

Gaps and inequities in health persist both within and between countries Emerging and Re-emerging Disease, catastrophic disease Environment Behavioural risks Rapid demographic and epidemiological transtition

Professional education has not kept with these challenges that produce ill-equipped graduates 

  


Missmatch of competencies to patient and population needs Poor teamwork Persistent gender stratification of professional status Narrow technical focus without broader contextual understanding

Professional education has not kept with these challenges that produce ill-equipped graduates  






Episodic encounters rather than continuous care Predominant hospital orientation at the expense of primary care Quantitative and qualitative imbalances in the professional labor market Weak leadership to improve health-system performance

Vicious Systems No Accreditation No Certification

Limited time Financial incentives Drugs & testing Poor communications

Supply Professionals

Lack Jobs

Overcrowded Hospitals

3-yr residency Curriculum mismatch No quality control Faculty-student ratio

Health

Education

Patient Flow

Health, inequity, quality Financial impoverishmen Patient dis-satisfaction

5-yr schooling Lack primary care Not top students

Status Salary Career Workload 6-in-1

Students

Demand

Problem based

Systems based

Instruction

Scientific curriculum

Problem-based learning

Competency learning

Institution

Three Generations of Reform

University based

Academic centers

Health-Educ Systems

1900

Science based

2000+

Universal Health Coverage in Indonesia

Started at the 1st of January 2014

Where Do We Want To Go ?

2018 2017

2016 2015

2019 UHC: “All Indonesian People Eligible To JKN”


REFERRAL SYSTEM Tertiary

Referral Authority

Secondary

Primary Care

GATE KEEPER

Tertiary Care

Self Care

Primary health Care

District Hospital

Regional Referral Hospital

NATIONAL REFERRAL HOSPITAL PROVINCIAL REFERRAL HOSPITAL REGIONAL REFERRAL HOSPITAL

Provincial Referral Hospital

: 14 RS : 20 RS : 110 RS

National Referral Hospital

Virtuous Systems for UHC 13

Supply Professionals

3-yr residency Competency-based curriculum

Graduates=Jobs Quality standards Accreditation Certification

Tertiary hospitals

Referral system

5-yr schooling

Top students

Students

Status Salary Career Workload 1-in-1

Demand

Primary care

Equity+quality Financial protection Satisfaction & trust




Academic Health System  Academic

Health Center which includes primary care

 Government

Pendidikan)

Decree 93 - 2015 (PP 93 ttg RS


REFORMATION OF HEALTH INSURANCE

Efficiency of the budgets

Economic value

NEW STRATEGIES EDUCATION

Cheap price

COMMUNITY SERVICES RESEARCHES

MAINSTREAMING

GOOD QUALITY OF HEALTH CARE AFFORDABLE COST

AHS GOALS


Realization of public health improvement, through:  Integrating service delivery, medical education and researches in order to achieve comprehensive health care by the main faculty of education and the teaching hospital.  Development of organizational governance, and a solid management system to unify the purpose, to be transparent and accountable in assessing the internal and external performance.

Public Hospital – Important roles 

Provider of last resort 



Major teaching institution   



Ensuring access to medical services for those who can not go elsewhere Medical students and residency program Provider of highly specialized care The only route for non-paying patients to the most sophisticated diagnostic and treatment services and equipment

Role  

Provide medical services Teaching and research

BUMN 2005

Productivity Press Taylor & Francis Group New York, NY 10016 2010

Restoring the outstanding care as the core miss and focus of Academic Medical Centre Developing integrated structure Pursuing and supporting disease-related research Educating the health work-force Focusing attention on the business of medicine

Organizational factors associated with high performance in quality and safety in academic medical centre 





The top-performing centers were integrated across the multiple components of the AMC The top peformers had leaders who articulated the view that patient care was first among the missions of patient care, teaching, and research The leaders of the top-performing AMC focused on pointing out the disparity between where they were and where they wanted to be rather than comparing themselves with competing institutions, and they linked quality to more than simply clinical outcomes Academic Medicine 82 (12): 1178-86. 2007



The lower ranked institutions seemed  unable

to resolve their internal conflicts between the missions of patient care, teaching, and and research  largely satisfied with the level of quality and safety at their institution  Display tension across the leadership team and a culture of “all persons for themselves”

Recomendations for integrating AMC structure   



Drive integration from the Top Include all stakeholders Develop a framework for integration that can withstand changes over time Ensure the central focus of integration is improved patient care

National Referral Center


TERSIER

SEKUNDER

PRIMER

Health-system based education = Academic-based health system CLINICAL MEDICINE


National Referral Center Subspecialty training

TERTIARY MEDICAL CARE Specialty-subspecialty training

SECONDARY MEDICAL CARE Specialty-Primary care physician training

PRIMARY MEDICAL CARE Primary care physician training COMMUNITY MEDICINE

DISTRIBUTION OF NATIONAL REFERRAL HOSPITAL

1. Dr. Adam Malik General Hospital, North Sumatera 2. Dr. Ciptomangunkusumo General Hospital, DKI 3. M. Djamil General Hospital, West Sumatera 4. M. Hoesin General Hospital, South Sumatera 5. Hasan Sadikin General Hospital, West Java 6. Dr. Kariadi General Hospital, Center Java 7. Dr. Sardjito General Hospital, DI Yogyakarta

8. 9. 10. 11.

Dr. Soetomo General Hospital, East Java Sanglah General Hospital, Bali Soedarso General Hospital, West Kalimantan Wahab Sjahranie General Hospital, East Kalimantan 12. Prof. Dr. Kandau General Hospital, North Sulawesi 13. Dr. Wahidin General Hospital, South Sulawesi 14. Dok II Jayapura General Hospital, Jayapura

ROADMAP KEGIATAN PROGRAM INDONESIA SEHAT DENGAN PENDEKATAN KELUARGA TAHUN 2015-2019 2015 4 PUSK 4 KAB/KO 4 PROV UJICOBA: KONSEP, INSTRUMEN & PENGUMPULAN DATA

KET:  JUMLAH PUSK ADALAH KUMULATIF DARI TAHUN KE TAHUN  TENAGA PEMBINA KLG = 5 ORG/PUSK  TENAGA TEKNIS/PROF = 5 ORG/PUSK  TENAGA MANAJEMEN = 2 ORG/PUSK  TABLET = 1 BH/TENAGA PEMBINA KLG  KOMPUTER = 1 BH/PUSK

2016

2017

2018

2019

470 PUSK, 9 PROV, 64 KAB/KO




REGULASI/PANDUAN:

REGULASI/PANDUAN:

REGULASI/PANDUAN:

REGULASI/PANDUAN:

PENERBITAN PERMENKES, JUKNIS & SOSIALISASI

SOSIALISASI PERMENKES & JUKNIS



ANGGARAN:

ANGGARAN:

ANGGARAN:

ANGGARAN:

PENYEDIAAN BIAYA TH 2016, PERENCANAAN BIAYA TH 2017




REKRUTMEN SDM:

REKRUTMEN SDM:

REKRUTMEN SDM:

REKRUTMEN SDM:

REKRUTMEN 2350 PEMBINA KLG UTK 470 PUSK



REKRUTMEN PEMBINA KLG UTK 3525 PUSK

PELATIHAN SDM:

PELATIHAN SDM:

PELATIHAN SDM:

PELATIHAN:

2350 PEMB. KLG, 2350 TENAGA TEKNIS/PROF, 470 PENGELOLA DATA, 940 TEN. MNJ UTK 470 PUSK

8840 PEMB. KLG, 8840 TENAGA TEKNIS/PROF, 1768 PENGELOLA DATA, 3536 TEN. MNJ UTK 1768 PUSK

14235 PEMB. KLG, 14235 TEN. TEKNIS/PROF, 2847 PENGELOLA DATA, 5694 TEN. MNJ UTK 2847 PUSK

17625 PEMB. KLG, 17625 TEN. TEKNIS/PROF, 3525 PENGELOLA DATA, 7050 TEN. MNJ UTK 3525 PUSK

SARANA-PRASARANA:

SARANA-PRASARANA:

SARANA-PRASARANA:

SARANA-PRASARANA:

PENYEDIAAN 2350 TABLET UTK PENDATAAN, 470 KOMPUTER, SERTA SARPRAS UTK 470 PUSK




KEGIATAN:

KEGIATAN:

KEGIATAN:

KEGIATAN:

PENGUMPULAN DATA, BUAT DATABASE & PELAKSANAAN PEND. KLG DI 470 PUSK

PENGUMP. DATA, BUAT/ UP-DATING DATABASE & PELAKS. PEND. KLG DI 2238 PUSK



SISTEM INFORMASI:

SISTEM INFORMASI:

SISTEM INFORMASI:

SISTEM INFORMASI:

INTEGRASI PELAPORAN DATA KELUARGA KE SP2TP, PELAKS. SI TERINTEGRASI DI 470 PUSK

PELAKS. SI TERINTEGRASI DI 2238 PUSK & PELAPORANNYA



INDIKATOR KELUARGA SEHAT INDIKATOR

Penderita hipertensi melakukan pengobata n secara teratur

PEMBINA KELUARGA

KOORDINATOR/PJ PROGRAM

MANAJER KLINIS

MANAJER INSTITUSI

Pememeriksaan tekanan darah

Merencanakan kegiatan dalam upaya pencegahan dan pengobatan hipertensi

Pemberian terapi pengobatan sesuai tingkat hipertensi (NYHA)

Menintegrasikan perencenaan di tingkat Puskesmas dalam upaya promotive dan preventif hipertensi antar lintas program

Pemeriksaan faktor resiko (obesitas, gula darah, lemak darah, dll)

Mengkoordinasikan kegiatankegiatan promprev spt Posbindu, Skreening anak sekolah pada UKS, Pos Kesehatan Kerja, dll

Mengontrol pengobatan penderita hipertensi secara berkala,

Mengkoordinasikan dengan LS terkait bila ada upaya yang perlu didukung dalam upaya prom prev hipertensi seperti kebijakan olah raga di tempat kerja secara teratur

Perubahan perilaku/pola hidup (CERDIK & PATUH)

Memastikan ketersediaan obat, reagen, alat kesehatan terkait pelaksaaan program

Merujuk penderita hipertensi ke FKTRL bila diperlukan

Mengkoordinasikan dengan Dinkes Kab/Kota dalam membangun sistem rujukan hipertensi dengan FKTRL

Mengingatkan minum obat secara teratur

Monitoring dan evaluasi terlaksananya program

Mengkoordinir penyusunan SOP penatalaksanan penderita hipertensi

Menetapkan prinsip kualitas pelayanan hipertensi melalui pelaksanaan akreditasi

Mendatangi penderita bila tidak rutin berobat dan kontrol

Menganalisa data-data hipertensi & data terkait (spt angka obesitas, DM, dll) serta merencanakan upaya yg akan dilakukan dalam upaya pencegahan dan pengontrolan hipertensi Asuhan mandiri pemanfaatan toga dan akupresur dalam penanganan hipertensi

Mengkoordinasikan dgn FKTP lainnya di wilayah kerja Puskesmas melalui forum lokmin bulanan dalam tindak lanjut hasil pendataan keluarga terkait kepesertaan JKN


Mission Medicine and health services

Health • • • •

Research

•

Innovation

Advanced services • Universal Health • Coverage Telemedicine Continuing services

Basic, clinic and community

• •

Education

•

Education of health worker according type of patients

•

Patient safety New operation technical

Community • •

New Technology trials Health Techology Assessment

•

Technic of new teaching process according to service changes

• •

Regulation

Visit family example screening disease Handling social problem that give impact to health

• •

Integration of AHS and community

•

Continuing professional development Involve community to improve the curriculum

•

•

•

•

Joint procurement Public Private Partnership Strengthen primary health care

Regulation based on evidence Commercial and non commercial researches Primary care physician education Interprofesional education


BENEFIT OF AHS

Government Ministry of Health

• Strategic study centre

• Develop effective and proffesional model of health care

Ministry of Research, Technology and Higher Education

• Improve quality of medicine and Health workers education • Improve university reputation

Ministry of Finance

• Being economic assets

Health Office Healthcare and Social Security Agency (Wong, 2011)

Community

• Recovery of Health care, referral system, urban model and rural health system • Health services in Health care facilities • Efficiency • Quality health care • Utilization result of medicine and health researches

DISTRIBUTION OF TEACHING HOSPITALS Zainoel Abidin Hospital

Soedarso Hospital Dorys Sylvanus Hospital


Wahab Sjahranie Hospital Dr. Wahidin Sudirohusodo Hospital

Adam Malik Hospital PirngadiHospital Djasamen Saragih Hospital Deli Serdang Hospital

Ulin Banjarmasin Hospital Prof. Dr, Kandou Hospital Anutapura Hospital

Arifin Achmad Hospital M. Djamil

M Yunus Hospital M.Hoesin Hospital Bari Hospital H Abdul Moeloek Hospital

Sanglah Hospital Tabanan Hospital Badung Hospital Sajiwani Hospital

Bahteramas Hospital

Not established yet. Dr Ciptomangunkusumo Hospital Fatmawati Hospital National Cardiovascular Center Harapan Kita Hospital National Cancer Center Dharmais Hospital Persahabatan Hospital Gatot Subroto l Hospital Mother and Child Harapan Kita Hospital Atmajaya Hospital UKI Hospital Mintohardjo Hospital Kepolisian Soekamto Hospital Tarakan Hospital

Tangerang Hospital Cilegon Hospital

Hasan Sadikin General Hospital RS Mata Cicendo Gunung Djati General Hospital Dustira General Hospital Imanuel General Hospital Majalaya General Hospital Siloam Gleaneagles General Hospital

Sardjito Hospital Yogyakarta Hospital Yap, Eyes Hospital

Dr. Kariadi Hospital Dr. Soeharso, Orthopedic Hospital Banyumas Hospital Salatiga Hospital Prof Margono Soekarjo Hospital Tugurejo Hospital Klaten Tirtonegoro Hospital Sultan Agung Islamic Hospital Prof. Dr. Soerojo psychiatric hospital Saras Husada Hospital

Prof. Dr. Yohannes Hospital

Dr. Soetomo l Hospital Haji Surabaya Hospital Soebandi Hospital Ramelan Hospital Sidoarjo Hospital Soedono Madiun Hospital

Major Teaching Hospital: 57 hospitals Satellite Teaching Hospital: 14 hospitals Affiliated Teaching Hospital: 10 hospitals

IMPROVEMENT OF AHC/AHS IN INDONESIA


should be defined as a TEACHING HOSPITAL

Should be NATIONAL / INTERNATIONAL ACCREDITED

The doctors are ready to be placed in planned area.

Affiliated Satellite

Education

satellite

Translational researches

Research

Major Teaching Hospital

Services

Faculty of Nursing

Delivering an excellent service, patient safety oriented

Hospital

AHS Practice Plan

University

Primary Health Care

Faculty of Pharmacy

Faculty of Public Health

Faculty of Dentistry

Faculty of Medicine

Public Health Office

TEACHING HOSPITAL AND EDUCATION INSTITUTIONAL AND STRUCTURAL INTREGRATION

FUNCTIONAL

Ultimate goal of AHS in Indonesia 




Center of excellence in medical care, workforce education and research Excellence Primary care

ACADEMIC HEALTH SYSTEM AS STRATEGY FOR INCREASING ACCESS AND QUALITY OF HEALTH CARE. Prof. Dr. dr. Akmal Taher, SpU (K)

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