Dra. Ayun Sriatmi, M.Kes
ORGANISASI ( PROFIT & NON PROFIT ) PENCAPAIAN TUJUAN TUJUAN KEMASYARAKATAN KEMASYARAKATAN PENCAPAIAN
SISTEM SISTEM & & FORMASI FORMASI SOSIAL SOSIAL
NEGARA // NEGARA STATE STATE Nirlaba )) (( Nirlaba
PASAR // PASAR MARKET MARKET Laba )) (( Laba
MASY. SIPIL SIPIL // MASY. SOCIETY SOCIETY Nirlaba )) (( Nirlaba
ORGANISASI PRINSIP FUNGSI : MEMBERI PELAYANAN PADA MASYARAKAT
ORGANISASI SWASTA SWASTA YANG YANG MENCARI MENCARI UNTUNG UNTUNG ORGANISASI PRIVATE FOR FOR PROFIT PROFIT )) (( PRIVATE ORGANISASI SWASTA SWASTA SETENGAH SETENGAH PEMERINTAH PEMERINTAH ORGANISASI PRIVATE QUASI QUASI PUBLIC PUBLIC )) (( PRIVATE ORGANISASI SWASTA SWASTA NON NON PROFIT PROFIT ORGANISASI PRIVATE NON NON PROFIT PROFIT )) (( PRIVATE ORGANISASI PUBLIK PUBLIK // BADAN BADAN PEMERINTAHAN PEMERINTAHAN ORGANISASI PUBLIC ORGANIZATION ORGANIZATION )) (( PUBLIC
1. SISTEM TERTUTUP ( CLOSE – SYSTEM APPROACH ) Didasarkan pada asumsi bahwa gambaran terpenting organisasi adalah pada aktivitasnya dengan struktur internal dan proses yang terisolisasi / tertutup secara relatif dengan lingkungan eksternalnya. 2. SISTEM TERBUKA ( OPEN – SYSTEM APPROACH ) Perilaku organisasi sangat dipengaruhi oleh kondisi lingkungannya. Struktur organisasi, proses dan performance / kinerjanya sangat dipengaruhi oleh kondisi input dari lingkungannya dan output yang dihasilkan ( outcome ).
CLOSED SYSTEM APPROACH
OPEN SYSTEM APPROACH
1. Rational Approach
1. Rational Approach a. Contingency Theory b. Decision Theory Aproach
2. Natural System Approach
2. Natural Approach a. Resources Dependences / Political Negotiation / Strategic Contingencies b. Population Ecology
I. CLOSED SYSTEM APPROACH 1. Rational Approach By Taylor, Gullick & Urwick, Mooney ( Principles of Management ) Fokus pada : • span of control
• unity of command • appropriate delegation of authority • departemenisasi • metode kerja Taylor ( Scientific Management ) menyarankan : • Programming the job • Choosing the right person to match the job • Training the person to do the job • Job design, etc
Max Weber ( Theory of Bureaucracy ) konsisten dengan model tertutup diatas, dengan memberikan 5 kriteria ideal birokrasi ( ideal type of bureaucracy) : 1.Kejelasan organisasi secara eksplisit, prosedur kerja spesifik untuk aktivitas pemerintahan. 2.Distribusi / pembagian kerja / aktivitas tertentu diantara office holder. 3.Struktur hierarki kewenangan yang digambarkan jelas. 4.Seleksi berdasarkan kemampuan dari kompetensi teknis yang dimiliki 5.Fungsi-fungsi official yang lebih bersifat hubungan impersonal
2. Natural Approaches • Dikembangkan sebagai reaksi atas pendekatan rasional. • Menekankan pada “ human relation “ individual (perilaku individu dalam organisasi) • Keberhasilan organisasi ditentukan oleh keberhasilan individu dalam pencapaian tujuan ( satisfaction of individual ) • Tokohnya antara lain : Chester I Barnard, Douglas Mc Gregor, Chris Argyris, Rensis Likert, dll.
ORGANISASI PRINSIP FUNGSI : MEMBERI PELAYANAN PADA MASYARAKAT PERSAMAAN : 1.
MELAYANI LINGKUNGAN
2.
MENGHADAPI TANTANGAN DARI LINGKUNGAN, antara lain : a. Birokrasi b. Internal dan Eksternal Organisasi yang tolak PERUBAHAN c. Tekanan – tekanan dari Interest Group d. Kesulitan untuk membagi “ ADIL “ ( keadilan ) karena sifatnya yang cenderung relatif.
3.
PERTANGGUNGJAWABAN ( ACCOUNTABILITY SYSTEM )
4.
KARAKTERISTIK ORGANISASI ( menyangkut prinsip2 organisasi ) : Struktur Organisasi Departemenisasi Pembagian Kerja Hierarki Wewenang & Kontrol SDM, capai dll ( untuk prinsip : TO GET THE JOB DONE
)
KLASIFIKASI KLASIFIKASI ORGANISASI ORGANISASI NON NON PROFIT PROFIT PUBLIC – CONSUMPTION GOODS PUBLIC – CONSUMPTION GOODS
VS PRIVATE – CONSUMPTION GOODS PRIVATE – CONSUMPTION GOODS By : KOTTEN 1. Badan Pemerintah yang dibentuk dengan UU & diberi wewenang untuk memberi pelayanan & pungut pajak. 2. Organisasi Non Profit Swasta / Sektor Independen yang diorganisir diluar kewenangan Pem & UU. 3. Organisasi Swasta Quasi Pemerintah, dibentuk berdasar wewenang legislatif. By : OLECK ( ditinjau dari sudut mencari untung ) 1. PUBLIC BENEFIT 2. MUTUAL BENEFIT 3. PRIVATE BENEFIT
ORGANIZATIONSAND ANDM M ANAGERS ORGANIZATIONS ANAGERS
•Org anizationTheory Theoryand andHealth HealthCare CareM M anag ement •Org anization anag ement M anag erialRole Role **M anag erial Need to …
M OTIVATEAND ANDLEAD LEAD M OTIVATE PEOPLEAND ANDGROUPS GROUPS PEOPLE
OPERATETHE THE OPERATE TECHNICALSYS SYS TEM TECHNICAL TEM
•S atisfyngindividual individual •S atisfyng needsand andvalues values needs Perception,M M otivati ((Perception, otivati vation,Neg Neg otiation)) vation, otiation
•Determiningthe the •Determining appropratework work approprate desig desig nn
•Providingdirection direction •Providing Leadershipand and ((Leadership M anag ership)) M anag ership •Recog nizingthe the •Recog nizing natureof ofgg roups nature roups (S ocialSS tructureof of (S ocial tructure W orkGroups Groups)) W ork
•Establishingcommu commu •Establishing nication&&coordina coordina nication tionmechanism mechanism tion •Controlling •Controlling Performance Performance Authority,Power Power&& ((Authority, Influence)) Influence
RENEW RENEW THEORGANIZATION ORGANIZATION THE
CHART CHART THEFUTURE FUTURE THE
•Determiningappropri appropri •Determining ateorg org anization ate anization desig desig nn •Acquiringresources resources •Acquiring manag ingthe the &&manag ing Environment Environm ent •M anag ingchang chang •M anag ing ee&& Innovation Innovation
M anag ing ••M anag ing trateg ically SS trateg ically Anticipatingthe the ••Anticipating Future Future
•Attaininggg oals •Attaining oals Effective&&Efficien Efficien)) ((Effective
By By By By In response to problems of In response to problems of In response to problems of In response to problems of personnil ( Commitment, technical performance the environment survival and growth Absenteeism, Turnover, ( Productivity, Efficiency , ( Complexity & uncertainty, ( longrun survival, longrun Apathy & Conflict among Quality & Consumer Technological & Social change, performance and growth ) Professionals ) Satisfaction ) Competitive force, Multiple performance demands )
TEORI TEORI ORGANISASI ORGANISASI & & MANAJEMEN MANAJEMEN PELAYANAN PELAYANAN KESEHATAN KESEHATAN
1. Sistem & Komposisi ? 2. Jenis & Karakteristik Organisasi Yankes ? 3. Persamaan & Perbedaan Organisasi Yankes dengan Organisasi Lain ? 4. Dukungan Teori Organisasi dalam Kerangka Manajemen & Organisasi Yankes ? 5. Issue – Issue Penting ttg Organisasi dan Manajemen Yankes ? * Efisiensi dan Efektivitas * Konflik dan Perubahan * Kelangsungan Hidup dan Pertumbuhan
ISTEM TEMYANKES YANKES SSIS ORGANIS AS ORGANIS AS II PENDUKUNG PENDUKUNG
PEM BIAYAAN PEM BIAYAAN
PEM ERINTAH PEM ERINTAH
KETENAGAAN KETENAGAAN
PROVIDER PROVIDER
DIVERSITY OF PROVIDERS
COMPLEXITY OF CARE
•VARIANS PROFESSIONAL •VARIANS KUALIFIKASI •TERORGANISIR & AKTIVITAS dlm BERBAGAI BENTUK & J ENIS
•BERSIFAT INDIVIDUAL s/d ORGANISASIONAL
P R O F IL O R G A N IS A S IY A N K E S (B E R D A S A R K A NT IP E/ B E N T U KP E L A Y A N A NY A N G D IB E R IK A N)
1 . 2 . 3 .
IN -P A T IE N TS E R V IC E S A M B U LA T O R YS E R V IC E S
C O M M U N IT Y
-B A S E DS E R V IC E S
4 .
O T H E RS E R V IC E S *H O S P IC E S *H O M EH E A LTHA G E N C IE S
ORGANISASI PENDUKUNG / PENYOKONG SISTEM PELAYANAN KESEHATAN 1. Regulatory and Quasi Regulatory ( Planning Services ) 2. Third Party Financing Organizations 3. Professional Association 4. Pharmaceutical & Medical Equipment Supply Corporation 5. Educational and Training Facilities
ORGANISASI PELAYANAN PELAYANAN ORGANISASI KESEHATAN KESEHATAN
1. Sulit mendefinisikan & mengukur output 2. Variabel yang mempengaruhi kinerja sangat banyak & kompleks 3. Pekerjaan cenderung bersifat kegawatdaruratan / emergency dan dalam suasana yang serba tidak terduga. 4. Aktivitas pekerjaan dengan tingkat ketergantungan yang tinggi diantara variasi kelompok profesional. 5. Ijin toleransi yang sangat kecil untuk kesalahan – kesalahan. 6. Pekerjaan / aktivitas dipengaruhi tingkatan spesialisasi yang tinggi ( spesialistik ) 7. Mengutamakan profesionalitas & loyalitas terhadap profesi 8. Eksistensi organisasi & manajemen yang lebih efektif dalam mengontrol semua kelompok dalam pertanggungjawaban & pembiayaan 9. Eksistensi pada 2 sisi kewenangan : a. Dalam “ create “ masalah – masalah koordinasi. b. Dalam akuntabilitas & “ confusion “ peranan masing masing.
Pelayanan Kesehatan
VALUES // NILAI NILAI VALUES
A Typology of Four Health Care Organizations
ATTRIBUTES
In-Patients Services
Ambulatory Services
Community Based Services
Nursing Homes
ENVIRONMENT ( COMPLEX & DINAMIC )
Highly complex & dinamic, large number of external regulation & high degree of competition
Somewhat less complex env, but competitive & regulatory factors increasing
Complexity limited primarily to wide variety of federal & state funded programs
Fairly complex environment due to state regulations and third party financing
MISSION & GOALS
Primarily treatment oriented
Primarily individual diagnosis, treatment & prev oriented
Community-wide prevention, diagnosis & treatment oriented
Maintenance and social supported oriented
GOAL CONGCRUENCE
Goals not particularly well integrated or congcruence
Relatively high degree of goal congcruence
Somewhat lower degree of goal congcruence & integration due to wide range of services typically offered
High degree of goal congcruence centered around maintenance and social support
TIME ORIENTATION TOWARD PATIENTS
On Average, Six days
Minutes
Hours
Months / Years
DEGREE OF SPECIALIZATION
Highly specialized
Dependent on the number of different specilaities in the practice
Highly specialized depending on range of programs & services offered
Least highly specialized
DEGREE OF TASK INTERDEPENDENCE
High degree of task interdependence
Relatively low interdependence
As a function of number of programs & services that must be coordinated
Moderate interdependence
CONCENTRATION OF DECISION MAKING
Low level of concentration, decision making diffused
Most highly concentrated in the patient’s physician
Low level of concentration, decision making diffused among the various programs
Decision making moderately concentrated
MANAGER – PHYSICIANS RELATIONSHIP
Impersonal, Structured
Personal, Unstructured
Peer to peer
Distant, transistory
WA RNING … !!!!
1. ADANYA ADANYA PERBEDAAN PERBEDAAN VARIASI VARIASI 1. SUBSTANSIAL (( ukuran, ukuran,kepemilikan kepemilikan,, SUBSTANSIAL lokasi & &hubungan hubungan faktor-faktor faktor-faktor lainnya lainnya )) lokasi 2.PERBANDINGAN PERBANDI NGANYG YGDILAKUKAN DILAKUKAN 2. HANYABERSIFAT BERSIFAT RELATIF RELATIF HANYA
( Summary of Mechanistic & Organic Design Characteristic ) ENVIRONMENT Complex & unstable
TASK TECHNOLOGY
PEOPLE
DESIGN
Higher efficiency & effectiveness
Variable
High percentage * Low specification of rules of professional and procedures * Decentralized participative decision making ORGANIC CHARACTERISTIC * Differentiated reward system * Nonprogrammed coordination and control
Simple & stable
Routine
Low percentage of professional
MECHANISTIC CHARACTERISTIC
* High specification of rules and procedures * Centralized nonparticipative decision making * Simple, undifferentiated reward system
* Programmed coordination and control Higher efficiency & effectiveness
