Dirjen Bina Upaya Kesehatan KEMENKES Prof Dr dr Akmal Taher Sp U (K) mengawali presentasinya dengan menegaskan bahwa, “Harus ada keyakinan bahwa sistem AHS akan dapat membawa perbaikan. Yang penting dari harmonisasi adalah hasil positif adanya kesepakatan karena harmonisasi sistem pendidikan dengan pelayanan kesehatan sangat penting dan tidak mudah, lebih kompleks dari kolaborasi antara FK dan RS. Mutlak diperlukan resources sharing, bukan hanya dalam bentuk uang tetapi juga sumber daya manusia. Integrasi stuktural dan fungsional harus terlaksana.” Prof Akmal melanjutkan, “Pelayanan kesehatan primer harus diperkuat untuk menjadi kontak pertama pasien yang membutuhkan pertolongan. Hal ini akan memperbaiki pelayanan sekunder sehingga berbagai kasus yang sulit benarbenar ditangani dengan baik oleh spesialis. RS rujukan harus dapat menjalankan fungsinya dengan baik, sebagai contoh angka kematian karena penyakit jantung tidak sama saja dengan RS di bawahnya. Untuk menurunkan angka kematian tersebut jawabannya bukanlah mengirim kardiologis tetapi meningkatkan layanan primer. Pelayanan kita akan sangat dipengaruhi oleh adanya JKN. Pada langkah awal pembentukan AHS harus dibuat template untuk pelayanan yang kemudian diterapkan di pendidikan, bukan membuat template sendiri-sendiri. Yang diharapkan dari AHS adalah pelaksanaan pelayanan yang baik, penelitian dan pendidikan yang maju. Lebih jauh lagi diharapkan akan ada perkembangan pada kesehatan publik, (inovasi) penelitian baru untuk diagnosis dan terapi, dan berbagai manfaat lain. Target yang ingin dicapai adalah universal coverage”. “Untuk menguatkan layanan primer (promotif dan preventif), salah satu faktor yang paling penting harus terwujud adalah sistem kolaborasi pendidikan tenaga kesehatan” ujar Prof Akmal. Sebagai penutup, beliau juga menekankan bahwa AHS menjadi bagian dari proses strategis yang harus dilakukan segera untuk mencapai pelayanan kesehatan primer yang prima dan model AHS akan diimplementasikan di level nasional.
HARMONISASI SISTEM PENDIDIKAN KEDOKTERAN DENGAN PELAYANAN KESEHATAN DALAM KONSEP ACADEMIC HEALTH SYSTEM (AHS) Prof. Dr. Akmal Taher, Sp.U(K) DIREKTUR JENDERAL BINA UPAYA KESEHATAN KEMENTERIAN KESEHATAN RI
• Harmony – the combination of simultaneously sounded musical notes to produce chords and chord progressions having pleasing effect – agreement or concord
Arah Pembangunan Kesehatan (20052024) RPJMN I 2005-2009
RPJMN II 2010-2014 20102019
RPJMN III 2015-2019
RPJMN IV 2020-2024
Universal Coverage
Upaya Kuratif
Pendukung/penunjang
Masyarakat Sehat Yang Mandiri Dan Berkeadilan
Pelayanan Kesehatan Primer 1. Kontak pertama untuk pasien yang memerlukan pertolongan 2. Penanganan fokus pada pasien (bukan hanya penyakit) berkesinambungan 3. Komprehensif – Promotif – Preventif – Kuratif – Rehabilitatif/paliatif
4. Koordinator bila diperlukan rujukan
PETA STRATEGI PELAYANAN KESEHATAN PRIMER 2014 - 2019 1. MASYARAKAT INDONESIA SEHAT YANG MANDIRI Penurunan AKI, AKB, Gizi Buruk Meningkatkan UHH
DAMPAK
2. TERWUJUDNYA PELAYANAN KESEHATAN PRIMER YANG PARIPURNA
OUTCOME
% kab/kota yang memiliki UKBM Aktif lebih dari 50 % Tingkat kepedulian Masy pd Kesehatan
5. OPTIMALISASI SISTIM RUJUKAN
6. REVITALISASI UKM
7. PENINGKATAN EFEKTIVITAS UKBM
8. ADVOKASI PEMBANGUNAN DAERAH BERWAWASAN KESEHATAN
PROSES STRATEGIS YG HARUS DILAKUKAN
9. TERWUJUDNYA SISTEM PERENCANAAN YANG TERINTEGRASI
10. TERWUJUDNYA SISTEM KOLABORASI PENDIDIKAN NAKES
11. PENGUATAN SISTEM INSENTIF DAN PROMOSI PARADIGMA SEHAT
12. TERWUJUDNYA KEMITRAAN YANG BERDAYA GUNA TINGGI
13. TERBANGUNNYA INFORMASI BERBASIS DATA DAN PENGALAMAN (Knowledge management) SUMBER DAYA KESEHATAN
14. TERSEDIANYA SDM YANG KOMPETEN DAN BERBUDAYA KINERJA
15. TERSEDIANYA DUKUNGAN REGULASI YANKES PRIMER
16. TERSEDIANYA SIK TERPADU
17. TERSEDIANYA SPA SESUAI STANDART, OBAT DAN DUKUNGAN PERBEKALAN KESEHATAN SESUAI STANDART DAN KEBUTUHAN
18. TERSEDIANYA DANA BIDANG KESEHATAN YANG PROPORSIONAL UNTUK UKM DAN UKP*)
3. TERWUJUDNYA MASYARAKAT YANG PEDULI KESEHATAN
% Fasyankes primer yang terakreditasi Tingkat Kepuasan Masy pd Yankes primer Tingkat kepuasan Nakes di Yankes Primer
4. OPTIMALISASI YANKES PRIMER SEBAGAI GATEKEEPER
KEUANGAN
• The Affordable Care Act set in motion dramatic changes to the way that health care is delivered in the United States. Yet in the entire law, academic health centers (AHCs)—the institutions that include a medical school, other health professions training programs, and affiliated teaching hospitals and health systems—are mentioned only 10 times, and never in reference to the sweeping health care delivery reforms initiated by the law. A New Conceptual Framework for Academic Health Center, Borden et al. Academic Medicine. 90. 2015.
What do government & public expect from AHSCs? • Conventional expectations: • Excellence in clinical care • Place where significant & cutting edge medical research is conducted • Place for training of doctors, nurses and care providers
Building an innovating academic health system. Dzau, 2014
Future expectations: • Clinical care includes improvement of • •
• • •
community health Research result in novel discoveries for dx & therapies Research can impact community & population health Develop new models of care delivery (including IT) Training for the future Economic driver & community leader
ACADEMIC HEALTH CENTRE • AHC is not a single institution but a constellation of functions and organizations commited to improving the health of patients and populations through the integration of their roles in research education and patient care to produce knowledge and evidence base that becomes the foundation for both treating illness and improving health. • The integration involves more than the simultaneous provision of education, research and patient care. It requires the purpose linkage of the roles so that research develops the evidence base, patient care applies and refines the evidence base and education teaches evidence based and team-based approaches to care and prevention (United States Academy of Science 2004)
AHCs should aspire to lead the transformation of healthcare & health • Reorganizing biomedical research and health delivery systems into a seamless continuum from discovery to clinical delivery to population health. Moving from Academic Health Center (AHC) to Academic Health Sciences System (AHSS). • Bench to Bedside to Population” • • Vertical integration of care delivery with population health • • Integrated translational model of Discovery-care continuum • Effective use of information for care & research : Learning Health System • • Emphasize & accelerate Innovation • • Community & Population Health • Globalization
• Transforming Academic Health Centers for an Uncertain Future – N Engl J Med 369;11 September 2013
• One key consideration will be balancing specialized clinical excellence and population health • AHCs will have to become higher performing regional health systems, spanning the spectrum from community based and primary care to highly specialized hospital and tertiary acute care
Creation of Leadership and Management Programs • Management and Leadership Pathway for Residents (MLPR) 15-18 months of project driven management rotations/modules combined with clinical training. Rotations aligned with clinical requirements, trainee interests, and institutional priorities where trainees are teamed with DUHS senior leadership • Provides a management toolkit for mid-career clinicians, that allows them to lead and grow their departments and divisions with increased efficacy. • The Master of Management in Clinical Informatics (MMCi) MMCi represents an innovative curriculum that develops the workforce of the future to address the needs of people who are fluent in the use of data to drive strategic decision making.
PENDAHULUAN Public Hospital – Important roles •Provider of last resort – Ensuring access to medical services for those who can not go elsewhere
•Major teaching institution – Undergraduate and postgraduate 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 – Education and research BUMN 2005
PENDAHULUAN (2) • How can Academic Medical Centre (AMC) compete, survive, and continue to fulfill their societal mission in highly competitive and hostile marketplace? AMC : one teaching hospital and at least one school of medicine (parent university)
Productivity Press Taylor & Francis Group New York, NY 10016 2010
Restoring the outstanding care as the core mission 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
• Research – 70% of top twenty AMC’s are integrated – 50% of ranked 21-30 AMC’s are integrated
• Medical services and general quality (US News and World report) – 11 of the 17 top hospitals are integrated at some form
• Only 44% of American have an integrated structured
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 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
Academic Medicine 82 (12): 1178-86. 2007
KERJASAMA STOVIA & CBZ • Pioner pelayanan spesialistik kedokteran di Indonesia 1924 (Dosen klinik STOVIA sebagai Kepala Bagian di CBZ)
• • • • • • •
1925 : Bagian Bedah, Bagian Kebidanan 1955 : Bagian Kesehatan Anak, Bagian THT
1960 : Bagian Penyakit Dalam, Bagian Penyakit Kulit & Kelamin 1961 : Bagian Mata
1962 : Bagian Bedah Saraf 1964 : Bagian Akupuntur 1965 : Bagian Anestesi, Laboratorium Kesehatan Pusat
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
• Transforming Academic Health Centers for an Uncertain Future – N Engl J Med 369;11 September 2013
• One key consideration will be balancing specialized clinical excellence and population health • AHCs will have to become higher performing regional health systems, spanning the spectrum from community based and primary care to highly specialized hospital and tertiary acute care
Toward JCI Accreditation in 2012 Accreditation (process & outcome) • Joint Commission International. – Patient Safety. – Risk Adjusted Mortality Rate. – Difficult to Treat Cases Outcome.
.
DOSEN PENDIDIKAN KEDOKTERAN
Didalam UU Pendidikan Kedokteran Pasal 21 dinyatakan : (1) Dosen dapat berasal dari perguruan tinggi, Rumah Sakit Pendidikan,dan Wahana Pendidikan Kedokteran. (2) Dosen di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteran melakukan pendidikan, penelitian, pengabdian kepada masyarakat, dan pelayanan kesehatan. (3) Dosen di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteran memiliki kesetaraan, pengakuan, dan angka kredit yang memperhitungkan kegiatan pelayanan kesehatan. (4) Ketentuan lebih lanjut mengenai kesetaraan, pengakuan, dan angka kredit Dosen di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteran sebagaimana dimaksud pada ayat (3) diatur dalam Peraturan Pemerintah.
YANG PERLU DITINDAKLANJUTI DARI UU PENDIDIKAN KEDOKTERAN Peraturan Pelaksanaan Undang-undang No.20 Tahun 2013 tentang Pendidikan Kedokteran salah satunya mengenai peralihan Dokter Pendidik Klinis menjadi Dosen harus ditetapkan paling lama 2 (dua) tahun terhitung sejak tanggal 6 Agustus 2013 – Aturan turunan dari UU Pendidikan Kedokteran (PP) mengenai kesetaraan dan pengakuan dosen PT dan dosen RS Pendidikan NIDN – Aturan mengenai Dosen dan angka kreditnya di Rumah Sakit Pendidikan dan Wahana Pendidikan Kedokteran ; – Aturan mengenai insentif gaji, remunerasi di RS pendidikan – Jenjang karir Dosen di RS Pendidikan – Sertifikasi dosen kedokteran – Aturan mengenai RS Pendidikan yang mengakomodasi kesetaraan dosen: Sertifikasi dosen, kompetensi dosen, jabatan akademik
GURU (UU No 14 thn 2005) Pendidik profesional Mendidik, mengajar, membimbing, mengarahkan,melat ih, menilai, dan mengevaluasi peserta didik pada pendidikan anak usia dini jalur pendidikan formal, pendidikan dasar, dan pendidikan menengah.
DOSEN (UU No 14 th 2005)
Pendidik profesional dan ilmuwan Mentransformasi kan,mengembang kan, dan menyebarluaskan ilmu pengetahuan, teknologi, dan seni melalui pendidikan, penelitian, dan pengabdian kepada masyarakat. Pendidikan 40% Penelitian 40% Penunjang 20% Guru besar S3
DOKDIKNIS PerMenPan 17/2008
Pendidik profesional dan ilmuwan di RS Pendidikan Pelayanan kesehatan/medik, pengabdian masyarakat, pendidikan dokter dan atau dokter spesialis serta melakukan penelitian di Rumah Sakit Pendidikan
UU DIKDOK Thn 2013
D O S E N R S P E N D I D I K A N
Core competence of residents The Accreditation Council for Graduate Medical Education (ACGME) Patient care Medical knowledge Practice-based learning Interpersonal and communication skills Professionalism Systems-based practice
Konsil Kedokteran Indonesia
Stanford University School of Medicine Faculty Handbook 8.2 Criteria and Application of Criteria for Appointments, Reappointments and Promotions A. Criteria The University recognizes that there are significant variations in how candidates qualify for and secure initial appointment, reappointment and promotion, according to field and discipline. Candidates come from different backgrounds and receive different educational training. In addition, there may be variation in emphasis among the components of activity (i.e., clinical care, teaching and, in some cases, scholarship and/or administrative duties). Given the many different activities in which Clinician Educators are engaged, such variations are expected and are appropriate. Nevertheless, all faculty appointments have in common the requirement of excellence, however measured.
The major criterion for appointment, reappointment and promotion for Clinician Educators, including Clinician Educators (Affiliated), is excellence in the overall mix of clinical care and clinical teaching appropriate to the programmatic need the individual is expected to fulfill.
Specific/Supplemental Criteria for Clinical Associate Professors a. Appointment as Clinical Associate Professor Appointment to the rank of Clinical Associate Professor in the Clinician Educator Line will be considered for those who have demonstrated excellence in the overall mix of clinical care and clinical teaching (and, if applicable, institutional service and/or scholarly activities). There should be evidence that candidates have attained regional recognition as superior clinicians and clinical teachers. There should be evidence that the candidates will successfully fill the programmatic need for which the appointment is made and will make meritorious contributions to their discipline and to the School.
Penilaian Kinerja Staf Medik RSUPN Dr. Cipto Mangunkusumo Indicator yang dinilai sesuai dengan 6 area core competency (ACGME, ABMS) : • Medical / clinical knowledge • Patient care : – Outcome – Complication, in depth analysis
• • • •
Practice-based learning and improvement Interpersonal and communication skill Professionalism System-based practiced
Enam Kompetensi Inti Staf Medik (1) 1. Medical/Clinical knowledge – Demonstrate knowledge of biomedical, clinical, and cognate sciences and application to patient care.
• Indicators – Hospital Based CME – New Training or Experience – Board Cert-Initial or Renewal
Enam Kompetensi Inti Staf Medik (2) 2. Patient care – Provide patient care that is compassionate, appropriate, and effective.
• Indicators (outcome and complication) – Organ Injury – Prophyladic antibiotic within one hour to incision – Compliance with DVT prevention – Post wound infection – Post- op ventilator associated pneumonia
Enam Kompetensi Inti Staf Medik (3) • Indicators “Patient care” (Anesthesia) – Re-intubation in OR or PACU – Anesthesia Incidents (Broken Teeth) – MI within 48 hours post anesthesia – Pneumothorax from CDIRECTOR Line Insertion
Enam Kompetensi Inti Staf Medik (4) 3. Practice-based learning and improvement
– Investigate and evaluate patient care practices, appraise and assimilate scientific evidence – Improve patient care practices
• Indicators
– Illegible Orders sent for Review – Adherence to National Patient Safety Goals: • Abbreviations • Universal Protocol, as applicable
Enam Kompetensi Inti Staf Medik (5) 4. Systems-based practice
– Provide cost-conscious, effective medical care . – Work to promote patient safety – Coordinate care with other health care providers • Indicators – Documentation of appropriate pre-and post anesthesia assessments – Medical Record Delinquency – Informed Consent Surgery
Enam Kompetensi Inti Staf Medik (6) 5. Professionalism – Commitment to carrying out responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population • Indicators
– Complaints related to Professionalism from Staf
Enam Kompetensi Inti Staf Medik 6. Interpersonal & communication skills – Demonstrate skills that result in effective information exchange – Work effectively with other members of the health care team
• Indicators – Feedback related to communication skills – Complaints from Patients/Famili
Kuantitas • Jumlah pasien rawat jalan • Jumlah pasien rawat inap • Jumlah tindakan medik
SPO Survey penilaian profesionalisme dan communication skill • Jumlah responden survey : (Alberta) – Dokter dan atasan = 6 orang – Pasien = 6 orang
RESPONDEN DOKTER • Penetapan responden sejawat dan atasan untuk masing masing dokter oleh Tim Survey : – Penetapan nama responden (dalam soft copy) – Memasukkan form survey ke amplop tertutup – Mengirimkan amplop tertutup ke departemen dan meminta tanda terima
• Pelaksanaan Survey penilaian profesinalisme dan komunikasi staf medis di Departemen : – PIC Departemen membagikan amplop ke responden di departemen / divisi – PIC Departemen mengambil hasil isian survey – PIC Departemen mengirimkan hasil penilaian ke Tim Survey Penilai Kinerja Medis
SPO Survey penilaian profesionalisme dan communication skill RESPONDEN PASIEN • PENETAPAN RESPONDEN
– Rawat jalan (3 orang) dilakukan setelah pasien diperiksa dokter – Rawat inap (3 orang) dilakukan saat pasien akan pulang (atas izin dokter maupun pulang paksa) – Bila jumlah pasien dari salah satu tempat kurang dari 3 maka dapat dipenuhi pasien dari tempat lainnya
• Pelaksanaan Survey penilaian profesinalisme dan komunikasi staf medis di unit layanan – Tim Survey membagikan kuisener dalam amplop terbuka kepada perawat unit kerja – Perawat unit kerja memberikan penjelasan kepada pasien / keluarga tentang survey dan memberikan amplop survey ke pasien di unit kerja – Pasien mengisi kuesioner survey dan mengembalikan ke perawat unit kerja – Perawat mengumpulkan kuesioner yang telah diisi dan dimasukkan dalam amplop tertutup dan menyerahkan ke Tim survey Unit – Tim Survey Unit mengirimkan isian survey dalam amplop tertutup ke Tim Survey Korporat.
Academic Medical Center Hospital Standard Medical Professional Education
• Hospital governance and leadership endorse of a set of metrics to monitor and evaluate the ongoing operation of medical education programs, and there is documented review of the monitoring data • Hospital governance and leadership review, at least annually, the medical education programs within the organization, and the review is documented • The review includes the satisfaction of patients and staff with the clinical care provided under the program
MPE4 Supervision • Organization policy identifies the required level of supervision for each level of trainee • The level of to be provided is based on the demonstrated competency of the trainee • Each trainee understands the level, frequency, and documentation of his or her supervision • The organization provides the required level of supervision for each trainee • There is a uniform process for documenting the required supervision that is consistent with organization policy, program goals, and the quality and patient safety
MPE5. Management of Medical Education in Hospital • The operational structure for medical education in the organization has been determined and is in operation as required • The leadership structure for medical education in the organization has been determined and is in operation required • There is a complete and current list of all student in the organization
Thank You
