|
JURNAL SOSIAL DAN SAINS VOLUME 3 NOMOR 9 2022 P-ISSN 2774-7018, E-ISSN 2774-700X |
|
|
THE MODEL OF
INPATIENT UNIT SERVICE QUALITY AT THE INDONESIAN CHRISTIAN UNIVERSITY GENERAL
HOSPITAL BASED ON MALCOLM BALRIDGE CRITERIA Fransisca,
Rokiah Kusumapradja, Endang Ruswanti Universitas Esa
Unggul, Indonesia Email: [email protected] |
|
|
Keywords: health service quality, Malcolm
Balridge |
ABSTRACT Background: In 2022,
there was a decrease in the satisfaction rate and BOR in the UKI General
Hospital inpatient unit. Improvements in the quality of health are needed.
The Malcolm Balridge criteria is the method of measuring the quality of
health services from the United States. The malcolm balridge criteria has a
dynamic framework and provide as an independent and comprehensive assessment. Purpose: Seven
criteria are leadership, strategic planning, patient focus, measurement,
analysis and knowledge management, workforce focus, work operation focus and
organizational performance results. The researcher measured the quality
assessment at the UKI General Hospital inpatient unit based on Malcolm
Balridge’s Criteria. Method: This
research was conducted on 70 respondents in the inpatient unit, using a
qualitative approach with univariate analysis and scoring based on Malcolm
Balridge’s Criteria. Results: The score
was 276.5 out of 1000 points. It is an early result position, the poor
quality. There are gaps in the approach and implementation stages as well as
the deployment in several categories. Criteria that are below the average
value are workforce focus and organizational performance results. Conclusion: The
purpose was to provide an overview of the model development for the quality
health services in the UKI General Hospital inpatient unit based on Malcolm
Balridg’s criteria. |
INTRODUCTION
Based on data from UKI RSU, in
2022 there will be a 75.3% reduction in patient satisfaction in the UKI RSU
inpatient unit. Then the UKI RSU BOR figure from 2022, has decreased by 66.7%.
In addition, there have been complaints from the workforce regarding the
inadequate education and training system. So that the UKI RSU inpatient unit
still shows deficiencies and needs improvement. Regulation of the Minister of
Health of the Republic of Indonesia number 80 of 2020, states that hospitals
are obliged to improve quality and maintain hospital service standards through
the implementation of good hospital quality governance
The Malcolm Balridge Criteria is
an independent measurement tool to improve the quality performance of an
organization. Parast and Golmohammadi (2019) state that Malcolm Balridge's
criteria are valid and reliable measurement tool for health service
organizations
The purpose of this research are:
1. Analyzing
the description of the quality of the inpatient unit at RSU UKI based on
Malcolm Balridge criteria.
2. To
explore the quality of inpatient units at RSU UKI based on the Malcolm Balridge
criteria
3. To
explore the problems that exist in the UKI RSU inpatient unit.
To explore the development model for
inpatient units at RSU UKI based on the Malcolm Balridge criteria.”.
The Malcolm
Balridge Criteria is an award given by an organization in the United States.
Malcolm Balridge (1981-1987) was a secretary of commerce in the United States
who contributed greatly to long-term quality improvement in the United States.
Malcolm Balridge have a dynamic work assessment framework that can be assessed
and assist the delivery of health services. Balridge assessment is an
instrument to improve organizational performance. There are 7 criteria of
Malcolm Balridge namely Leadership, strategic planning, patient focus,
measurement, analysis, and knowledge management, focus on workforce, focus on
process, and organizational performance results. The Malcolm Balridge criteria
not only assess input and process components, but also assess output
components, namely results.
RESEARCH
METHODS
The research begins with
conducting an initial survey, system identification and hospital profiles. Data
collection was carried out using questionnaires, in-depth interviews, and
document review. The researcher made a list of questions based on Malcolm Balridge's
criteria guided by three experts as expert judgements. Then a Forum Group
Discussion (FGD) was held with the UKI General Hospital. and given an
assessment according to Malcolm Balridge's criteria. Assessments are made
according to process criteria, namely ADLI (Approach, Deployment, Learning
and Integration) and outcome criteria, namely LeTCI (Levels, Trends,
Comparisons, Integration).
Then a final score is determined
and a discussion is carried out to provide implications for the problems found.
The number of respondents was 70 respondents. The validity test and reliability
test have been carried out by previous researchers, namely by Manurung (2017)
with cronbach alpha ≥ 0.8
RESULTS AND DISCUSSION
Relations Between Criteria
Service Quality Related to Leadership Based on the
Malcolm Balridge Criteria
Leadership is how senior leaders
can guide and sustain the organization, setting the organization's vision,
values and performance expectations. Communicating with employees, developing
future leaders and creating an environment that encourages ethical behavior and
high performance. Leaders also outline how to improve organizational
performance and capabilities. The literature says that there is a significant
relationship between leadership and the service quality of a hospital
Service Quality Related to Strategic Planning Based on
the Malcolm Balridge Criteria
The ability of the organization
to develop strategies properly will provide opportunities for innovation and as
a performance reference that can understand core competencies. Organizations
are able to compete and collaborate with various parties now and in the future.
Good strategic planning will be a change that may affect the quality of
organizational services, increase innovation and the ability to take advantage
of a variety of opportunities, and can direct resources to be able to make
priorities in dealing with health service problems. Strategic planning is the
main step to carry out a strategic management that provides direction and
boundaries for operational activities. Trilogy Juran (1999), one of the
activities to improve the quality of which is strategic planning that leads to
operational activities
Service Quality Related to Patient Focus Based on the
Malcolm Balridge Criteria
The patient focus variable
indicates that providing services with empathy aimed at patients and their
families. The hospital is a service where humans are the center of service.
According to Gaspersz (2011), patient satisfaction is highly dependent on perceptions,
patient expectations, as well as factors that influence it such as needs and
desires, past experiences, experiences from friends, and advertising or
marketing
Service Quality Related to Measurement, analysis and
knowledge management Based on the Malcolm Balridge Criteria
The organization analyzes and
develops information data and assets that are owned to then review its
performance. Quality can be known if the organization is willing to analyze and
develop its performance as a service provider at all levels. This can be done
with performance measurement, performance analysis and performance improvement.
Information data, information resources and technology can be used to determine
the state of the quality of an organization. Performance measurement, analysis
and performance review can be a reference for the quality assessment process.
According to Crosby (1979), the management of quality is zero defect
Service Quality Related to Workforce based on the Malcolm
Balridge criteria
Organizations must be able to
assess the capabilities and capacities of their workforce in order to build a
good working climate. A good work environment creates safety, security and an
appropriate work climate so as to improve the quality of an organization. The
workforce involved in every decision making increases the sense of belonging
and love of the workforce towards the hospital. Rewards employees for achieving
high performance. The success of an organization depends on the quality and
capacity of its employees, so it depends on the knowledge, skills, creativity
and motivation of employees and the placement of employees. The organization
defines, manages and develops its workforce to utilize its full potential in
alignment with the overall organization's mission, strategy and work plan.
Quality management according to Deming (1986) is the TQM triangle in the form
of commitment, scientific knowledge and workforce involvement
Service Quality Related to Focus on Process based on the
Malcolm Balridge criteria
A good process at work produces a
good output. Organizations that build good work systems can produce good
quality output. Work system design, system management built for patient
satisfaction and organizational quality. The key to a good work process
resulting in effectiveness in the work process is the key to obtaining patient
satisfaction which leads to good quality. Work systems, work design, management
and improvement of work processes to implement work systems and organizational
sustainability. Improvement of work processes produces quality of service
quality. The Juran Trilogy (1999) stated that quality planning in the form of
process development is capable of producing the features of a product
Service Quality Related Organizational Performance
Outcome Based on Malcolm Balridge criteria
The results of performance in
health services in the form of patient satisfaction. To be able to determine
the good quality of an organization, the results of leadership, products and
processes, the focus of health services on patients, the effectiveness of
operations, strategy implementation, and focus on patients are the key results
of quality patient satisfaction. According to Kotler (2007), the role of the
quality of health services will increase consumer satisfaction that arises
after comparing the resulting performance to the expected performance
Leadership
According
to Balridge, senior leadership in an organization not only manages and directs
the organization but also must be capable of managing and socially responsible.
The results showed that the leadership variable had an average total value of
3.08 (table 1) . The results of the study illustrate that inputs for
organizational improvement and support for community activities have not been
realized. Organizational management related to resources to improve service
quality is still lacking. Senior leadership in the UKI RSU inpatient unit pays
little attention to input from the workforce for organizational improvement.
Perhaps this is due to the limited authority of senior leaders. In the journal
written by Prybutok and Cutshal (2004), there is a significant
relationship between leadership and service quality in terms of Malcolm
Balridge's criteria
Leadership in the UKI RSU
inpatient unit is centered on the UKI hospital foundation. So that the cascade
of hospital leadership and governance needs to be further evaluated.
Strategic Planning
Malcolm Balridge describes
strategic planning by examining how strategy development is how the
organization determines its strategy and strategy deployment is how the
organization transforms strategic objectives into action plans related to
performance measures. The results showed that the implementation of strategic
planning has an average total value of 3.03 (table 1) .
UKI RSU inpatient unit strategic planning already has
an approach that is responsive to basic needs and has involved senior
leadership. But in improving the strategic plan there are obstacles. Its
implementation is still in its early stages and not yet comprehensive. And
still in
several work units.
The strategic objectives of the
UKI RSU inpatient unit are starting to be in line with patient needs. RSU UKI
already has strategic planning in the form of strategic planning for health
facilities and physical strategic planning, namely the construction of hospital
renovations, but may be constrained by implementation and procurement. Here the
researchers see that maybe this is due to the many considerations from the UKI foundation.
In the study of Duarte et al (2013) strategic planning is an innovation that
can be carried out in innovating in hospitals
Focus on the Patient
According to Balridge, patient
focus tests how organizations listen to patient voices and earn patient
loyalty. Listening to the patient's voice means how the organization can
determine the patient's expectations and needs, involve the patient in every
policy in the organization, ensure the linkage of health services. While patient
loyalty means how the organization builds relationships to acquire, fulfill and
retain customers, increase loyalty and develop new opportunities for health
services.
In a study conducted by
Ayuningtyas et al in 2005, it was stated that focus on patients is a variable
that has a significant effect on improving the quality of service in hospitals
The results of the study on
patient focus criteria illustrate that the conditions that take place in the
UKI General Hospital inpatient unit are in good condition, where each question
has an average value of 3.16 (table 1). Systematic and effective patient
information has been carried out through patient satisfaction surveys and
service performance reports. Evaluations have been carried out and patient
loyalty has been built through good communication with patient-focused
services.
Knowledge Measurement, Analysis and Management
According to Balridge, the
criteria for measurement, analysis and knowledge management test how an
organization selects, obtains, analyzes, manages and develops the data,
information and knowledge assets it has. Measurement, analysis and improvement
of organizational performance describes how an organization measures
performance, analyzes and reviews performance and improves performance.
Meanwhile, information management, information technology and knowledge
describe how an organization ensures the quality and availability of data and
information needed by employees, suppliers and patients.
The results of measurement,
analysis, management and knowledge research have a value of 3.00 (table 1). The
approach has been carried out systematically, effectively and responsively to
the basic need for data and information. There has been an evaluation of the
existing process. To improve service performance, in this case the hospital
seeks to make efforts to improve hospital quality by conducting PDCA and root
cause problem analysis (RCA) so that corrective action plans can be formulated.
The implementation of PDCA and RCA also needs to be disseminated frequently to
all units so that it can become a sustainable culture in the UKI RSU inpatient
unit.
In research conducted by Cahyono
at the Bhineka Husada hospital in 2012, it was stated that one of the elements
that influence the quality of service at the hospital is measurement, analysis
and knowledge management (Cahyono 2012).
Workforce Focus
According to Balridge, the
criterion of workforce focus examines how an organization assesses the ability
and capacity of the workforce and builds a conducive work environment to
produce a good level of performance. The work environment describes how the
organization provides a supportive work environment so that safety, security
and a good work climate are created for its workers. Workforce involvement
describes how the organization provides compensation and rewards for the
workforce to achieve high performance.
In Rachmawati's research, (2017)
it was found that the focus variable on workforce significantly affected the
quality of inpatient performance at Mampang Prapatan Hospital
Focus on Process
According to Balridge's criteria,
the focus is on the process of testing how organizations design, manage and improve
work systems and work operations for patient satisfaction. The work system
prepares the design and management of work systems while the work process
prepares the design and management of work processes. Organizational
capabilities in designing, managing, improving and innovating work processes
can increase the effectiveness of work processes and achieve success.
The results of the study
illustrate that the criteria for focusing on surgery have a fairly good average
value of 3.16 (table 1). The approach taken is in accordance with the SOP even
though there are still obstacles in its implementation. The dissemination of
SOPs has been carried out in each work unit but systematic evaluation and
improvement has not been carried out optimally. Trilogy Juran (1999) states
that quality planning in the form of process development is able to produce
features of a product. In research conducted by Duarte (2013), it was stated
that one of the innovations that affect the quality of the service system in
hospitals is process management innovation
Organizational Performance Results
This criterion examines health
care and process outcomes, patient focus outcomes, workforce focus outcomes,
leadership and governance outcomes and financial and market outcomes. Malcolm
Balridge provides a systems perspective to manage the organization and process
objectives of an organization to achieve optimal performance. The seven Malcolm
Balridge criteria are a mechanism for integrating criteria in developing a
superior organizational system. System perspective means viewing and managing
the organization as a whole by integrating components towards optimal
performance.
The Balridge Burger diagram
(figure 1) consists of leadership, strategic planning and customer focus. It
illustrates and represents the triad of leadership that these categories are
placed together to emphasize and become the basis for the importance of
leadership that focuses on strategic planning and customers. Focus on people,
focus on process and performance results represents the trinity of results.
Workforce and process objectives do the work of the organization to produce
superior performance results. Then the leadership triad and results triad are
connected by horizontal lines in order to illustrate the important linkages for
organizational excellence. Two-way arrows indicate the need for feedback within
a management system to produce effective performance. Meanwhile measurement,
analysis and knowledge management are important to management effectiveness and
to knowledge management systems based on facts, namely performance measurement
and analysis for continuous performance improvement. According to Kotler
(2007), the role of the quality of health services will increase consumer
satisfaction that arises after comparing the resulting performance to the
expected performance
Research conducted by Tiara
Alyssa et al in 2020 states that performance results have significant results
in improving quality in health services
Performance
results of leadership and governance results are reported well to meet several
requirements and existing SOPs, there is no clear performance improvement and
performance sustainability. For financial and market performance results, few
performance results are reported and there is no comparative information. While
the patient focus and process focus variables have a major contribution. This
is in accordance with the balridge burger diagram (figure 1).
Figure 1. Balridge Burger Diagram
Table 1. Table of Score Results and Average Value of
Malcolm Balridge Criteria
|
Kategori
Baldrige |
% skor |
Point MB |
Skor
hasil (% x point) |
Nilai
rata-rata |
|
Leadership |
|
120 |
34 |
3,08 |
|
a.
Senior leadership b.
Responsible management |
20% 20% |
70 50 |
14 10 |
|
|
Strategic planning |
|
85 |
23 |
3,03 |
|
a.
Strategy Development b.
Strategy deployment |
35% 20% |
40 45 |
14 9 |
|
|
Focus on the patient |
|
85 |
28 |
3,16 |
|
a.
Patient's voice b.
patient loyalty |
35% 35% |
45 40 |
14 14 |
|
|
Measurement,
analysis and knowledge management |
|
90 |
29,5 |
3,00 |
|
a.
Measurement, analysis and improvement of
organizational performance b.
Information Management, Information
Technology and Knowledge |
30% 35% |
45 45 |
13,5 15,75 |
|
|
|
||||
|
Focus on the workforce |
|
85 |
12,75 |
2,95 |
|
a.
Working Environment b.
Workforce Engagement |
15% 15% |
40 45 |
6 6,75 |
|
|
Focus on Operations |
|
85 |
32 |
3,18 |
|
a.
Work System b.
Work Process |
40% 35% |
45 40 |
18 14 |
|
|
Organizational
performance results |
|
450 |
127,5 |
2,96 |
|
a.
process results and health services b.
Focus Results on Patients c.
Results Focus on Workforce d.
Leadership and governance outcomes e.
Financial and Market Results |
40% 35% 25% 30% 15% |
110 90 80 80 80 |
40 31,5 20 24 12 |
|
|
The total score of the inpatient unit of RSU UKI is
276.5 |
Total 3,04 |
|||
CONCLUSION
The variables of leadership, patient focus and surgery
focus have higher average values than the other variables. Meanwhile, the
variable focus on labor and performance outcomes has a lower average value than
the other variables. So the researchers concluded that the criteria for
workforce focus and performance results were considered not in accordance with
Malcolm Balridge's criteria.
Complaints from the workforce include a lack of
education/training, an unclear transfer/rotation system, and inappropriate
compensation. According to the researchers, this was due to a lack of
coordination and communication between the workforce and the UKI hospital
management department. The function of the leadership cascade can be restored
and improved to make it even better. For performance issues in the form of
patient visits, namely a significant reduction in BOR, cases of labor accidents
and complaints from patients. According to information, this is due to the
infrastructure facilities of UKI Hospital which are starting to fall behind.
UKI General Hospital physical strategic planning has been prepared so that acceleration
is needed to make it happen.
The overall inpatient unit score at RSU UKI was 276.5
out of 1000 points. This means that the UKI RSU inpatient unit is in an early
result position where the quality of the UKI RSU inpatient unit is relatively
not good and still needs to be improved. The UKI RSU inpatient unit is in a
systematic approach, early stages of deployment, with minimal evaluation and no
improvement yet
References
Ayuningtyas, D. (2005). Penilaian
Mutu Rumah Sakit Tugu Ibu dengan The Malcolm Baldrige National Quality Award
Tahun 2005. Jurnal Manajemen Pelayanan Kesehatan, 8(04), 22314.
https://www.neliti.com/id/publications/22314/
Chandrawati. (2017, June). Analisis
Implikasi Kebijakan RSUD Kemayoran Provinsi DKI Jakarta Terhadap Kinerja
Pelayanan Maternal menurut Malcolm Balridgel . Depok.
https://lib.ui.ac.id/file?file=digital/2017-11/20456009-T48517-Chandrawati.pdf
Duarte, N. T., Goodson, J. R.,
& Arnold, E. W. (2013). Performance Management Excellence Among the
Malcolm Baldrige National Quality AwardWinners in Health Care. The Health
Care Manager, 32(4). https://doi.org/10.1097/HCM.0b013e3182a9d704
Gaspersz. (2011). Malcolm
Baldrige Criteria For Perfomance Excellence. PT gramedia utama.
Juran, J. M., & Godfrey, A. B.
(1999a). Juran’s quality handbook (5th ed). McGraw Hill.
https://gmpua.com/QM/Book/quality%20handbook.pdf
Juran, J. M., & Godfrey, A. B.
(1999b). Juran’s quality handbook (5th ed). McGraw Hill.
https://gmpua.com/QM/Book/quality%20handbook.pdf
Katsioloudes Marios. (2002). Global
strategic planning : cultural perspectives for profit and non profit
organizations. Philadelphia : Butterworth Heinemann.
kemenkes RI. (2020). Peraturan
Menteri Kesehatan Nomor 80 Tahun 2020.
https://persi.or.id/wp-content/uploads/2020/12/pmk802020.pdf
Kotler, P. (2007). manajemen
pemasaran. indeks kelompok gramedia.
Kusumapradja, R., Adhikara, M. F.
A., & Livinus, V. (2021). Usefulness of Hospital Management Information
System at Teaching Hospital.
Manurung, J. M. (2017). Kajian
Implementasi Mutu Dengan Pendekatan Integrasi Six Sigma dan TQM melalui
Penilaian Malcolm Balridge di Rumah Sakit Charitas Palembang. FKM UI.
https://lib.ui.ac.id/file?file=digital/2017-11/20454065-T48634-Jessihana%20Morgan%20Manurung.pdf
Organ Denis W. (1997). Organizational
citizenship behaviour : its contract-up time, human performance.
Parast, M. M., & Golmohammadi,
D. (2019). Quality management in healthcare organizations: Empirical evidence
from the baldrige data. International Journal of Production Economics, 216,
133–144. https://doi.org/10.1016/J.IJPE.2019.04.011
Prybutok, V., & Cutshall, R.
(2004). Malcolm Baldrige National Quality Award leadership model. Industrial
Management & Data Systems, 104(7), 558–566.
https://doi.org/10.1108/02635570410550223
Rachmawati, D. S. (2017). Analisis
Mutu Kinerja Rawat Inap Rumah Sakit dengan Pendekatan Kriteria Malcolm
Balridge di RSUD Prapatan. FKM UI.
Ruswanti Endang, Yanti Rina
Aprilita, & Kusumawati Diyah Medina. (2020). Word of mouth, trust,
satisfaction and effect of repurchase intention to Batavia hospital, Jakarta,
Indonesia. http://www.m.growingscience.com/msl/Vol10/msl_2019_258.pdf
Tannenbaum, R., Wreschler, R.
rving, & Massarik, F. (1997). Leaderships and organization : A
Behavioural Science Approach. Mc Graw Hill Book Company., Inc.
Tiara, A., Situmorang, L., Widhy,
L., & Gumilang, M. (2020). Implementasi Penilaian Kinerja Menggunakan
Metode Malcolm Balridge Pada Rumah Sakit di Indonesia. FKM UI.
Wijono, D. (2000). manajemen
mutu pelayanan kesehatan (Vol. 1). airlanggga university press.
|
This
work is licensed under a Creative Commons Attribution-ShareAlike 4.0
International License. |