Prof. Dr. Akmal Taher, Sp.U(K)

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