academic health system as strategy for...

ACADEMIC HEALTH SYSTEM

AS STRATEGY FOR

INCREASING ACCESS AND

QUALITY OF HEALTH CARE

Yogyakarta, January 12 2017

Prof. Dr. dr. Akmal Taher, SpU (K)

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

MINISTRY OF HEALTH

REPUBLIC OF INDONESIA

INTEGRATION

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

Functional 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.

Structural Integration

Source : PP 93/2015

MINISTRY OF HEALTH


Health Challenges - 21st 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

MINISTRY OF HEALTH


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

MINISTRY OF HEALTH


3-yr residency

Lack primary care

5-yr schooling

Students

Supply

Demand

Patient

Flow Education Health

Professionals

Overcrowded Hospitals

Vicious Systems

Health, inequity, quality

Financial impoverishment

Patient dis-satisfaction

Lack Jobs

Status

Salary

Career

Workload 6-in-1

Not top students

Limited time

Financial incentives

Drugs & testing

Poor communications

Curriculum mismatch

No quality control

Faculty-student ratio

No Accreditation

No Certification

Science based Problem based Systems based

Scientific

curriculum

University

based

Problem-based

learning

Academic

centers

Competency

learning

Health-Educ

Systems

Inst

ruct

ion

In

stitution

1900 2000+

Three Generations of Reform

Universal Health Coverage in Indonesia

Started at the 1st of January 2014

Where Do We Want To Go ?

2015

2016

2017

2018 2019

UHC:

“All Indonesian

People Eligible

To JKN”

REFERRAL SYSTEM

Self Care

Primary Care

Secondary

Tertiary

Tertiary Care

Referral - Authority

GATE KEEPER

NATIONAL REFERRAL HOSPITAL : 14 RS PROVINCIAL REFERRAL HOSPITAL : 20 RS REGIONAL REFERRAL HOSPITAL : 110 RS

Primary health Care

District Hospital Regional

Referral Hospital Provincial

Referral Hospital National

Referral Hospital

MINISTRY OF HEALTH


3-yr residency

Primary care

5-yr

schooling

Students

Supply

Demand

Professionals Tertiary hospitals

Virtuous Systems for UHC

13

Top students

Equity+quality

Financial protection

Satisfaction & trust

Quality standards

Accreditation

Certification

Graduates=Jobs

Status

Salary

Career

Workload 1-in-1

Referral

system

Competency-based

curriculum

Academic Health System

Academic Health Center which includes primary care

Government Decree 93 - 2015 (PP 93 ttg RS

Pendidikan)

MINISTRY OF HEALTH


NEW STRATEGIES

GOOD QUALITY OF HEALTH CARE

AFFORDABLE COST

Cheap price

Efficiency of the

budgets

Economic value

REFORMATION OF HEALTH

INSURANCE

EDUCATION

COMMUNITY

SERVICES

RESEARCHES

MAINSTREAMING

MINISTRY OF HEALTH


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.

MINISTRY OF HEALTH


Public Hospital – Important roles

Provider of last resort

Ensuring access to medical services for those who can not go elsewhere

Major teaching institution

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

Developing integrated

structure

Pursuing and supporting

disease-related research

Educating the health

work-force

Focusing attention on the

business of medicine

Restoring the outstanding care as the core mission

and focus of Academic Medical Centre

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

PRIMER

SEKUNDER

TERSIER

National Referral

Center

MINISTRY OF HEALTH


TERTIARY MEDICAL CARE

Specialty-subspecialty

training

SECONDARY MEDICAL CARE Specialty-Primary care

physician training

PRIMARY MEDICAL CARE Primary care physician

training

CLINICAL

MEDICINE

COMMUNITY MEDICINE

Health-system based education = Academic-based health system

MINISTRY OF HEALTH


National Referral Center Subspecialty training

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. Dr. Soetomo General Hospital, East Java

9. Sanglah General Hospital, Bali

10. Soedarso General Hospital, West Kalimantan

11. 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

2016470 PUSK, 9 PROV,

64 KAB/KO

20172238 PUSK,

9 PROV, 64 KAB/KO

20185085 PUSK,

9 PROV, 203 KAB/KO

20198610 PUSK,

34 PROV, 352 KAB/KO

20154 PUSK

4 KAB/KO 4 PROV

REGULASI/PANDUAN:PENERBITAN PERMENKES,

JUKNIS & SOSIALISASI

ANGGARAN:PENYEDIAAN BIAYA TH 2016,

PERENCANAAN BIAYA TH 2017

REKRUTMEN SDM:REKRUTMEN 2350 PEMBINA KLG

UTK 470 PUSK

PELATIHAN SDM:2350 PEMB. KLG, 2350 TENAGA TEKNIS/PROF, 470 PENGELOLA

DATA, 940 TEN. MNJ UTK 470 PUSK

SARANA-PRASARANA:PENYEDIAAN 2350 TABLET UTK PENDATAAN, 470 KOMPUTER, SERTA SARPRAS UTK 470 PUSK

KEGIATAN:PENGUMPULAN DATA, BUAT DATABASE & PELAKSANAAN

PEND. KLG DI 470 PUSK

SISTEM INFORMASI:INTEGRASI PELAPORAN DATA

KELUARGA KE SP2TP, PELAKS. SI TERINTEGRASI DI 470 PUSK

UJICOBA:KONSEP, INSTRUMEN & PENGUMPULAN DATA

REGULASI/PANDUAN:SOSIALISASI PERMENKES

& JUKNIS




UTK 1768 PUSK

PELATIHAN SDM:8840 PEMB. KLG, 8840 TENAGA TEKNIS/PROF, 1768 PENGELOLA

DATA, 3536 TEN. MNJ UTK 1768 PUSK


KEGIATAN:PENGUMP. DATA, BUAT/ UP-DA-TING DATABASE & PELAKS. PEND.

KLG DI 2238 PUSK

SISTEM INFORMASI:PELAKS. SI TERINTEGRASI

DI 2238 PUSK & PELAPORANNYA

REGULASI/PANDUAN:SOSIALISASI PERMENKES

& JUKNIS




UTK 2847 PUSK

PELATIHAN SDM:14235 PEMB. KLG, 14235 TEN.

TEKNIS/PROF, 2847 PENGELOLA DATA, 5694 TEN. MNJ

UTK 2847 PUSK



KLG DI 5085 PUSK



REGULASI/PANDUAN:SOSIALISASI PERMENKES &

JUKNIS



REKRUTMEN SDM:REKRUTMEN PEMBINA KLG

UTK 3525 PUSK

PELATIHAN:17625 PEMB. KLG, 17625 TEN.

TEKNIS/PROF, 3525 PENGELOLA DATA, 7050 TEN. MNJ

UTK 3525 PUSK



KLG DI 8610 PUSK



KET: JUMLAH PUSK ADALAH

KUMULATIF DARI TAHUNKE 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

ROADMAP KEGIATAN PROGRAM INDONESIA SEHAT

DENGAN PENDEKATAN KELUARGA TAHUN 2015-2019

INDIKATOR KELUARGA SEHAT

INDIKATOR PEMBINA KELUARGA KOORDINATOR/PJ

PROGRAM

MANAJER KLINIS MANAJER INSTITUSI

Penderita

hipertensi

melakukan

pengobata

n secara

teratur

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 kegiatan-

kegiatan 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

Mengkoordinasikan dgn FKTP

lainnya di wilayah kerja

Puskesmas melalui forum lokmin

bulanan dalam tindak lanjut

hasil pendataan keluarga

terkait kepesertaan JKN

Asuhan mandiri pemanfaatan

toga dan akupresur dalam

penanganan hipertensi

Mission Health Innovation Community Regulation

Medicine and health

services

• Advanced services

• Universal Health

Coverage

• Telemedicine

• Continuing

services

• Patient safety

• New operation

technical

• Visit family

example

screening disease

• Handling social

problem that give

impact to health

• Joint procurement

• Public Private

Partnership

• Strengthen

primary health

care

Research • Basic, clinic and

community

• New Technology

trials

• Health Techology

Assessment

• Integration of

AHS and

community

• Regulation based

on evidence

• Commercial and

non commercial

researches

Education • Education of

health worker

according type of

patients

• Technic of new

teaching process

according to

service changes

• Continuing

professional

development

• Involve community

to improve the

curriculum

• Primary care

physician

education

• Interprofesional

education

MINISTRY OF HEALTH


• Strategic study centre Government

• Develop effective and proffesional model of health care

Ministry of Health

• Improve quality of medicine and Health workers education

• Improve university reputation

Ministry of Research, Technology and Higher

Education

• Being economic assets Ministry of Finance

• Recovery of Health care, referral system, urban model and rural health system

Health Office

• Health services in Health care facilities

• Efficiency Healthcare and Social

Security Agency

• Quality health care

• Utilization result of medicine and health researches

Community

(Wong, 2011)

BENEFIT OF AHS

MINISTRY OF HEALTH


DISTRIBUTION OF TEACHING HOSPITALS

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

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

Sardjito Hospital

Yogyakarta Hospital

Yap, Eyes Hospital

Dr. Soetomo l Hospital

Haji Surabaya Hospital

Soebandi Hospital

Ramelan Hospital

Sidoarjo Hospital

Soedono Madiun Hospital

Sanglah Hospital

Tabanan Hospital

Badung Hospital

Sajiwani Hospital

Not established yet. Prof. Dr. Yohannes

Hospital

Prof. Dr, Kandou Hospital

Dr. Wahidin Sudirohusodo Hospital

Wahab Sjahranie Hospital

Ulin Banjarmasin Hospital

Zainoel Abidin Hospital

H Abdul Moeloek Hospital

Arifin Achmad Hospital

Adam Malik Hospital

PirngadiHospital

Djasamen Saragih

Hospital

Deli Serdang Hospital

M Yunus

Hospital

M.Hoesin Hospital

Bari Hospital

M. Djamil

Soedarso Hospital

Dorys Sylvanus Hospital

Major Teaching Hospital: 57 hospitals

Satellite Teaching Hospital: 14 hospitals

Affiliated Teaching Hospital: 10 hospitals

Anutapura Hospital

Bahteramas Hospital

MINISTRY OF HEALTH


Major

Teaching

Hospital

Practice

Plan University

AHS

Satellite

Affiliated

satellite

Hospital

Primary Health Care

Public Health Office Faculty of

Dentistry Faculty of Medicine

Faculty of Public Health

Faculty of Pharmacy

Faculty of Nursing

The doctors are ready to be placed in planned area.

Education

Research

Translational researches

Services Delivering an excellent service, patient safety oriented

should be defined as a TEACHING HOSPITAL

Should be NATIONAL / INTERNATIONAL

ACCREDITED

TEACHING HOSPITAL AND EDUCATION INSTITUTIONAL FUNCTIONAL AND STRUCTURAL INTREGRATION

IMPROVEMENT OF AHC/AHS IN INDONESIA MINISTRY OF HEALTH


Ultimate goal of AHS in Indonesia

Center of excellence in medical care, workforce

education and research

Excellence Primary care

MINISTRY OF HEALTH


academic health system as strategy for...

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