Relationship of Integrated Quality Management with Health Services
The growth and equity of an advanced and modern economy increase the needs and demands of the community for quality and affordable health services according to the ability of the community. This is in line with the increasing ability of the community to pay for health costs. Health Law No. 23/1992 states that the goal of health development is to increase everyone's awareness, willingness, and ability to live a healthy life in order to achieve optimal public health.
To realize the goal of health equity, efforts are made to develop a community center, increase community participation, and develop a referral system. Community Health centers are at the forefront of providing primary health care to remote villages and the general public. Community participation is in the form of Integrated Healthcare Center institutions throughout the country.
Hospitals are the basis of a referral system for doctors, especially in matters related to healing and restoring human health. To encourage equitable development of health facilities and institutions, the government opens opportunities for the private sector to provide health services in accordance with the needs and demands of the community.
Health care is still a civil right. (Invitation Number 23/1992). But here it does not mean that it is obtained for free, but it can be interpreted that health services are available, easily accessible, of high quality and at affordable prices by all levels of society. Management of patient-friendly health services requires modern and socio-economic management. Hospitals must always react to changes quickly enough and then immediately anticipate them in accordance with the wishes and needs of the community by always referring to customer satisfaction. The current social demand is health services that are simple, fast and convenient, which in the end can create satisfaction with the results of treatment according to the disease being treated. Therefore, better health services are increasingly demanded by hospitals as community health service providers.
Hospital quality is highly dependent on hospital resources, such as the quality of services provided by doctors, nurses, staff and workers, as well as available facilities and infrastructure. A quality hospital must know what its patients expect, because patients have the right to assess the quality of services provided.
In some hospitals, there is still a gap between what patients expect and the reality experienced by patients in terms of the quality of hospital-friendly services. This can be seen in many complaints, including those left by patients in public hospitals, patients from eye clinics, who were reprimanded by their staff when asked if there might have been an error in the results of the eye test two weeks earlier. In addition, safety must be considered in the patient environment. So that the difference between service expectations and the reality achieved leads to patient satisfaction.
Looking at the state of the hospital for 5 fiscal years, it is very interesting to know the work system in obtaining health information from the public, so that the quality of services provided by the hospital concerned will be high. Measurement must be continuous to create improvements or service improvements.
One of the factors causing limited human resources, especially in the medical field, is the weakness of integrated quality management. The problem is the lack of professional staff in managing patient services, there are still patients who feel uncomfortable in their services. And it still refers to the weak use of total quality management or integrated quality management that is not yet optimal.
The phenomenon of total quality management that has not been implemented optimally is a major challenge for hospital managers and general hospital employees. The results of field observations while researchers show that patients still often complain about the vigilance of medical officers in handling community complaints, medical officers often delay medical operations for a long time, service facilities are still lacking and limited. medical personnel, especially specialist doctors. However, to improve public health quality assurance between the expectations and reality of consumer patients or general hospitals, it is necessary to implement integrated quality management or total quality management. The business management policy is related to this perspective, namely continuous improvement of the quality of health services, supported by general autonomy at all levels and work units to ensure hospital responsibilities and a smooth competitive strategy. This policy is manifested in a comprehensive and effective quality management implementation program.
Integrated Quality Management
Principles of Total Quality Management
In the information age, every organization must face increasingly complex business olympiads, because in order to survive and develop, organizations must have a competitive advantage.
In the increasing competition for training service managers, quality is a major issue. Quality improvement is a requirement of the new paradigm of organizational management. Achieving the title of health and quality is the responsibility of every health organization, including public hospitals. Continuous improvement is carried out, one of which is by managing the overall hospital service system, which is oriented to high quality and fast operation. This approach is known as total quality management or integrated quality management in hospitals where excellence in health care is required, such as speed, responsiveness, flexibility, processing, operations and expertise of doctors and nurses.
Total quality management as a concept that seeks to implement a world-class quality system requires major changes in the culture and value system of the organization. According to Hensler and Brunel (Christopher, 1993), Total Quality Management has four main principles.
The four principles are as follows:
Customer satisfaction In total quality management, the concept of customer and quality is expanded. Quality no longer means only meeting certain requirements, but quality is determined by the customer. The customers themselves are internal and external customers. We strive to meet customer needs in all aspects including price, safety and timeliness. Therefore, all activities related to health services must be coordinated to satisfy customers.
Honor. In a world-class quality hospital, every doctor and nurse is seen as an individual with their own talents and creativity, who are fast and responsive. Therefore, health workers are the organization's most valuable resource. Therefore, everyone in the organization is treated well and given the opportunity to be involved and participate in the decision-making team.
Fact-based management. Fact-based world-class healthcare. This means that every decision is always based on information, not just on emotion. There are two main concepts involved. First, priority is the concept that not all aspects can be improved simultaneously due to limited resources. Therefore, management and enterprise teams can use the data to focus their efforts on several important situations. Another term, variability in human activity. Statistical data can provide insight into variation that is a natural part of any organizational system. Thus, management can predict the outcome of each decision and action.
Continuous Improvement. To be successful, every company must implement a systematic process for implementing continuous improvement. At this point, the PDCA (plan-do-check-act) concept is applied, which consists of the stages of planning, implementing the plan, checking the results of the implementation plan and correcting the results obtained.
Simultaneously, Russell and Taylor (in Fitrian, 2008; 23) explained the principles of total quality management, including;
(1) Customer orientation (consumer focused)
(2) Management
(3) Strategic planning
(4) Personal responsibility (involving everyone)
(5) Continuous improvement continuously)
(6) Collaboration
(7) Statistical method
(8) Education