4. In which ways is the initiative creative and innovative?
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4. The core innovation done by Pontianak Public Hospital is through its service mechanism. It implements a breakthrough mechanism that classified patients regardless their economic and social status, which is known as an anti discrimination or a non class service. The explanation of the service classification will be done based on the current condition and the future development of the Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital.
Current condition – a non-class hospital service. The hospital does not distinguish the rooms facility. So at the moment, all rooms are using the third class room standard. Regarding the medical treatments, all treatments are classified by the diseases and the severity of patients’ condition instead of financial condition of the patients. There is no difference in the service quality, the use of equipment and service for medical treatments or operation, and other supporting check up. All patients also get a proportional medical treatment based on the standard operational procedure of the service.
By implementing a non discrimination service, Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital are able to deliver a non discrimination and effective services by prioritizing and facilitating the patients’ importance based on standard, professional, on-time and fast, easy and affordable.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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5. The initiator of Non Discrimination Public Hospital idea is the Mayor of Pontianak, Sutarmidji. He came up with the idea to support Pontianak City’s Vision as an Environmentally Oriented Equator City, leading in human resources development and public service. The city government is the one who runs the hospital under a unit called Sultan Syarif Mohamad Alkadrie Hospital supervised by Health Department of Pontianak City.
Even though it is a city owned public hospital, but it does not limit the service only for the Pontianak people that is around 600.000 people but also the surrounding area. The healthcare service is open for all people. People in Pontianak and the neighbor city next to it get a lot of benefit with the existence of the new public hospital. Before, there was only one public hospital in Pontianak, Sudarso Public Hospital that owned by the province government. Sudarso Public hospital is also the biggest hospital in West Kalimantan, so it becomes a reference hospital for all smaller public hospital all over West Kalimantan. Therefore, Soedarso Public Hospital always has an over capacity of patients that they need to be taken care of. The existence of Pontianak Public Hospital becomes a breath of a fresh air to the people in accessing healthcare. Pontianak Public Hospital becomes a new option for people especially those who are under the universal healthcare. An additional healthcare facility will help the government in providing healthcare service to its people, and help to overcome the problem of patients over-load. When the quantity of over-load patients are lowered, public hospital can give a better healthcare service to the patients.
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6. How was the strategy implemented and what resources were mobilized?
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6. The strategy to successfully implement an anti discrimination hospital service are, the making of policy, the development of a clear program operation manual, supporting activities to maintain organizational resources and steps to overcome the environmental change with more detail explanations below.
A strong commitment shown by the Mayor of Pontianak and the entire officials represents the core purpose of this hospital which is to provide a qualified service to all people especially those who were being marginalized overtime –the poor. Hence, the mayor decided to convey his idea into reality. His idea of policies serve as the foundation of service and medical treatment price in the hospital. Since the hospital has no class discrimination, there is only one set of prize for all treatments and services.
To embody the policies into reality, a set of ground rules need to be made to act as a guidance for the brand new policy. Besides, ground rules also need to be established in order to set standard of services. Then, some rules were made to establish a system of standardized service throughout the entire hospital. Some rules are Medical Service standard, standard operating procedure for all services, clinical pathway, until service procedures. The ground rules also regulate the hospital rooms. The rooms are divided into some categories, which are children room, male room, female room, contagious disease, maternity room. The nurses also categorized in two groups based on the disease and rooms.
It is important for all staffs to understand their roles, responsibility and job characterization. They are also responsible to make improvements in the healthcare service they provide to all patients. The service characteristic all employee needs to obey is that the healthcare should be equal, economical accessible, appropriate and acceptable for all.
To improve the ability of the employee, the capacity building improvement for all staffs is very important. In house training for the medical staffs are often conducted. To achieve certain level of competence, the staffs need to enroll the educational and training process related to their expertise held by health professional institution.
In management level, strategies to implement the non discrimination healthcare services are establishing policies and operational programs and activities by taking into account the organization’s resources and environmental conditions encountered, as follows:
1. A strong commitment by the mayor, the board of management and staffs;
2. Determining the Medical Service Standards, Standard Operating Procedures, and Clinical Pathway
3. Treatment rooms assignment based on the type of disease, gender and age group.
4. Nurse group assignment into two groups, responsible for the care of patients according to the type of disease and treatment rooms.
For evaluating all staffs and management commitments, services and staff encouragements, the hospital regularly conduct monitoring in such ways:
1. Conduct a regular monthly meeting;
2. Conduct a meeting between management and the medical committee;
3. Conduct an internal meeting of management, with directors, health of division and the heads of section /sub-division;
4. Apply a mechanism of costumer complains and suggestions (suggestion box) and
5. The monthly report of financial section.
6. Conduct the customer satisfaction index
Pontianak city government also committed to give sufficient support to the public hospital, since the public hospital operated on a non-profit orientation. Therefore, the financial support from the Pontianak city government plays an important role in the running of Pontianak Public Hospital. The other funding for Pontianak Public Hospital are BLUD financial system from National insurances. The hospital also gets financial support from central government, West Kalimantan Provincial government.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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7. The idea of anti discrimination service or more known by non-class service was initiated by the mayor of Pontianak, Mr. Sutarmidji, in order to actualize the big vision of Pontianak to become an environment oriented equator city, the front row of human resources development and public service. The successful implementation of the concept of anti discrimination service needs a holistic support and awareness of multiple important stakeholders, which are management of the hospital, medical crew, nurses, and all supporting staff members.
Since most of the patients come from low economic and social background, the implementation of anti discrimination service requires a total change of point of view of all employees from doctors, nurses, other medical staff, until administration staff. All of them have to realize that even though the patients are coming from a low economic background they have to give an optimal service without any discrimination. The working culture of the whole hospital has to be based on the basic value, belief and commitment to give service that can satisfied all patients despite their background.
Pontianak city government also committed to give sufficient support to the public hospital, since the public hospital operated on a non-profit orientation. Therefore, the financial support from the Pontianak city government plays an important role in the running of Pontianak Public Hospital.
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8. What were the most successful outputs and why was the initiative effective?
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The results and the impact that can be reported are the increase in the number of patient (walk-in and hospitalized patients) and also community satisfaction index. Increase in the number of patients and the use of emergency room has proved that the hospital has been used well and in accordance with the needs of society in Pontianak and outside Pontianak. It also represent the increasing level of trust to the hospital Based on the Community Satisfaction Index Surveys in the hospital, the services in Sultan Sharif Mohamad Alkadrie Hospital of Pontianak is categorized as good.
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9. What were the main obstacles encountered and how were they overcome?
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Along the way, the implementation of this brand new concept comes with some obstacles. First problem, nurses as the front row of hospital service in the medical treatment have not yet master all specialty in medical work such as surgery, internal disease, pediatric, neurology, sight and hearing. Therefore, to overcome this problem, nurses are categorized to two groups, surgical and non surgical patients. Furthermore, the hospital also held some in-house training to increase the capability of the nurses, general practitioners are assigned as inpatient doctor for 24 hours (divided in three work shifts).
Second problem, the implementation of non class based service influences the income of the staffs. Employees get less take-home pay since there is no cross-subsidy like a regular hospital. In class based hospital system, the income from the upper class patients are distributed to all staff member. Pontianak city government stepped in to solve this condition by giving an extra intensives other than regular payment for all employees and for the medical specialists, the government provides houses and cars to support their activity
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