<![CDATA[The Public Service Agency (Badan Layanan Umum/BLU) status grants public hospitals flexibility in financial management, yet this flexibility frequently generates idle cash that is not optimally utilized. At RSUP Prof. Dr. R. D. Kandou Manado, the main referral hospital in North Sulawesi, idle cash rose from IDR 50.25 billion in 2024 to IDR 144.08 billion as of 30 June 2026, an almost threefold increase, while empirical evidence on how treasury strategy is formulated, implemented, and evaluated in vertical BLU hospitals remains limited. This study aims to determine the treasury optimization strategy applied at the hospital. A descriptive qualitative approach with a single case study design was employed. Primary data were collected through in-depth semi-structured interviews with five purposively selected key informants, supported by observation and documentation, and were analyzed through data reduction, data display, and conclusion drawing with source and technique triangulation. Interpreted through David's three-stage strategic management model and stewardship theory, the findings show that the treasury strategy is conservative and tends to be reactive to external signals, particularly the Ministry of Health's centralized time-deposit beauty contests, rather than proactive based on medium- to long-term cash flow projections. Buffer cash is set from historical expenditure averages without a quantitative formula or internal standard operating procedure; idle cash is placed in one-month time deposits that are rolled over and comply with prudential principles, but no formal model such as the Miller-Orr model is applied and the financial information system is not integrated; layered internal controls are in place, yet treasury income contributes at most about 1 percent of total revenue. The study recommends an integrated financial information system, stronger inter-unit coordination, internal procedures on buffer cash and fund placement, and gradual diversification of short-term instruments.]]>
