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Lucia Ratna Kartika Wulan
Fakultas Kesehatan Masyarakat Universitas Diponegoro, Semarang
Decision Sciences, Operations Research & Management Health Professions

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Factors that Affect the Performance of the Village Midwife in the Standard Implementation of Midwifery Birthing Mothers and Orphans in Semarang Setiyana Sri Subekti; Laksmono Widagdo; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 2 (2014): Agustus 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (514.178 KB) | DOI: 10.14710/jmki.2.2.2014.%p

Abstract

AbstrakSalah satu indikator pelayanan kesehatan yang berkualitas dapat terlihat dari perbandingan AKI (Angka Kematian Ibu ) dan AKB ( Angka Kematian Bayi ). Di Kabupaten Semarang , AKI tahun 2010 mencapai 101, 92/ 100.000 kelahiran hidup,dan pada tahun 2011 naik menjadi 146,24/100.000 kelahiran hidup. Penyebab langsung kematian ibu 90 % disebabkan karena persalinan dan segera setelah persalinan. Penyebab kematian ibu diantara lain perdarahan (52%), ekalmasi (18 %), infeksi (15 %), persalinan lama (15 %). Untuk menurunkan angka kematian ibu, harus dilakukan pelayanan kesehatan maternal yang berkualitas sesuai dengan standar asuhan. Pelaksanaan standar asuhan di Kabupaten semarang belum dilaksanakan dengan baik. Tujuan penelitian adalah untuk menganalisis faktor-faktor yang mempengaruhi kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin oleh bidan desa di Kabupaten Semarang. Jenis penelitian adalah observasional analitik dengan pendekatan crosssectional.Cara pengambilan data dilakukan dengan wawancara menggunakan kuesioner. Populasi adalah 311 bidan desa di Kabupaten Semarang. Pengambilan sampel dipilih dengan tehnik proportional random sampling dari bidan desa yang memenuhi kriteria inklusi dan eksklusi pada tiap puskesmas. Analisis data dilakukan dengan uji product moment dan regresi linier.Hasil penelitian menunjukkan bahwa bahwa rerata umur responden 33 tahun, dengan rerata masa kerja 11 tahun, pendidikan responden sebagian besar D III kebidanan (72,36 %). Hasil analisis univariat menunjukkan bahwa kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin fisiologis adalah kurang (83 %), kinerja bidan dalam penerapan standar asuhan kebidanan ibu bersalin patologi kurang (87%), pengetahuan kurang (57 %), motivasi tinggi (51%), persepsi supervisi kurang (55 %), persepsi beban kerja rendah (57 %), persepsi imbalan kurang (57 %), persepsi sanksi kurang (55 %). Faktor yang berhubungan dengan kinerja adalah pengetahuan (nilai p = 0,000), motivasi (nilai p =0,007), persepsi supervisi ( nilai p = 0,008), persepsi beban kerja (nilai p =0,012), persepsi imbalan (nilai p = 0,000), persepsi sanksi (nilai p = 0,000). Faktor yang berpengaruh terhadap kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin adalah pengetahuan (p = 0,000), persepsi beban kerja (p = 0,027), persepsi sanksi (p = 0,000).Saran bagi Dinas Kesehatan Semarang adalah sosialisasi tentang pelayanan ibu bersalin sesuai standar asuhan kebidanan kepada seluruh bidan desa, Memperbaiki teknik supervisi yang diterapkan antara lain dengan penyusunan jadwal supervisi dan kesepakatan waktu antara supervisor dan staf tentang pelaksanaan supervisi. AbstractIn Semarang district, maternal mortality rate (AKI) increased from 101.92/ 100000 live-births in 2010 to 146.24/100000 live-births in 2011. The majority of death patients were caused by referral delay and a delay in detection of in labour emergency signs. This indicated that the implementation of obstetric standard care in Semarang district was not done properly. Objective of the study was to analyze factors affecting work performance of village midwives in the application of obstetric standard care for in labour mothers in Semarang district. This was an observational analytical study with cross sectional approach. Data were collected through interview guided by questionnaire. Study population was 311 village midwives in Semarang district. The number of respondents was 76 midwives selected purposively according to inclusion and exclusion criteria in each primary healthcare center. Product moment test and linear regression were applied in the data analysis.Results of the study showed that average age of respondents was 33 years old, average working period was 11 years old, majority of respondent’s education background was D III in midwifery (72.36%). Work performance of village midwives in the implementation of obstetric standard care for physiological mother in labour was insufficient (83%), work performance of village midwives in the implementation of obstetric standard care for pathological mother in labour was insufficient (87%), respondents with insufficient knowledge was 57%, respondents with high motivation was 51%, respondent’s perception on supervision was inadequate (55%), respondent’s perception on workload was low (57%), respondent’s perception on incentive was insufficient (57%), and respondent’s perception on sanction was inadequate (55%). Factors related to work performance of village midwives were knowledge (p= 0.000), motivation (p= 0.007), perception on supervision (p= 0.008), perception on workload (p= 0.012), perception on incentive (p= 0.000), perception on sanction (p= 0.000). Factors affecting work performance of village midwives in the implementation of obstetric standard care for in labour mothers were knowledge (p= 0.000), perception on workload (p= 0.027), perception on sanction (p= 0.000). Suggestions for Semarang district health office are to conduct refreshing on maternity services according to obstetric standard care to all village midwives, to improve supervision technique by implementing facilitative supervision. 
Quality Management of Emergency Room (ER) Services in the District General Hospital of Kudus Elok Mariyatul Qibtiyah; Sudiro Sudiro; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (152.143 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Mutu pelayanan Instalasi Gawat Darurat (IGD) RSUD Kudus yang meliputi sumber daya manusia, kebijakan dan prosedur serta sarana prasarana IGD belum sesuai standar IGD RS level III. Penelitian ini bertujuan untuk mengetahui manajemen mutu pelayanan IGD yang meliputi proses manajemen mutu, kepemimpinan mutu dan organisasi mutu. Jenis penelitian ini dilakukan secara kualitatif menggunakan metode observasi, Focus Group Discussion (FGD) dan wawancara mendalam. Subyek sebanyak 13 orang terdiri atas: 4 orang sebagai informan utama, 9 orang sebagai informan triangulasi terdiri atas 3 orang petugas IGD RSUD Kudus dan 6 orang keluarga pasien. Variabel yang diukur adalah proses manajemen mutu, kepemimpinan mutu, organisasi mutu dan mutu pelayanan IGD RSUD Kudus. Hasil penelitian ini meliputi perencanaan mutu: jumlah dan kompetensi petugas kurang, belum ada pedoman orientasi, belum ada pedoman mutasi, pengadaan, pemeliharaan dan kalibrasi alat kurang. Pengendalian mutu : evaluasi kinerja belum ada. Peningkatan mutu : peningkatan sumber daya manusia kurang, belum ada pedoman pelatihan, belum ada pengaturan anggaran terintegrasi dengan pengadaan sarana prasarana dan sarana prasarana kurang. Kepemimpinan mutu : gaya demokratis dengan kebijakan yang jelas. Organisasi mutu: pengalaman manajemen dan kompetensi Kepala IGD baik, perubahan yang mundukung mutu pelayanan IGD bisa diterima baik. Mutu pelayanan IGD meliputi SDM yaitu kepala IGD yang mempunyai kriteria khusus baik, petugas IGD yang mempunyai kriteria khusus kurang, sarana prasarana kurang, kebijakan dan prosedur kurang. Kesimpulan penelitian ini adalah proses manajemen mutu IGD RSUD Kudus belum berjalan baik, gaya kepemimpinan demokratis dengan kebijakan jelas, organisasi mutu berjalan baik, petugas IGD belum memenuhi kriteria khusus. Saran penelitian ini adalah mengadakan rapat kerja guna menyusun rencana strategis dan kebijakan pimpinan yang jelas sebagai arah dan pedoman yang dituangkan dalam program kerja tahunan di RSUD Kudus. Service quality of an emergency room unit (IGD) of Kudus District General Hospital (RSUD) included human resource, policy, procedure and facility of IGD. This was not fit properly with level III IGD standard. Objective of this study was to identify service quality management of IGD including quality management process, quality of leadership, and quality of organization. This was a qualitative study using observation, focus group discussion, and in-depth interview methods. Study subjects were 13 people: four main informants, nine triangulation informants. Triangulation informants included 3 workers at IGD of RSUD Kudus, and six patient’s family members. Measured variables were quality management, quality of leadership, organizational quality, and service quality of IGD of RSUD Kudus. Results of this study included quality planning: the number of workers and worker’s competence were insufficient; no orientation guideline and transfer or workers guideline were provided; maintenance and instrument calibration were insufficient. Quality control: no evaluation of work performance was provided. Quality improvement: human resource improvement was not adequate; no training guideline was provided; no integrated budget regulation was performed; supply of facilities was not adequate. Quality of leadership: Democratic style with understandable policy was applied. Organizational quality: management experience and the competence of head of IGD were good; changes that supported IGD service quality were well accepted; Service quality of IGD, that included human resource such as chief of IGD with special criteria, was good. IGD workers with special criteria were insufficient. Facilities were insufficient. Policy and procedure were insufficient. In conclusion, the quality management process of IGD RSUD Kudus was insufficient; democratic leadership with understandable policy was applied; organizational quality was good; IGD workers were not matched with specific qualification. Suggestions: to conduct meeting to formulate clear strategic plan and clear leader policy as guidelines. It should be included in the annual working program in RSUD Kudus.
Co-Authors Elok Mariyatul Qibtiyah Laksmono Widagdo Setiyana Sri Subekti Sudiro Sudiro