<![CDATA[Hospital domestic wastewater carries organic and microbiological pollution loads requiring both adequate treatment and reliable monitoring; however, effectiveness is often judged solely from laboratory pass/fail results rather than the monitoring system itself. This study examines the effectiveness of the wastewater quality monitoring system at a general hospital’s wastewater treatment plant in Buleleng Regency, Bali, Indonesia, using five years of outlet monitoring data (2021–2025). A sequential explanatory mixed-methods design was applied: a quantitative phase analyzed 16 laboratory test records for trend and compliance, followed by a qualitative phase comprising a document checklist, a gap analysis against national wastewater regulation, a SWOT analysis, and limited staff clarification. Results show 93.75% of test results met the applicable standard, with one pH exceedance in December 2022 never followed by documented corrective action. Monitoring frequency reached the minimum target in only three of four fully recorded years, and no single test covered the complete mandatory parameter set. Gap analysis across nine monitoring-system aspects found none fully compliant with ideal provisions. Treatment performance is generally sound, but the monitoring system remains structurally weak in governance. Priority strategies identified are a formal corrective-action procedure, a standardized operation-and-maintenance logbook, and completion of the mandatory testing parameter package.]]>
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