Introduction
The
hospital is a public service organization responsible for every health service
provided to the community. Hospitals are responsible for providing quality and
affordable health services based on Law Number 44 of 2009. Hospitals as organizations
in the health sector have an important role in realizing optimal public health.
Therefore, hospitals are required to manage their activities by prioritizing
the responsibilities of professionals in the health sector. Article 4 of Law
Number 36 of 2009 concerning Health stipulates that everyone has the right to
health. Health is very important for humans. Human
health is the objective of innovation in the health industry, whose objective
is a healthy population (�ınar & Eren, 2015). Without
health, human life will not be perfect in carrying out their daily duties.
Discussing
health will be related to several aspects such as the following, namely health
services, health facilities, and health workers. For instance, in hospitals,
interpersonal trust between patients and providers has been associated with
improved health outcomes (Topp et al., 2022). In improving the
quality of health services based on Law Number 44 of 2009 concerning Hospitals,
that everyone has the right to get health services and is guaranteed in the
1945 Constitution of the Republic of Indonesia, which must be realized by
efforts to increase the degree of public health as high as possible. . In the
1945 Constitution of the Republic of Indonesia, Article 28 H paragraph (1)
which states that "every citizen has the right to health services. Every Indonesian
citizen is guaranteed by law that they have the right to health services
regardless of social status".
The health
services provided must meet the standards regulated in Law Number 44 of 2009
concerning Hospitals. Article 13, paragraph (3) states that: "every health
worker who works in a hospital must comply with professional standards,
hospital service standards, applicable standard operating procedures,
professional ethics, respecting patient rights and prioritizing patient
safety." This states that hospital service standards are a guideline
consisting of standard operating procedures, medical service standards, and
nursing care standards. Health development is part of national development to
achieve an optimal level of public health. In achieving this goal, the
government must take concrete actions to improve the health status of the
underprivileged. Law No. 44 of 2009 Article 13 states that health service
standards are not only seen from the final result but are related to the
process of providing health services to patients who must meet standard
operating procedures. The standard operating procedure is a set of instructions
carried out to complete certain routine workers.
Hospital is
a public service business unit that provides services in the health sector, as
regulated in Law Number 25 of 2009 related to Public Services. The management
of the Hospital business unit has its uniqueness because apart from being a
business unit, the Hospital also should carry out social functions. Social function
implies that a hospital must serve patients based on medical needs, not based
on the patient's ability to pay. So in hospital management, there is a risk of
conflict between the hospital manager and the patient. This kind of conflict
stems from the classification of the hospital organization. Hospital
organization classification can be divided into profit organizations and
non-profit organizations. This problem is a matter that is often the subject of
debate regarding the nature of the Hospital as a profit organization or as a
non-profit institution.
The debate
regarding the classification of hospitals and the management of hospital
business units is unique. Apart from being a business unit, it also has social
function obligations, so hospitals are very complex and high-risk institutions.
The pillar of medical services is the medical committee, which is dominated by
medical staff. The performance of medical staff in hospitals is a determinant
of the quality of hospital services. In addition, another important thing is
the performance of the medical staff because this will greatly affect patient
safety in the hospital. Therefore, hospitals are required to implement good
clinical governance to protect patients. It is not uncommon for people to
complain that the hospital does not serve the community well. According to Wila
Chandrawila Supriadi, a patient is a sick person who needs the help of a doctor
to cure his illness. Some hospitals are currently being sued for services that
do not meet expectations (Supriadi, 2001).
One of the
events in the community was the Prita Mulyasari case, where the case was in the
media spotlight. In this case, it can be seen that errors in hospital
governance can lead to services that can make patients suffer due to negligence
in handling health care for patients. Therefore, there is a need for accountability
from the hospital for negligence or intentional negligence, which ultimately
causes harm to the patient. In hospitals' implementation of health services,
many people think that hospitals do not provide good services. Sometimes
unexpected things can happen in the form of losses suffered by the patient,
such as physical disability and even death, which usually assumes that the
hospital has an act of medical malpractice. In this condition, the medical
staff facilitated by the hospital's medical committee is the group most closely
related to the patient, so the hospital is obliged to regulate all parties'
medical responsibility and legal liability.
This aims
to ensure the implementation of good health services, hospital responsibilities,
and accountability through internal regulations, the medical profession on
duty, especially in hospitals, with the hope of carrying out self-governing
(self-management), self-controlling (independent supervision), and
self-administration, discipline (self-discipline). The purpose of the
regulation is to maintain the quality of medical staff in providing services.
Therefore, it is necessary to make different regulations (medical staff bylaws)
that can regulate medical staff internally. The development of hospitals in South
Sulawesi is very rapid, whether it is a government hospitals or a private
hospitals. Law Number 44 Year 2009 Article 29 paragraph (1) letter r states
that every hospital is required to prepare and implement hospital internal
regulations (Hospital by Laws). Based on preliminary observations made by the
author, it was found that the hospital's internal regulations in several
hospitals in South Sulawesi Province were made only as a condition for hospital
accreditation so that the knowledge and understanding of hospital
organizations, especially medical staff, was very lacking.
Hospital by Laws (HBL)
can be in the form of Standard Operating Procedures (SOP), Hospital
Regulations, Decrees, Announcements, Letters of Assignment, Notifications and
Agreements (MOU). Each Hospital has a Hospital by Laws that is different from
one another, it depends on its history, establishment, ownership, and the
situation and condition of the Hospital. Hospital by laws must not conflict
with the regulations above. Therefore, in implementing hospital management,
among others, it is regulated based on Article 29 paragraph (1) letter r of Law
Number 44 of 2009 concerning Hospitals. Then in Article 36 of Law Number 44 of
2009 concerning Hospitals it is stated that every hospital must carry out
hospital governance and good clinical governance. Hospital governance and
clinical governance are also regulated in Permenkes Number
755/Menkes/PER/IV/2011 concerning Hospital Medical Committees. With this
regulation, it is hoped that the hospital's professionalism will be maintained
through the credential mechanism, maintaining the quality of the medical
profession, and maintaining the ethics and discipline of the medical profession,
as stated in Article 1 of PMK Number 755/Menkes/PER/IV/2011 concerning Hospital
Medical Committees.
Based on the
explanation above, the formulation of the problem in this writing is as
follows:
1. How is the
implementation of the Hospital Internal Regulations by the medical committee in
the hospital?
2. What is the
role of the Medical Committee in improving good clinical governance in
hospitals?
Method
This research was
conducted using an empirical approach, namely, discussing the legal phenomena'
social aspects. The analytical method used is qualitative analysis, namely by
analyzing data collected from interviews with several respondents and secondary
data in legal literature. There are two types of data used in this study,
namely primary data and secondary data sourced from Field Research, namely
field data sources as one of the considerations in supporting the truth of the
data to be discussed by the author, and Library Research. Namely the
source of data obtained from a review of several kinds of literature and other
reading sources that can support this writing.
�
Results And Discussion
A.
Implementation
of Hospital by Laws by the Medical Committee in Hospitals
1. Implementation of
Hospital by Laws by the Medical Committee at Labuang Baji Hospital
a) General Provisions
Hospital by laws Labuang Baji Hospital
Hospital
Internal Regulations (Hospital by Laws) Labuang Baji Regional General Hospital
are the basic hospital rules that regulate hospital management mechanisms,
including internal regulations concerning corporate rules and internal
regulations concerning medical staff. This regulation was drafted and ratified
by the Regional Government of South Sulawesi Province as the owner and Director
of the Labuang Baji Regional General Hospital as the manager in the context of
implementing good hospital governance and good clinical governance. In general,
the Hospital by laws (HBL) at Labuang Baji Hospital consists of Corporate
Internal Regulations and Internal Regulations for Medical Staff (Internal
Regulations for Labuang Baji Hospital (Pergub No. 58, 2015). The Corporate
Internal Regulations consist of the vision, mission, goals, functions and
duties of the hospital, the identity of the hospital which includes the name
and position, philosophy, motto, logo, and work culture of the hospital. In
addition, it also regulates the organizational structure and owner These
provisions are regulated in Article 2 to Article 93 of the Internal Regulations
of the Labuang Baji Hospital (Governor Regulation No. 58 of 2015 concerning
Internal Regulations for the Labuang Baji Regional General Hospital, South Sulawesi
Province).
Labuang
Baji Hospital is a hospital owned by a local government in the form of a
Regional Public Service Agency (BLUD), so that the organizational structure of
the Labuang Baji regional public hospital refers to the South Sulawesi Provincial
Regulation Number 6 of 2011 concerning the Second Amendment to the Regulations
and Governance of the Inspectorate, Regional Development Planning Agency,
Regional Technical Institute and other Institutions of South Sulawesi Province.
In Hospital by laws the Labuang Baji Regional General Hospital also explains
that the owner of the hospital is represented by the Governor of South Sulawesi
and regulates various provisions related to the supervisory board, directors,
remuneration, honorarium and services and regulations related to hospital
committees, each of which has a different function according to the function of
authority determined by the director. The Internal Regulations for Medical
Staff discuss various matters related to implementing good clinical governance
through good cooperative relationships between owners, managers, and medical
committees in hospitals. In detail, the internal regulations of medical staff
regulate related to general provisions, objectives, scope of internal
regulations of medical staff, categories of medical staff, needs of hospital
medical staff, requirements for medical staff acceptance, administrative and
professional requirements of medical staff, clinical authority, requirements
clinical authority, the authority to take medical action, as well as
regulations related to efforts to create clinical governance by the medical
committee of the Labuang Baji Regional General Hospital. The rules related to
internal regulations for medical staff are explained in Article 94 to Article
131 of the Gubernatorial Regulation No. 58 of 2015 concerning Internal Regulations
for the Labuang Baji Hospital, South Sulawesi Province.
The
Medical Committee plays a very important role in the formulation and
implementation of Hospital by laws at the Labuang Baji Regional General
Hospital, where the medical committee is the one who drafts the Medical Staff
by Laws Internal Regulations and is then ratified by the hospital director. The
medical committee membership is determined by the hospital director by considering
professional attitudes, reputation and behavior. Based on the results of
interviews conducted with the Chairman of the Medical Committee at Labuang Baji
Hospital, it is known that the medical committee at the hospital was formed in
2006. Hospital by laws Labuang Baji Regional General Hospital explained that the
medical committee is a hospital instrument to implement clinical governance
(clinical management). governance) so that medical staff in hospitals maintain
professionalism through credentialing mechanisms, maintaining the quality of the
medical profession, and maintaining ethics and discipline in the medical
profession. This is as regulated in Article 1 number (10) Hospital by Laws of
the hospital. The medical committee structure includes the chair and members of
the medical committee. Director is a person who has the authority to appoint
and dismiss the chairman and members of the medical committee after completing
a term of office of 3 (three) years. In carrying out its duties and functions, the
medical committee is responsible to the director and has the right to
coordinate with the deputy director of medical and nursing services. The
medical committee of the Labuang baji hospital consists of a chairman, vice
chairman, secretaries 1 and 2, and sub committees.
The
hospital director establishes a medical committee based on suggestions or input
from the hospital's medical staff. As for the deputy chairman, vice chairman of
the medical committee, the secretary, and the medical sub-committee, the hospital
director also considers the input of the medical committee and medical staff
working in the hospital. In addition to containing internal corporate
regulations and internal regulations for medical staff, Hospital by laws
Labuang Baji Regional General Hospital also regulates natural resource management,
financial management and asset management and cooperation with other parties
based on applicable laws and regulations. The financial management includes the
hospital's ability to manage the hospital business. Meanwhile, related to the arrangement
and development of assets derived from revenue, it is managed by the
procurement service unit. In addition, cooperation with third parties is
carried out based on sound business practices with efficiency, effectiveness,
and mutual benefit.
b) Synchronization
between the Internal Regulations of the Labuang Baji Regional General Hospital
Hospital with the prevailing laws and regulations in Indonesia
Even
though Hospital by Laws is a tailor made rule which means that each hospital
has different Hospital by laws, in its preparation it still requires references
regarding the content or content that must be regulated in the Hospital by
laws. The preparation of Hospital by laws must not conflict with the applicable
laws and regulations. Hospital by laws at Labuang Baji Hospital has referred to
several laws and regulations in force in Indonesia. In Chapter III (Third) the
Decree of the Minister of Health of the Republic of Indonesia Number
772/Menkes/SK/VI/2002 concerning Guidelines for Hospital Internal Regulations stipulates
that there are references to basic matters that must be regulated in Hospital
by laws related to the owner or representative, hospital directors and medical
staff. These three elements are referred to as the "triad" or
"three furnaces parallel". Referring to these three elements, two
main things must be included in Hospital by Laws, namely:
1) Internal regulations
governing the relationship of the owner or representative with the Director of
the Hospital (Hospital Management) which is called the Corporate by Laws Regulations;
and
2) Internal regulations
that regulate medical staff are called internal regulations of medical staff
(Medical Staff by Laws).
In
preparing internal corporate regulations, several materials need to be
regulated or included, namely (Lampiran Keputusan Menteri Kesehatan, 2002):
a. The name, purpose and
philosophy of the hospital;
b. Arrangements on the
Governing Body, which includes composition or membership, authority and
responsibility, roles for medical staff, and meeting arrangements;
c. Organizing the owner
or representative contains the number of participants, requirements to become members,
procedures for selecting, appointing and dismissing, and working period.
d. Supervision
mechanisms;
e. hospital director; and
f. Mechanism of
review and revision.
Suppose
you refer to the Hospital by Labuang Baji Regional General Hospital laws. In that
case, it is known that the Labuang Baji Regional General Hospital has published
the first content, which includes the name, purpose and philosophy of the
hospital, even in the Hospital by laws it includes several things in detail.
such as the vision and mission, duties, functions and goals of the hospital,
logo, motto and work culture of the Labuang Baji hospital. In addition,
regulations related to the supervisory mechanism have also been comprehensively
regulated.
Furthermore,
the Hospital by laws Labuang Baji Regional General Hospital has also regulated
the governing body and organization. Because the Labuang Baji Regional General
Hospital is a hospital owned by the local government in the form of a BLUD, the
composition of its membership is adjusted according to the type of hospital. In
Article 14 Hospital by Laws of the Labuang Baji Regional General Hospital, it
is stated that the regional government of South Sulawesi Province, represented
by the Governor of South Sulawesi Province, is the owner of the hospital. As
regulated in Article 13 paragraph (2), the organizational structure consists of
directors, deputy directors, divisions, sections, sections, sub-sections, and
functional positions. Furthermore, the deputy director is divided into three
sections: the deputy director of medical and nursing services, the deputy director
of general affairs, human resources and education, and the deputy director of
finance, each of which has different responsibilities and authorities. Articles
24 to 33 of the Hospital by Laws also regulate the appointment and dismissal,
and the tenure of hospital directors.
In
addition, the Hospital by laws of the Labuang Baji Regional General Hospital
also regulates hospital committees tailored to the hospital's needs. The committees
owned by the Labuang Baji Regional General Hospital are the medical committee,
the pharmacy and therapy committee, the nursing committee, the hospital ethics
committee, the hospital quality improvement and patient safety committee, and
the infection prevention and control and the home occupational health and
safety committee. The rules related to these committees are regulated in
Articles 37 to 47 of the Governor Regulation. However, the Hospital by laws
Labuang Baji Regional General Hospital do not contain a mechanism for reviewing
and revising the internal regulations that have been made. Arrangements
regarding the mechanism for reviewing and revising regulations are very
important to ensure that the contents of the Hospital by laws are still in line
with the needs of hospitals and the times. The lack of clarity on changes to
internal regulations and who is authorized to make changes to those regulations
can also create legal uncertainty.
Meanwhile,
in Articles 61 to 92 there are Hospital by laws Regional General Hospital
Labuang Baji also regulates other matters related to finance in its Corporate
Internal Regulations and other technical or administrative matters such as
arrangements for evaluation and job appraisal. The additional material is an
action to respond to developments in law, politics and economics. As for the
Internal Regulations of the Medical Staff (Medical Staff by Laws) it refers to
the Regulation of the Minister of Health of the Republic of Indonesia Number
755/MENKES/IV/2011 concerning the Organization of Medical Committees in Hospitals.
Basically, Medical Staff by Laws contains rules on how hospitals carry out the
medical profession and the work functions of medical committees in hospitals
which are designed by the medical committee and then determined by the head or
director of the hospital. Medical Staff by Laws regulates the mechanism for the
formation of a medical committee, the duties and functions, the working
mechanism of the medical committee and its subcommittees, peer-group partners,
and the decision-making process in the medical committee. Therefore, as a valid
legal basis, every decision regarding medical staff must be based on Medical
Staff by Laws. In addition, regarding hospital directors, Medical Staff by Laws
also regulates how the medical committee is accountable for its performance to
the hospital director.
The
things that should not be included in the Medical Staff by Laws are everything
related to the hospital management mechanism, even though these things are
related to the duties of medical staff in daily activities such as needs related
to the purchase of medical equipment, medical services. , setting the daily
task schedule and so on. In addition, Medical Staff by Laws does not regulate
medical staff's rights and obligations, such as provisions related to medical
records, approval of medical services, welfare of medical staff, and medical
confidentiality. Suppose you refer to the Medical Staff by Laws contained in
the Hospital by Labuang Baji Regional General Hospital laws. In that case, it
is known that the regulation has regulated several things to create good
clinical governance as regulated in the Minister of Health Regulation Number
755/MENKES/IV/2011 concerning the Implementation Medical Committee in Hospital.
Hospital by laws Labuang Baji Hospital in Article 102 has regulated the clinical
authority, stipulating that medical staff can only provide medical services if
authorized through the credential process. The Medical Staff By Laws has also
regulated various matters relating to medical committees ranging from
organizational structure, medical committee duties, medical committee powers,
credentialing mechanisms, various rules related to sub-committees, medical
committee meeting mechanisms, and clinical governance implementation
regulations. The various rules related to the medical committee are regulated
in Article 106 to Article 129 Hospital by hospital laws.
In
addition, the Medical Staff by Laws of Labuang Baji Hospital contained in the
Hospital by laws also contains several things that are not contained in the
Minister of Health Regulation Number 755/MENKES/IV/2011 concerning the
Implementation of Medical Committees in Hospitals, such as rules regarding
violations committed based on discipline profession, discipline and ethics of
medical staff in carrying out the profession as well as the procedures taken
when there is a violation of the professional discipline of professional order
and ethics. The things that are not included in the Medical Staff by Laws that
should be included are the rules regarding the mechanism for evaluating and
improving the internal regulations of the hospital staff as described in the
attachment to the Minister of Health concerning the Implementation of Medical
Committees in Hospitals.
c) Factors Affecting
the Implementation of Hospital by laws Labuang Baji Hospital by the Medic
Committee
In
Article 29 paragraph (1) letter r of Law Number 44 of 2009 concerning
Hospitals, it is stated that hospitals have the responsibility to formulate and
implement internal hospital regulations. A hospital by laws regulates the
rights, duties, obligations, and authorities of the parties relating to
hospitals. Therefore, it is an obligation for every manager, owner, medical
committee and hospital staff to implement the Hospital by laws. However, as
with other regulations, the implementation of Hospital by laws is also
influenced by factors that both help and hinder their implementation. The
factors that encourage the application of hospitals by laws at RSUD Labuang Baji
are juridical, these rules have legal certainty and refer to the relevant laws
and regulations that apply in Indonesia. Meanwhile, the obstacle in
implementing Hospital by laws in the hospital is technical obstacles where the
level of knowledge and understanding is related to the Hospital by laws. As
stated by the Chairman of the Medical Committee at Labuang Baji Hospital, he
did not clearly understand the contents of the Hospital by laws at the hospital (Hospital, 2021). In addition, the assumption
that Hospital by Laws only aims to obtain hospital accreditation, not as a
basic hospital rule that serves as a guide in creating good hospital clinical
governance, becomes an obstacle to the implementation of Hospital by Laws in
the hospital.
The
lack of knowledge and understanding regarding the importance of Hospital by
laws is caused by the absence of socialization. As explained by the head of the
medical committee of RSUD Labuang Baji, the absence of socialization is the
main problem that causes hospital parties to be unaware of the existence of
Hospital by Laws. In addition to the low understanding of Hospital by Laws, the
absence of an evaluation of the implementation of Hospital by Laws is also an
obstacle to the implementation of Hospital by Laws. Based on the results of an
interview with the head of the medical committee of the Labuang Baji Hospital,
it was stated that he had never seen an evaluation of the implementation of
Hospital by Laws. This has a consequence that the parties in the hospital
including the owner, manager, hospital medical staff cannot analyze the
relevance of the rules in Hospital by laws to the needs or conditions of the
hospital which are certainly not the same every time.
d) Elements of Hospital
by laws Labuang Baji Hospital that has been implemented
In
addition to being the rule of the game, Hospital by Laws is a legal product
that contains the values of legal certainty, justice and benefit.
Therefore, as a public service provider based on good governance principles, hospitals
must be able to implement the elements contained in Hospital by Laws in each
hospital. The head of the medical committee at Labuang Baji Hospital stated
that his hospital had applied all the elements regulated in the Hospital by
laws of the hospital. He further explained that the medical committee has held
regular monthly meetings as stated in Hospital by Laws. In addition, he also
explained that his party also carries out credentials, namely by evaluating
medical staff so that they can identify eligibility in carrying out clinical
authority, and actively conducting medical audits if there are cases in patient
care. However, if you look at the content or content of the Hospital by laws at
the hospital, of course there are still many rules that must be implemented and
not only limited to conducting routine meetings or presidential activities. The
hospital by laws must be the legal basis for hospitals in carrying out various
hospital activities.
e) Elements of Hospital
by laws Labuang Baji Hospital that have not been implemented
Based
on the results of interviews with the medical committee of the Labuang Baji
Hospital, it was stated that there were no elements of Hospital by laws that
were not implemented. However, suppose you look back at the statement by the
head of the medical committee at the Labuang Baji Hospital who stated that he
did not know and had never seen the hospital draft by laws. In that case, it
seems that the opinion that all the elements of the Hospital by laws in the
hospital have been implemented needs to be questioned.
In
addition, the absence of an evaluation process is another factor that adds to
the doubts about the implementation of Hospital by laws in the hospital.
Without an evaluation process, it is certainly difficult to prove the truth of
the statement that the elements of Hospital by laws in the hospital have actually
been implemented. The view that Hospital by Laws is only for accreditation
purposes is also evidence that Hospital by Laws is only used as a formality,
not a basic rule that becomes a guideline in carrying out hospital governance
and a reference for other regulations in the hospital.
2. Implementation
of Hospital by Laws by the Medical Committee at Haji Hospital
a) General Terms
Hospital by laws Haji Hospital
The
existence of hospital by laws is to have a high urgency in realizing the protection
of all forms of hospital service delivery, especially the protection of
patients and health workers. Internal hospital regulations (hospital by laws)
basically regulate justice and benefits in the provision of hospital services,
hospital administration and hospital management (Mertokusumo & Hukum, 1999). The legal basis for making hospital
internal regulations began with the issuance of the Decree of the Minister of
Health Number 772/Menkes/SK/VII/2002 concerning Guidelines for Hospital
Internal Regulations (Hospital by Laws). In the MENKES decision, there are two
main parts, namely the internal regulations of the medical staff and the
internal regulations of the corporation. It was only in 2009, that 2 new laws
and regulations were issued which provide additional explanations for the
decision of the Minister of Health, namely Law Number 36 of 2009 concerning
Health and Law Number 44 of 2009 concerning Hospitals. In 2011, a new regulation
was issued which replaced the regulation on medical staff in the 2002 Minister
of Health Decree, namely the Minister of Health Regulation Number
755/Menkes/Per/IV/2011 concerning the Organization of Medical Committees in
Hospitals
(Lalu Riyana Dody Setiawan et al., 1999).
Hospital
by laws in terms of regulation itself is a legal benchmark for hospitals in
providing services, consisting of internal corporate regulations and internal
regulations for medical staff. In practice in South Sulawesi, these types of
regulations will be determined by the head of the regional government and
compiled by the South Sulawesi regional government as manager. The preparation
of this regulation is to implement good hospital governance. The internal
regulations of the Makassar Haji Regional General Hospital are contained in the
South Sulawesi governor's regulation: 116 of 2017 concerning the Internal
Regulations of the Makassar Haji Makassar Regional General Hospital, South
Sulawesi Province. This internal regulation is divided into four chapters of
rules and has 133 articles in total. The first chapter, which regulates general
provisions, contains definitions of technical terms in hospital by laws.
Internal hospital regulations, corporate internal regulations, internal
regulations for medical staff, owners, supervisory boards, directors, deputy
directors, Regional Public Service Agency (BLUD) and others. In total there are
37 points in this general provision section with only one article.
The
second chapter in Hospital by Laws is divided into 28 sections consisting of
discussions about the vision, mission, goals, functions, identity, organizational
structure, etc.� Article 4 Governor Regulation No. 116 of 2017 concerning
Internal Regulations for the Haji Makassar Regional General Hospital, South
Sulawesi Province, it is explained that the Haji Makassar Hospital in South
Sulawesi Province has functions that include formulating hospital technical
policies, coaching and administering in the field of medical services,
administering hospital service affairs and organizing other affairs. . The
organizational structure of the Regional Hajj General Hospital of South
Sulawesi Province is regulated in Article 13 paragraph (2) of the South
Sulawesi Governor's Regulation No. 116 of 2017 concerning Internal Regulations
of the Makassar Haji Regional General Hospital, South Sulawesi Province, it is
stated that the composition consists of Directors, Deputy Directors, Divisions,
Sections, sections, sub-sections and functional positions.
In
the third chapter, namely Article 94 paragraph (1) Hospital by laws RSUD Haji
Makassar regulates internal regulations for medical staff. This chapter
explains that the medical committee at the Haji Regional General Hospital is a
hospital apparatus that aims to carry out clinical governance at the hospital.
This arrangement is to ensure the professionalism of the medical staff is maintained.
Additional explanation regarding the medical committee is in the third part of
article 106 of this Hospital by laws. The fourth chapter of the hospital's internal
regulations at RSUD Haji Makassar is the concluding chapter which consists of
two articles, article 132 and article 133.
b) Hospital Synchronization
by laws Labuang Haji Hospital with Relevant Legislation
Every
hospital in Indonesia must make internal hospital regulations or hospital by
laws. This obligation is stated in Article 29 paragraph (1) letter r of Law
Number 44 of 2009 concerning Hospitals that hospitals have obligations to draft
and implement internal hospital regulations (hospital by laws). This law is the
main source of law regarding making internal regulations for each hospital in Indonesia.
Indeed, the Makassar Haji Makassar general hospital had internal hospital
regulations before Governor Regulation No. 116 of 2017 concerning internal regulations
for the Makassar Haji Makassar general hospital, South Sulawesi province. The internal
regulations are stated in the South Sulawesi Governor's Regulation Number 40 of
2016 concerning Internal Regulations for the Makassar Haji Regional General
Hospital. However, the 2016 gubernatorial regulation, after careful examination
of its contents, found that this regulation was not under the governance and demands
of hospital health services and the laws and regulations requiring it, so it
needed to be replaced. In terms of content, Governor's Regulation Number: 116
of 2017 concerning internal regulations for the Haji Makassar general hospital,
South Sulawesi province is very complete and the content does not have any
conflict with the laws and regulations on it. Especially because the new
Hospital by laws are actually an improvement over the previous regulations that
were considered flawed.
The
preparation of the draft Hospital by laws at the Haji Makassar general hospital
refers to and is based on the laws and regulations, among others, as follows:
1) Law Number 36 Year
2009 concerning Health
2) Law No. 29 of 2004
concerning Medical Practice
3) Law Number 12 of 2011
concerning the Establishment of Legislation.
4) Regulation of the
Minister of Home Affairs Number 971 of 2009 concerning Competency Standards for
Health Structural Officials
5) Regulation of the Minister
of Health Number 755/Menkes/PER/IV/2011 concerning the Implementation of the
Medical Committee
6) And other laws and
regulations.
c) Factors Affecting
Hospital Implementation by laws Haji Hospital
Hospital
by laws at RSUD Haji Makassar as a legal product is prepared by referring to
Indonesia's prevailing laws and regulations so that there are no legal
obstacles in its implementation. This is as stated by the Chairman of the Medical
Committee of RSUD Haji Makassar. In addition, technical matters such as human resources
were also not mentioned as factors that hinder efforts to provide maximum
service (Apriyanti, 2021). However,
regarding the implementation of Hospital by laws in his hospital, the chairman
of the medical committee of RSUD Haji Makassar stated that his party had an
understanding that Hospital by laws was only prepared to complete the file to
obtain hospital accreditation and was not a basic rule that was used as a reference
for the implementation of hospital activities. As a result, the hospital
parties do not know the rights and obligations that must be carried out
regarding the contents of Hospital by laws. Meanwhile, as the executor of
medical services, all parties must know the rules that form the basis for every
other technical regulation, decision-making, and medical action. Based on the
provisions of the laws and regulations regarding hospitals, the hospital is
responsible for all medical services and the impact thereof. The reason for
understanding that Hospital by laws is only an accreditation requirement is
because there is no socialization about Hospital by laws. Dissemination of
Hospital by laws that are not implemented indicates that the communication between
hospital parties, including hospital owners, directors, and medical staff, is
not well established. Therefore, the ineffective communication between the
parties is also a factor that affects the implementation of Hospital by laws in
the hospital.
d) Elements of Hospital
by laws Haji Hospital that has been Implemented
One
of the parameters of whether the elements in an internal hospital regulation
have been successfully implemented or not is the success of the committees or
parts of the organizational structure in carrying out their duties and
functions. Hospital by laws at the Haji Makassar general hospital regulates the
duties and functions of several committees or sections within the hospital
organizational structure. Of the several regulated functions and tasks, most
have been implemented very well such as credentials, medical audits, regular
meetings and others (Apriyanti, 2021). The medical support committee, for example,
in Hospital by laws RSUD Haji Makassar has 12 duties and functions. Based on
the twelve tasks and functions, most of them have been implemented in the
administration of public hospital services in the Haji Makassar area. However,
the medical committee of RSUD Haji Makassar was unable to provide a detailed
explanation of how the duties and functions of the Hospital by laws were
carried out. The medical committee also does not have a standard frame of
reference to identify what elements have been implemented properly. So it can
be concluded that the above statement is unreasonable. Moreover, the regulations
in Hospital by Laws do not only regulate the duties and functions of the
medical committee, but also all elements of the organizational structure of the
medical staff in the hospital. coupled with the fact that medical staff lacks
understanding of Hospital by laws, it is impossible for the medical committee
to ensure that all elements in Hospital by laws have been implemented properly.
e) Elements of
Hospital by laws Haji Hospital that has not been implemented
Regional
General Hospital Haji Makassar, through the head of the medical committee
stated that RSUD Haji has fully implemented the elements of regulations in
hospital by laws. So far, there have been no problems related to the administration
of services at this hospital. Because the manufacture and implementation of
hospital by law is an accreditation standard for a hospital, and the fact that
RSUD Haji Makassar has passed hospital accreditation, it can be ascertained
that the application of hospital by law has been running optimally and does not
have elements in hospital by law that have not been implemented (Apriyanti, 2021). However, this statement is more likely to be
a one-sided statement from the Medical Committee. Judging from the results of
previous interviews, the medical committee chairman chose the term "mostly
implemented" in the question of what elements of hospital by laws have
been implemented in this hospital. This indicates that there are still several
elements that have not been implemented. This changed statement confirms the
assumption that the medical staff regarding hospital by laws at RSUD Haji is
lacking.
3. Implementation
of Hospital by laws by the Medical Committee at Dadi Hospital
a) General Terms
Hospital by laws Dadi Hospital
Dadi
Regional Special Hospital, South Sulawesi Province, is one of the first special
hospitals to treat mental illness in eastern Indonesia. The vision of the Dadi
Regional Special Hospital as a referral center for Mental, Drug and Stroke health
services that is service-oriented, innovative, competitive, inclusive and
characterized in supporting the acceleration of prosperity in South Sulawesi in
2023". Hospital by laws is a form of written rule that is the result of an
agreement and evaluation between the South Sulawesi Provincial Government as
the owner of the Dadi Regional Special Hospital in South Sulawesi Province,
with the Manager in this case the Hospital Director, structural officials and
the entire staff group. Dadi Regional Special Hospital Medical, South Sulawesi
Province. The hospital's internal regulations (Hospital by Laws) for the Dadi
Regional Special Hospital, South Sulawesi Province are contained in the Decree
of the Director of the Dadi Regional Special Hospital Number 445/14164/XII/2018
concerning the Enforcement of Internal Hospital Regulations (Hospital by Law)
at the Hospital. Special for Dadi Region, South Sulawesi Province.
The
hospital by laws apply to hospitals to protect all parties involved properly
and correctly, based on a sense of justice and the laws and regulations that apply
in Indonesia. Hospital management is determined by the three components, the
parties who play a major role, namely the Owner, including the Supervisory
Board, Director, structural officers and Functional Medical Staff, and the role
of the Medical Committee and the Nursing Committee. Therefore, the Hospital by
laws (Statute) will regulate the relationship, rights and obligations,
responsibilities of the role of the Supervisory Board, Director and Medical
Staff Group, and the Role of the Medical Committee and Nursing Committee in
Hospitals.
The
benefits of the Dadi Makassar Regional Special Hospital (RSKD) are:
1) To become a
"written, clear legal basis that can regulate a balanced triangular relationship
between owners and directors as management managers and internal customers -
external customers, both rights and obligations" to anticipate various
impacts, both internal and external impacts that are not desired;
2) Can protect
the rights and obligations of all hospital parties in a balanced and fair
manner, such as owners with directors as management managers and external and
internal customers in a balanced manner based on justice, to achieve good
hospital services. (good corporate and clinical governance);
3) Become a
reference that all parties can follow, can be a legal solution in the event of
a dispute. In addition, these internal regulations can also be a means of
improving the quality of medical services, as well as being a requirement for advanced
hospital certification;
4) Regulate the
rights and obligations of owners, rights and obligations and authorities of
hospital directors, rights and obligations of hospital staff and patients, and
hospital obligations to the government and law enforcement officers.
Hospital
by laws RSKD Dadi Makassar contains two books, namely the first book on
Corporate Internal Regulations (Corporate by Laws) and the second book on
Medical Staff Regulations (Medical Staff by Laws.
The
Corporate Internal Regulations aim to create regulations for good corporate
governance by regulating the relationship between the parties involved in the
Hospital. In the internal regulations of the Dadi RSKD corporation, namely in
Articles 2 to 4, it is regulated on the identity of the hospital which includes
the name and position of the hospital, the vision, mission, goals and
objectives of the hospital and the hospital logo. In addition, it also
regulates the owner of the hospital, in which the owner of the Dadi RSKD
belongs to the Regional Government of South Sulawesi Province. Furthermore, it
was also explained that there is a supervisory board with various duties and
authorities, meetings that the hospital must hold. These various provisions are
regulated in Article 5 to Article 10 Hospital by Law Hospital. Special Dadi
South Sulawesi Province. As for hospital directors, Article 11 point (3)
stipulates that hospital directors are appointed based on the requirements and
procedures specified in the Corporate by Laws at the hospital. It also regulates
the internal hospital committees and supervisory units at Corporate by Laws at
Dadi Hospital.
The
Medical Staff by Laws regulates the organization of medical staff groups,
clinical authority (Clinical Privilege), doctors in charge of services (DPJP),
clinical assignments (Clinical Appointments), medical committees, credentials
sub-committees, professional-quality sub-committees, ethics and discipline
sub-committees. Profession, nursing committee, professional and ethical
development, and the quality of professional care to patients. In addition, it
also regulates the process of amendment and ratification of the Dadi Hospital
by laws.
b) Hospital
Synchronization by laws Dadi Hospital with Relevant Legislation
The
internal regulations of the Dadi Regional Special Hospital are contained in the
Decree of the Director of the Dadi Regional Special Hospital Number:
445/14164/XII/2018 concerning the implementation of hospital internal
regulations at the Dadi Regional Special Hospital of South Sulawesi Province.
Regarding the number of charges, Hospital by laws at Dadi RSKD has a higher number
than Hospital by laws in the other two RSUD. The internal regulations of this
hospital have a section of rules up to chapter XXIII and the number of Articles
65. As in the case of Hospital by laws in the Labuang Baji Regional General Hospital
and the Makassar Haji Regional General Hospital, the internal regulations of
the Dadi Regional Hospital are also very concerned the prevailing laws and
regulations in Indonesia regarding the preparation of the Hospital by laws draft
in this hospital. The drafting process is based on the Decree of the Minister
of Health of the Republic of Indonesia Number 631/Menkes/SK/IV/2005 concerning
Guidelines for Internal Regulations of Medical Staff in Hospitals. From the
explanation above, it can be concluded that in relation to the prevailing laws
and regulations in Indonesia, the internal regulations of the Dadi RSKD do not
have conflicting rules and it is certain that the above laws and regulations
also guide their contents.
c) Factors Affecting
the Implementation of Hospital by laws RSKD Dadi by the Medical Committee
Implementing
Hospital by laws is an obligation for every hospital in Indonesia. Each
hospital will make real efforts to provide hospital services in accordance with
those regulated by internal regulations. In the implementation process, several
things are considered to be able to help or hinder the implementation of
Hospital by Laws at RSKD Dadi. It can be said that all elements of the hospital
consisting of management, doctors, nurses, and other technical personnel, are
factors that have a significant influence in the effort to implement Hospital
by laws RSKD Dadi (Alamsyah, 2021). So an
understanding of Hospital by laws is felt to be very necessary to be given to
these elements. However, this is not easy considering that many medical
personnel do not know anything about the regulations contained in the internal
regulations of the Dadi Regional Special Hospital. This fact greatly affects
the implementation of Hospital by laws in this hospital. The biggest problem in
implementing internal regulations at RSKD Dadi is the lack of socialization and
understanding of hospital elements regarding their own internal regulations.
Technical
factors are often the most influential factor in implementing a regulation. Not
infrequently technical problems create their own obstacles in realizing the
implementation of internal hospital regulations. Problems such as the number of
human resources and medical staff communication with patients are a small part
of these technical obstacles. Until now, RSKD Dadi itself has never experienced
any technical problems. even during the covid pandemic, this hospital was
designated as a covid referral/treatment center. This hospital provides the
best service and adapts to the latest rules/policies from the center. In terms
of human resources, this hospital is quite complete with special hospital
service standards, and during the pandemic it was given a policy to recruit
medical personnel to help treat Covid patients (Alamsyah, 2021).
d) Elements of
Hospital by laws Dadi Hospital that has been implemented
All
elements in the form of functions and tasks that have been regulated in the internal
regulations of the Dadi RSKD have been carried out or carried out to the
maximum. RSKD dadi's strong commitment in implementing all elements of hospital
by laws is to increase the professionalism of doctors who work in this hospital (Alamsyah, 2021). The head of the
medical committee of the RSKD Dadi gave an overview of the successful
implementation of hospital by laws in the RSKD such as credentialing for
medical personnel who will join the RSKD, which we then submit the results of
the recommendations to the leadership. A medical audit is carried out every time
a case is considered not under the SOP. Regular meetings are also held every
month to evaluate services and provide input to the management (Alamsyah, 2021). Based on the
statement above, it is very clear that the head of the medical committee of
RSKD Dadi failed to understand the very broad elements of hospital by laws. The
regulation in hospital by laws at the Dadi Hospital is very broad, while the
reason the head of the medical committee stated that all hospital by laws have
been implemented to the maximum is the duties and functions of the medical committee,
where the rules are only a small part of the overall rules in hospital by laws.
e) Elements of
Hospital by laws Dadi Hospital that have not been implemented
According
to the head of the medical committee, the internal regulations of RSKD Dadi
regarding medical staff have been implemented properly. So far, the
implementation of these elements has not encountered any obstacles (Alamsyah, 2021). This statement is
full of errors. First, the implemented elements described are purely the
functions and duties of the medical committee. Even these tasks and functions
are not complete. So it is very difficult to say that there are no elements
that have not been implemented. Second, the existence of obstacles or not is
not a parameter of whether or not a regulation is implemented. It is possible
that a policy can be said to be implemented even though the implementation
process encounters many obstacles. However, there can also be a statement on
the implementation of a policy without problems because from the start the
policy was never implemented, due to the inability and even ignorance of the
policy.
B. The Role of
the Medical Committee in Improving Good Clinical Governance.
1. Duties and
Authorities of the Medical Committee in Hospital by Laws at Labuang Baji
Regional General Hospital, Haji and Dadi Regional Special Hospital
The medical
committee is a hospital committee formed by the hospital director and reports
to the hospital director. The medical committee is a hospital instrument that
was established to implement clinical governance so that the medical staff in
the hospital can maintain their professionalism through credentialing
mechanisms, quality assurance, the medical profession, and the maintenance of
ethics and discipline of the medical profession. Hospital by laws in these
three (3) hospitals state the similarity of duties and authorities of the
medical committee. The duties of the medical committee are in accordance with
those stipulated in Hospita by Laws in the 3 hospitals, namely (Article 114 of South Sulawesi Governor Regulation, 2019):
The Medical Committee
has the duty and responsibility to improve the professionalism of the medical
staff in the hospital in several ways, namely: All medical staff who will carry
out their duties to provide medical services must go through a credential
process. In addition, the medical committee must be able to maintain the
professional quality of medical staff, and maintain discipline, ethics, and
professional behavior among medical professionals. In carrying out the
credential function, the medical committee as well as the medical committee
must also compile a list of clinical authorities based on suggestions from
medical staff groups in accordance with applicable professional norms. The
medical committee also has a function to examine and review competence,
physical and mental health, professional behavior and ethics. In addition, the
medical committee also evaluates data on continuing medical/dentistry
professional education, conducts interviews with applicants for clinical
authority and assesses and terminates adequate clinical authority. The medical
committee must also prepare a report on the results of the credential assessment
to issue recommendations for clinical authority to the chair of the medical
committee. The medical committee also issues recommendations and issues
clinical assignments. If the validity period of the clinical assignment letter
has expired, the medical committee must carry out the recredential process. In
an effort to maintain the professional quality of medical staff, the medical
committee has the function of conducting medical audits, conducting regular
scientific meetings in the context of continuing education for medical staff.
The medical staff also recommends that medical staff be actively involved in
external activities in continuing education for hospital medical staff and
recommends a proctoring process for medical staff in need.
Concerning
efforts to maintain discipline, ethics and professional behavior of medical
staff, the medical committee has the function of fostering ethics and discipline
of the medical profession, examining medical staff suspected of violating
discipline, recommending discipline if there are violations in the profession
in hospitals and playing a role in providing consideration in every ethical
decision making in patient medical nursing care. The chairman of the medical
committee at Labuang Baji Hospital explained that the medical committee plays a
very important role because the spearhead of hospital services are doctors so
that the medical committee must work and arrange so that medical services can
run well and professionally (Apriyanti, 2021). Meanwhile, in
carrying out its duties and functions, the medical committee of the Labuang
Baji Hospital has the authority to (Article 115 of South Sulawesi Governor Regulation, 2019):
1) Provide
recommendations on details of clinical authority (delineation of clinical
privileges);
2) Provide a recommendation
for a clinical assignment letter (clinical appointment);
3) Provide
recommendations for refusal of certain clinical privileges;
4) Provide
recommendations for changes/modifications of details of clinical authority (delineation
of clinical privileges);
5) Provide
recommendations for medical audit follow-up;
6) recommend continuing
medical education, mentoring (proctoring); and administering disciplinary
action.
This
activity is carried out every month and at the same time becomes a gathering
place for fellow medical staff at Labuang Baji Hospital. The output that has
been achieved through these efforts is an increase in the professionalism of medical
staff (Ummuh, 2021). Meanwhile, the steps that have been taken by
the medical committee of the Haji Makassar Hospital are trying to maintain the
professionalism of the medical staff/medical personnel by credentialing the doctors
who will join this hospital. With this credential, the medical committee can
determine the doctor's competence. In addition, the committee also forms a
medical audit team in charge of conducting an audit if there are cases deemed
necessary to be audited. The committee also always holds meetings with
management to provide input on how to improve further hospital services (Apriyanti, 2021). The
medical committee of RSUD Haji Makassar conducts credentialing, medical audits,
and conducts scientific meetings to improve or refresh the medical knowledge of
the medical staff of RSUD Haji Makassar. The committee also seeks to assist and
provide recommendations to doctors who wish to continue their education (Apriyanti, 2021).
The
outputs that have been obtained from these efforts are as follows (Apriyanti, 2021):
a. The professionalism
of medical personnel is maintained;
b. Increased
types of services after our medical staff is educated;
c. Assisted
management in improving hospital services;
d. Of course,
the hospital's income is increasing.
Meanwhile,
the real efforts made by the medical committee of RSKD Dadi in realizing good
clinical governance can be divided into five main activities, namely (Alamsyah, 2021):
a. Providing
input related to how to improve health services in hospitals.
b. Credential
execution
c. Implementation
of clinical audit
d. Increasing
the professionalism of medical staff by engaging in scientific activities
e. Regular
meetings as service evaluation
The
outputs that have been after these efforts have been carried out are as follows
(Alamsyah, 2021):
a. Improved
services by improving facilities and infrastructure
b. Maintained
professionalism of medical staff
If
you look at the findings above, it can be concluded that the three hospitals
have some similarities and differences regarding the efforts made by their
medical committees to realize clinical governance in their respective
hospitals. The difference indicates that these efforts are less than optimal.
The implementation of the duties and functions of hospital medical committees throughout
Indonesia must be guided by Permenkes no. 755 concerning the organization of
medical committees in hospitals. In Article 11, the duties and functions of the
medical committee are fully regulated in carrying out clinical governance. The
arrangement of the functions and duties above is the main work guideline for
all medical committees as hospital apparatus which aims to implement good
clinical governance. The regulation has also been adopted into hospital by laws
owned by three hospitals belonging to the province of South Sulawesi, namely,
RSUD Labuang Baji, RSUD Haji and RSKD Dadi. Referring to this rule, it can be
said that the efforts that the three hospitals have carried out have not been
maximized.
The
medical committee at Labuang Baji Hospital only carried out three activities in
order to realize clinical governance at this hospital. The first is
credentialing, which is one of three efforts by the medical committee to improve
the professionalism of medical staff. The remaining two attempts were not
carried out. Second and third, carry out medical audits and scientific
meetings. The implementation of medical audits and scientific meetings themselves
in Permenkes 755 of 2011 is 2 of 4 tasks to maintain medical staff quality in
the medical committee. The rest was never attempted. From this fact, it can be
said that only about 15-20% of the efforts of the medical committee at Labuang
Baji Hospital to realize clinical governance.
This
is similar to the efforts made by the medical committee of RSUD Labuang Baji,
the Medical Committee of RSUD Haji Makassar also only carries out three tasks
regulated by the Minister of Health and hospital by laws, namely credentialing,
medical audits and meetings. So the analysis of the shortcomings can be categorized
as not optimal. Meanwhile, at Dadi Hospital, the medical committee carried out
five activities: credentialing, medical audits, regular meetings, providing recommendations
for hospital services, and involving medical staff in various scientific activities.
So far, it can be seen that the efforts in RSKD Dadi are more than the other
two hospitals. There are two additional real efforts: providing service
recommendations and involving medical staff in scientific activities. In terms
of efforts to realize clinical governance, the Dadi RSKD medical committee is
comparatively better. However, it still cannot be said to be optimal because
there are still many duties and functions of the medical committee based on
Permenkes 755 of 2011 and hospital laws that have not been implemented.
4. Obstacles
Faced by the Medical Committee in Improving Clinical Governance in Hospitals
Hospital
owners and managers have various problems that must be faced, while guaranteeing
the protection and safety of patients remains the main thing in managing a
hospital. In order to maintain the quality of health services and protect
patient safety, the professionalism of medical staff is absolute and must be
improved. With this professionalism, it is hoped that patients can be served
properly and can be accounted for. Controlling the competence and behavior of
medical staff is an important and strategic role for the medical committee to
support this professionalism (Murniati & Santoso, 2016). Obstacles faced by the medical
committee of RSUD Haji Makassar in realizing clinical governance are facilities
and infrastructure, especially regarding medical equipment that supports
hospital services (Apriyanti, 2021). The same problem is also faced by Labuang
Baji Hospital where facilities and infrastructure are the main obstacles in the
implementation of hospital services under hospital by laws. Although it has
been designated as a BLUD, budgeting is not fully focused on the facilities and
infrastructure in this hospital (Ummuh, 2021). The main obstacle to the medical committee at RSKD Dadi
is the same thing (Deliarnoor & SH, 2016). Often this lack of facilities makes
services less than optimal in three hospitals belonging to the provincial government
of West Sulawesi.
The
obstacle is because the government owns this hospital, so all budget planning
must go through a tender process so that facilities and infrastructure cannot be
immediately available. It takes a long process so that facilities and infrastructure
can be available (Apriyanti, 2021). This obstacle is
understandable considering that this hospital belongs to the provincial
government, of course, it must go through a budgeting process. RSKD Dadi
understands this and is trying through management to fix it (Alamsyah, 2021). Even so, RSUD Haji Makassar is still trying
to provide the best and professional service, according to the availability of
facilities and infrastructure. Suppose it cannot be resolved at this hospital.
In that case, it will be referred to a hospital with more complete facilities (Apriyanti, 2021). Efforts to solve this problem are to provide
professional services, under the available facilities and infrastructure (Ummuh, 2021). Even with the Dadi RSKD in solving this problem, the
RSKD made adjustments. if hospital services can be performed in this hospital,
then the service will be performed. However, if this cannot be done at this
location, then the option is to refer the patient to a more complete
place/service (Alamsyah, 2021).
Conclusion
Based on
the analysis of the results of the research and discussion, it can be concluded
that the implementation of hospital by laws by the medical committee in
improving clinical governance of the regional public hospitals of the South
Sulawesi provincial government, that the South Sulawesi Provincial Government
Hospital has not implemented Hospital by laws properly. Hospital by laws is
only used for administrative purposes in the hospital accreditation process.
This shows that Hospital by Laws, which should be the basic reference in the
implementation of hospital services, are only seen as completeness of the file
which is only a formality. The lack of understanding and awareness about the
importance of Hospital by laws is caused by the absence of socialization of Hospital
by laws among all medical officers in hospitals.
The role of
the medical committee to improve good clinical governance at the South Sulawesi
provincial government hospital has not been maximized because of the
information provided by the medical committee that has not fully carried out
the duties and functions of the medical committee as stated in the Hospital by
Laws hospital. This is evidenced by the statement of the head of the medical committee
who explained what duties and functions had been carried out. From this
information, the medical committee has not carried out its duties and functions
optimally as stated in the Minister of Health Regulation 755/MENKES/Per/IV/2011
concerning the hospital's medical committee and internal relations. The South
Sulawesi Provincial Government Hospital does not include a review and
evaluation mechanism for the hospital's internal regulations. Based on the
regulations for the preparation of Hospital by laws, hospitals need to review
and evaluate Hospital by laws owned by hospitals so that they are always
relevant and follow developments and hospital needs.
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THE MEDICAL
COMMITTEE'S IMPLEMENTATION OF HOSPITAL INTERNAL REGULATIONS TO IMPROVE
HOSPITAL�S CLINICAL GOVERNANCE