INTRODUCTION
Quality
health services are the main focus in meeting the needs of the community (Iskandar,
2016).
Therefore, hospitals as one of the health service providers must continue to
develop the services provided in order to meet the needs and expectations of
patients. In the development of health services in hospitals, a comprehensive
analysis of internal factors is very important to be carried out. This analysis
aims to identify the strengths and weaknesses of the internal hospital, so as
to determine the right strategic steps to improve service quality (Sari et al.,
2014).
Some
internal factors that need to be analyzed in the development of health services
in hospitals include the quality of medical and non-medical personnel,
available facilities and technology, hospital management, and the availability
of necessary resources (Rohmani et
al., 2016).
However, in recent years, there are several recent facts and issues that need
to be considered in the analysis of internal factors (Nasution,
2018).
Improving
the quality of health services is the main focus in the hospital development
strategy (Suprapto et
al., 2021).
This is driven by increasing competition between hospitals in providing the
best service for patients. The application of technology and innovation in
health services is also becoming increasingly important (Putra,
2018).
There is an increasing use of technology in healthcare, such as telemedicine
and health applications. However, there are still many hospitals that have not
utilized this technology optimally.
Hospital
management is a key factor in the development of health services. Effective
management can optimize the use of existing resources and improve service
quality (Utami,
2013).
However, there are still many hospitals that experience problems in management,
such as lack of transparency in the use of budgets and inappropriate management
decisions.
The
COVID-19 pandemic has affected the development of health services in hospitals.
Many hospitals are experiencing great pressure in providing health services to
patients, especially during the peak of the pandemic (Ambarwati,
2021).
In this regard, a comprehensive analysis of internal factors is essential to
ensure the availability of sufficient resources and the effectiveness of
hospital operational management.
In order to improve the quality of health
services, analysis of internal factors is very important for hospitals to do.
By identifying the strengths and weaknesses of the internal hospital,
appropriate strategic steps can be determined to improve service quality
(Arya &; Rahayu, 2021). Through a comprehensive analysis
of internal factors, it is hoped that hospitals can develop better health
services and be able to meet expectations
(Nugraheni &; Kirana, 2021).
METHODS
In
this study, the author uses qualitative analysis, which is an analysis carried
out on data, written descriptions, and verbal descriptions, then connected with
data, written descriptions, and other verbal descriptions to get clarity about
the truth or vice versa so that new perspectives are obtained or strengthen
existing opinions (Basias
&; Pollalis, 2018) . This research is included in descriptive research
because this study intends to describe an event, namely human resource planning
at Bungur Medika Hospital with the development of hospital services as an
effort to improve employee performance. The approach in this study uses an
interdisciplinary approach.
RESULTS AND DISCUSSION
1. Internal Factor Analysis Framework
Figure 1
Internal Factor Analysis Framework
Internal analysis has an important role and is needed in
starting a business to find out which are the resources and capabilities
of a business consisting of marketing, operations, human
resources and finance in assessing and determining the strengths and weaknesses so
as to determine the company's business strategy and competitive advantage
the company (Riniwati,
2016).
Hospitals as one of the individual health service facilities are part of health
resources that are indispensable in supporting the implementation of health
efforts (Nurdiah
&; Iman, 2016). Government Regulation of the Republic of Indonesia No. 47
of 2021 article 2 paragraph 2 states that the classification of hospitals is based on service capabilities, health
facilities, supporting facilities and human resources (Susetiyo
&; Iftitah, 2021). Article 5 paragraph 2 hospitals must meet the
availability of human resources, buildings, facilities, and equipment.
2. Analysis of Demand
2.1 Quality Service (C1)
Running the Bungur Medika Hospital business that focuses
on health services that serve hospital patients has a very important
role because it is one of the success factors in running a hospital business from inpatient services, outpatient services,
medical services and medical support, how responsive doctors and nurses are in
handling and serving patients, responsibility, ready to receive complaints by
providing services friendly, straightforward, and quick to respond. Bungur Medika Hospital in providing quality BPJS patient
services starting from providing services that are not complicated and fast from
the initial process starting from registration to getting the drugs needed by
BPJS patients, BPJS patients seeking treatment at the hospital are given
convenience if the patient has not completed one of the requirements, namely a
referral letter, then the patient can still seek treatment at this hospital by
making an agreement in advance between patients with the hospital to complete
the next day to this hospital so as to provide satisfaction for BPJS patients
to seek treatment at Bungur Medika Hospital.
The quality of service provided by the hospital to patients
shows the picture and view of the hospital
itself. Service that is not good and not of good quality will result in a
decrease in patients seeking treatment at the hospital.
2.2 Hospital Information Technology System (C2)
The development of the era of digitalization and technology
is currently very developed, giving a huge impact on the progress of
information technology systems, including in the health sector, so technology
is one of the components that need to be assessed and taken into account in
running a business to be able to compete and improve quality and service (Astuti
&; Salisah, 2016; Sudirman et al., 2020). Starting and running
a type C hospital business and improving services for patients requires
technology where the
hospital already
has an integrated and guaranteed
hospital technology information system, and the hospital system is connected to the BPJS system
so as to provide speed of data accuracy ranging from the online registration
system, bed availability, surgery schedules in hospitals , service queues,
electronic medical records, and
electronic
claims as well as
providing telemedicine services with the aim of providing convenience for
patients and improving health services for patients and providing satisfaction
for hospital patients.
This technology information system is a form of
Hospital Management System specifically designed to manage various aspects
of hospital operations such as patient
medical records, doctor practice schedules, data in and out of patients, drug
stock inventory, financial to administrative. This system will help support
activities that occur in the
hospital which
will integrate and simplify operational activities with the aim that the hospital can focus more on providing excellent
service for patients.
In supporting hospital services, a hospital information
technology system is needed in managing data and accelerating the
hospital administration process, a registration process that aims to provide
convenience and acceleration of integration between systems precisely and
quickly, assist the data management process, provide accurate information, and
assist the process of management and management, hospital data be secure
and transparent, and efficiency and effectiveness are achieved.
Bungur Medika Hospital applies
digitalization in providing
hospital services so that information technology systems become a very
important role in the development
of hospitals,
for
that a strategy is needed to maintain and improve the quality of the system,
the quality of information and the quality of
hospital
services.
The strategy used to maintain and improve the quality of
the technology requires device specifications and good network quality to avoid
system failure during peak hours or the system can always process data during
peak loads. This strategy will affect service satisfaction in using the
application or website.
2.3 Qualified Human Resources (R1)
In accordance with Law No. 36 of 2014 concerning health
article 1 paragraph 5 it is stated that competence is the ability possessed by
a health worker based on science, skills, and professional attitudes to be able
to carry out practice. In this case, it emphasizes the importance of human
resources as a factor that is indeed an important role in the success of an
organization. As stipulated in the Regulation of the Minister of Health No. 3
of 2020, article 11 states that human resources in public hospitals in the form of permanent personnel
include:
1.
Medicaldragon
2.
Clinicalpsychology
3.
Nursing
4.
Obstetrics
5.
Pharmaceutical Surgery
6.
Publichealth
7.
Environmentalhealth
8.
Nutrition
9.
Physicaltherapy
10.
Medicaltechnicians
11.
Biomedicalengineering
12.
Otherhealth effects
13.
Non-health
gender
Human resources for non-health include IT personnel, programmers, marketing personnel, financial
personnel, insurance personnel, operational personnel, HRD personnel and other human resource
personnel. The number and qualification of resources are adjusted to the
results of the workload analysis as well as the needs and capabilities of hospital services.
2.4Supporting Facilities (Facilities and Infrastructure)
(R2)
Hospitals as health facilities
must provide optimal services to patients supported by decent, functioning and
adequate facilities and infrastructure. Bungur Medika Hospital in the Minister of Health
Regulation No. 3 of 2020 article 8 must have the ability to provide medical
services and medical support. Article 21 requirements include location,
building, infrastructure, human resources, pharmaceuticals and equipment. In
addition to outpatient rooms, inpatient rooms, other supporting facilities in
the form of: laboratories, pharmacy, radiology, physiotherapy and other
installations are also facilities and infrastructure that will support hospital operations.
2.5 Online Registration (R3)
One of the efforts to improve services and provide
satisfaction for BPJS patients is the existence of an online registration
system to make it easier for BPJS patients to seek treatment and check at
Bungur Medika Hospital, where BPJS patients do not need to wait long, do not
need to be complicated and complicated for the registration process and can
save time and faster to seek treatment at Bungur
Medika Hospital.
2.6 Easy Hospital Access to the Community (R4)
In achieving the success of a business, it is necessary to
pay attention to access to place because it is one of the factors in success in
running a business. One part that affects the success of a business is in
determining access to places that are easily accessible to the community for a
strategic business, located on the edge of a large road and easily accessible
by using private vehicles and public transportation. Access to this hospital is easily accessible to the community
with a population density based on data from the Central Bureau of Statistics,
the population of Central Jakarta in 2021 was 1,066,460 people. Patients and
hospital visitors will be easily affordable
to seek treatment at the hospital using
private vehicles or public transportation.
2.7Medical and Hospital Equipment (R5)
A hospital needs medical equipment needed to support type C hospital facilities. Minister of Health
Regulation No. 3 of 2020 article 26 paragraph 1 includes medical equipment and
non-medical equipment that meets service standards, quality requirements,
security, safety and wearability. The use of medical equipment is one of the
important elements so that it is necessary to improve and maximize health
equipment and hospitals in an effort to improve health services for BPJS patients
which has an impact on the quality of service and access to health and BPJS
patient satisfaction.
3.1 Digital Marketing (C3)
The hospital that will be established is a type C private
public hospital utilizing digital marketing and requires professional marketing
personnel to have expertise and experience in marketing to be able to introduce
and inform products (services), provide services for BPJS patients, market
products (services), promote and increase the growth of this hospital.
The concept he does is B2B (Business to Business) and B2C
(Business to Customer). The B2B concept is carried out by collaborating
with health clinics that have become BPJS Kesehatan partners and the B2C
concept in collaboration with health marketplaces such as haloDoc, Dokter.id
and KlikDokter, in addition to promotional activities using the hospital's website and social media such as twitter, facebook and
Instagram.
3.2 Cooperation Between Health Facilities and Satellite
Clinics (C4)
Establish a good network and cooperative relationship with
clinics and puskesmas in the same rayon with this hospital in accordance with
the BPJS health
network and also type
D referral hospitals in terms of patient referrals and medical support needed
to increase income to increase growth for the
hospital. Satellite clinics help BPJS patients to check and seek
treatment at puskesmas, clinics and at Bungur Medika
Hospital
and to get hospital referral letters quickly because it can save BPJS patients'
time, no need to queue long and long to
get a hospital referral letter. With the satellite clinic, the queue of BPJS patients in the
queue for treatment to the puskesmas is different from the queue to get a
referral letter for treatment to Bungur Medika Hospital and provide
notifications on BPJS patients' cellphones on the day and time of treatment to Bungur
Medika Hospital, where to get a
hospital referral letter, BPJS patients do not need to wait long because the
queue line is distinguished from the queue of BPJS patients who want to seek
treatment at the puskesmas nor clinics.
3.3 Hospital Culture that Creates a Conducive Environment
(C5)
Creating a culture that supports positive values such as
honesty, professionalism, high work ethic, discipline, service and empathy to
patients and their families to provide a conducive hospital environment and
increase a sense of family.
3.4 Large Working Capital (R6)
In starting this hospital business, large working capital
is needed, where large working capital is one of the most important factors in
running a hospital business starting from building, preparing equipment and
machinery needs, supplies,
hospital facilities,
as well as in carrying
out planning from marketing, operational planning, human resource planning and
financial planning as well as developing innovations in terms of technology to
provide excellent service for BPJS patients and improving hospital performance. Where the working capital can be obtained
from investors, own capital or from bank loans.
3.5 Human Capital Management (R7)
This hospital is a health service provider that provides
medical services, medical support and even non-medical to the community. In
medical services, one of them is the need for full-time specialist doctors who have just
graduated because they can establish faster and closer cooperation, simplify
the process of claiming BPJS, simplify the hospital administration process and
reduce the possibility of errors that occur. A strategy is needed to improve
the quality of employee performance and develop the potential of its employees.
The strategy used to improve the quality of employee performance by conducting
training and development and performance management, for that requires
support from Top Management in achieving its success.
This training and development aims to improve the
quality of work, skills and work productivity so as to achieve the vision and
mission of this hospital. Its
implementation must be in accordance with the needs and on target in order to
provide benefits to employees and can improve performance optimally.
Performance Management is used so that
employees can understand their role in providing services and improving their
performance. Measurement or assessment of the quality of hospital services must
be carried out to provide satisfaction to the community, which includes
assessment of the quality of building facilities, the quality of medical
devices and the quality of human resources.
3.6 Claim Documentation System to BPJS (C10)
The management of claim documentation to BPJS related
to the cost of treatment and examination of BPJS patients at this hospital is
still an obstacle for this hospital, because sometimes the documents are still
incomplete, there is incorrect coding writing, returned documents from BPJS to
the hospital due to incorrect diagnosis writing or administrative writing
errors, thus making the disbursement of funds from BPJS to this hospital longer
which results in cashflow
This
hospital is not doing well.
3.7 Speed In Service (C6)
The development of hospitals must be able to pay attention
to patient satisfaction. One of the factors that has a significant influence on
BPJS Hospital patient satisfaction is the speed of service that the hospital
provides to BPJS Hospital patients who are in accordance with hospital service
standards from the waiting time for patients starting registration, the
outpatient service process starting from the registration counter at the
polyclinic to taking drugs at the pharmacy.
3.8 No Additional
Charge (C7)
In our hospital in providing satisfaction for BPJS
patients and getting quality services carry out a commitment for BPJS patients,
where BPJS patients who seek treatment at our hospital are not charged
additional fees in accordance with applicable regulations.
3.9 Specialist
Practice Poly Schedule (R8)
To provide excellent service
for BPJS patients in seeking treatment and conducting examinations at this
hospital, there is a specialist practice poly schedule every day except for red
dates at this hospital, so that BPJS patients who want to seek treatment and
see a specialist doctor can be done every day except red dates quickly because
of the availability of existing specialist practice poly schedules and
available every day except red dates.
3.10 First Level
Health Facility Services (C8)
BPJS patients who want to seek
treatment and check at this hospital must have a referral letter from a
first-level health facility first, both from the puskesmas and health clinics
in one rayon with this hospital. Where this hospital makes it easy for
patients to get referral letters quickly, there is no need to wait long and
queue too long, because this hospital collaborates with puskesmas and health
clinics in Serayon with this hospital.
3.11
Pharmaceutical Services (C9)
One of the services for BPJS
patients is pharmaceutical services to take drugs needed by BPJS patients after
conducting an examination from a specialist. BPJS patients can save time, do
not have to wait too long and queue for drug collection at the pharmacy, thus
providing satisfaction for BPJS patients.
Table
1 Resources and Capabilities Assessment
|
|
|
Importance
|
Relative strength
|
Comment
|
|
|
Resources > company asett
|
|
|
R1
|
Quality human resources
|
6
|
5
|
HR
qualification qualifications that meet the required standards
|
|
|
R2
|
Supporting Facilities
|
6
|
4
|
Facilities and Infrastructure
|
|
|
R3
|
Online Registration
|
8
|
9
|
Make it easier for BPJS patients to seek treatment, no need to
be complicated, convoluted and faster
|
|
|
R4
|
Access to hospitals that are easily accessible to the community
|
8
|
7
|
Strategic Hospital Access
|
|
|
R5
|
Medical Equipment and Hospitals
|
7
|
5
|
Not the maximum health equipment and hospitals needed
|
|
|
R6
|
Large working capital
|
7
|
7
|
Available and well-managed capital
|
|
|
R7
|
Human capital Management
|
7
|
4
|
High employee productivity
|
|
|
R8
|
Schedule of specialist poly practice
|
9
|
8
|
Availability of a specialist practice poly schedule every day
except red dates
|
|
|
Capabilities
> what the company does
|
|
|
|
|
|
C1
|
Quality service
|
8
|
9
|
Provide satisfaction for patients in quality service
|
|
|
C2
|
RS Information Technology System
|
8
|
8
|
Information technology systems facilitate services for the
community and management
|
|
|
C3
|
Digital Marketing
|
9
|
8
|
Marketing Digitalization in B2B and B2C
|
|
|
C4
|
Cooperation between health facilities and satellite clinics
|
8
|
8
|
In accordance with Minimum Service Standards and Hospital
Accreditation Service Standards
|
|
|
C5
|
Hospital culture that creates a conducive environment
|
6
|
5
|
Culture Formation
|
|
|
C6
|
Speed in service
|
9
|
8
|
Speed of serving patients in hospital treatment
|
|
|
C7
|
No additional fees apply
|
8
|
8
|
BPJS patients are not charged additional treatment fees at this
hospital
|
|
|
C8
|
First-level health facility services
|
7
|
8
|
Providing convenience for BPJS patients starting from puskesmas
and health clinics
|
|
|
C9
|
Pharmaceutical Services
|
7
|
5
|
BPJS patient services for taking medicines
|
|
|
C10
|
Claim documentation system to BPJS
|
8
|
5
|
Management of claim documents to BPJS in disbursement of funds
from BPJS to hospitals
|
|
|
Information
|
|
|
|
|
|
a. Scale 1-10 (1= not important 10= very important)
|
Figure 2 Resources Valuation Diagram
Figure 3. Capabilities Assessment Diagram
Based on the results of the assessment in the table above,
the strengths and weaknesses can be formulated in hypothetical form as follows:
Figure 4 Hypothetical
RS Bungur Medika Key Strength and Weakness
4
Competitive
Advantage
Resource-Based View (RBV) analysis using the VRIO
framework (Value,
Rare, Imitability, Organization) is carried out to assess all resources owned by the company
based on the
analysis of strengths and weaknesses that have been carried out previously,
and then determine the VRIO framework on each potential of resources )
and those capabilities.
Table
2 VRIO resource analysis
|
Resources
(Resources)
|
Valuable
|
Rare
|
Immitable
|
Organized
|
Implication
|
|
Online Registration
|
Yes
|
Yes
|
Yes
|
Yes
|
Sustainable competitive advantage
|
|
Schedule of Specialist Doctor Practice Poly
|
Yes
|
Yes
|
Not
|
Yes
|
Parity advantages
|
Table
3. VRIO capability analysis
|
Capabilities
(Capability)
|
Valuable
|
Rare
|
Inimitable
|
Organized
|
Implication
|
|
Quality service
|
Yes
|
Yes
|
Yes
|
Yes
|
Sustainable Competitive Advantage
|
|
RS Information Technology System
|
Yes
|
Yes
|
Yes
|
Yes
|
Sustainable Competitive Advantage
|
|
Digital Marketing
|
Yes
|
Yes
|
Not
|
Yes
|
Parity advantages
|
|
Speed in service
|
Yes
|
Yes
|
Not
|
Yes
|
Parity advantages
|
|
Cooperation between health facilities and
satellite clinics
|
Yes
|
Yes
|
Yes
|
Yes
|
Sustainable Competitive Advantage
|
|
No Additional Charge
|
Yes
|
Yes
|
Not
|
Yes
|
Parity advantages
|
Based on the results of the analysis above, the company's
Strengths and Weaknesses can be obtained as Internal Factors Evaluation
(IFE), which is shown in the table below:
Table
4 Internal Factor Evaluation – IFE RS Bungur Medika
|
KEY INTERNAL FACTORS
|
|
Strength
|
|
1
|
Ease
of BPJS Patients for Treatment
|
|
2
|
Hospital access that is strategic or affordable by the community
|
|
3
|
Available and well-managed capital
|
|
4
|
Provide satisfaction for patients in quality service
|
|
5
|
Information technology systems to facilitate services to the
community and management
|
|
6
|
Marketing Digitalization with B2B and B2C
|
|
7
|
Plenary accredited hospital
|
|
8
|
Speed of serving patients in hospital treatment
|
|
9
|
Schedule of specialist practice poly every day except Sunday
|
|
10
|
BPJS patients are not charged additional treatment fees at this
hospital
|
|
11
|
Providing convenience for BPJS patients starting from puskesmas
and health clinics
|
|
Debilitation
|
|
1
|
Facilities and infrastructure
|
|
2
|
Not the maximum hospital health equipment needed
|
|
3
|
Culture Formation
|
|
4
|
Quite high employee productivity
|
|
5
|
Have
the required HR qualifications
|
|
6
|
BPJS patient services for taking medicines
|
|
7
|
Management of claim documents to BPJS in disbursement of funds
from BPJS to hospitals
|
CONCLUSION
The conclusion obtained based on the results
of the study is that internal analysis has an important role and is needed in
starting a business to find out which are the resources and capabilities of a
business consisting of marketing, operations, human resources and finance in
assessing and determining the strengths and weaknesses so as to determine the
company's business strategy and competitive advantage of the company. Running
the Bungur Medika Hospital business that focuses on health services that serve
hospital patients has a very important role because it is one of the success
factors in running a hospital business from inpatient services, outpatient
services, medical services and medical support, how responsive doctors and
nurses are in handling and serving patients, responsibility, ready to receive
complaints by providing friendly service, is not convoluted, and quick to
respond.
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Internal
Factor Analysis in the Development of Health Services at Bungur Medika Hospital