ABSTRACT: Background. Interdisciplinary model of patient care was developed to integrate
multiprofessional practices in health care services of tertiary teaching hospital in
Bandung West Java. The aim of the development of this model primarily is to
enhance a good health care services in hospital ward through cohesive colaborative
practice. Cohessiveness in collaborative practice is needed to bridge the classical
problems of multidisiplinary approach of caring where every single discipline work
on their own, so that lack of coordination and role overlap could be managed and
patient’s need of care were delivered safely, integrated and continuously.
Cohessiveness was established by creating the culture of interdisciplines in the four
components of model namely care path, teamwork on patient care, integrated patient
documentation, and interdisciplinary case conference. The aim of this study is to
evaluate collective and expert culture among physicians and nurses and its impact on
patient safety, quality of care and patient satisfaction.
Methodology. Post test only research design was conducted to measure collective
and expert culture of physicians and nurses. In the 1st measurement 39 phisicians and
32 nurses participated, in 2nd measurement 22 physicians and 25 nurses participated .
Incidents of patient safety was identified through the number of diagnostic error,
treatment error, preventive error, and others error. Evaluation of quality of care was
examine through observation based on objective standards of care delivery, and
patients satisfaction through questionnaires. Data were analyzed with test of mean
difference, Poisson regression and anova at α 0,05.
Results. Collective culture signicantly greater than expert culture in three
components of model in the 1st measurement. In the 2nd measurement collective
culture greater significantly than expert culture in the four components of model. On
the incidence of patient safety there was decreasing between 1st and 2nd measurement
by 45% in diagnostic errors, 49.5% in treatment errors, 88.12% in preventive errors
and 100% in others. On the quality of care, there was an increase in the compliance of
standard of care from 76.4% in the 1st to 80.57%in 2nd measurement. There was
decreased of patients satisfaction from 94.5% in the 1st to 89.48% in 2nd
measurement, but the patients’ expectation increase from 4.12 to 4.61 in the scale of
1-5. Statistically there was no significant difference of the effect of culture of
interdisciplines on the patients safety, quality of care and patients satisfaction.
Conclussion. Shared expertise as the core of collective culture and spirit of the
Interdisciplinary health care do exist and strengthen in this collaborative professional
practice. However its effect on the patient satisfaction, quality of care and patient
satisfaction is not statistically significant.
INTISARI: Latar belakang. Penelitian tentang pengembangan Model Pelayanan Rawat
Inap Terpadu (MPRIT) sebagai basis integrasi antar profesi dalam pelayanan
kesehatan dilakukan di RSUP Dr Hasan Sadikin Bandung. Tujuan awal
pengembangan model adalah meningkatkan tata kelola pelayanan kesehatan di
tatanan rawat inap guna mengatasi fragmentasi pelayanan karena tumpang tindihnya
peran dan fungsi pelaksana asuhan dari berbagai disiplin profesi baik sebagai praktisi,
pendidik maupun praktikan, sehingga potensi kerawanan terhadap berbagai kesalahan
yang utamanya terkait dengan situasi atau sistem dapat diminimalisasi.
Pengembangan MPRIT difokuskan pada proses menumbuhkan kultur interdisiplin
sebagai spirit praktik kolaborasi antar professional kesehatan melalui empat
komponen model. Penelitian ini bertujuan untuk mengevaluasi kultur interdisiplin
dan pengaruhnya terhadap keselamatan pasien, kualitas asuhan dan kepuasan pasien.
Metodologi. Evaluasi kultur interdisiplin menggunakan rancangan post test
design only dengan melakukan dua periode pengukuran terhadap dokter dan perawat.
Pada pengukuran I, 39 dokter dan 32 perawat berpartisipasi, pada pengukuran II, 22
dokter dan 25 perawat berpartisipasi. Evaluasi terhadap insiden keselamatan pasien
diukur dari angka kejadian terkait kesalahan (proses) diagnosis, kesalahan perlakuan,
kesalahan pencegahan dan kesalahan lain. Evaluasi kualitas asuhan dilakukan
melalui pengamatan dengan standar objektif terhadap alur proses pengelolaan pasien
, survey kepuasan pasien dengan evaluasi subjektif melalui kuesioner. Data dianalisis
menggunakan uji beda mean, regresi poisson dan uji anova.
Hasil. Kultur kolektif secara signifikan lebih besar dari kultur individu, pada
tiga komponen di pengukuran I dan menguat di pengukuran II yang ditunjukkan oleh
kultur kolektif lebih besar dari kultur individu secara signifikan di semua komponen
model. Antara pengukuran I dan II, pada insiden keselamatan pasien terdapat
penurunan angka kejadian sebesar 45% pada insiden terkait kesalahan proses
diagnosis, 49,5% pada insiden terkait kesalahan perlakuan, 88,12% terkait kesalahan
pencegahan dan 100% terkait kesalahan lain. Pada kualitas pelayanan, terjadi
kenaikan dari 76,4% menjadi 80,57%. Pada variable kepuasan pasien, ada penurunan
kesesuaian antara pengalaman dan harapan pasien yaitu 94,5% pada pengukuran I
menjadi 89,48% pada pengukuran II karena terjadinya kenaikan ekspektasi pasien
dari 4,12 menjadi 4,61. Tidak terdapat pengaruh yang signifikan antara menguatnya
kultur interdisiplin dengan keselamatan pasien, kualitas asuhan dan kepuasan pasien.
Kesimpulan. Kultur interdisiplin sudah terbentuk dan menguat pada dokter dan
perawat di unit MPRIT. Menguatnya kultur interdisiplin secara signifikan belum
berpengaruh pada keselamatan pasien, kualitas pelayanan dan kepuasan pasien.
