Study guide Health System 14 April 2015 Semester 2
List of Content
Curriculum of Health System Based Practice 3
Planners Team 9
Facilitators 9
Reserve Facilitators 10
Time Table 11
Time Table for Discussion of Student Project 23
Assessment Method 23
Module 1 – 18 24
(2)
List of Modules
Day 1: MODULE ~ 1 p.24
Introduction to Health System and Primary Health Care: The Basic Principles
Day 2 -3: MODULE ~ 2 p.29
Health Indicators and Health Services Related Problems
Day 2-3: MODULE ~ 3 p.31
Health Care System in Several Countries
Day 4-5: MODULE ~ 4 p.33
National Health Care System of Indonesia 2012
Day 4-5: MODULE ~ 5 p. 35
Puskesmas as a Primary Health Care Service
Day 6-7: MODULE ~ 6 p.37
Primary Health Care and Health Promotion
Day 6-7: MODULE ~ 7 p.39
Basic Theories underlying Health Promotion
Day 8-9: MODULE ~ 8 p.41
Health Management in Health Services
Day 8-9: MODULE ~ 9 p.43
Health Workforce and Human Resource Management
Day 10-11: MODULE ~ 10-11 p.45
Quality Management 1 & 2
Day 12-13: MODULE ~ 12 p. 49
Management of Facilities, Information, and Finance
Day 12-13: MODULE ~ 13 p. 53
Managed Care
Day 14-15: MODULE ~ 14 p. 55
Health Insurance and SJSN
Day 14-15: MODULE ~ 15 p.57
Family Medicine Practices: Family as a Unit of Care
Day 16-17: MODULE ~ 16 p.59
Health Delivery System and Family Medicine Practices
Day 16-17: MODULE ~ 17 p. 63
Disease Management Skills
(3)
CURRICULUM
Health System Based Practice
Competency Statements
Instructional Goals
Learning Objectives Topics
Manage health services in primary health system
1. Demonstrate ability to provide health services in accordance with a country’s health system
1. Describe health problems using health indicators. 2. Describe definition and areas
of health care system 3. Explain the relationship
among people, health provider and finance state in health delivery system. 4. Explain the importance of
implementation of health care system as a solution of health problem Health Indicators and Health Services Related Problems
5. Explain the role of a country in desGNing a health care system.
6. Describe the role of health care system toward health status of the people.
7. Describe stakeholders’ roles in health care system. 8. Describe the challenges
that might be faced in delivering health services. 9. Explain the dilemmas in
delivering health services. 10. Describe the roles of family
medicine in health care system.
11. Describe the steps of family medicine development. 12. Explain the objectives of
health services.
13. Explain the functions of health services.
14. Describe the values that
Introduction to Health System and Primary Health Care: The Basic Principles
(4)
care system.
Competency Statement
Instructional Goals
Learning Objectives Topics
16. Explain the challanges that are faced by every country in developing a health care system.
17. Describe the roles of primary health services in solving the health care system’s
problems.
18. Explain the objectives of SKN. 19. Describe the subsystems in
SKN including: a. Health services. b. Health financing. c. Human resources. d. Drug & health facilities. e. Community empowerment. f. Health management 20. Describe relationship among
sub systems.
21. Describe the application of SKN.
National Health System (Sistem Kesehatan Nasional (SKN)) 2012
22. Describe various types of Health Care System which have been or being adopted by a certain country.
23. Explain advantages and disadvantages of each system.
24. Describe the role of government and private sector in each system.
25. Describe various professions in Health Care System. 26. Explain the effect of Health
Care financing to the health status of people.
27. Describe basic principles of WHO recommendation to the National Health Care System
Health Care System in Several Countries
(5)
Competency Statement
Instructional Goals
Learning Objectives Topics
28. Describe major factors affecting health status. 29. Define Health Education and
Health Promotion
30. Explain the aspects of health promotion based on the Ottawa Charter.
31. Explain the strategic role of Health Education and Health Promotion in achieving optimum health status of every individual.
32. Comprehend Health Promotion glossary.
Primary Health Care and Health Promotion
33. Explain basic theories underlying Health Education and Health Promotion. 34. Describe basic principles of
diffusion of innovations and the decision making process. 35. Summarized major theories of
behavior change.
Basic theories underlying health promotion
2. Demonstrate ability to apply the concept of management to provide health services at primary level
1. Describe the structure of primary health services in puskesmas.
2. Explain the basic programs and the additional programs in puskesmas.
3. Describe the financing system of basic programs in puskesmas.
4. Explain the application of private health services management based on the finance resources:
a. Askes
b. Askeskin/JPKMM
Puskesmas as a Primary Health Care Service
(6)
(7)
Competency Statement
Instructional Goals
Learning Objectives Topics
6. Describe the principles of management in health care services.
7. Comprehend the concepts of managing people in health services
8. Explain the concepts of supplies and stores management (SSM). 9. Describe how to control
discrepancies in a clinic.
Health Management Concepts in Health Services (Management of people, facilities, information, finance, and quality) 10. Comprehend the concepts of
managing information and finance.
11. Describe basic concept of quality in health-care
12. Describe how to manage health-care in whole system for quality improvement
13. Explain the concept of managed care.
14. Describe the types of managed care.
Managed Care
15. Explain the basic concept of health insurance.
16. Describe several models of health insurance.
17. Explain the financing system of health insurance.
18. Explain the application of health insurance through SJSN.
19. Describe the application of a managed care in health insurance.
Health
Insurance and SJSN
3. Apply family medicine approach in primary health services
1. Describe the definition of a family.
2. Describe the functions of family. 3. Explain the cycle of family
development including the main objective in each step.
Family Medicine Practices: Family as a Unit of Care
(8)
Competency Statement
Instructional Goals
Learning Objectives Topics
5. Differentiate the characteristics of a happy and an unhappy family.
6. Describe the roles of family doctor in assisting an unhappy family
7. Explain the level of a doctor’s involvement in a family with health problems.
8. Describe the family dynamics that affecting health status of family member.
9. Draw and describe a family genogram.
10. Describe the definition of family medicine as a discipline.
11. Describe place and position of family medicine in the health care system.
12. Explain the knowledge and skill that are required in family medicine practice.
13. Compare integrated health activities within and between providers.
14. Describe the application of the principles of family doctor services covering:
a. personal care b. primary care
c. comprehensive care d. continuing care
15. Explain the coordinative and collaborative aspects using basic approaches of family medicine.
16. Describe the basic approaches of family medicine at the
individual, family and community levels.
Health delivery system and family medicine
(9)
Competency Statement
Instructional Goals
Learning Objectives Topics
17. Describe the differences between acute and chronic diseases management. 18. Explain how to help patients
to evaluate their conditions. 19. Describe how to educate
patients with chronic
diseases in order to empower them in diseases
management.
20. Describe how to make similar perception of diseases with patients and how to
determine the objectives to be achieved together. 21. Explain how to desGN and
to apply the clinical management of chronic diseases.
Diseases management skill
(10)
~ PLANNERS TEAM ~
N
o Name Department Phone
1 DR. Luh Seri Ani, SKM., M.Kes (Coordinator)
Community/Preventive 08123924326
2 dr. Komang Ayu Kartika Sari, MPH (Secretary) Community/Preventive 082147092348 3 dr. I Nyoman Sutarsa, MPH Community/Preventive 087860380028 4 DR. dr. I Wayan Weta, MS, SpGK Community/Preventive 081337005360 5 dr. I.B. Wirakusuma, MOH Community/Preventive 08124696647 6 DR. dr. GN Indraguna Pinatih, MSc,
SpGk,Akp Community/Preventive 08123816424
7 dr. Ni Luh Putu Ariastuti, MPH Community/Preventive 0818560008
~ FACILITATORS ~
Regular Class (Class A)No Name Department Phone Group Room
Number 1 dr. Putu Anda Tusta Adiputra ,
Sp.B(K)Onk Surgery 08123826430
A-1 A.3.09
2 dr. Komang Ayu Kartika Sari, MPH Public Health 082147092348 A-2 A.3.10 3 Ni Wayan Tianing, S.Si, M.Kes Biochemistry 08123982504 A-3 A.3.11 4 dr. Ni Putu Ekawati, M.Repro,
Sp.PA Anatomy Pathology 08113803933 A-4 A.3.12
5 Drs. I Nyoman Toya Wiartha, Apt Pharmacy 0811399886 A-5 A.3.13 6 dr. A.A.A. Yuli Gayatri, Sp.PD Interna 08123803985 A-6 A.3.14
7 dr. Made Lely Rahayu, Sp.THT ENT 08113809882 A-7 A.3.15
8 dr. Ida Bagus Ngurah , M For Pharmacology 08123687288 A-8 A.3.16 9 dr. Wira Gotera,
Sp.PD-KEMD-FINASIM Interna 08155736480
A-9 A.3.17
(11)
English Class (Class B)
No Name Department Phone Group Room
Number
1 dr. Ni Luh Ariwati Parasitology 08123662311 B-1 A.3.09
2 dr. Muliani , M Biomed Anatomy 085103043575 B-2 A.3.10
3 dr. Ni Luh Putu Ariastuti, MPH Public Health 0818560008 B-3 A.3.11 4 dr. I Ketut Mariadi, Sp.PD Interna 08123853700 B-4 A.3.12 5 Desak Gde Diah Dharma Santhi,
S.Si, Apt, M.Kes Clinical Pathology 0817569021 B-5 A.3.13
6 dr. I Gusti Ngurah Wien Aryana ,
Sp.OT Orthopaedi 0811385263 B-6 A.3.14
7 dr. I Gusti Ngurah Pramesemara ,
S.Ked Andrology 081338605087 B-7 A.3.15
8 dr. I Gusti Lanang Ngurah Agung
Artha Wiguna, Sp.OT (K) Orthopaedi 0811388859 B-8 A.3.16
9 dr. Putu Andrika, Sp.PD-KIC Interna 08123989192 B-9 A.3.17 10 dr. I Gede Eka Wiratnaya, , Sp.OT Orthopaedi 081338493832 B-10 A.3.19
Reserve Facilitators
No Name Department Phone
1 DR. dr. GN Indraguna Pinatih, MSc, SpGk,
Akp Com/Prev 08123816424
2 dr. A.A.Sg. Sawitri, MPH Com/Prev 0817340145
3 DR. dr. I Wayan Weta, MS, SpGK Com/Prev 081337005360
(12)
Regular Class (A)
Days/date Time Activity Venue Lecturers
1
Tuesday 14th of April
08.00 – 09.00
Introductory Lecture
Introduction to Health System and Primary Health Care: The Basic Principles
Theatre Room (4th floor)
dr. I Nyoman Sutarsa,
MPH 09.00 –
11.00 Movie Presentation (“John Q” )
Theatre Room (4th floor) 11.00 –
12.30 SGD (Task-1)
Discussion Room (DR) 12.30 –
13.00 Independent Learning 13.00 –
14.00
Student presentation (SP) and feedback
Class Room (CR) 3.01
dr. I Nyoman Sutarsa,
MPH
2
Wednesday 15th of April
09.00 – 10.00
Introductory lecture
Health Indicators and Health Services Related Problems
CR 3.01
DR. Luh Seri Ani, SKM.,
M.Kes
10.00 – 11.00
Introductory Lecture
Health Care System in Several Countries
CR 3.01 dr. I Nyoman Sutarsa, MPH 11.00 – 12.00 Break/Lunch 12.00 – 15.00
SGD (Task-2): Health Indicators and Health Services Related
Problems DR
SGD (Task-3): Health Care System in Several Countries
3
Thursday 16th of April
09.00 – 10.00
Student presentation and feedback:
Health Indicators and Health Services Related Problems
CR 3.01
DR. Luh Seri Ani, SKM.,
M.Kes 10.00 –
11.00
Student presentation and feedback:
Health Care System in Several Countries
CR 3.01
dr. I Nyoman Sutarsa,
MPH 11.00 –
12.00 Break/Lunch 12.00 –
(13)
Days/
date Time
Activity Venue Lecturers
4
Friday 17th of April
09.00 – 10.00
Introductory Lecture
National Health Care System of Indonesia 2012
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
10.00 – 11.00
Introductory Lecture
Puskesmas as a Primary Health Care Service
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
11.00 –
12.00 Break/Lunch
12.00 – 15.00
SGD (Task-4):
National Health Care System of
Indonesia 2012 DR
SGD (Task – 5):
Puskesmas as a Primary Health Care Service
5
Monday 20th of
April
09.00 – 10.00
Student Presentation and Feedback:
National Health Care System of Indonesia 2012
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
10.00 – 11.00
Student Presentation and Feedback:
Puskesmas as a Primary Health Care Service
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
11.00 –
12.00 Break/Lunch SGD 12.00 –
15.00 Independent Learning
6
Tuesday 21st of
April
09.00 – 10.00
Introductory Lecture
Primary Health Care and Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH 10.00 –
11.00
Introductory Lecture
Basic Theories underlying Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH 11.00 –
12.00 Break/Lunch 12.00 – SGD (Task-6):
(14)
DR SGD (Task-7):
Basic Theories underlying Health Promotion
(15)
Days/
date Time
Activity Venue Lecturers
7
Wednesday 22nd of April
09.00 – 10.00
Student Presentation and Feedback:
Primary Health Care and Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH
10.00 – 11.00
Student Presentation and Feedback:
Basic Theories underlying Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH 11.00 – 12.00 Break/Lunch
12.00 – 15.00 Independent Learning
8
Thursday 23rd of April
09.00 – 10.00
Introductory Lecture
Health Management in Health Services
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
10.00 – 11.00
Introductory Lecture
Health Workforce and Human Resource Management
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp 11.00 – 12.00 Break/Lunch
12.00 – 15.00
SGD (Task-8):
Health Management in Health
Services DR
SGD (Task-9):
Health Workforce and Human Resource Management
9
Friday 24th of April
09.00 – 10.00
Student Presentation and Feedback:
Health Management in Health Services
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
10.00 – 11.00
Student Presentation and Feedback:
Health Workforce and Human Resource Management
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp 11.00 – 12.00 Break/Lunch
(16)
Days/
date Time
Activity Venue Lecturers
10
Monday 27th of April
09.00 – 10.00 Introductory Lecture
Quality Management (1) CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH
10.00 – 11.00 Introductory Lecture
Quality Management (2) CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH 11.00 – 12.00 Break/Lunch
12.00 – 15.00
SGD (Task-10):
Quality Management (1) DR
SGD (Task-11):
Quality Management (2)
11
Tuesday 28th of April
09.00 – 10.00
Student Presentation and Feedback:
Quality Management (1)
CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH 10.00 – 11.00
Student Presentation and Feedback:
Quality Management (2)
CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH 11.00 – 12.00 Break/Lunch
12.00 – 15.00 Independent Learning
12
Wednesda y 29th of April
09.00 – 10.00
Introductory Lecture
Management of Facilities, Information, and Finance
CR 3.01 DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp 10.00 – 11.00 Introductory Lecture
Managed Care
CR 3.01 DR. dr. I Wayan Weta, MS, SpGK 11.00 – 12.00 Break/Lunch
12.00 – 15.00
SGD (Task-12):
Management of Facilities,
Information, and Finance DR
SGD (Task-13): Managed Care
13
Thursday 30th of April
09.00 – 10.00
Student Presentation and Feedback:
Management of Facilities, Information, and Finance
CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
10.00 – 11.00
Student Presentation and Feedback:
Managed Care
CR 3.01 DR. dr. I Wayan Weta, MS, SpGK 11.00 – 12.00 Break/Lunch
(17)
Days/date Time Activity Venue Lecturers
14
Monday 4th of May
09.00 – 10.00 Introductory Lecture
Health Insurance and SJSN CR 3.01
dr. I Nyoman Sutarsa, MPH
10.00 – 11.00
Introductory Lecture
Family Medicine Practices: Family as a Unit of Care
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK 11.00 – 12.00 Break/Lunch
12.00 – 15.00
SGD (Task-14):
Health Insurance and SJSN
DR SGD (Task-15):
Family Medicine Practices: Family as a Unit of Care
15
Tuesday 5th of May
09.00 – 10.00
Student Presentation and Feedback:
Health Insurance and SJSN
CR 3.01 dr. I Nyoman Sutarsa, MPH
10.00 – 11.00
Student Presentation and Feedback:
Family Medicine Practices: Family as a Unit of Care
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
11.00 – 12.00 Break/Lunch
12.00 – 15.00 Independent Learning
16
Thursday 7th of May
09.00 – 10.00
Introductory Lecture
Health Delivery System and
Family Medicine Practices CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
10.00 – 11.00 Introductory Lecture
Disease Management Skills CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp 11.00 – 12.00 Break/Lunch
12.00 – 15.00
SGD (Task-16):
Health Delivery System and
Family Medicine Practices DR
SGD (Task-17):
Disease Management Skills
17
Friday 8th of May
09.00 – 10.00
Student Presentation and Feedback:
Health Delivery System and Family Medicine Practices
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
10.00 – 11.00
Student Presentation and Feedback:
Disease Management Skills CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp 11.00 – 12.00 Break/Lunch
(18)
Days/date Time Activity Venue Lecturers 18
Monday, 11th of May
Basic Clinical Skill (Group Discussion of Student
Project)
CR 3.01 Team
19
Tuesday, 12th of May
Basic Clinical Skill (Group Discussion of Student
Project)
CR 3.01 Team
20
Wednesday, 13th of May
Presentation of Student Project CR 3.01 Team
Thursday, 14th of May 2015 – Pre-Examination Break
Monday, 18th of May
(19)
~ TIME TABLE ~
English Class (B)
Days/
date Time Activity Venue Lecturers
1
Tuesday 14th of April
08.00 – 09.00
Introductory Lecture
Introduction to Health System and Primary Health Care: The Basic Principles
Theatre Room (4th floor)
dr. I Nyoman Sutarsa, MPH 09.00 –
11.00 Movie Presentation (“John Q” )
Theatre Room (4th floor) 11.00 –
12.30 Independent Learning 12.30 –
14.00 SGD (Task-1)
Discussion Room (DR) 14.00 –
15.00
Student presentation (SP) and feedback
Class Room (CR) 3.01
dr. I Nyoman Sutarsa, MPH
2
Wednesda y 15th of April
09.00 –
12.00 Independent Learning 12.00 –
13.00 Break/Lunch 13.00 –
14.00
Introductory lecture
Health Indicators and Health Services Related Problems
CR 3.01
DR. Luh Seri Ani, SKM., M.Kes
14.00 – 15.00
Introductory Lecture
Health Care System in Several Countries
CR 3.01 dr. I Nyoman Sutarsa, MPH
3
Thursday 16th of April
09.00 – 12.00
SGD (Task-2): Health Indicators and Health Services Related
Problems DR
SGD (Task-3): Health Care System in Several Countries
12.00 –
13.00 Break/Lunch 13.00 –
14.00
Student presentation and feedback:
Health Indicators and Health Services Related Problems
CR 3.01
DR. Luh Seri Ani, SKM., M.Kes 14.00 – Student presentation and feedback: dr. I Nyoman
(20)
Days/
date Time
Activity Venue Lecturers
4
Friday 17th of April 09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture
National Health Care System of Indonesia 2012
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
14.00 – 15.00
Introductory Lecture
Puskesmas as a Primary Health Care Service
CR 3.01
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
5
Monday 20th of
April
09.00 – 12.00
SGD (Task-4):
National Health Care System of
Indonesia 2012 DR
SGD (Task – 5):
Puskesmas as a Primary Health Care Service
12.00 –
13.00 Break/Lunch SGD 13.00 –
14.00
Student Presentation and Feedback:
National Health Care System of Indonesia 2012
CR 3.01 dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
14.00 – 15.00
Student Presentation and Feedback:
Puskesmas as a Primary Health Care Service
dr. I.B Wirakusuma, MOH / DR. dr. I Wayan Weta, MS, SpGK
6
Tuesday 21st of
April 09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture
Primary Health Care and Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH 14.00 –
15.00
Introductory Lecture
Basic Theories underlying Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH
(21)
Days/
date Time
Activity Venue Lecturers
7
Wednesd ay22nd of
April
09.00 – 12.00
SGD (Task-6):
Primary Health Care and Health
Promotion DR
SGD (Task-7):
Basic Theories underlying Health Promotion
12.00 – 13.00 Break/Lunch
13.00 – 14.00
Student Presentation and Feedback:
Primary Health Care and Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH
14.00 – 15.00
Student Presentation and Feedback:
Basic Theories underlying Health Promotion
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / dr. Ni Luh Putu Ariastuti, MPH
8
Thursday 23rd of April
09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch
13.00 – 14.00
Introductory Lecture
Health Management in Health Services
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
14.00 – 15.00
Introductory Lecture
Health Workforce and Human Resource Management
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
(22)
Days
/date Time
Activity Venue Lecturers
9
Friday 24th of April
09.00 – 12.00
SGD (Task-8):
Health Management in Health
Services DR
SGD (Task-9):
Health Workforce and Human Resource Management
12.00 – 13.00 Break/Lunch
13.00 – 14.00
Student Presentation and Feedback:
Health Management in Health Services
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
14.00 – 15.00
Student Presentation and Feedback:
Health Workforce and Human Resource Management
CR 3.01
dr. Komang Ayu Kartika Sari, MPH / DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
10
Monday 27th of
April
09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch
13.00 – 14.00 Introductory Lecture
Quality Management (1) CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH
14.00 – 15.00 Introductory Lecture
Quality Management (2) CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH
11
Tuesda y 28th of
April
09.00 – 12.00
SGD (Task-10):
Quality Management (1)
DR SGD (Task-11):
Quality Management (2)
12.00 – 13.00 Break/Lunch
13.00 – 14.00
Student Presentation and Feedback:
Quality Management (1)
CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH 14.00 – 15.00
Student Presentation and Feedback:
Quality Management (2)
CR 3.01
dr. I Nyoman Sutarsa, MPH / dr. Ni Luh Putu Ariastuti, MPH
(23)
Days/
date Time Activity Venue Lecturers
12
Wednes day 29th of
April
09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch
13.00 – 14.00
Introductory Lecture
Management of Facilities, Information, and Finance
CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
14.00 – 15.00 Introductory Lecture
Managed Care CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
13
Thursda y 30th of
April
09.00 – 12.00
SGD (Task-12):
Management of Facilities,
Information, and Finance DR
SGD (Task-13): Managed Care
12.00 – 13.00 Break/Lunch
13.00 – 14.00
Student Presentation and Feedback:
Management of Facilities, Information, and Finance
CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
14.00 – 15.00
Student Presentation and Feedback:
Managed Care
CR 3.01 DR. dr. I Wayan Weta, MS, SpGK
14
Monday 4th of
May
09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch
13.00 – 14.00 Introductory Lecture
Health Insurance and SJSN
CR 3.01 dr. I Nyoman Sutarsa, MPH 14.00 – 15.00
Introductory Lecture
Family Medicine Practices: Family as a Unit of Care
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
15
Tuesday 5th of
May
09.00 – 12.00
SGD (Task-14):
Health Insurance and SJSN
DR SGD (Task-15):
Family Medicine Practices: Family as a Unit of Care
12.00 – 13.00 Break/Lunch 13.00 – 14.00
Student Presentation and Feedback:
Health Insurance and SJSN
CR 3.01 dr. I Nyoman Sutarsa, MPH
Student Presentation and
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
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16
Thursday 7th of
May
09.00 – 12.00 Independent Learning 12.00 – 13.00 Break/Lunch
13.00 – 14.00
Introductory Lecture
Health Delivery System and Family Medicine Practices
CR 3.01
DR. dr. I Wayan Weta, MS, SpGK
14.00 – 15.00 Introductory LectureDisease Management Skills CR 3.01 DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
Days/date Time Activity Venue Lecturers
17
Friday 8th of May
09.00 – 12.00
SGD (Task-16):
Health Delivery System and
Family Medicine Practices DR
SGD (Task-17):
Disease Management Skills
12.00 – 13.00 Break/Lunch
13.00 – 14.00
Student Presentation and Feedback:
Health Delivery System and Family Medicine Practices
CR 3.01 DR. dr. I Wayan Weta, MS, SpGK
14.00 – 15.00
Student Presentation and Feedback:
Disease Management Skills CR 3.01
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
18
Monday, 11th of May
Basic Clinical Skill (Group Discussion of Student
Project)
CR 3.01 Team
19
Tuesday, 12th of May
Basic Clinical Skill (Group Discussion of Student
Project)
CR 3.01 Team
20
Wednesda y, 13th of
May
Presentation of Student Project CR 3.01 Team
Thursday, 14th of May 2015 – Pre-Examination Break
Monday, 18th of May
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TIME TABLE FOR DISCUSSION OF STUDENT PROJECT
(Regular and English Class)
Date: 1. Monday 11th May 2015
2. Tuesday 12th May 2015
No Class Group SGD Activity Time/Place
1 Regula r
I, II, III, IV, V Group Discussion 08.00 – 09.30 / Class room
2 Regula r
VI, VII, VIII, IX, X Group Discussion 09.30 – 11.00 / Class room
Break/Lunch 11.00 – 12.00 WITA
3 English I, II, III, IV, V Group Discussion 12.00 – 13.30 / Class room
4 English VI, VII, VIII, IX, X Group Discussion 13.30 – 15.00 / Class room
Guidance:
1. Each group is required to bring at least one laptop.
2. Each group will be provided with data/report of a community health center and will discuss the data based on a guideline. The data/report and the discussion guideline will be provided before the first discussion session.
ASSESSMENT METHOD
Student assessment of this block consists of:
1. a paper test with multiple choice questions at the end of the block with a proportion of 80% of the total score
2. a student project with a proportion of 15% of the total score
3. evaluation of activity during the small group discussion with a proportion of 5% of the total score
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M O D U L E ~ 1
M O D U L E ~ 1
Introduction to Health System and Primary Health Care:
The Basic Principles
dr. I Nyoman Sutarsa, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1. Explain the role of a country in designing a health care system.
2. Describe the role of health care system toward health status of the people. 3. Describe stakeholders’ roles in health care system.
4. Describe the challenges that might be faced in delivering health services. 5. Explain the dilemmas in delivering health services.
6. Describe the roles of family medicine in health care system. 7. Describe the steps of family medicine development.
8. Explain the objectives of health services. 9. Explain the functions of health services.
10. Describe the values that should be included in a health care system. 11. Describe the problems of a country in developing health care system.
12. Explain the challanges that are faced by every country in developing a health care system.
13. Describe the roles of primary health care in solving the health care system’s problems.
CURRICULUM CONTENTS:
Introduction to Health System and Primary Health Care: The Basic Principles ABSTRACTS
(References: “John Q” movie; Boelen C, et al, pp.1-36) Meeting People’s Health Needs
This topic covers the philosophy of Health Care System in which each country has a fundamental interest and responsibility for maintaining and improving the health status of its people. To reach this responsibility, each country should always consider its social and
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and fully supported by health professionals, academic institutions and civil society.
The Health Care System is intended to provide a high quality of health care services. However, the system should always agree with the basic principles of health care which include quality, equity, relevance and cost-effective to meet an optimal health status of its people. In this regards, Family Medicine seems to be the best choice for delivering health care services at the front line.
Family Medicine is believed be able to adapt with health system challenges and creating synergies among polarities which universally been encountered by every country. Therefore, flexibility of each stakeholder will be necessary in order to manage tensions exemplified by preceding polarities in health care. Careful assessment of each nation’s economic, political and social conditions and epidemiological pattern of disease will allow leaders to select appropriate health policy strategies and to determine the resources necessary for Family Medicine to grow and contribute to health system improvements.
Strategies for changes toward implementing Family medicine approach could be initiated by presenting evidence in which factual information and arguments emphasizing the benefit of it. It is also necessary to show living examples by doing side-visits and case studies to successful family medicine program.
Improving Health Care System
This chapter reviews the goals, functions and values of health care systems. It also describes common challenges that undermines their successful implementation and outlines strategies to respond to these challenges. It provides the context for assessing the contributions that family medicine can make to people’s health as an integral component of health care systems.
The goals of health care system are to achieve optimal level of health as define by The World Health Organization at the smallest possible discrepancies in health status among individuals and groups. Therefore, health care systems should consist of several functions such as providing health care services, generating human and physical resources, financing and collecting data to inform planning and policy development. Furthermore, responsible leadership should direct and coordinate these interdependent functions to achieve the best possible outcomes.
The importance of applying basic fundamental values of health care system is also covered in this subject. The values include quality, equity, relevance and cost effective.. In short, health care system of every country should provide a high quality of health care services possible at an affordable cost of the government and individual. The services should also equally assessable to everyone and relevance to the majority health problem of every country.
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of the people.
SCENARIO & LEARNING TASKS
SYNOPSIS OF “JOHN Q” MOVIE
Several concepts of Health System Based Practice that you can see in the movie: 1. Health care system in America uses social and private health insurance system. It can be
seen in the movie while John Q brings his son to the hospital, he is asked to show the health insurance card at the receptionist.
2. Communication is an important thing in health care system. We can see in the movie, the doctor and the head of the hospital call John Q and his wife to explain their son’s condition. The doctor explains the condition of the patient and the alternative treatment. It is very important to use language that can be understood by the patient’s family. The head of the hospital explains about the cost of the treatment and John Q’s health insurance.
3. Health care system using health insurance has several models such as HMO, PPO, IPA and IPO. There is a scene that shows the first insurance followed by John Q is PPO. In PPO model, a company must pay a quite expensive premium. The company where John Q works then changes his insurance into HMO because he becomes a part time worker. The insurance is changed without any communication with John Q. Because of that change, John Q cannot get full treatment for his son.
4. Note: In HMO system, clients must pay a fixed amount of money and get the health services that are appropriate to the premium (contract). It has been arranged since the first contract. HMO will pay a doctor based on the standard in the contract, and then the doctor cannot make an additional examination even though it is needed by patient. 5. A nurse in the movie says that the heart disease suffered by John Q’s son cannot be
detected because the health insurance only covers particular examination. 6. Health care system of a country is also influenced by its political condition:
1. The head of the hospital says that changing the health care system needs the legislative involvement. 2. There are different opinions in the community. People who are contra say that there are still a lot of people who cannot afford the health services. On the other hand, the government tries to emphasize the importance of a country’s authority to deliver health services. 3. It can be seen that government wants to hide the real situation because there will be a general election soon.
7. The mass media has various roles in disseminating the real situation. It can help the health care system to be better in the future.
Task 1
1. Discuss in your group the importance of health care system for a country. Discussion should include the objectives of the government and the other stakeholders’ roles in the health care system. The discussion should also cover the challenges that might be faced in developing the health system and the dilemmas that need to be anticipated.
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system. What trends and challenges that might appear in the future of health services? What strategies should be prepared to solve the problems?
3. Discuss about the possibility of family medicine in national health care system. How is the possibility of the role of Family Medicine in Indonesia and Malaysia’s Health Care System? Through which steps Family Medicine possibly to be introduced in those countries?
Discuss in your group the phenomena of health care system implementation; please refer to the movie presentation.
1. Why did the hospital refuse to deliver complete treatment to John Q’s son?
2. How many and what institutions that were responsible to cover John Q’s son hospitalization?
3. Why did John Q feel that his son has the right for hospitalization without any additional expectations?
4. Refer to the above phenomena and discuss the background of health care financing. 5. PPO and HMO give health service based on contract, not comprehensive care. Please
discussed within the group, what type of health insurance that implemented by PPO or HMO? Is it social, regulated private or voluntary private insurance?
6. What are the duties of the government to solve the problem of highly cost health care? 7. Explain the relationship between politics and health care service in the movie.
Self assessment
1. How are the roles of the government in health care system? 2. Describe several factors that influence health status of the people! 3. Describe stakeholder’s roles in health care system!
4. Explain challenges that are faced by every country in arranging health care system! 5. What dilemmas are possibly to appear in developing health care system? Explain your
answer!
6. What are the roles of Family Medicine in health care system? Explain your answer! 7. Describe several steps that should be taken in introducing family medicine!
8. What will be the ultimate objective of health care system? Explain your answer! 9. Describe several functions of health care system!
10. Describe problems and challenges that are possibly to be faced by every country in developing health care system.
11. Explain why delivering Primary Health Services has an important role in health care system.
12. What strategies must be prepared to solve the problems in developing health care system? Explain your answer!
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M O D U L E ~ 2
Health Indicators and Health Services Related Problems
DR. Luh Seri Ani, SKM., M.Kes
AIM:
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1. Describe health problems using health indicators 2. Describe definition and areas of health care system
3. Explain the relationship among people, health provider and finance state in health delivery system.
4. Explain the importance of implementation of health care system as a solution of health problem
CURRICULUM CONTENTS:
Health Indicators and Health Services Related Problems ABSTRACT
(References: Gan GL, et al, pp.14-21)
There are three dimensions of health delivery service namely: patient, health provider and payment system. In general, the medical service is expensive, because it implements high competency of human resources, sophisticated medical technology and some kinds of drug regiments. If there is no medical guarantee (insurance) system, patient often complaints a high cost of medical service that is not affordable. This problem usually appears in countries where there is no social health guarantee systems conducted by the state or health insurance.
SCENARIO AND LEARNING TASKS Task 2
Based on Primary Health Centre’s data, health indicators of the sub-district displayed in table below:
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Table 1. Health Indicators of Sundari Loka Sub District, 2006.
Indicators Rate
1. Infant Mortality Rate (per 1000 life birth) 68.0
2. Under five mortality Rate (per 1000 under five children) 81.0 3. Mother mortality rate (per 100,000 live births) 450
4. Crude mortality rate (per 1000 people) 6.5
5. Life expectancy (year): - Males - Females
55 60
6. Under weight birth (%) 25
7. Children with Protein Energy Malnutrition (%) 40
8. Latrine occupation (%) 40
8. Interpret the community health status in sub-district of Sundari Loka year 2006 (Compare to data in Indonesia (available in Gan, G.L.))
Self Assessments:
1. Describe several aspects that are related to health problem and health care services. 2. Explain the rights and duties of medical doctor as a health provider in health care
system.
3. Describe the prevalent health problems related to health care services in a clinic (hospital).
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Health Care System in Several Countries
dr. I Nyoman Sutarsa, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system LEARNING OUTCOMES:
1. Describe various types of health care system which have been or being adopted by a certain country.
2. Explain advantages and disadvantages of each system.
3. Describe the role of government and private sector in each system. 4. Describe various professions in health care system.
5. Explain the effect of health care financing to the health status of people.
6. Describe basic principles of WHO recommendation to the National Health Care System
CURRICULUM CONTENTS:
Health Care System in Several Countries ABSTRACT
(References: Taylor, RJ, pp.133-144 & Boelen C, et al, pp.1-36)
The topic covers a wide range of Health Care System which has been or being adopted by many countries. In one hand, such system is totally own and control by the government (totalitarian) while the other is totally private (liberal). In addition, combination of the two systems is also being practiced by many countries in which government and private working side by side in synergy. Description of advantages and disadvantages of each system and the role of primary care/private sector are also covered in this topic. Further description concerning the role of various professions in Health Care System and allocation of fund are also discussed in this topic. No matter which Health System is adopted, the basic principle of WHO recommendation should always be put into consideration which include optimum health status of people, responsiveness and fair financing.
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Task 3
1. Discuss in the group about 3 types of National Health Care System. The discussion should also include the advantages and disadvantages of each system. Give at least 1 example the country that adopting each system!
2. Discuss about the role of the government and private sectors in each system!
3. Identify various types of professions taking part in National health Care System and estimated budget allocation among them depending upon the economic status of the country.
4. Discuss in the group about possible health seeking pattern of family in each types of Health Care System if each of the following is happening:
a. One family member is suffering from pink eyes.
b. A child in the family suffering from short breathing, coughing and extreme raise of body temperature!
c. One family member suffering from prominent chest pain followed by cold sweating. He has been experiencing similar symptoms previously!
d. A 60 years old grandfather is suffering from chronic coughing and blood strip in his sputum. He also lost his appetite and body weight.
Self Assessment
1. Describe 3 types of National Health Care System which have been or being adopted and give at least 1 example of the country!
2. Explain the advantages and disadvantages of each system!
3. What is the role of the government and private sectors in each system!
4. Define various types of professions and their role in National Health Care System and average budget allocation among them depending upon the economic status of the country!
5. Describe 3 basic fundamental principles of WHO recommendation that should be considered in developing National Health Care System!
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M O D U L E ~ 4
National Health Care System of Indonesia 2012
dr. I.B Wirakusuma, MOH
DR. dr. I Wayan Weta, MS, SpGK
_____________________________________________________
AIMS
Demonstrate ability to provide health services in accordance with a country’s health system LEARNING OUTCOMES:
1. Explain the objectives of SKN.
2. Describe the subsystems in SKN including: a. Health services.
b. Health financing. c. Human resources. d. Drug & health facilities. e. Community empowerment. f. Health management
3. Describe relationship among sub systems. 4. Describe the application of SKN
CURRICULUM CONTENTS:
National Health Care System of Indonesia 2012 ABSTRACTS
(References: Gan GL, et al, pp.14-21; SKN 2012, pp.1–97; Azwar A.)
Indonesia National Health System (SKN) 2012 is the order that organizes all Indonesian nation resources through integrated, and synergisted approaches, for guaranting the optimal public health status, as a representative of people wellbeing, that has been mentioned in preface of Indonesian Constitutions (UUD 1945).
SKN 2012 consists of six sub systems namely: 1. Health care service
2. Health financing
3. Human health resources 4. Drug and health facilities 5. Community empowerment 6. Health management
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SCENARIO & LEARNING TASK
As a developing country with population more than 200 million, Indonesia has complex health problems. The average per capita income is 680 US dollar per year. More than 30% of the population is under the poverty line. Thirty percent of the health financing is from government and 70% is from community. Most of the government’s funding is for public services while the community funding is for private services. About 80% of the community funding is available from fee for services and 20% is from insurance. Based on the gross per capita income, only 2,5% of it is allocated for health financing. Because most of the population is not covered by health insurance, they don’t depend on any particular health services. The authority of health provider is quite high. People are often unable to pay health services especially in a hospital. They are even getting poorer, because they have to spend almost all of their money to pay the health services.
Task 4
1. What components should be considered to find the solution of various problems above? 2. How is the application of public and private health services in Indonesia?
3. How public and private services will be applied based on SKN 2012?
4. Can SKN 2012 give the solution of all problems above? Explain the several possibilities! 5. What facilities need to be prepared and optimal zed in order to apply the SKN 2012
concept? Self Assessment
1. What is the background of SKN 2012?
2. What are the subsystems of SKN 2012? What are the relevancies of each subsystem toward health problems in Indonesia?
3. Who are the subjects of SKN 2012? What are the roles of each subject? 4. How is the financing system of public health services based on SKN 2012? 5. How is the financing system of private health services based on SKN 2012?
6. How should the following system be done to deliver comprehensive, holistic, integrative and continuous services?
a. Financing system b. Services approaches c. Teamwork of the subjects
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M O D U L E ~ 5
Puskesmas as a Primary Health Care Service
dr. I.B Wirakusuma, MOH
DR. dr. I Wayan Weta, MS, SpGK
_____________________________________________________ AIM
Demonstrate ability to apply the concept of management to provide health services at primary level.
LEARNING OUTCOMES (Reference: Azwar, A.)
1. Describe the structure of primary health services in puskesmas.
2. Explain the basic programs and the additional programs in puskesmas. 3. Describe the financing system of basic programs in puskesmas.
4. Explain the application of private health services management based on the finance resources:
a. Askes
b. Askeskin/JPKMM c. General patients
5. Describe the application of private and public health services management in puskesmas.
CURRICULUM CONTENTS
Puskesmas as a Primary Health Care Service SCENARIO AND LEARNING TASK
Scenario:
Sub-district of Sundari Loka with population of 30,000 people, most of them work as farmers, their income not constant depend on climate and natural condition, the average income only sufficient for simple daily life. In Sub-district there are one Public Health Center (PHC/Puskesmas), 4 health satellites (Puskesmas Pembantu), and 8 village’s midwifes (bidan di desa). There are also 2 private medical doctors, 4 private midwifes, and 2 nurses. Beside of the conventional health provider, there are also 3 traditional healers.
The six basic programs that are served by Public Health Center namely: 1. Mother and child health and family planning.
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5. Health education 6. Polyclinic services
People who go to public health center pay less than those who go to private health services. People choose whether the public or private health services, depend on their perception and financial situation.
Task 5
1. Describe the characteristics and examples of public health services! 2. Describe the characteristics and examples of private health services! 3. Discuss the differences between public and private health services!
4. Based on the above scenario, discuss how the health care system in Sundari Loka is! 5. Discuss the concept of integrated health services!
6. Discuss the concept of comprehensive health services!
Self Assessment
1. Differentiate the finance resources, facilities and human resources between public and private health services!
2. Discuss the differences between structured and unstructured health services!
3. Discuss the differences between structure of public health services and private health services!
M O D U L E ~ 6
Primary Health Care and Health Promotion
dr. Komang Ayu Kartika Sari, MPH
dr. Ni Luh Putu Ariastuti, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system.
LEARNING OUTCOMES:
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optimum health status of every individual
CURRICULUM CONTENTS:
Primary Health Care and Health Promotion ABSTRACTS
(Reference: FHI, WHO, Jirojwong, S.)
This topic contains major factors affecting health status. It also describes the definition of Health Education and Health Promotion and their strategic roles in improving health status of every individual in the community. It explains how the aspects of health promotion conceptualised by The Ottawa Charter. The topic also describes some health behaviors that need to be practiced by every individual in order to be able to maintain his/her health status.
SCENARIO & LEARNING TASKS Task 6
Discuss in your group the following topics or aspects of Public Health: 1. The definition of Public Health
2. The definition of health
3. Major factors affecting health status
4. The definition of Health Education and Health Promotion 5. Aspects of health promotion in the Ottawa Charter
6. The strategic role of Health Education and Health Promotion in achieving optimum health status of every individual
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M O D U L E ~ 7
Basic Theories underlying Health Promotion
dr. Komang Ayu Kartika Sari, MPH
dr. Ni Luh Putu Ariastuti, MPH
AIM:
Demonstrate ability to provide health services in accordance with a country’s health system.
LEARNING OUTCOMES:
1. Explain basic theories underlying Health Education and Health Promotion
2. Describe basic principles of diffusion of innovations and the decision making process 3. Summarized major theories of behavior change
4. Comprehend Health Promotion glossary
CURRICULUM CONTENTS:
Basic Theories underlying Health Promotion ABSTRACT
(References: FHI, WHO, Nutbeam, D.)
This topic discusses basic theories underlying Health Education and Health Promotion and their relationship to basic principles of diffusion of innovations and decision making process. Moreover, the topic also summarized major theories of behavior change and health promotion glossary.
SCENARIO AND LEARNING TASK Task 7
Discuss in your group the following topics or aspects of Public Health: 1. Some basic theories underlying Health Education and Health Promotion 2. Basic principles of diffusion of innovations and the decision making process. 3. Classification of individual based on their rates of adoption
4. Major theories of behavior change.
5. Describe relationship between decision making and stages of behavior change. 6. Comprehend Health Promotion glossary.
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4. Describe the definition of Health Education and it gradual sifts to Health Promotion. 5. Explain the strategic role of Health Education and Health Promotion in achieving optimum
health status of every individual.
6. Describe some basic theories underlying Health Education and Health Promotion. 7. Describe basic principles of diffusion of innovations and the decision making process. 8. Describe classification of individual based on their rates of adoption and their specific
characteristics.
9. Explain 4 major theories of behavior change.
10. Describe relationship between decision making and stages of behavior change. 11. Describe 7 core definitions of Health Promotion and some important terminology
being used in Health Promotion.
M O D U L E ~ 8
Health Management in Health Services
dr. Komang Ayu Kartika Sari, MPH
DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
AIMS:
Demonstrate ability to apply the concept of management to provide health services at primary level
LEARNING OUTCOMES:
Describe the principles of management in health care services.
CURRICULUM CONTENTS:
Health Management in Health Services ABSTRACT
(Reference: Gan GL, et al, pp.78-87)
A doctor is often the manager of the practice. Managing is to get work done through the efforts of others. Managing is also producing an aoutput from input and process. The four basic functions of a manager are planning, organizing, leading and control. The process whereby one person influences the thoughts and behaviors of others is a definition of leadership. Between the extrems of complete autocracy on the one hand and a totally permissive approach on the other, there exists a continuum of possible leadership styles. Each of us has a basic personal leadership style and may be motivating or demotivating depending on the situation. An insight of the range of personal leadership styles helps us to
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SCENARIO & LEARNING TASKS TASK 8
CASE-1
Dr. Drupadi will make a family medicine clinic in Denpasar. It needs knowledge and basic competencies in management.
a. Discuss some definitions of management.
b. What aspects needed to be managed in a clinic? CASE-2
Dr. Drupadi thinks that finally she has to be the manager of his clinic. If she doesn’t want to, she has to choose somebody with good qualification.
a. What skills must be owned by a manager?
b. What are the roles of a manager in leading a clinic? c. What is the meaning of leadership?
CASE-3
In a meeting (conducted after the clinic was made), dr. Drupadi tells all of her staff that purposes of the clinic were responsibilitiy of all staff to achive them.
a. Which leadership model is applied by dr. Drupadi? b. Explain the reasons of your answer!
SELF ASSESSMENT
1. Describe the definitions of management.
2. Explain the meaning of planning in management.
3. Explain in your own words the meaning of leading in management. What do we need to be a good leader?
4. What components must be in control process?
5. Describe in your own words the definition of human skill. 6. What is the meaning of leadership?
7. Make a comparation of the task, group and individual need leadership model! 8. Describe the meaning of personal leadership!
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M O D U L E ~ 9
Health Workforce and Human Resource Management
dr. Komang Ayu Kartika Sari, MPH
DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
AIM:
Demonstrate ability to apply the concept of management to provide health services at primary level.
LEARNING OUTCOME:
Comprehend the concepts of managing people in health services CURRICULUM CONTENTS:
Health Workforce and Human Resource Management ABSTRACT
(Reference: Gan GL, et al, pp.78-87)
Motivating staff to contribute their best is a big challange. There is a need for an ongoing appraisal of the motivation level of staff. Channels for upward communication must be open for staff dissatisfaction to be identified and dealt with before it has caused widespread motivational problems. People management also requires the ability and willingness to deal with unpleasant issues, such as grievances, discrepancies and absenteeism.
SCENARIO AND LEARNING TASK Task 9
CASE-1
Cleaning services have a lot of duties including cleaning the clinic and open the clinic’s door every morning. Ambulance’s driver has duties to bring the referred patients to hospital and take the doctor to patient’s house for oncall services.
a. Which model of leadership that is needed for those cases? b. Discuss your reason in your group!
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others will take the job only if they are asked to.
a. What are the possible cause of different motivation level of staff? b. What should be done to increase the motivation of staff in the clinic? CASE-3
Sinta, the clinic nurse, reports that there are fewer antibiotics in the place than they should be. Ambulance driver has already been absent for 4 times because of sickness and out of town. Dr. Bima and dr. Arjuna complained that their rooms are less ventilated.
a. What problems are facedby dr. Drupadi? b. Which problem must be solved soon? c. How to solve the absence problem? CASE-4
Dr. Drupadi’s clinic has been operated for 2 years, she wants to develop it (open the new clinics) in Kuta.
a. What sould be done by dr. Drupadi?
b. Explain the steps that must be taken by her. c. Explain the meaning of SWOT analysis. d. Are point b and point c different?
Self Assessments:
1. Explain the diagram that shows the scope of human resources management. 2. How many factors that influence motivation? Explain each of the components! 3. Describe the meaning of grievances and give 1 example.
4. Describe the meaning of discrepancies and give 1 example. 5. Explain how we can solve absenteeism problem!
6. Describe the meaning of one minute manager!
M O D U L E ~ 10 - 11
Quality Management 1 & 2
dr. I Nyoman Sutarsa, MPH
dr. Ni Luh Putu Ariastuti, MPH
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primary level
LEARNING OUTCOMES:
1. Describe basic concept of quality in health-care
2. Describe how to manage health-care in whole system for quality improvement
CURRICULUM CONTENTS: Quality Management
ABSTRACT
(References: Gan GL, et al, pp.108-110; Boelen C, et al, pp.148-160; WHO. Quality of Care) There are wide variations in standards on health care delivery within and between health care systems. The aim of managing quality is optimizing resource use and expanding coverage based on a specified standard. The process of improving quality in health-care would be based on sound local strategies in order to achieve the best results by optimizing resources use and new investment.
Quality of Health Care
Quality in health care is simply defined as care that meets or exceeds expectations, both technical and patient satisfaction. In can be evaluated by three indicators those are (1) structure personnel, facilities, equipment, organization and coverage), (2) process (activities with continuous monitoring and evaluation), and (3) outcomes (health status of patient or community). Dimensions of quality in health care would be (1) effective (improved health outcomes), (2) efficient (maximize resource use), (2) accessible (timely and geographically), (4) acceptable (patient centered needs), (5) equitable (does not vary in quality), and (6) safe (minimize risk and harm). Besides that health care would be also comprehensive (includes primary, secondary and tertiary prevention), and appropriate (evidence based).
The Process of Quality Improvement
Managing quality in health care means that to follow the process of quality improvement. This process includes three steps those are (1) analysis (stakeholder involvement, situational analysis and confirmation of health goals), (2) building strategy (defining quality goals and choosing interventions for quality), and (3) implementation (process of implementation and monitoring progress). However, the quality intervention would be determined by six dimensions such as leadership, management information system, patient or population engagement, regulation (standard), organizational capacity, and the model of care. Implementation change may be needed that based on monitoring progress or self auditing process.
SCENARIO & LEARNING TASKS Task 10
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health-would be based on sound local strategies in order to achieve the best results by optimizing resources use and new investment.
1. Describe quality of health-care based on point of view of patients and healthcare providers.
2. Describe dimensions of health-care quality, and give example for each dimension. 3. Describe assessment of health-care quality, and what indicators do we use?
4. Describe the difference between quality goals and health goals, and give examples. 5. Describe seven activities (elements) those are grouped into three categories (analysis,
strategy and implementation) for quality improvement, and give examples foe each element.
6. Describe six domains of quality intervention, and give examples for each domain. 7. Explain what quality assurance program in health-care is.
8. Explain the importance of self-auditing or self evaluation for quality assurance program, and what aspects?
Task 11
Case: MELATI Health Center
Health Centre of Melati that located in suburban area was always crowded by ambulatory patients, especially on Monday. Some patients often stand on their own legs in a relative inconvenient space because of unfriendly weather and limited seats in the waiting room. That was quite common; the patients have to wait 2 hours until they got turn of medical service. However, Melati Health Centre becomes the first choice of community for seeking health services, because of some reasons. The price of visit to Melati Health Centre is relatively very cheap, and the location is not so far from most of the community.
Monday at 9.30 AM: Conversation between patients in waiting room
Mrs Ani: “Finally the doctor is coming too. Last week I had same experience, wait from 7 AM, and did not know what time the doctor would come. Then I had turn at 10 AM”. Mrs Mur: “There are 2 doctors here, which one you will meet?”
Mrs Ani: “Who knows, which doctor would come. I just need my daughter get examination and medicine”.
Mrs Mur: “What’s happened with your daughter?”
Mrs Ani: “At the beginning my daughter was suffered from high fever, and the followed by bad coughing. That was 4 four days already. Three days ago she was treated here but she won’t recover. Even she was getting difficulties to breathe and fever again. To go to private doctor must be very expensive, maybe I can’t afford it”.
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to now he won’t recover”.
At 10 AM the same day: between doctor and patient
Doctor: “What’s happened with your daughter?”
Patient: “My daughter was treated three days ago, but she still suffered from high fever. Please Doctor, help my daughter”.
Doctor: “Your daughter was 4 years old, yes? (Saw the card). Please, lying down there (pointed the bed). Woo, your daughter is quite ill”
Patient: “Please help doctor, I want my daughter get recover”
Doctor: “Ye, if she still gets fever, please control again (writing prescription). Please, you get medicine next door”.
At 11 AM: at Pharmacy of Health Centre
Pharmacy’s staff: “Mom, there was no stock of antibiotic that was written in this prescription. The doctor should write other kind of antibiotic”
Patient’ mother: “Do I have to turn back to the doctor?”
Pharmacy’s staff: “No need Mom. Maybe the antibiotic could not be changed. (the pharmacy’s staff knows that was no stock of other antibiotics). Mom, there is one pharmacy not so far from here. Maybe you can buy the antibiotic over there.
Patient’ mother: “……… ?????” (I am worried that my money is not enough). Questions:
1. From the above case, please analyze how was the health service quality of Melati Health Centre? Analyze each dimension of quality!
2. What kind of strategy that you can implement in order to increase the health service quality in that health centre?
Self Assessment
1. Could you explain what means by quality in health-care?
2. How you will implement each dimension of quality in health-care delivery? 3. How you can optimize resource use for better quality of heal-care.
4. Could you explain building strategy for quality in health-care? 5. What indicators do you use to assess quality and health outcomes?
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M O D U L E ~ 12
Management of Facilities, Information, and Finance
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
AIM:
Demonstrate ability to apply the concept of management to provide health services at primary level
LEARNING OUTCOME:
1. Explain the concepts of supplies and stores management (SSM).
2. Describe how to control discrepancies in a clinic.
3. Comprehend the concepts of managing information and finance.
CURRICULUM CONTENTS:
Management of Facilities, Information, and Finance ABSTRACT
Managing Facilities
(Reference: Gan GL, et al, pp.87-90)
The supplies and stores system deals with ordering, receipt, maintenance, and issue when required. The supplies can range from drugs and pharmaceuticals to syringes and needles as well as general use items like stationery. Stocks of pharmaceuticals and medical require close monitoring to ensure they do not deteriorate or reach expiry dates, they are not pilfered and their storage and usage comply with existing regulations.
The operating principles of supplies and stores management are: have an efficient system,
Day 12 - 13
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(Reference: Gan GL, et al, pp.90-97)
Medical records are more than a documentation of clinical details. Properly kept and used, they allow us to see the problem solving process from which we can deliver better care. An effective record keeping system contributes to the standard of care. Attention paid to how medical records are organized, filed, and maintained is integral to effective practice. The problem oriented medical record (POMR) is better than the source oriented medical record (SOMR) and we should progress towards it.
Managing Finance
(References: Gan GL, et al, pp.97-107; Boelen C, et al, pp.135-143; Sulastomo, pp. 173-180)
Financial management consists of: keeping proper records of income, expenditure and profit; preparing financial statements at the end of accounting period; analysing financial statements and taking the necessary actions; implementing inventory and stock control processes; acting on discrepancies; ensuring that financial records are audited and developing financial plans.
It is essential to have accurate knowledge of the financial status of the practice in order to plan ahead. This is in turn dependent on keeping proper records for income, expenditure and profit.
It is also important to have summaries of the financial activities of an organization, which contain information useful to management (financial statement). Financial audits and financial planning, as the other activities, have purposes to ensure accountability in the use of financial and material resources and to develop the organization’s budgets (operating budgets and financial budgets) respectively.
SCENARIO AND LEARNING TASK TASK 12
CASE 1
After the medicines have been lost several times, dr. Drupadi evaluates the system of managing facilities and utilities in her clinic.
a. What are the principles of managing facilities and utilities? b. Explain briefly each of the principles!
c. Describe the possible causes of discrepancies in facilities and utilities management. d. What efforts should be done to prevent the discrepancies happened again?
e. What rules should be determine in managing drugs and chemical agent? f. What principles should be noticed in managing drugs and vaccines? CASE-2
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5-making diagnosis because the previous medical records cannot be found. a. What are the benefit of using medical records? Why is it very important? b. What are the principles of managing patients’ medical records?
c. What are the differences between SOMR and POMR? Which one is better? d. What steps should be taken to manage the medical record better?
e. How are the principles of computer usage in managing medical records? f. How is the using of PDA to look for an information?
CASE-3
One day, Dr. Drupadi saw somebody in medical record room whom are known as a boyfriend of a nurse in that medical record room. She saw him openned and read several medical records on the nurse’s table. After gave advices and told him to go out, dr. Drupadi called some nurses that worked in medical records room.
a. What information will dr. Drupadi tell to her nurses?
b. When are medical records able to be informed to people other than patients? CASE-4
After being operated for 5 years, dr. Drupadi’s clinic shows an increasing of the number of patients. However, she has never got a high income even though the finance capital has never runned out. Her wish to develop a clinic in Kuta has not been realized. All this time, dr. Drupadi manage her clinic’s finance, helped by one of her nurse.
1. What should be done to manage a clinic’s finance? 2. What is the meaning of:
a. financial records? b. financial statement? c. financial audit?
3. Do we need to do an external audit? CASE-5
Based on an audit result of a public accountant, the doctor and the nurse has already made a complete finance records. However dr. Drupadi has not made a good financial planning, particularly in calculating the unit cost of each services in the clinic.
a. What is the meaning of financial planning? b. What is the definition of unit cost?
c. Why is it mportant to determine the unit cost?6 CASE-6
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As a good primary health provider, doctor must have basic family medicine competencies. The competency characteristics of family doctors are in:
Attitudes:
Patient centre care and attention to doctor-patient relationship
Holistic approach to the patient and his/her problem that contribute to ill-health and well being not only physical, but also social and psychological dimensions (the bio-psycho-social model of ill-health) as well as from the family and community.
Emphasize on preventive medicine, because it has greater long term impact on health status than curative medicine.
Central values of family doctor’s work:
Looks after health problem that may be initially unclear.
Looks after whole spectrum of age (specialist in breadth, unlike hospital specialist- in depth).
Looks after patient not only in consultation room but also at home and other settings. Skill:
General clinical skill Special clinical skill:
1. Doctor-patient relationship 2. Communication
3. Skill in managing special groups of patient 4. Solute undifferentiated problems
5. Identify risk and early departure from normality. Skill in resource management
Practical management skill
SCENARIO & LEARNING TASKS Scenario:
A 25 years old woman came to “Sehat” family medicine clinic, complaining that she had been coughing for 1 month. She also experienced fever particularly at night and loosing weight.
The patient had worked as a waitress in a cafe and also as a commercial sex worker since 5 years ago. One of her client was suffering from HIV-AIDS and died several days before. Task 16
As a family doctor you are required giving appropriate service.
1. What will you do to apply patient-center care with attention to doctor-patient relationship?
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3. How do you do the preventive medicine to this problem? Who is the target of preventive medicine? Explain your reason!
4. What do you do to solve the undifferentiated/unclear case above? 5. With whom the coordinative and collaborative cares should be done?
6. What approach should you take for the medical team, family and community to solve this problem?
Self Assessments
1. What are the differences between family medicine services and conventional general practitioner?
2. What are the authorities and the duties of family doctor? 3. Explain the 7 areas of integrated health services.
4. Describe the principles of family medicine service approach.
M O D U L E ~ 17
Disease Management Skills
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
AIMS:Apply family medicine approach in primary health services LEARNING OUTCOMES:
1. Describe the differences between acute and chronic diseases management. 2. Explain how to help patients to evaluate their conditions.
3. Describe how to educate patients with chronic diseases in order to empower them in diseases management.
4. Describe how to make similar perception of diseases with patients and how to determine the objectives to be achieved together.
5. Explain how to design and to apply the clinical management of chronic diseases. CURRICULUM CONTENTS:
Disease Management Skills ABSTRACTS
(Reference: Gan GL, et al, pp.145-155)
Medical services must be constructed depend on type of illnesses whether acute or chronic disease. There are two approaches of care: doctor centered and patient centered. Doctor centered only works in acute care, not works effectively in chronic disease care. New disease paradigm is needed for chronic disease care. Effective chronic disease care requires two things; the medical care team and an active involved patient (patient centered).
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Patients must be empowered to solve their problems, they can change their behavior. The patient should be able to set self management goal for their problem. Patient Intervention grouped included into three strategies: Education, Behavior and Affective. Health provider team must imply the care management process included: Practice guideline, population disease management, case management, health promotion or disease prevention, and clinical information system.
Frame work for action of the team is how to: 1. Identify the problem
2. Organize a multidisciplinary team
3. Define core component, treatment protocols and evaluation methods 4. Measure the outcome and aims.
The ways ahead those are emphasized in disease management: Providing care that is respectful to patients preferences
Educating and supporting patient to self-manage their condition Linking to resources in the broader community
Developing and supporting health care providers Reorganizing health system
Coordinating care across patients condition Monitoring quality of service and outcome Reorganizing health care financing SCENARIO & LEARNING TASKS Task 17
Case 1:
Mr. Nyoman Polos, a 50 years old man, came to his family doctor, dr. Siddhi. He complained about frequent coughing for more than 1 month and sometimes he saw blood strip the sputum. He lost weight and weak. He was diagnosed with tuberculosis (TB) based on the physical and laboratory results. The treatment regimen was given for 6 months. In the first month he had to take 5 different pills every day. For the following 5 months he had to take the medicine twice a week.
At the end of the first month he stopped the medication for several reasons such as he felt his complain would not getting better, he lost his hearing and worried about experiencing severe side effects. He then tried to find alternative medication by visiting a traditional healer. Assignments:
Discuss in your group:
1. What are Mr. Nyoman Polos’ reasons to stop his medication?
2. If you are his family doctor, what will you do to anticipate the drop out of the treatment? 3. What can you do to empower patients to help themselves?
4. What can you do to the patients’ family to prevent the drop out of the treatment?
5. Try to develop a TB medication system which involves the family to increase compliance. Explain how is the methode of the system! (Read: The DOTS system from WHO)
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6. What should be done to prevent transmission of the diseases to the other family members?
7. What approach will you use toward the patients’ behavior using alternative medication? Case 2:
Luh Manis, a 35 years old woman, a housewife, came to dr. Siddhi complaining of feeling thirsty and hungry very often. She also felt weak since few months. Luh Manis loved to eat various food until she gain weight. She was diagnosed suffering from Diabetes Mellitus (DM). The doctor said that the disease could not be totally recovered without controlling her eating habit. The doctor adviced to combine the treatment with life style modification such as diet control and appropriate sports. She had never comply the doctor’s advice.
Her disease became uncontrolled. She is now suffering from a severe wound at her right leg and cannot be treated with antibiotics. The only choice to save her life is by performing amputation of her leg.
Assignments:
1. What was the cause of Luh Manis’ difficulties to change her habits? 2. How to make the same perception between doctor and patients?
3. How to determine the objectives of the treatment in order to be understood and applied by the patients?
4. What kind of approach should be used to anticipate such a case above?
5. As a family doctor, what should you inform to the patient and her families related to the amputation that must be done?
Self Assessments
1. Compare the approaches of caring the acute and chronic diseases!
2. Describe the differences between doctor centered model and patient centered model in treatment program!
3. What information should be told to patients with chronic diseases in order to make them actively involved in their treatment?
4. How to make the same perception of diseases between doctor and patient?
5. How to determine the objectives of the treatment in order to be understood and obeyed by the patients
M O D U L E ~ 18 Basic Clinical Skills (Discussion of Student Project)
Data/report and discussion guidelines will be provided before the first discussion session
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~ CURRICULUM MAP ~
Smstr Program or curriculum blocks
10 Senior Clerkship
9 Senior Clerkship
8 Senior clerkship
7
Medical Emergency (3 weeks) BCS (1 weeks)
Special Topic: -Travel medicine (2 weeks)
Elective Study III (6 weeks)
Clinic Orientation (Clerkship) (6 weeks) 6 The Respiratory System and Disorders (4 weeks) BCS (1 weeks)
The Cardiovascular System and Disorders (4 weeks) BCS (1 weeks)
The Urinary System and Disorders (3 weeks) BCS (1 weeks)
The Reproductive System and Disorders (3 weeks)
BCS (1 weeks)
5
Elective Study II (1 weeks) Alimentary & hepato-biliary systems & disorders (4 Weeks) BCS (1 weeks)
The Endocrine System, Metabolism and Disorders (4 weeks) BCS (1 weeks)
Clinical Nutrition and Disorders
(2 weeks) BCS (1 weeks)
Special Topic : - Palliative medicine -Compleme ntary & Alternative Medicine - Forensic (3 weeks) Elective Study II (1 weeks) 4 Musculoskeletal system & connective tissue disorders (4 weeks) BCS (1 weeks)
Neuroscience and
neurological disorders (4 weeks) BCS (1 weeks)
Behavior Change and disorders (4 weeks) BCS(1 weeks) The Visual system & disorders (2 weeks) BCS (1 weeks) 3 Hematologic system & disor-ders & clinical oncology (4 weeks) BCS (1 weeks)
Immune system & disorders (2 weeks) BCS(1 weeks) Infection & infectious diseases (5 weeks) BCS (1 weeks)
The skin & hearing system & disorders (3 weeks) BCS(1 weeks) 2 Medical Professionalism (2 weeks) BCS (1 weeks)
Evidence-based Medical Practice (2 weeks) Health System-based Practice (3 weeks) BCS (1 weeks)
Community-based practice (4 weeks) Special Topic - Ergonomi - Geriatri (2 weeks) Elective Study I (2 weeks) 1 Studium Generale and Humaniora (3 weeks) Medical communication (3 weeks) BCS (1 weeks)
The cell as bioche-mical machinery (3 weeks) BCS(1 weeks) Growth & development (4 weeks) BCS: (1 weeks) Pendidikan Pancasila & Kewarganegaraan (3 weeks)