PENGARUH FAKTOR OBLIGATION DAN VOLUNTARY TERHADAP KEPATUHAN PENGISIAN BERKAS REKAM MEDIS DI RSUD dr. M. SOEWANDHIE SURABAYA (KAJIAN BERDASARKAN TEORI MILGRAM DAN NIVEN) Repository - UNAIR REPOSITORY

TESIS PENGARUH FAKTOR OBLIGATION DAN VOLUNTARY TERHADAP KEPATUHAN PENGISIAN BERKAS REKAM MEDIS DI RSUD dr. M. SOEWANDHIE SURABAYA (KAJIAN BERDASARKAN TEORI MILGRAM DAN NIVEN)

MOHAMAD JUNAIDI UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI ADMINISTRASI DAN KEBIJAKAN KESEHATAN SURABAYA 2015

TESIS PENGARUH FAKTOR OBLIGATION DAN VOLUNTARY TERHADAP KEPATUHAN PENGISIAN BERKAS REKAM MEDIS DI RSUD dr. M. SOEWANDHIE SURABAYA (KAJIAN BERDASARKAN TEORI MILGRAM DAN NIVEN)

MOHAMAD JUNAIDI NIM 101214453040 UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI ADMINISTRASI DAN KEBIJAKAN KESEHATAN SURABAYA 2015

PENGARUH FAKTOR OBLIGATION DAN VOLUNTARY TERHADAP KEPATUHAN PENGISIAN BERKAS REKAM MEDIS DI RSUD dr. M. SOEWANDHIE SURABAYA (KAJIAN BERDASARKAN TEORI MILGRAM DAN NIVEN) TESIS Untuk memperoleh Gelar Magister Kesehatan Minat Studi Administrasi Rumah Sakit Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat Universitas Airlangga Oleh: MOHAMAD JUNAIDI NIM 101214453040 UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI ADMINISTRASI DAN KEBIJAKAN KESEHATAN SURABAYA 2015

PENGESAHAN Dipertahankan di depan Tim Penguji Tesis Minat Studi Administrasi Rumah Sakit Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat Universitas Airlangga dan diterima untuk memenuhi persyaratan guna memperoleh gelar Magister Kesehatan (M.Kes.) pada tanggal 13 Agustus 2015 Mengesahkan Universitas Airlangga Fakultas Kesehatan Masyarakat Dekan, Prof. Dr. Tri Martiana, dr., M.S. NIP 195603031987012001

Tim Penguji: Ketua : Dr. M. Bagus Qomaruddin, Drs., M.Sc.

Anggota : 1. Widodo J. Pudjirahardjo, dr., M.S., M.PH., Dr.PH.

2. Dr. Thinni Nurul Rochmah, Dra.Ec., M.Kes.

3. Dr. Djazuly Chalidyanto, S.KM., M.Kes.

4. Dr. Windhu Purnomo, dr., M.S.

5. Farida Ariati, drg., M.Kes.

PERSETUJUAN TESIS Diajukan sebagai salah satu syarat untuk memperoleh gelar Magister Kesehatan (M.Kes.) Minat Studi Administrasi Rumah Sakit Program Studi Administrasi dan Kebijakan Kesehatan Fakultas Kesehatan Masyarakat Universitas Airlangga Oleh MOHAMAD JUNAIDI NIM 101214453040 Menyetujui, Surabaya, 13 Agustus 2015 Pembimbing Ketua Widodo J. P., dr., M.S., M.PH., Dr.PH. NIK 139131793 Pembimbing Dr. Thinni Nurul R., Dra.Ec., M.Kes. NIP 196502111991032002 Mengetahui, Ketua Program Studi Administrasi dan Kebijakan Kesehatan Dr. Thinni Nurul Rochmah, Dra.Ec., M.Kes. NIP 196502111991032002

SURAT PERNYATAAN ORISINALITAS

Yang bertanda tangan di bawah ini, saya: Nama : Mohamad Junaidi NIM : 101214453040 Program Studi : Administrasi dan Kebijakan Kesehatan Minat Studi : Magister Adminstrasi dan Kebijakan Kesehatan Angkatan : 2012/2013 Jenjang : Magister menyatakan bahwa saya tidak melakukan kegiatan plagiat dalam penulisan tesis saya yang berjudul:

PENGARUH FAKTOR OBLIGATION DAN VOLUNTARY TERHADAP KEPATUHAN PENGISIAN BERKAS REKAM MEDIS DI RSUD dr. M. SOEWANDHIE SURABAYA (KAJIAN BERDASARKAN TEORI MILGRAM DAN NIVEN)

Apabila suatu saat nanti terbukti saya melakukan tindakan plagiat, maka saya akan menerima sanksi yang telah ditetapkan. Demikian surat pernyataan ini saat buat dengan sebenarnya.

Surabaya, 13 Agustus 2015 Mohamad Junaidi

KATA PENGANTAR

Puji syukur kehadirat Allah SWT karena atas Karunia dan Hidayah-Nya penyusunan tesis dengan judul “Pengaruh Faktor Obligation dan Voluntary

terhadap Kepatuhan Pengisian Berkas Rekam Medis di RSUD dr. M. Soewandhie Surabaya (Kajian Berdasarkan Teori Milgram dan Niven)” ini

dapat terselesaikan Tesis ini berisi faktor yang mempengaruhi kepatuhan dokter dalam melengkapi rekam medis di rumah sakit. Faktor kepatuhan dilihat berdasarkan

Teori Milgram dan Teori Niven dan hasil temuan dapat membantu meningkatkan kualitas analisis data yang sebelumnya banyak terjadi kesalahan dalam proses pengolahan data.

Ucapan terima kasih yang tak terhingga saya sampaikan kepada Bapak Widodo J.P., dr., M.S., M.PH., Dr.PH., selaku Pembimbing Ketua yang dengan kesabaran dan perhatiannya dalam memberikan bimbingan, semangat,dan saran, tesis ini bisa terselesaikan dengan baik. Ucapan terima kasih yang tak terhingga juga saya sampaikan kepada Ibu Dr. Thinni Nurul R., Dra.Ec., M.Kes., selaku pembimbing kedua yang telah banyak meluangkan waktu untuk memberikan bimbingan, motivasi, dan saran demi kesempurnaan tesis ini. Dengan terselesaikannya tesis ini, perkenankan saya mengucapkan terima kasih yang sebesar-besarnya kepada:

1. Prof. Dr. Moh. Nasih, SE., MT., Ak. selaku Rektor Universitas Airlangga;

2. Prof. Dr. Tri Martiana, dr., M.S., selaku Dekan Fakultas Kesehatan Masyarakat Universitas Airlangga;

3. Dr. Thinni Nurul R., Dra.Ec., M.Kes., selaku Ketua Program Studi Administrasi dan Kebijakan Kesehatan;

4. Dr. Djazuly Chalidyanto, S.KM., M.ARS., selaku Ketua Minat Studi Administrasi Rumah Sakit; 5. Ketua Penguji, Dr. M. Bagus Qomaruddin, Drs. M.Sc., dan Tim Penguji, Dr.

Djazuly Chalidyanto, S.KM., M.ARS.,., Farida Ariati, drg., M.Kes., serta Dr. Windhu Purnomo, dr., M.S. atas kesediaan menguji dan membimbing dalam perbaikan tesis ini;

6. Istri tercinta, Dr. Ernawaty, drg., M.Kes. yang selalu mendampingi dan memberikan semangat tiada henti.

7. Keluarga dan putra tercinta yang selalu memberikan dorongan dan semangat selama penulisan tesis; serta

8. Semua pihak yang tidak dapat saya sebutkan satu persatu yang turut serta memberikan dorongan hingga terselesaikannya tesis ini.

9. Responden penelitian, dokter di RSUD dr. M. Soewandhie Surabaya, atas partisipasinya dalam penelitian ini.

Demikian, semoga tesis ini bisa memberi manfaat bagi diri kami sendiri dan pihak lain yang menggunakan.

Surabaya, 13 Agustus 2015 Penulis

SUMMARY Influence of Obligation and Voluntary Factors on Compliance in Filling Out Medical Records in dr. M. Soewandhie Hospital Surabaya (Study Based on Milgram and Niven Theory) The landscape of health service in Indonesia changed when National Social Coverage System Act (Undang-Undang Sistem Jaminan Sosial Nasional ) took st into effect in January 1 , 2014, ushering in the era of National Health Coverage (Jaminan Keseharan Nasional). dr. M. Soewandhie Hospital has been having an obstruction in making complete medical records and this was a trouble not only because complete medical records is important in the era of JKN, but also because it is a necessary tool used in monitoring and evaluation. For instance, in February 2014 amongst the treatment rooms, only one room (ICU room) had no inpatient medical records incompleteness. The rest of them (Tulip and Safir, Bugenvil, Teratai, Anggek, Seruni, Nifas, Neonatus, NICU, and ICCU) had incompleteness. The incompleteness was because (1) medical resume was unfilled (29%), (2) new patient admission form had no doctor ‘s signature (15,2%), (3) responsible doctor form (lembar Dokter Penanggung Jawab Pelayanan) was unfilled (11,3%), (4) final diagnosis was unfilled (11,2%), (5) informed consent was unfilled (8%), and (6) nursery care (asuhan keperawatan) was unfilled (6%). Note that the doctor accounted for the first five of those items while the paramedic accounted only for the last item.

Explanation for the lack of compliancecan be possibly found by analyzing the factors stated in Milgram’s theory and Niven’s theory. Based on the two theories, two kinds of factors were concocted, namely obligation factors and voluntary factors. The obligation factors consisted of status of the hospital; status of the hospital chairperson and the monitoring and evaluation director; legitimacy of the hospital chairperson and the monitoring and evaluation director; responsibility of doctors; support among doctors; and closeness of the hospital chairperson and the monitoring and evaluation director.The voluntary factors consisted of understanding of instruction, quality of interaction, assurance, attitude, personality, and social isolation. Besides, there are also other influencing

factors,namely: law penalty and Hospital Management Information System.

The study aimed to (1) analyze the compliance in filling out the medical records in inpatient unit in dr. M. Soewandhie Hospital, (2) analyze the obligation factors of compliance based on Milgram’s theory in the completeness of the filling out of medical records in inpatient unit in dr. M. Soewandhie Hospital, (3) analyze the voluntary factors of compliance based on Niven’s theory in the completeness of the filling out of medical records in inpatient unit in dr. M. Soewandhie Hospital, (4) analyze the influence of doctor’s compliance according to obligation factors and voluntary factors on the completeness of the filling out of medical records in inpatient unit in dr. M. Soewandhie Hospital, and (5) compose a recommendation in increasing doctor’s compliance in the completeness of the

filling out of medical records in inpatient unit in RSUD dr. M. Soewandhie.

The study used observational study using questionnaires to collect data from doctors in inpatient unit. Secondary data, medical records and recapitulation data of the completeness of the filling out of medical records, was also used. The research design was descriptive observational method, chosen according to the aim to compose a recommendation in increasing the compliance in completing the filling out of medical records. This was a cross-sectional research with a sample of 35 specialist doctors. The study was conducted in inpatient unit of dr. M. Soewandhie Hospital during January and February 2015.

The research’s findings were as follows. The majority of the obligation factors (i.e. status of the hospital, status of the hospital chairperson and the monitoring and evaluation director, legitimacy of the hospital chairperson and the monitoring and evaluation sub-division chiefs, responsibility of doctors, support among doctors, and closeness of the hospital chairperson and the monitoring and evaluation director) scored high according to doctors in dr. M. Soewandhie Hospital. The same condition was also found in the voluntary factors (i.e. understanding of instruction, quality of interaction, assurance, attitude, personality, and social isolation) with the majority of them scores high according to doctors in dr. M. Soewandhie Hospital. All medical records that should be filled out were found to be incomplete. Hence, it could be inferred that the doctors aren’t compliant in filling out the medical records. Subvariables that influenced doctor’s compliance in filling out medical records, according to influence test on obligation factors, werelegitimacy of the hospital chairperson and the monitoring and evaluation director and responsibility of doctors. On the influence test on voluntary factors, subvariable that influenced doctor’s compliance in filling out medical records was understanding of instruction. Considering the above findings,the study recommendedthe followings: (1) usingdoctors’ performance in filling out medical records as one of the measures of overall work performance; (2) analyzing each doctor’s work strain in order to identify doctors with too much work strain; (3) increasing the capacity of the Medical Records Committee (Panitia Rekam Medis) and optimizing its functions; (4) evaluating and publicizing the content of Medical Records Guidebook (Buku Pedoman Pengisian Rekam Medis) continually; (5) evaluating the forms of medical record periodically; (6) involving Medical Committee (Komite Medik) and representations from Functional Medical Staff (Staf Medis Fungsional) in arranging and evaluating medical records and (7) procuring Medical Records Guidebook for all doctors and all rooms.

ABSTRACT Influence of Obligation and Voluntary Factors on Compliance in Filling Out Medical Records in dr. M. Soewandhie Hospital Surabaya (Study Based on Milgram and Niven Theory) The implementation of National Social Security Reform Act (SJSN) urged dr. M. Soewandhie Hospital to fix its medical records system. In February 2014, amongst the treatment rooms, only one room had complete inpatient medical records. Explanation for this could be possibly found in the theories by Milgram and by Niven. The factors in Milgram’s theory (i.e. status of the hospital, status of theHospitalchairpersonandthe monitoring and evaluation sub-division chiefs, legitimacy of the hospital chairperson and the monitoring and evaluation sub- division chiefs, responsibility of doctors, among doctors, and closeness of the hospital chairperson and the monitoring and evaluation director) are related to obligation whereas in Niven’s, the factors (i.e. understanding of instruction, quality of interaction, assurance, attitude, personality, and social isolation) are related to voluntary. The purpose of the study was to compose a recommendation in increasing doctors’ compliance in filling out medical records. The study used observational study using questionnaires. Secondary data, medical records and recapitulation data of the completeness of the filling out of medical records, was also used. The research design was descriptive observational method. This was a cross-sectional research with sample of 35 specialist doctors. The study was

conducted in inpatient unit of the hospital during January and February 2015.

The findings were as follows. The majority of both the obligation factors and the voluntary factors scored high according to the doctors. Most of the medical records that should be filled out were found incomplete, signaling that the doctors weren’tcompliant in filling out the medical records. Influence test on obligation factorsshown that legitimacy of the hospital chairperson and the monitoring and evaluation director and responsibility of doctors were significant subvariables in influencing compliance while influence test on voluntary factorsshown that understanding of instruction was significant. The study suggests using medical records performance as measure for work performance, identifying doctors with too much work strain, optimizing Medical Records Committee (Panitia Rekam Medis), conducting evaluation and publication on Medical Records Guidebook (Buku Pedoman Pengisian Rekam Medis), evaluating forms in medical record periodically, involving Functional Medical Staff (Staf Medis Fungsional) and Medical Committee (Komite Medik) in composing medical records, and procuring Medical Records Guidebook for every doctor and in every room.

Keyword: Obligation, Voluntary, Hospital medical record, Doctor

DAFTAR ISI

Halaman SAMPUL DEPAN ............................................................................................. i SAMPUL DALAM ............................................................................................ ii HALAMAN PRASYARAT GELAR ................................................................ iii HALAMAN PENGESAHAN ............................................................................ iv HALAMAN PERSETUJUAN ........................................................................... v SURAT PERNYATAAN TENTANG ORISINILITAS .................................... vi KATA PENGANTAR ....................................................................................... vii

SUMMARY .......................................................................................................... viii ABSTRACT .......................................................................................................... x

DAFTAR ISI ...................................................................................................... xi DAFTAR TABEL .............................................................................................. xv DAFTAR GAMBAR ......................................................................................... xix DAFTAR LAMPIRAN ...................................................................................... xx DAFTAR ARTI LAMBANG, SINGKATAN DAN ISTILAH ......................... xxi

BAB 1 PENDAHULUAN ............................................................................... 1

1.1 Latar Belakang dan Identifikasi Masalah ..................................... 1

1.2 Identifikasi Penyebab Masalah ..................................................... 6

1.2.1 Faktor Obligation (berdasarkan Teori Milgram) .............. 7

1.2.2 Faktor Voluntary (berdasarkan Teori Niven) .................... 12

1.2.3 Faktor Lain …………………………………………….. .. 16

1.3 Rumusan Masalah ........................................................................ 18

1.4 Tujuan Penelitian ......................................................................... 19

1.4.1 Tujuan Umum ................................................................... 19

1.4.2 Tujuan Khusus .................................................................. 19

1.5 Manfaat Penelitian ....................................................................... 20

1.5.1 Bagi Rumah Sakit ............................................................. 20

1.5.2 Bagi Peneliti ...................................................................... 20

BAB 2 TINJAUAN PUSTAKA ...................................................................... 21

2.1 Rumah Sakit .................................................................................. 21

2.1.1 Definisi Rumah Sakit ......................................................... 21

2.1.2 Tujuan Rumah Sakit .......................................................... 22

2.1.3 Fungsi Rumah Sakit ........................................................... 22

2.1.4 Pelayanan Kesehatan Rawat Inap ...................................... 23

2.2 Rekam Medis ................................................................................ 23

2.2.1 Pengertian .......................................................................... 23

2.2.2 Manfaat Rekam Medis ....................................................... 24

2.2.3 Jenis Rekam Medis ............................................................ 27

2.3 Kepatuhan .................................................................................... 28

2.3.1 Kepatuhan menurut Stanley Milgram ................................ 28

2.3.2 Kepatuhan menurut Neil Niven ......................................... 34

BAB 3 KERANGKA KONSEPTUAL PENELITIAN .................................... 39 BAB 4 METODE PENELITIAN ..................................................................... 41

5.1.3 Instalasi Rekam Medis RSUD dr. M. Soewandhie .............. 76

5.6 Isu Strategis .................................................................................... 124

5.5 Pengaruh Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie............. 114

5.4 Faktor Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie Berdasarkan Faktor Voluntary menurut Teori Niven .................... 104

5.3 Faktor Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie Berdasarkan Faktor Obligation menurut Teori Milgram ............... 94

5.2.8 Kepatuhan dalam Melengkapi Rekam Medis di RSUD dr. M. Soewandhie ................................................................ 93

5.2.7 Pengisian Form 9: Discharge Summary (Ringkasan Pulang) ................................................................................. 91

5.2.6 Pengisian Form 13: Lembar Penolakan Tindakan Pasien…. 90

5.2.5 Pengisian Form 12: Lembar Persetujuan Tindakan Pasien .. 88

5.2.4 Pengisian Form 6: Catatan Perkembangan Pasien Terintergrasi (CPPT)…………………………………. ....... 87

5.2.3 Pengisian Form 4: Penetapan Dokter Penanggungjawab Pasien (DPJP) ....................................................................... 86

5.2.2 Pengisian Form 11: Pemberian Informasi………………. ... 85

5.2.1 Pengisian Formulir 1a: Lembar Masuk dan Keluar RS ....... 83

5.2 Kelengkapan Pengisian Berkas Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie ................................................... 82

5.1.2 Struktur Organisasi .............................................................. 74

4.1 Jenis & Rancang Bangun Penelitian ............................................. 41

5.1.1 Visi, Misi, Motto dan Nilai Dasar Organisasi .................... 72

5.1 Gambaran Umum RSUD dr. M. Soewandhie ................................ 71

BAB 5 HASIL DAN ANALISIS DATA ......................................................... 71

4.8 Teknik Analisis Data ...................................................................... 64

4.7.3 Hasil Uji Validitas dan Reliabilitas....................................... 61

4.7.2 Instrumen Pengumpulan Data……………………………… 61

4.7.1 Teknik Pengumpulan Data……………………………….. .. 61

4.7 Teknik dan Instrumen Pengumpulan Data ..................................... 61

4.6 Variabel Penelitian, Definisi Operasional dan Cara Pengukuran Variabel .......................................................................................... 46

4.5 Kerangka Operasional……………………………………………. 44

4.4 Lokasi dan Waktu Penelitian ........................................................ 43

4.3 Sampel dan Besar Sampel .............................................................. 42

4.2 Populasi Penelitian ......................................................................... 42

5.7 Focus Group Discussion (FGD) dan Rekomendasi ....................... 125

BAB 6 PEMBAHASAN ...................................................................................129

6.1 Kepatuhan Pengisian Berkas Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie .....................................................129

6.2 Analisis Faktor Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie menurut Faktor Obligation Teori Milgram .....................................131

6.3 Analisis Faktor Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M. Soewandhie Berdasarkan Faktor Voluntary menurut Teori Niven .................... 134

6.4 Faktor yang Mempengaruhi Kepatuhan Dokter dalam Melengkapi Pengisian Rekam Medis di Instalasi Rawat Inap RSUD dr. M.

Soewandhie………………………………… ................................ 137

6.4.1Analisis Pengaruh Faktor Obligation terhadap Kepatuhan Dokter dalam Pengisian RekamMedis……… ...................... 137

6.4.2 Analisis Pengaruh Faktor Voluntary terhadap Kepatuhan Dokter dalam Pengisian Rekam Medis……… .. 139

6.5 Penyusunan Rekomendasi ………………………………………. 140

BAB 7 PENUTUP ............................................................................................ 143

7.1 Kesimpulan ................................................................................... 143

7.2 Saran ............................................................................................. 146 DAFTAR PUSTAKA ........................................................................................ 147 LAMPIRAN……………………………………………………………………. 152

DAFTAR TABEL

Nomor Judul Tabel Halaman 1.1 Isi Berkas Rekam Medik RSUD dr. M. Soewandhie…………………...

1.2 Kelengkapan Pengisian Berkas Rekam Medis Rawat Inap per Ruang Perawatan Bulan Februari 2014 di RSUD dr. M. Soewandhie Surabaya………………………………………………………………...

4.1 Jenis Dokter Spesialis di RSUD dr. M. Soewandhie Surabaya 2014……………………………………………………………………..

4.2 Variabel Penelitian, Definisi Operasional, Cara Pengukur Variabel…………………………………………………………………

4.3 Hasil Uji Validitas Awal pada Kuesioner Dokter di Rumah Sakit X Tahun 2015……………………………………………………………..

4.4 Pengelompokan Item Rekam Medis Formulir 1a menjadi Beberapa Aspek……………………………………………………………………

4.5 Pengelompokan Item Rekam Medis Formulir 11 menjadi Beberapa Aspek……………………………………………………………………

4.6 Pengelompokan Item Rekam Medis Formulir 4 menjadi Beberapa Aspek……………………………………………………………………

4.7 Pengelompokan Item Rekam Medis Formulir 6 menjadi Beberapa Aspek……………………………………………………………………

4.8 Pengelompokan Item Rekam Medis Formulir 12 menjadi Beberapa Aspek……………………………………………………………………

4.9 Pengelompokan Item Rekam Medis Formulir 13 menjadi Beberapa Aspek……………………………………………………………………

4.10 Pengelompokan Item Rekam Medis Formulir 9 menjadi Beberapa Aspek……………………………………………………………………

5.1 Persentase Kelengkapan Pengisian Aspek Rekam Medis Formulir 1a: Lembar Masuk dan Keluar RS di RSUD dr. M.