Performance Measurement Barriers of Specialist Doctors

in General Government Hospitals in Medan City

Zulfendri, Juanita and Arfah Mardiana Lubis

Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Performance Measurement Barriers, Specialist Doctors, General Government Hospital, Medan City.

Abstract: Performance measurements if implemented properly can be an effective tool for improving the performance

of specialist’s doctors. The previous research showed there are barriers in the implementation of doctors’

performance measurements in private hospitals in Medan City. However, some barriers are felt by the

specialist doctors in general government hospital in Medan City. This qualitative research uses in-depth

interviews as data collection and then analyzed by thematic analysis. Informants in this research are 16

specialist doctors. The results showed that the specialist doctors felt that the medical services they received

were less suitable to the number of patients they handled since the financial section is less transparent about

the number of patients paid out regarding to the performance measurement of specialist doctors. They also

did not know how the performance measurement process was carried out. Therefore, it can be concluded that

the barriers perceived by specialist doctors in government hospitals in Medan City particularly in the

performance measurement of specialist doctors are non-transparency and miscommunication between the

specialist doctors with the human resource department as well as the financial section about the performance

measurement system of specialist doctors.

1 INTRODUCTION

According to the Constitution of the Republic

Indonesia year 1945 and Pancasila, health is a Human

Right. In the Law of the Republic Indonesia number

36 year 2009 about Health and Law of the Republic

Indonesia number 29 year 2004 about Medical

Practice, explains that “health is a healthy condition,

physically, mentally, spiritually and socially which

enables every person to live productively social and

economic”, which must be realized in the form of

health services. The essence of health service delivery

is the organization of medical practice (Undang-

Undang Republik Indonesia Number 36 Year 2009).

However, according to Romadhon (2006) which

proves Leape's opinion, compared to other industries,

the errors are most prevalent in the healthcare

industry. Based on research from the National Health

Service (NHS), it is estimated that there have been 25

medical negligence in every medical negligence

reported (Alim, Musakkir, and Irwansyah, 2013). In

the United States, in the 1970s, the number of medical

malpractice cases increased threefold compared to

previous years and Thesisituation continued to

increase until in the 1990s (Dokter Anak Indonesia,

2013). Research in the United States shows that local

doctors are less able to communicate effectively with

patients and the lack of collaboration between

personal doctors and consultants (Aditama, 2003).

Even these complaints to doctors happened in

Indonesia. According to Wibisono (2013), citing the

opinion of the Chairman of the Indonesian

Association of Specialist Surgical Specialists, from

2006 to 2012, there were 98 cases of medical

negligence/malpractice that occurred by specialists

throughout Indonesia. The city that has the most

complaints is in Jakarta, Bandung, Tangerang, and

Medan (Adisasmito, et al., 2010; Panggabean, 2014).

Based on the result of Humairah (2014) interview

with the Chairman of the Association of Indonesian

Pediatricians of North Sumatra, communication

between doctors and patients in Medan city is not

maximal, so is the coordination of fellow doctors in

Medan City. These resulted in many

misunderstandings, causing the patient's family to

protest which eventually led to malpractice

accusation.

These cases indicate the poor performance of

specialist doctors in Medan, in providing health

services. Therefore, to know the performance of

232

Zulfendri, ., Juanita, . and Lubis, A.

Performance Measurement Barriers of Specialist Doctors in General Government Hospitals in Medan City.

DOI: 10.5220/0010014502320236

In Proceedings of the 3rd International Conference on Social and Political Development (ICOSOP 3 2019) - Social Engineering Governance for the People, Technology and Infrastructure in

Revolution Industry 4.0, pages 232-236

ISBN: 978-989-758-472-5

 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reser ved

specialist doctor in the actual hospital, it is necessary

to measure the performance of specialist doctor at the

hospital. In addition to knowing the performance of

specialist doctor in the actual hospital, the

measurement of the performance of specialist doctor

in hospital also important to spur the specialist doctor

to continue or to improve specialist doctor’s

performance. Performance measurement is one of the

fundamental functions of the existing medical

committee in the hospital. If implemented properly,

performance measurement can be an effective tool for

improving the performance, productivity and

development of specialist doctors. For the specialist

doctors themselves, the measurement is one way to

know the results of the effort as their contribution to

the continuity of the hospital (Wijayanti and

Wimbarti, 2012; Sulistyawan, Wurijanto, and

Subiyantoro, 2013; Koeswanto, 2016).

However, from the results of Lubis and Nasution

(2017) research that conducted interviews with

medical committees in private general hospitals

around Medan City, there were several barriers in

doctor performance measurement in the private

general hospitals around Medan City, the doctors

themselves do not support the performance

measurement system, the medical committee does not

monitor well the performance measurement system,

and doctors are less likely to be measured. This is

contrary to the opinions of Moorhead and Griffin

(2013) and Aamodt (2016), citing Bernardin and

Beatty, that the performance measurement system is

a process of measuring employee behavior with

measurements and comparisons with predefined

standards, documenting the results, communicating

the results to the employees, and the results of the

performance measurement are requested approval

from the employees in the performance measurement

sheet. When viewed from the definition of the

performance measurement system above, that the

performance measurement should be communicated

to the measured person, then the hospital

management that does not communicate its

performance measurement, it can be said that the

hospital did not conduct a performance measurement.

Based on the opinion of Romadhon (2006), no

performance measurement is one example of system

failure in health care organization that can cause

medical error.

This is accordance with the results of Zulfendri

(2014) study, the absence of doctor’s performance

measurement in private general hospitals around

Medan City, meaning that the role of Medical

Committee in private general hospitals around Medan

City is not optimal. This is contrary to the Regulation

Minister of Health in Republic Indonesia (Peraturan

Menteri kesehatan Republik Indonesia, 2011)

Number 755/Menkes/Per/IV/2011 about the

organization of medical committee in hospital. Under

this regulation, the medical committee of each

hospital is required to verify the validity of a person's

competence evidence, even though a medical staff

has obtained a specialist degree from the concerned

medical college (credential).

However, it is not known whether these barriers

occur also in general government hospital in Medan

City or there are other barriers that are felt by

specialist doctors who are in government hospitals in

Medan City. Therefore, this research aims to

determine the barriers perceived by specialist doctors

in government hospitals in Medan City about the

performance measurement of specialist doctor, so that

the government hospitals in Medan City can improve

specialist doctor performance measurement

effectiveness and efficiency.

2 METHODS

The research aims to know the barriers of

performance measurement of specialist doctors in

general government hospital of Medan City, so this

qualitative research uses in-depth interviews to 16

specialist doctors which are in 16 SMF as data

collection. The data obtained are then analyzed by

thematic analysis. The research was conducted from

May to November 2017.

3 RESULT AND DISCUSSION

From the results of interviews with 16 specialist

doctors in general government hospital of Medan

city, performance measurement has been done with

the online system. The process and the result of

performance measurement can be seen by superiors

and specialist doctor themselves. This result is

different from Lubis and Nasution (2016; 2017)

study. From the research in private general hospitals

around Medan City, performance measurement

hasn’t been done with the online system. They still

use paper stuffed manually.

The purpose of performance measurement of

specialist doctor in general government hospital

Medan city is to determine the remuneration / medical

service (Pay for Performance / P2) which is directly

sent to each specialist doctor's account. This is in

accordance with the opinion of Aamodt (2016) that

Performance Measurement Barriers of Specialist Doctors in General Government Hospitals in Medan City

233

performance measurement should be clear about its

purpose, and one of them is salary increases. This

result is similar to Lubis and Nasution's (2016; 2017)

study. From they’re research in private general

hospitals around Medan City the purpose of

performance measurement is to see the potential of

the doctors, monitor, evaluate and ensure the

performance of the doctors whether it is in

accordance with the operational standard of the

procedure or not, so it can give a decision whether the

doctor gets a salary increase or not.

The appropriate amount of remuneration is critical

to the improvement of the specialist doctor’s

performance. This is consistent with the results of

Alhamidah, Adenan, and Pujianti (2016) studies

indicating that there is a significant relationship

between rewards on performance and doctor

satisfaction. Even from the results of research

Kurniadi (2012), compensation has a very strong

influence on performance.

Performance measurement of specialist doctor in

general government hospital Medan city is done once

a month. This is in accordance with the opinion of

Aamodt (2016) that performance measurement

should be done once in 6 months so that the medical

committee or specialist doctor measured more

quickly improve the specialist doctor’s performance.

This result is different from Lubis and Nasution

(2016; 2017) study. From they’re research time

measurement is done once every 4 months, once

every 6 months or 1 year.

There are four components of a specialist's

performance measurement of specialist doctor in

general government hospital Medan city, namely the

quantity of work (target number of patients treated),

the quality of work, behavior and additional activities

of the presence. These four components are arranged

using ratings of graphic rating scale or behavioral

checklists. There is weighting in every rank. In the

opinion of Aamodt (2016), these four components fall

into the Goal-focused and Trait-focused performance

dimension.

The quantity of work made by the specialist

doctor himself and see whether at the end of the

month has reached the target or not, the quality of

work, behavior and additional activities of the

presence, measured by the medical committee as

supervisor of the performance of specialist doctor in

the hospital. This is in accordance with the opinion of

Aamodt (2016) that who can be an appraiser is a

superior and specialist doctor himself. This result is

different from Lubis and Nasution (2016; 2017)

study. From they’re research the appraiser iswho is

appointed by the medical committee that is the

superior or co-worker of the measured doctors.

From the results of deep interviews with 16

specialist doctors in general government hospital

Medan city, the doctor can’t refuse the performance

measurement system, because if the performance

measurement is not performed, the specialist doctor

will not receive his medical remuneration/medical

service. This result is different from Lubis and

Nasutions (2017) study. From they’re research

doctors are less likely to be measured and do not

support the performance measurement system.

However, from deep interviews with 16 specialist

doctors in general government hospital Medan city,

there are some specialist doctors felt that he was not

included in the targeting of the number of patients

treated, so the doctor feels the target number of

patients treated by one specialist with another

specialist does not meet the standards. There is also a

specialist who feels that the remuneration/ medical

service he received were less suitable for the number

of patients he was working with. There are even

specialist doctors who do not know how the process

and results of the doctor's performance measurement.

There is also a specialist doctors, although the feeling

of acceptable remuneration/ medical service is

inconsistent with the number of patients treated, the

specialist accepts voluntarily and assumes his work is

a devotion to society and worship with God.

From the results of deep interviews it can be

concluded that the barriers perceived by specialist

doctors in government hospitals in Medan City about

the performance measurement of specialist doctor are

non-transparency and miscommunication between

the specialist doctor itself, with the Human Resources

department (HR department) as well as the financial

section of the system performance measurement of

specialist doctors. From the results of Silaban, Lubis

and Salmah (2013; 2015), as well as the results of

Lubis and Nasution (2017) study, non-transparency

and miscommunication of these performance

measurement results not only in specialist doctor at

government hospitals in Medan, but also in doctors

and nurses in private public hospitals and midwives

in maternal and child hospitals around Medan City.

Based on the opinion of Wijayanti and Wimbarti

(2012), satisfaction in the process of measurement

and involvement and employee participation in

determining the measurement factors and the process

of making the measurement system can improve the

perception of procedural justice which can also

minimize the measurement bias. Specialist doctors

should know the results of their performance

measurement, because with feedback can improve the

ICOSOP 3 2019 - International Conference on Social Political Development (ICOSOP) 3

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quality of the performance of the specialist doctors.

However, these can happen if the specialist doctors

accept and assume that the performance measurement

is a source of information that can help them to

improve their performance. These can happen if

every specialist doctors is informed of the results of

their performance measurement as well as followed

by explanations of the measurement results and how

to improve their performance (Giesbers et a.l, 2014).

4 CONCLUSION

From the results of the above research and discussion,

it can be concluded that the barriers perceived by

specialist doctors in government hospitals in Medan

City about the performance measurement of specialist

doctor are non-transparency and miscommunication

between the specialist doctor itself, with the HR

department as well as the financial section of the

system performance measurement of a specialist

doctor.

Therefore, all sections related to performance

measurement, such as medical committee, HR

department, finance section and specialist doctor

themselves must provide time to sit together, to

explain the overall performance management

process, then the calculation of medical services from

performance measurement results, and more recently

determine the target number of patients treated in

each specialist doctor. After the measurement, a

specialist should be aware of the results of the

specialist doctor’s performance measurement by

means of the medical committee should be able to

provide time and choose a neutral, special place, and

there is no limit table between the medical committee,

the HR department, the finance department and the

specialist, although performance measurement results

can already be viewed online. The medical committee

should prepare for an interview by reviewing the

results of an existing performance measurement and

the reasons for the performance measurement. Firstly

a specialist doctor should see that the feedback

provided comes from a credible source. This is

important to be done so those specialist doctors are

satisfied with the performance measurement process

that has been done. Another important thing is to let

a specialist doctor discuss his thoughts and feelings

and set performance goals for future goals.

ACKNOWLEDGEMENTS

Thanks to Universitas Sumtera Utara which has

funded this research (TALENTA University of

Sumatera Utara) through Non PNBP fund for Fiscal

Year 2017.

REFERENCES

Aamodt, M.G., 2016. Industrial/Organizational

Psychology an Applied Approach, Cengage Learning.

USA, 8

edition.

Adisasmito, W., Purwantyastuti, Djuwita, R., Thabrany, H.,

Iljanto, S., Kamso, S., et al., 2010. Persepsi

stakeholders tentang kompetensi dokter di layanan

kesehatan primer. Majalah Kedokteran Indonesia,

60(1).

Aditama, C.Y., 2003. Manajemen administrasi rumah

sakit, UI Press. Jakarta, 2

edition.

Alhamidah, N. R.., Adenan, & Pujianti, N., 2016.

Hubungan sistem kapitasi dan penghargaan dengan

kepuasan kerja dokter umum praktik perorangan BPJS

kesehatan Banjarmasin. Journal of Public Health

Publications Indonesia, 3(3), 106-111

Alim, N., Musakkir, & Irwansyah. 2013. Putusan majelis

kehormatan disiplin kedokteran indonesia (mkdki)

sebagai alat bukti awal dalam penegakan hukum

kesehatan. Thesis. Retrieved from http://pasca.unhas.

ac.id/jurnal/files/bfaf75c2e6da88787575bf63e38fa2e4.

pdf

Dokter Anak Indonesia, 2013. Malapraktek Kedokteran,

Penyebab dan Dampak Hukumnya. Retrieved from

http://dokteranakonline.com/2013/12/01/malapraktek-

kedokteran-penyebab-dan-dampak-hukumnya/

Giesbers, S., Schouteten, R. L. J., Poutsma, E., van der

Heijden, B. I. J. M., van Achterberg, T. 2014. Nurses’

Perception of Feedback on Quality Measurements:

Development and Validation of a Measure. Zeitschrift

für Personal forschung/ German Journal of Research in

Human Resource Management, 28(3), 391-398.

Humairah, S., 2014. IDAI Cabang Sumut Serius

Tanggulangi Penyakit Anak. Tribun. December 7

2014. https://medan.tribunnews.com/2014/12/07/idai-

cabang-sumut-serius-tanggulangi-penyakit-anak.

Koeswanto, C.A., 2016. Strategi pengembangan bisnis

pada PT. Putrasean Rubber Industri. Agora, 4(2), 217-

221

Kurniadi, F., 2012. Pengaruh kepuasan kompensasi dan

motivasi terhadap kinerja karyawan di apotek berkah.

Retrieved from https://repository.widyatama.ac.id/

xmlui/bitstream/handle/123456789/2266/Fajar%20Ku

rniadi.pdf

Lubis, A.M., & Nasution, P.C.C.A., 2016. Physician

performance measurement in private general hospital

around Medan city. Proceeding of International

Conference on Multidisciplinary Research 2016

Performance Measurement Barriers of Specialist Doctors in General Government Hospitals in Medan City

235

(ICMR 2016), Faculty of Social and Political Science

Universitas Hasanuddin. Makassar.

Lubis, A.M., Nasution, P.C.C.A., 2017. Physician

performance measurement barriers in private general

hospitals around Medan City, Jurnal Kesehatan

Masyarakat, 13(1), 13-18.

Moorhead, G., & Griffin, R.W., 2013. Perilaku organisasi:

Manajemen sumber daya manusia dan organisasi,

Salemba Empat. Jakarta.

Panggabean, H.P., 2014. Penanganan kasus malapraktek

yang responsif dalam sistem peradilan Indonesia. (D.

Noor, M. Yamin, & M. F. Rohman, Eds.) Jurnal Law

Review, 13(3), 357-374.

Peraturan Menteri Kesehatan Republik Indonesia No. 755.

2011. Penyelenggaraan komite medik di rumah sakit.

Retrieved from http://www.hukor.depkes.go.id/up_

prod_permenkes/PMK%20No.%20755%20ttg%20Pen

yelenggaraan%20Komite%20Medik%20Di%

Romadhon, Y.A., 2006. Doctors, market yourselves atau

praktik anda tidak laku, PT. Tiga Serangkai Pustaka

Mandiri. Solo. 1

print.

Silaban, G., Lubis, A. M., & Salmah, U., 2013.

Perancangan sistem penilaian kinerja berdasarkan

metode kompetensi spencer di rumah sakit khusus se-

Kota Medan, Lembaga Penelitian USU. Indonesia.

Silaban, G., Lubis, A. M., & Salmah, U., 2015.

Perancangan sistem penilaian kinerja berbasis

kompetensi perawat gawat darurat di RSU Herna

Medan. Jurnal Kesehatan Masyarakat Andalas, 10(1),

59-64.

Sulistyawan, F., Wurijanto, T., & Subiyantoro, Y. Y., 2013.

Sistem informasi penilaian kinerja pegawai

menggunakan metode graphic rating scales dan 360

derajat. Jurnal JSIKA, 2(1), 7-13.

Wibisono, S. G. 2013. Sampai Akhir 2012, Terjadi 182

Kasus Malapraktek. Tempo. September 20, 2014,

Retrieved from http://www.tempo.co/read/ news/2013/

03/25/058469172/Terjadi-182-Kasus-Malapraktek-di-

Balikpapan

Wijayanti, A., Wimbarti, S., 2012. Evaluasi dan

pengembangan sistem penilaian kinerja pada PT HKS.

Jurnal Psikologi Undip, 11(2), 1-14.

Zulfendri, 2014. Respons dokter dan kesiapan pemangku

kepentingan dalam implementasi undang-undang

praktik kedokteran di Kota Medan, Betha Grafika.

Yogyakarta.

ICOSOP 3 2019 - International Conference on Social Political Development (ICOSOP) 3

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