Implementation of Hospital Accreditation in Jakarta

Nauri Anggita Temesvari and Loli Adriani

Department of Health Information Management, Faculty of Health Sciences, Universitas Esa Unggul, Jl. Arjuna Utara

No. 9, Kebon Jeruk, Jakarta, 11510, Indonesia

Keywords: Hospital, Accreditation, Health Service, Quality, Standards.

Abstract: Hospital accreditation aims to evaluate the quality of a hospital. Assessment of accreditation in Indonesia is

carried out by independent institutions, namely the Hospital Accreditation Commission (KARS). Until 2017,

the percentage of accredited hospitals in Indonesia was 53.47%. There were 62.24% of hospitals from 196

hospitals in Jakarta were accredited. This study aimed to analyze the implementation of hospital accreditation

in Jakarta. The research design of this study using the literature review method with topics related to hospital

accreditation in Jakarta. A total of 971 articles were found, with 16 articles meeting the criteria. Hospitals in

Jakarta use a national accreditation policy, as does the information system used. The concerning issue in

human resources was the STR that must be had by health workers. In order to accelerate the accreditation

process at the Hospital, KARS provides SISMADAK (Accreditation Document Management System) and

SIKARS. Hospitals in Jakarta used the accreditation standards of both the KARS 2012 Version and SNARS

Ed 1 in 2018. However, not all hospitals have been accredited. The problem has not been accredited by

hospitals in Jakarta because it requires readiness from all available resources at the hospital to carry out

accreditation and management commitment.

1 INTRODUCTION

The system of improving the quality of health

services is a dynamic system that can follow various

changes both from changing health systems. One

major change in the health system is a change in the

national health insurance system or better known as

JKN. JKN has made fundamental changes including

changes in the development and supervision of health

efforts through health quality regulation. Efforts to

improve quality have been carried out in a variety of

activities and are carried out by the various

government and private hospitals. One of the efforts

made is to carry out hospital accreditation

(Kemenkes, 2016).

Hospital accreditation is an official recognition

from the government to hospitals that have met health

service standards and are required to be carried out by

all hospitals in Indonesia. Each hospital has an

obligation to be accredited at least once every 3 years.

Hospital accreditation is needed as an effective way

to evaluate the quality of a hospital by setting service

quality standards. Accreditation assessments in

Indonesia are carried out by independent institutions

recognized by the government, namely the Hospital

Accreditation Commission (KARS) and the Joint

Commission International (JCI) (Kemenkes, 2012).

Basically, the main goal of hospital accreditation

is the quality of services that are integrated and

become the culture of the hospital service system. In

addition, the specific objectives of accreditation

include: obtaining an overview of the extent to which

the hospital has met various standards determined so

that the quality of hospital services can be accounted

for, giving recognition and appreciation to hospitals

that have reached the level of health service in

accordance with established standards, providing

guarantee to hospital staff that all necessary facilities,

personnel, and environment are available so that they

can best support patients' healing and treatment

efforts, provide assurance and satisfaction to

individuals, families, and communities as customers

that the services provided by hospitals are carried out

as well as possible (Poerwani, SK; Sopacua, 2013).

Besides being beneficial for patients,

accreditation is also beneficial for health workers in

hospitals, for hospital administrators themselves, for

hospital owners and for third parties such as

insurance. For health workers in hospitals,

accreditation functions to create a sense of security

Temesvari, N. and Adriani, L.

Implementation of Hospital Accreditation in Jakarta.

DOI: 10.5220/0009562100200024

In Proceedings of the 1st International Conference on Health (ICOH 2019) - Improving Quality of Care and Equity on Health, pages 20-24

ISBN: 978-989-758-454-1

for them in carrying out their duties. In addition,

facilities and infrastructure that are in accordance

with standards are also very helpful in facilitating

their work processes. For hospitals, accreditation is

useful as a tool for negotiations with third parties such

as insurance or companies. In this case, accreditation

can be said to function as a means of promotion. For

hospital owners, accreditation functions as a tool to

measure the performance of hospital managers. As

for insurance companies, accreditation is useful as a

reference in selecting and entering into contracts with

hospitals. Insurance companies are reluctant to risk

their good name in front of their clients by choosing

a hospital with poor services (Rahma, 2012)

Gradually KARS applies accreditation standards:

5 services, 12 services, and 16 services with the

orientation to the input and documents that are valid

until June 2012. Since 2012 KARS has applied the

2012 version standard which was adopted from JCI

edition 4. In KARS 2012 Version standard has

applied input, processes, and outputs in an integrated

way. In 2015 KARS became an independent

institution and received ISQUA Certification, which

is an international institution that carries out

accreditation of institutional accreditation institutions

and surveillance training (Kemenkes, 2016).

Until 2017, the percentage of accredited hospitals

in Indonesia was 53.47%. The provinces with the

highest accredited hospitals and above 50% were

Bali, East Java, and East Nusa Tenggara, respectively

77.78%, 69.62%, and 68.09%. North Maluku

Province is the province with the lowest percentage

of accredited hospitals, which is 22.73% of the 22

hospitals. In 2017, there were 196 hospitals in Jakarta

of which 48 government hospitals were accredited

and 74 private hospitals were accredited so that

62.24% of hospitals in Jakarta were accredited

(Kementerian Kesehatan RI, 2018). from the data, it

can be seen that there are still hospitals in Jakarta that

have not been accredited, so this research will analyze

the implementation of hospital accreditation in

Jakarta.

2 RESEARCH METHODS

The research design of this study using the literature

review method with topics related to hospital

accreditation in Jakarta. The literature search was

performed using Google Scholar and Google Search.

The keywords used are hospital accreditation, KARS,

hospital accreditation results. The articles reviewed

are articles published from 2012 to 2019. A total of

971 articles were found, with 16 articles meeting the

criteria.

Concepts in research using a systems approach.

The system approach in this study will look at the

inputs, process, and output in the implementation of

hospital accreditation in Jakarta. The inputs to be seen

are policies, human resources, and information

systems. Whereas in the process is the

implementation of the accreditation itself. The last,

the output will see the results obtained from

accreditation. The data obtained were analyzed,

compiled systematically, compared with each other

and discussed related literature.

3 RESULT AND DISCUSSION

3.1 Input

3.1.1 Policies

Policies related to hospital accreditation are contained

in Regulation of the Minister of Health of the

Republic of Indonesia Number 34 the Year 2017 and

also the Regulation of the Minister of Health of the

Republic of Indonesia Number 417/ MENKES/ PER/

II/ 2011 regarding the Hospital Accreditation

Commission or shortened to KARS.

The regulation explains that hospital accreditation

is an acknowledgment of the hospital provided by an

independent institution established by the Minister,

after being judged that the hospital meets the

applicable hospital service standards. Every hospital

must be accredited. Hospital accreditation is held

periodically at least every 3 (three) years. Hospitals

must extend accreditation before the validity period

ends (Kemenkes, 2017).

3.1.2 Human Resources

Health workers are an important component in

implementing hospital accreditation. The mandate of

Law Number 36 the Year 2014 concerning Health

Workers Article 44 explained that every health

worker who practices implements must have a

Registration Certificate (STR) that is valid for five

years and can be re-registered. STR has fulfilled the

requirements issued by the Indonesian Health

Workers Council (KTKI) (Kemenkes, 2013).

KTKI publishes STR for 26 types of health

professions which consist of: Nurses, Midwives,

Physiotherapy, Dental, and Mouth Therapists,

Efficient Refractionists, Speech Therapists,

Radiographers, Occupational Therapists,

Implementation of Hospital Accreditation in Jakarta

Nutritionists, Medical Recorders and Health

Information, Dental Technicians, Sanitarians,

Electromedists, Speech Therapists, Radiographers,

Occupational Therapists, Nutritionists, Medical

Recorders and Health Information, Dental

Technicians, Sanitarians, Electromedists, Medical

Laboratory Technologists, Anesthesiologists,

Acupuncturists Therapists, Medical Physicists,

Prosthetic Orthotics, Blood Transfusion Technicians,

Cardiovascular, Public Health Specialists, Health

Promoters, Health Epidemiologists, Clinical

Psychologists, Traditional Health Practitioners, and

Audiologists. In Jakarta, the number of new STRs

issued by KTKI is 200,489 for all types of health

workers (Kemenkes, 2019).

In a previous study at PKU Muhammadiyah

Gamping Hospital explained that not all nurses had

STR. It will have an impact if criminal, civil and

administrative violations occur, the legal position of

the hospital will be weak due to violations of the law

(Yustoro; Tri, 2013). Whereas STR ownership for

nurses and other health workers in health facilities is

mandatory based on applicable laws. In the latest

accreditation, SNARS Ed 1 the Year 2018 requires all

health workers to have STR because hospitals must

ensure that patients are served by competent health

workers according to their knowledge.

3.1.3 Information System

In line with Indonesia's roadmap entering the

industrial revolution 4.0, KARS developed

information systems for KARS institutions

(SIKARS), Hospital Accreditation Documentation

Information Systems (SISMADAK), Hospital

Information Systems (SIRSAK), Tracking Systems

for Surveyor (ReDOWSKo), and Surveillance

Learning Systems (KARS) e-learning). In this study,

an information system that will be discussed is

SISMADAK and SIKARS (Sutoto; Utarini, 2019).

SISMADAK is an application tool for Hospitals

(Hospitals) to collect, store, and search for evidence

documents related to accreditation. SISMADAK is

managed by each hospital so as to ensure the

confidentiality of hospital documents. To minimize

the risk of document damage and large costs, as well

as a faster storage and search process, the Hospital

needs to be encouraged to use the SISMADAK

application. The Surveyors who conduct an

assessment to the Hospital will use the SISMADAK

application to trace the required documents.

(Diyurman, 2017).

Figure 1: Front Page of the SISMADAK Website from One

of the Hospitals.

SIKARS is used by hospitals for submission of

accreditation, conducting guidance and self-

assessment. Another advantage of SIKARS is that it

can update hospital profile data, get a list of surveyor

profiles, view activity schedules, and obtain

assessment instruments (Gea and Hp, no date).

Figure 2: Front Page of the SIKARS website.

3.2 Process

Hospital accreditation standards in Indonesia have

changed. These standards are grouped according to

functions within the hospital related to patient care,

efforts to create a safe, effective, well-managed

organization. These functions are also consistent,

applicable to and obeyed by each

unit/section/installation. Standards are statements

that define the expectations of the performance,

structure, and processes that a hospital must have to

provide quality and safe care and care. For each

standard, an assessment element is prepared, which is

a requirement to meet the relevant standard.

KARS 2012 Version Standard is Patient Safety

Goals - Care of Patients - Hospital Management -

National Standards. For graduation criteria that are

applied to this standard are the basic, intermediate,

primary, and complete levels. In 2018 KARS issued

the latest hospital accreditation standard, SNARS Ed

ICOH 2019 - 1st International Conference on Health

1 by adding Hospital Management standards,

National Standards, and Integration of Health

Education in Hospital (Sutoto, 2017).

Presidential Regulation 82 of 2018 concerning

Health Insurance origin 67 states that health facilities

that meet the requirements can establish cooperation

with the Health BPJS. Hospital accreditation is also

one of the hospital requirements for extending

cooperation with BPJS Health. On January 4, 2019,

referring to the Minister of Health's letter Number

HK.03.01/Menkes/18/2019 regarding the Extension

of Hospital Cooperation with BPJS, the BPJS

conducted a selection and recruitment of hospitals

that had cooperated. As a result, there are a number

of hospitals that do not meet the requirements, one of

which is due to accreditation. With a variety of

considerations and services for JKN patients not

stopping, the Ministry of Health and BPJS Health

agreed to extend cooperation with the hospital and

provide an opportunity until 30 June 2019 to

complete the accreditation process (BPJS Kesehatan,

2019).

3.3 Output

This research will explain the 2018 hospital

accreditation data in Jakarta. In 2018 some hospitals

are still using the 2012 version of the accreditation

standard and others are using SNARS Ed 1.

In figure 3 explains the graduation of hospitals in

Jakarta using KARS 2012 Version, hospitals in

Jakarta Utara had the highest number of Lulus

Perdana, while Kepulauan Seribu occupied the lowest

number. Hospitals in Jakarta Timur has the highest

number of Tingkat Madya graduations. Hospitals in

Jakarta Pusat has the highest number of Tingkat

Paripurna. Whereas Jakarta Selatan has the highest

number of Tingkat Utama graduations.

Figure 3: KARS 2012 Version Results Per Year 2018 in

Jakarta (KARS, 2018).

In figure 4 explains the graduation of hospitals in

Jakarta using SNARS Ed 1, hospitals in Jakarta

Selatan and Jakarta Timur had the highest number of

Lulus Perdana. Hospitals in Jakarta Timur have the

highest number of Tingkat Madya, Utama and

Paripurna graduations.

Figure 4: SNARS Ed 1 Results Per Year 2018 in Jakarta

(KARS, 2018).

Hospitals in Jakarta that have not yet been

accredited have several problems, including:

a) Expensive Accreditation Fees.

Hospitals are charged with accreditation fees

from preparation to evaluation, the amount of

which is not small. Plus, to meet the standards

set by KARS, it requires the provision of other

resources in the hospital. Therefore, the

hospital needs to make every effort to carry out

accreditation.

b) Hospital Management Commitment.

As explained earlier that the purpose of

accreditation is to meet the quality of the

hospital. If management is not committed to

improving hospital quality, accreditation may

only be considered a burden on the

organization (Sari, 2018).

However, with the policy of the BPJS in 2019

for collaborating hospitals required to carry out

accreditation, this triggers the hospital to renew

its hospital accreditation so that cooperation is

not terminated by BPJS.

4 CONCLUSIONS

From this study, it can be concluded that:

1. Input from hospital accreditation is a policy

that regulates hospital accreditation, health

resources in the hospital, and hospital

accreditation information system.

2. The process of hospital accreditation in Jakarta

is in accordance with the hospital accreditation

standards issued by KARS. The standard used

in 2018 is KARS 2012 Version and SNARS Ed

3. Hospitals in Jakarta have accredited using

standards of KARS 2012 Version and some

have used SNARS Ed 1. Not all hospitals have

Implementation of Hospital Accreditation in Jakarta

accredited because of cost and management

commitment issues.

ACKNOWLEDGMENTS

The author would like to thanks:

1. LPPM Universitas Esa Unggul which has

provided the opportunity for writers to conduct

internal research.

2. Co-author, Ms. Loli Adriani for helping the

author complete this research.

REFERENCES

BPJS Kesehatan (2019) ‘Info BPJS Kesehatan’. Diyurman,

G. (2017) ‘Petunjuk Teknis Instalasi Dan Penggunaan

Aplikasi Sistem Manajemen Dokumen Akreditasi

(Sismadak) Bagi Rumah Sakit Di Indonesia’,

(November), pp. 1–31.

Gea, D. and Hp, M. M. (no date) ‘Tata Laksana k

Penggunaan Aplikasi lk SIKARS Berbasis Web Untuk

Rumah Sakit Sistem Akreditasi RS’.

KARS (2018) Daftar Rumah Sakit Terakreditasi. Available

at: http://beta.kars.or.id/application/report/

report_accredited.p hp (Accessed: 4 February 2019).

Kemenkes (2012) Peraturan Menteri Kesehatan Nomor 12

Tahun 2012 tentang Akreditasi Rumah Sakit. Available

at: http://bprs.kemkes.go.id/v1/uploads/

pdffiles/peraturan/24PMK No. 012 ttg Akreditasi

RS.pdf.

Kemenkes (2013) Permenkes RI No 46 Tahun 2013

Tentang Registrasi Tenaga Kesehatan. Indonesia.

Kemenkes (2016) ‘Direktorat Mutu Dan Akreditasi

Pelayanan Kesehatan’, pp. 1–70. Available at:

http://yankes.kemkes.go.id/app/lakip2/downloads/201

7/K P/may/renaksi_may_2016.pdf.

Kemenkes (2017) Peraturan Menteri Kesehatan Republik

Indonesia NomoR 34 Tahun 2017 Tentang Akreditasi

Rumah Sakit. Indonesia.

Kemenkes (2019) Profil Kesehatan Indonesia 2018

[Indonesia Health Profile 2018]. Available at:

http://www.depkes.go.id/resources/download/pusdatin

/profil-kesehatan-indonesia/Data-dan-

Informasi_Profil- Kesehatan-Indonesia-2018.pdf.

Kementerian Kesehatan RI (2018) Profil Kesehatan

Republik Indonesia Tahun 2017.

Poerwani, SK, Sopacua, E. (2013) ‘Akreditasi Sebagai

Upaya Peningkatan Mutu Pelayanan Rumah Sakit’,

Buletin Penelitian Sistem Kesehatan, 3(3), pp. 1–13.

Available at: http://ejournal.litbang.depkes.go.id/

index.php/hsr/article/view/1886.

Rahma, P. A. (2012) Akreditasi Rumah Sakit, Pengakuan

Atas Kualitas Layanan. Available at:

https://www.mutupelayanankesehatan.net/19-

headline/151-akreditasi-rumah-sakit-pengakuan-atas-

kualitas-layanan (Accessed: 4 February 2019).

Sari, W. I. (2018) ‘How Does Policy on Accreditation

Affect the Quality Improvement in Indonesian

Hospitals’, 35(Miceb 2017), pp. 243–250. doi:

10.2991/miceb-17.2018.37.

Sutoto; Utarini, A. (2019) ‘Editorial Mendorong Riset dan

Berbagi Pengalaman Untuk Peningkatan Mutu’, 01, pp.

1–2. Available at:

http://jha.mutupelayanankesehatan.net/index.php/JHA/

article/view/18/8.

Sutoto (2017) ‘Standar Akreditasi Rumah Sakit : Sambutan

Ketua Eksekutif Komisi Akreditasi Rumah Sakit’,

Standar Akreditasi Rumah Sakit, p. 421.

Yustoro, Tri, R. (2013) ‘Evaluasi Pemenuhan Str Dan

Pelimpahan Wewenang Sebagai Implementasi UU No

38/2014 Tentang Keperawatan Pada Rumah Sakit Pku

Muhammadiyah Gamping’, Journal of Chemical

Information and Modeling, 53(9), pp. 1689–1699. doi:

10.1017/CBO9781107415324.004.

ICOH 2019 - 1st International Conference on Health