Pengembangan Instrumen Pengukur Kualitas Pelayanan Kesehatan berdasar atas Harapan Peserta Jaminan Kesehatan Nasional di Rumah Sakit

Abstract

Perbaikan kualitas pelayanan kesehatan di rumah sakit perlu dilakukan secara berkesinambungan. Pengukuran kualitas pelayanan kesehatan dapat dilakukan melalui beberapa pendekatan, di antaranya berdasar atas harapan pasien. Dengan menggali harapan pasien, aspek pelayanan kesehatan yang dianggap penting bagi pasien dapat dipahami oleh penyedia layanan. Pada era Jaminan Kesehatan Nasional (JKN), di Indonesia belum terdapat instrumen pengukur kualitas pelayanan berdasar atas harapan pasien sehingga peneliti bermaksud menyusun instrumen untuk mengukur kualitas pelayanan kesehatan berdasar atas harapan pasien. Penelitian ini merupakan penelitian kuantitatif dengan desain cross-sectional yang dilakukan terhadap 39 peserta JKN di Instalasi Rawat Jalan, RSUD Al-Ihsan, Kabupaten Bandung pada November 2016–Januari 2017. Pasien peserta JKN yang berobat rawat jalan lebih dari satu kali, dapat berkomunikasi dengan bahasa Indonesia, dan berpendidikan minimal SMA atau sederajat dilibatkan menjadi responden dalam penelitian ini. Data diperoleh melalui wawancara menggunakan instrumen yang disusun dari penelitian kualitatif mengenai kualitas pelayanan berdasar atas harapan pasien. Data yang diperoleh merupakan data ordinal yang merupakan tingkatan harapan pasien. Metode analisis yang digunakan untuk uji validitas dan reliabilitas adalah analisis pemodelan Rasch. Diperoleh instrumen pengukur kualitas pelayanan kesehatan berdasar atas harapan pasien yang terdiri atas 11 aspek, yakni sarana prasarana, karyawan, pelayanan medik, pelayanan administrasi, keamanan, kepercayaan, akses, transparansi informasi, kesetaraan, iur biaya, dan kualitas antarbagian. Nilai reliabilitas instrumen 0,92 dan alfa Cronbach 0,94. Terdapat 43 butir pertanyaan yang memiliki nilai outfit mean square di antara +2,0 dan +0,5; nilai outfit z-standard di antara +2,0 dan −2,0; serta nilai point measure correlation yang positif. Simpulan, diperoleh instrumen pengukur kualitas pelayanan kesehatan berdasar atas harapan pasien JKN yang valid dan reliabel, terdiri atas 11 aspek dan 43 butir pertanyaan.

DEVELOPMENT OF A HEALTH CARE QUALITY INSTRUMENT BASED ON NATIONAL HEALTH INSURANCE PATICIPANT'S EXPECTATION AT HOSPITAL

Improving healthcare quality at the hospital should be done continually. Quality of healthcare can be evaluated using some methods, one of them is measuring patient’s expectation. Exploring patient’s expectation describes important aspects of healthcare that should be understood by healthcare provider. In this era of the National Health Insurance, in Indonesia there’s still no health care quality instrument available yet, especially based on patients’ expectation. The author aimed to develop an instrument measuring quality of health care based on patient’s expectation at hospital. A qualitative study designed by cross-sectional was conducted to 39 participants of National Health Insurance at Outpatient Installation of Al-Ihsan Bandung District Hospital in November 2016–January 2017. National Health Insurance participants who had treatment more than once, could speak Indonesian fluently, and graduated from senior high school was involved in this study. The data was obtained by an interview using an instrument which was developed from a qualitative study. The data was an ordial scale measurement describing level of patient expectation. The method to analyze validity and reliability of the instrument was the Rasch model. Instrument measuring health care quality based on patient expectation consists of 11 aspects, those are facility and infrastructure, hospital staff, medical service, administrative service, safety, trustworthiness, access, transparacy of information, equality, cost sharing, and interdepartment quality. The reliability index of the instrument was 0.92 and Cronbach’s alpha index was 0.94. There were 45 items which have outfit mean square index between +2.0 and +0.5, outfit z-standard index between +2.0 and -2.0, and positive point measure correlation index. In conclusion, the instrument measuring quality of health care based on patient’s expectation is valid and reliable, contains 11 dimensions and 43 items.