The management systems framework of hospitals in Jakarta / Tranggano Imam Suwongso Turner. 6

Thesis (Ph.D.) -- Pamantasan ng Lungsod ng Maynila, 2000.;A dissertation presented to the faculty of the Graduate School of Management in partial fulfillment of the requirements for the degree Doctor of Business Administration. 56

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Indonesian hospitals encounter various challenges in providing adequate health care services. The accreditation of hospitals was introduced in 1996 to alleviate the long history of mediocre service care (Ministry of Health, 1996), yet up to now has only been slowly embraced by Indonesian hospitals. Another challenge is the government pressure for Indonesian hospitals to acquire and manage its own resources and to be less reliant on subsidies. There two phenomena led to the crux of the dissertation problem: whether present hospital management practices can meet the emerging demands of hospitals socioeconomic objectives. There is a notable research gap in hospital management practice literature, especially in an Indonesian setting, which makes it worthwhile to conduct this study. Key concepts, models and definitions are researched to come up with a hospital management systems framework. Based on the framework, a descriptive survey on general hospitals in Jakarta was then conducted to investigate four key research objectives: the delineation of socioeconomic objectives; the translation of objectives into budget; presence of planning, implementation and control infrastructure; and presence of feedback mechanism. General hospitals were selected as the subjects of the study, as they are generally considered as the most complex organization within the healthcare delivery system. Four hypotheses concerning the key objectives were tested using chi-square statistical computation. The null hypotheses were: 1.

Hospitals have no clear delineation of their socioeconomic objectives 2.

The translation of objectives into budget is not performed adequately 3.

There is inadequate planning, monitoring, and feedback infrastructure present at hospitals 4.

Proper monitoring and feedback mechanisms are not conducted The alternative hypotheses were: 1.

Hospitals have clear delineation of their socioeconomic objectives. 2.

The translation of objectives into budgeting is performed adequately 3.

There is adequate planning, monitoring, and feedback infrastructure present at hospitals 4.

Delineation of the socioeconomic objectives 2.

Translation of objectives into budget 3.

Presence of planning, implementation and control infrastructure 4.

Presence of monitoring and feedback mechanism A hospital management systems framework was then developed as a synthesis of the four partial constructed models. The variables comprising the model were validated by means of questionnaire distributed to hospital directors in Jakarta. The statistical tests indicated the rejection of all four null hypotheses. Six areas of concern were raised by the results of the statistical tests: 

Effectiveness objective 

Budget process 

Implementation infrastructure 

Control infrastructure 

Monitoring mechanism Based on the decision rule, it was decided that as regards hospitals in Jakarta, present hospital management practice could meet in general the socioeconomic objectives with some weak areas of concern. The understanding of these areas of concern gives practical value to the Hospital Directors considering that more than 60% of these top hospital executives have no formal training in management. The business implication of this research comes from the original model put forth that can be used as diagnostic tools for gauging the ability of general hospitals in Indonesia to meet their socioeconomic objectives. The same tool can be applied in different general hospital population to give comparisons, or benchmarks of hospital management systems performance in lieu of fulfilling the socioeconomic objectives; therefore setting up an impetus for better management standards for hospitals in Indonesia.