Jurnal Administrasi Kesehatan Indonesia Volume 9 No 1 Juni 2021

Published by Universitas Airlangga

doi: 10.20473/jaki.v9i1.2021.9-22

ORIGINAL RESEARCH

BEST PRACTICE OF HOSPITAL MANAGEMENT STRATEGY

TO THRIVE IN THE NATIONAL HEALTH INSURANCE ERA

Praktik Terbaik Strategi Manajemen Rumah Sakit untuk Berkembang

di Era Jaminan Kesehatan Nasional

*Wahyu Pudji Nugraheni1, Asri Hikmatuz Zahroh2, Risky Kusuma Hartono3

1
National Institute of Health Research and Development, Ministry of Health Republic of Indonesia,
Jakarta, Indonesia
2
Health Foundation of Telkom Indonesia, Bandung, Indonesia
3
Sekolah Tinggi Ilmu Kesehatan Indonesia Maju, Jakarta, Indonesia
*Correspondence: [email protected]

ABSTRACT

Background: The implementation of the National Health Insurance (JKN) program has created a transformation
in the health care system in Indonesia. Many hospitals were overwhelmed and unable to adapt to the new
payment system. Some hospitals experienced cost losses due to INA-CBG rates which were lower than the
actual rates.
Aims: This study identified the best practice of hospital management strategy to thrive in the JKN era in
Indonesia.
Methods: This study used a qualitative design. The data collection was recorded through in-depth interviews with
the Director of Dr. Iskak Tulungagung District General Hospital and the Director of An-Nisa Tangerang Hospital as
best practice of hospital management in the implementation of JKN from public and private hospital, respectively.
The interviews were obtained by using audio recorded and it were transcribed as a verbatim. Supporting data
were obtained by reviewing the hospital documents. The data was analyzed by conducting content analysis.
Results: The best practice management strategy of the two hospitals to thrive in the JKN era is increasing
efficiency in operational cost through digitalization, increasing the capability of human resources, customer
relationship management, developing collaborations and support from stakeholders.
Conclusion: Both hospitals could survive from delay claims payment and bankruptcy by implementing strategy
and innovation to adapt in the JKN era. The results of this study can be used by government-owned and private
hospitals as references to improve the management strategy of hospital in Indonesia.

Keywords: best practice, hospital, National Health Insurance, strategy

ABSTRAK

Latar Belakang: Implementasi program Jaminan Kesehatan Nasional (JKN) telah menciptakan transformasi
sistem pelayanan kesehatan di Indonesia. Tidak sedikit rumah sakit yang gagap dan tidak mampu beradaptasi
dengan sistem pembayaran yang baru. Beberapa rumah sakit juga mengeluhkan tarif INA-CBG yang lebih
rendah dari tarif riil rumah sakit yang menyebabkan rumah sakit mengalami kerugian.
Tujuan: Penelitian ini mengidentifikasi praktik terbaik strategi manajemen rumah sakit untuk dapat berkembang
di era JKN Data pendukung didapatkan dengan menelaah dokumen rumah sakit. Data diolah secara analisis
konten.
Hasil: Strategi yang dilakukan oleh kedua rumah sakit untuk berkembang di era JKN adalah efisiensi biaya
operasional melalui digitalisasi, peningkatan kapabilitas sumber daya manusia, manajemen hubungan
pelanggan,dan kolaborasi dan dukungan pemangku kepentingan.
Kesimpulan: Kedua rumah sakit tersebut dapat bertahan dari pembayaran klaim yang tertunda dan
kebangkrutan dengan menerapkan strategi dan inovasi untuk beradaptasi di era JKN. Hasil penelitian ini dapat
digunakan oleh rumah sakit pemerintah dan swasta di Indonesia sebagai pedoman untuk dapat berkembang di
era JKN.

Kata kunci: Jaminan Kesehatan Nasional, rumah sakit, strategi, praktik terbaik.

Received: 20 May 2020 Accepted: 7 June 2021 Published: 11 Juni 2021

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INTRODUCTION JKN program was also required to

implement cost control of health services.
Indonesia began the initial steps of One of the forms of cost control was by
implementing the National Health implementing a Diagnosis-Related Group
Insurance (JKN) in 2014 as mandated by (DRG) payment commonly referred to
Law No. 40 of 2004 concerning the INA-CBGs for hospitals. INA CBGs are
National Social Security System and Law package payment systems based on the
No. 24 of 2011 about the Social Security common diagnoses of diseases and the
Agency (BPJS). JKN program gave high resources used. The implementation of the
expectations for all Indonesian to access INA-CBGs payment system was expected
affordable and qualified health care to be more efficient compared to the fee
services. This expectation has been for service payment system (Hidayat,
proven since the first year of JKN by the 2016; Happy, 2018).
increasing of inpatient services until Hospitals as health care providers
110.5% (Nugraheni, 2017). Moreover, the for 224.1 million participants of JKN
JKN program could reduce the impact of program had to adapt with the changes
poverty due to high health care costs that occur (BPJS Kesehatan, 2019). This
(Hartono, 2017). Research conducted by change occurs where the hospital must
Dartanto et al. (2017) showed that there treat patients properly with efficient
were 1.16 million people saved from resources (Prayitno and Suharmiati,
poverty and 14.5 million people saved 2018). Besides, hospitals were required to
from severe poverty in 2016. The JKN innovate to excel competition in the JKN
program could protect 320.000 poor era. Many hospitals were not been able
people from debt of up to Rp.7.3 million to for the health care system reform in the
pay decent health services. JKN era. Some hospitals complained that
The JKN program not merely opened INA-CBGs rates were lower than the real
the access to health services for all hospital rates, and thus deficit continued to
Indonesian, but also directly created a occur due to higher costs (Edya, 2017;
transformation of the health service Muslimah, Tri Murti Andayani, Rizaldy
system in Indonesia (Nugraheni and Pinzon, 2018). Some of Indonesian
Hartono, 2017). The JKN program forced Ministry of Health’s vertical hospitals also
health services to increase their quality experienced deficits due to high costs,
services to the patients. The credentialing limited resources and poor management
process carried out by the Social Security (Wijayani, 2018). The deficits experienced
Agency for Health (BPJS-Health) required by BPJS-Health also impacted on delayed
hospitals to improve the quality of services claims and hospital cash flow.
through hospital accreditation. In 2014, Although the health care system
there were only 535 accredited hospitals, changes after the implementation of JKN,
equivalent to 22% of the total hospitals in some hospitals could overcome these
Indonesia. Within five years of the JKN challenges, even grow and innovate.
program implementation, the number of Based on the observations, there are 2
accredited hospitals increased sharply hospitals that have succeeded in
become 2,926 hospitals or equivalent to increasing the profitability and hospital
76% of the total hospitals in Indonesia growth in JKN era (JPNN, 2019; Times
(BPJS Kesehatan, 2019). Indonesia, 2019). They are Dr. Iskak
In addition to prioritizing the quality Tulungagung District General Hospital as
of health services for the community, the the government hospital who received the

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IHF 2019 Gold Award at the 43rd conducted for one hour. The audio was
International Hospital Federation (IHF) transcribed into a verbatim by AHZ.
Congress and Award at the Oman Supporting data were obtained through a
Convention and Exhibition Center Muscat, review of hospital documents, such as
United Arab Emirates, 8 November 2019 hospital’s work and budget plan, strategic
due to the implementation of public safety plan, management and finance reports.
to the JKN and Non-JKN patients (JPNN, The study was conducted for three weeks
2019; Times Indonesia, 2019) and An- between 2 and 20 December 2019.
Nisa Tangerang Hospital as the private In order to answer the purpose of
hospital who received up to 1,000 patient this study, the analysis was done by using
visits every day and get an average profit content analysis by WPN, AHZ, and RKH.
of 25% every year (BPJS Kesehatan, We analyze all information obtained from
2017). An-Nisa hospital received 40,094 the results of the study through excerpt of
outpatients in 2014 and increased to interview results, sentences, and table
136,694 and 211,247 in 2016 and 2018, summary of hospital strategy with consider
respectively (RS Annisa, 2019). the validation. The validation was carried
Although both hospitals have been out by conducting the data triangulation.
known for their best management practice, The data was derived from in-depth
their key of successful management interview complemented by secondary
strategies to increase the hospital growth data collection from both hospital which
have not been documented yet. This study have the best practices of hospital
identified the best practice of the hospital management strategies. The description of
management strategies to thrive in the the review included profile, organization
JKN era in Indonesia. The similarities of and management, financial condition,
strategies implemented by both hospitals strategy, and innovation of the hospitals in
were described in this study. surviving the transformation of health
services in the JKN era (Genesys, 2008;
METHOD Blocker et al., 2011; Chiang and Wang,
2015; Kabene et al., 2006; Nigam et al.,
This study used a qualitative design 2014). The protocol for the study was
with a case study approach. Qualitative reviewed and approved by the National
design was chosen to obtain in depth Institute of Health Research and
reason key success of the hospital growth. Development, Ministry of Health Republic
Inclusion criteria of the study was the top of Indonesia with the reference number:
management of Dr. Iskak Tulungagung LB.02.01/2/KE.212/2019.
District General Hospital and An-Nisa
Tangerang Hospital. The data were RESULTS AND DISCUSSION
collected through in-depth interviews with
the Director of Dr. Iskak Tulungagung Dr. Iskak Tulungagung District General
District General Hospital and the Director Hospital
of An-Nisa Tangerang Hospital with semi-
structured interviews. The interview was Hospital Profile
conducted by AHZ and RKH. The Dr. Iskak Tulungagung District
interviews were conducted after obtaining General Hospital was classified as Class-
participants consent to participate in this B Teaching Hospital established on May
study. We recorded the audio of the in- 25, 2016 based on the Decree of the
depth interview. Each of interview was Indonesian Minister of Health Number:

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HK.02.03/I/1147/2016. Since May 18 real Public Service Agency (BLU), and all
2015, Dr. Iskak Tulungagung District employees can work professionally.
General Hospital was appointed as a
District Referral Hospital based on the "Our hospital can thrive rapidly
East Java Governor Decree Number: because it is free from external
188/359/KPTS/013/2015 which assigned intervention, so the management
referrals from the Trenggalek Regency, can work professionally ..."
Blitar City, Blitar Regency and Pacitan (Director of Dr. Iskak
Regency. In 2018, Dr. Iskak Tulungagung Tulungagung District General
District General Hospital was fully labelled Hospital).
as a District Public Service Agency based
on the Decree of the Tulungagung Regent Dr. Iskak Tulungagung District General
Number: 188.45/554/031/2008. Hospital believed that human resources
Dr. Iskak Tulungagung District are the main asset of the hospital. The
General Hospital has 13 specialist hospital management has held regular
services and 7 subspecialist services with trainings and formed accredited internal
476 beds. In 2018, the average monthly training program. They also guarantee the
outpatient visits, monthly inpatient visits, welfare of employees with negotiation by
and emergency room visits were 15,864, calculating the amount of remuneration
2,713 and 3,703 respectively. The vision expected by each employee higher than
of Dr. Iskak Tulungagung District General that in other competing hospitals. This
Hospital is to create a referral and step has been carried out by the hospital
teaching hospital that is reliable and management to maintain employee
affordable in services. While the mission of loyalty.
Dr. Iskak Tulungagung District General
Hospital is to improve the quality and "We gather all doctors and
access to health services, conduct quality staffs. We ask one by one how
education and research in the fields of much salary is expected. We
health and medicine, and implement adjust the salary to their
accountable hospital management. expectations so that each
employee can work happily..."
Hospital Organization and Management (Director of Dr. Iskak
The biggest challenge in the Tulungagung District General
management of government-owned Hospital).
hospitals is the large amount of political,
legal, media, and other external Hospital Strategy
interventions that can disrupt Dr. Iskak Tulungagung District
organizational processes and General Hospital has a low-cost hospital,
management that have been established. high quality and hospital social
Dr. Iskak Tulungagung District General responsibility strategy. The low-cost
Hospital could develop themselves quickly strategy was implemented with the
because they had no external intervention principle of efficiency and effectiveness in
to the hospital management, such as each hospital function, both service and
undone practice from the executive, management. The hospital has utilized
legislative, law enforcement officers, technology to implement efficient and
NGOs and journalists. Until now, the effective strategies in every business and
hospital can operate independently as the management process, such as

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establishing a floating slip system and an departments to give a quick response to

electronic drug management system (Si emergency events. The system
Monic). A floating slip is a digitizing system implements a response time at 0 minutes
that simplifies the process of or it is handled directly by the officer. For
correspondence that can be monitored example, when a fire occurs, fire
accurately and speeds up the bureaucratic departments can immediately respond and
process. Whereas, Si Monic is a drug handle fire problem, while public
procurement system that is integrated with healthcare centers and private hospitals
information systems to avoid drug stockout can immediately giving health services to
and avoid manipulation in drug the victims. The Public Safety Center
procurement. (PSC) is supported by a complete and
The high-quality strategy carried was modern emergency department called
fully committed to the quality of service as INSTAGRAM is a strategy to increase
outlined in Public Service Regulation No. hospital utilization. Data from service
16 of 2018. The hospital prioritizes report mentioned that 80% of the
services to patients by forming a complaint inpatients reaching to 150 people per day
handling unit that is in charge of going came from the emergency room. PSC and
around the hospital to resolve complaints INSTAGRAM system have made the
and help patients who are confused when hospital uninterrupted for the tiered referral
visiting the hospital. To avoid long patient regulations implemented by BPJS-Health.
queues, the hospital has created Si Poetri
application for online patient registration "Dr. Iskak District General
without queuing at the hospital. With these Hospital’s motto is a “hospital
innovations, Dr. Iskak Tulungagung without a wall". Basically, we
District General Hospital received a provide community services not
Community Satisfaction Index of 83.05 in limited in our hospital area but
2018. also outside the hospital through
Dr. Iskak Tulungagung District this PSC system. We collaborate
General Hospital has a motto “hospital with primary healthcare centers,
without a wall” as a form of social private hospitals, polices if there
responsibility to provide health services is an accident, and Regional
not only limited within the hospital area but Disaster Management Agency if
also outside the hospital. They provide the there is a disaster" (Director of
services by developing the Public Safety Dr. Iskak Tulungagung District
Center (PSC) system. This system General Hospital).
provides a fast response to all emergency
events that endanger lives of the "We are not affected by the
community, such as illness, traffic tiered referral policy of BPJS-
accidents, natural disasters, fires, riots etc. Health. Thanks to the PSC
People can access these services through system that we built. Our
telephone and emergency button emergency room visit was very
applications. This system automatically high, and this contributed greatly
encourages good cross-sector to inpatient visits" (Director of Dr.
collaboration among district health offices, Iskak Tulungagung District
public healthcare centres, private General Hospital).
hospitals, regional disaster management
agencies, regional polices, and fire

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Hospital Finance Syndroma Service System (LASKAR) that

The deficit conditions experienced by was integrated with the previous two
BPJS-Health has caused delayed claim systems. If there is a heart attack in the
payment to the hospital for six months. community, then the PSC Team at the
However, delayed claim payment did not nearest health facility will pick up the
affect the hospital operations. Dr. Iskak patient that will be treated at the nearest
Tulungagung District General Hospital hospital or primary healthcare center that
circumvented this problem by diverting the has an electrocardiogram (ECG) facility,
hospital’s construction funds to cover However, if it is a very emergency case,
operational costs aduring the unpaid Dr. Iskak Tulungagung District General
claims by BPJS-Health. The hospital’s Hospital will immediately handle it.
construction fund was originally planned Other than that, the hospital has also
for new buildings and beds. Dr. Iskak developed maternal and child health
Tulungagung District General Hospital is services that are integrated with PSC.
one of the hospitals that no longer gets Maternal and child health services provide
subsidies from the government. Even information services to the community and
though hospitals are not subsidized, they a quick response to emergencies occurred
have proven to operate optimally with a to pregnant women, infants and toddlers.
CRR (Cost Recovery Rate) of 104% in With the development of this system,
2018. Tulungagung District succeeded in
reducing the maternal mortality rate into
"In 2019, we experienced a 34.6 per 100,000 births which has far
delay in payment of BPJS- exceeded the target of the SDGs in 2030
Health claims for 6 months. We by 70 per 100,000 births. In 2019, Dr.
covered our operational cash Iskak Tulungagung District General
flow using development funds Hospital developed post-hospital care
that should be used for new services that monitor the development of
building construction and bed patient’s health after being discharged
additions" (Director of Dr. Iskak from the hospital.
Tulungagung District General
Hospital). "In the future, we are
developing post-hospital care
"Our hospital is one of the services, so the health
hospitals that does not get condition of discharged patients
funding from the regional can still be monitored" (Director
government anymore because of Dr. Iskak Tulungagung
we could be independent. In District General Hospital).
2018, our CRR was 104%”
(Director of Dr. Iskak An-Nisa Tangerang Hospital
Tulungagung District General
Hospital). Hospital Profile
An-Nisa Tangerang Hospital started
Hospital Innovation as a maternity hospital under the
After the successful operation of the ownership of the Permata Bunda
PSC and INSTAGRAM systems, Dr. Iskak Foundation with a capacity of 20 beds in
Tulungagung District General Hospital 1991. In 2008, the maternity hospital was
established an Integrated Acute Coronary developed into a general hospital with a

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capacity of 100 beds and 6 specialist Tangerang Hospital).

services. At present, An-Nisa Tangerang
Hospital is classified as Class-C General Hospital Strategy
Hospital under the ownership of PT Annisa The target market of An-Nisa
Utama with a capacity of 187 beds and 18 Tangerang Hospital was 90% of total
specialist services. In 2018, the average patients are JKN participants. With this
monthly outpatient, inpatient, and target market, the business strategy used
emergency department visits were 17,491, was the low-cost strategy in every aspect
1,579 and 2,103 respectively. An-Nisa of the hospital business such as the use of
Tangerang Hospital has a vision to be an generic drugs, purchasing drugs through
Islamic hospital that is trusted and chosen e-catalogs and technology and utilize
by the community. While, its mission is to technology and digitalization to achieve
provide qualified and professional efficiency. Procurement of generic
services, to brand the image of Islam at all medicines as well as through e-catalogs
levels in all actions and appearances, and system needs lower costs than
to develop a spirit of services in every procurement of patent brands. In addition,
employee. digitization helps to accelerate service
flow, reduce paper printing, and minimize
Hospital Organization and Management service errors, so that it save hospital
An-Nisa Tangerang Hospital realized operational costs
that human resources is the main asset in The marketing strategy chosen was
the hospital business, and thus the a word of mouth recommendation from
organizational environment is formed to patients who have visited the hospital. To
create thriving employees. All nursing get an income margin that exceeds the
staffs have a minimum nursing education, average margin of the hospital industry in
and all the main management line has Indonesia, the hospital management
postgraduate education. An-Nisa optimized every existing asset and
Tangerang Hospital provided scholarships increased service utilization capacity. The
to employees who wish to continue their current income of An-Nisa Tangerang
studies and conducted comparative Hospital reached 15 billion every month.
studies visit to the best hospital in other
countries every year. In terms of "So the biggest income is
organizational aspect, An-Nisa Tangerang actually from BPJS-Health
Hospital instilled a culture of serving and patients as much as 12 billion
working hard in every staff in the and from non-BPJS-Health
organization. The organizational patients as much as 3 billion. It
environment also promoted collaboration is equivalent to 90% of BPJS
between hospital owners, management patients and 10% of non-BPJS
and doctors. patients..." (Director of An-Nisa
Tangerang Hospital).
"The fourth thing that locks
them to be royal to An-Nisa "The marketing target of An-
Hospital is that we give 30% of Nisa Tangerang Hospital got a
the hospital shares to the turnover of 15 billion, but our
doctors. If this hospital is marketing was only up to 5 to 6
profitable, the profits will return million. Why do they only not
to them..." (Director of An-Nisa have the cost to print leaflets?

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Because An-Nisa Hospital uses not want to serve those patients

recommendation marketing according to INA-CBGS, they
strategy. Why not promotion but do not fit to the practice here "
recommendations? Word of (Director of An-Nisa Tangerang
mouth from well-treated Hospital).
patients will elevate the hospital
promotion...." (Director of An- "Basically, we have to do these
nisa Hospital Tangerang). things. First, the Director has an
entrepreneurial spirit. Second,
Hospital Finance for cash flow, the hospital uses
An-Nisa Tangerang Hospital had a SCF. Third, the claim
annual profit margin at 15-20% with a management must be timely.
strategy to increase the service capacity Fourth, open management..."
and maximize the existing assets. By (Director of An-Nisa Tangerang
increasing the service capacity, the Hospital)
hospital’s fixed cost will decrease and
increase profit margins. The hospital also Hospital Innovation
had a unit cost based on INA-CBGs, and An-Nisa Tangerang Hospital
thus the hospital management knew the admitted that information technology was
group of diseases that are financially at needed to improve the efficiency of
risk. In addition, the hospital used generic services. Now, the hospital has
drugs, control length of stay and improve implemented an Electronic Medical
diagnostic support to improve cost Record (EMR) for outpatient and inpatient
containment. The hospital’s Cost Of services. Its strategic plan in 2020 was to
Goods Sold (COGS) was only 10-12% of use Artificial Intelligence (AI) technology to
the total hospital costs. During the delayed further enhance service capacity and cost
claims from BPJS-Health, An-Nisa efficiency. In the service aspect, the
Tangerang Hospital utilized Supply Chain hospital prioritized customers’ experience.
Financing (SCF) program to maintain their The hospital provided free patient
cash flow. The hospital also formed a discharge services and gave small gifts to
good claim management with the timely pediatric patients. The hospital had a good
delivery of claims files to BPJS-Health. patient discharge system.
Claims were scheduled to be sent every In the evening, the doctors made a
3rd day and 21st day to BPJS-Health that list of patients who could be discharged
has finished verifying. the next day, and they completed the
medical record, as well as patient
"The pharmacy is no longer administration. If the next day the patient
wandering around An-Nisa was declared stable based on the nurse's
Hospital because all of the examination, the patient would be sent
generic drugs are already in. home immediately without waiting for the
Thus, they do not work on the doctor to visit. The hospital also formed a
hospital’s pharmaceuticals. fraud prevention team that functions to
That is why I said that every detect "abnormal" events in the service.
doctor who wants to join in the After the claim verification process was
hospital practice need to know complete, the fraud team reviewed the
that our target is to serve BPJS- problematic claim to decide whether or not
Health patients. If doctors do the claim could be submitted to BPJS-

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Health. ICD X. If it suits right, the BPJS-

"In 2019, we only implemented Health cost would come out. It
electronic medical records, so is a design that would be
the casemix team, which had implemented in 2020..."
12 people, left only 2 people (Director of An-Nisa Tangerang
because the doctor had written Hospital).
the diagnosis. We match with

Table 1. Summary of Two Best Hospital Management Practice after JKN Era in Indonesia.
Dr. Iskak Tulungagung District
Description An-nisa Tangerang Hospital
General Hospital
Hospital Profile - Classified as class-B teaching - Classified as class-C general
hospital hospital
- Having 13 specialist services - Having 187 beds and 18
and 7 subspecialist services specialist services.
with 476 beds. - Monthly outpatient, inpatients
- Appointed as a District Referral and emergency were 17,491;
Hospital which assign referrals 1,579 and 2,103 respectively
from the Trenggalek Regency, in 2018.
Blitar City, Blitar Regency and
Pacitan Regency.
- Monthly outpatient, inpatients
and emergency were 15,864;
2,713 and 3,703 respectively in
2018.
Hospital - Operated independently as the - Human resources as the
Organization Public Service Agency (BLU) main asset of the hospital
- Having employees who work - The management provides
professionally. scholarships to employees
Hospital Finance - Diverting hospital construction - Maximizing existing assets
funds to cover operational with 15-20% of annual profit
costs. margin.
- Cost Of Goods Sold (COGS)
at 10-12% of the total hospital
costs.
- Applying Supply Chain
Financing (SCF) program to
maintain hospital cash flow.
Hospital Strategy - Low-cost hospital, high quality - JKN participants with a
and hospital social responsibility composition of 90% of total
strategy. patients as the target market
- A word of mouth
recommendation from
patients as the best marketing
strategy
Hospital - Establishing an Integrated Acute - Developing information
Innovation Coronary Syndroma Service technology such as Electronic
System (LASKAR) for patients Medical Record (EMR) to
with cardiac arrest. improve the efficiency of
- Developing maternal and child services at the Hospital.
health services that are - Building a good patient
integrated with PSC. discharge system

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Contras with the result of this study, changing market (Coughlin et al., 2014).
Irwandy and Sjaaf (2018) stated that 56%
of hospitals in South Sulawesi were Common Implemented Strategies
classified as inefficient within 4 years after From this present study, the best
JKN implementation. Research conducted hospital management practice at Dr. Iskak
by Harmadi and Irwandy (2018) assessing Tulungagung District General Hospital and
the efficiency level in government An-nisa Tengerang Hospital could make
hospitals in Indonesia also found that them adapt and grow in the National
66.7% of class-A hospitals, 70.3% of Health Insurance (JKN) era. They have
class-B hospitals and 61.1% of class-C four common strategies implemented,
hospitals in Indonesia were classified as such as efficiency in business process,
inefficient. In addition, Ross and Dutta investment in human resources, customer
(2019) did a survey to 61 private hospitals relationship management, and
in collaboration with BPJS-Health and stakeholders’ collaboration and support.
showed that efficiency only occurred in
inpatient services. Efficiency in Business Process
This condition is also happened in Efficiency in hospital business
other countries. Many hospitals hospitals process is the key to survive and thrive in
were closed within 5 years of the National Health Insurance (JKN) era.
introduction of the DRG payment system Hospitals must regenerate a whole
in America (Jane et al., 2016). In Taiwan, management and service process to
the number of hospitals in 1995 was 787, operate efficiently. Regeneration process
which then decreased into 490 in 2016 must focus on cost containment,
due to the number of hospitals that closed transparency improvement and capacity
or merged due to service inefficiencies, improvement of hospital resources. Many
poor financial management, and low levels hospitals were more focused on managing
of competition (Chiang and Wang, 2015; revenue rather on cost containment to
Gilhawley, 2018; Kuo and Yang, 2018). In insure profitability (Dewi, 2018). Whereas,
Germany, since DRG payment with a proper cost containment strategy
implemented in 2004, high hospital and optimalization of the capacity of
mergers and 19 hospitals were closed resources which lead to reduce fixed
within 5 years of implementing the DRG costs, hospitals will get greater profit
payment system (Mullner and McNeil, margins (Dong, 2015). Transparency is
1986; Pilny, 2015). essential in reducing fraud and is easier to
Hospitals were demanded to carry achieve with the help of technology and
out strategies to adapt with transformation digitization tools. Both of Best Practice
that occurred due to the payment system Hospital use information technology
reform. The four strategies were used to (computerized the management work flow)
increase efficiency, reduce costs, create and digitalization (paperless work system)
more flexible organization reform to adapt to cut administration bureaucracy, reach
market changes, change the service effectiveness in service delivery and cost
culture oriented to increasing customer efficiency. Research from University of
satisfaction, and improve hospital Sidney proved that digitalization in
infrastructure. All of these strategies were healthcare providers could accelerate
focused on ensuring the long-term quality and safety of service and efficiency
financial sustainability of hospitals in a of organization process (Shaw, Hines and

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doi: 10.20473/jaki.v9i1.2021.9-22

Kielly, 2018). hospitals conducted a survey and word

moth strategy to know the patients’
Investment in Human Resources feedback. Genesys Consumer Survey
One of the top three reasons people 2006 in USA showed that 88% of patients
leave organizations is the lack of would have a more positive opinion of a
interesting and meaningful development hospital after receiving a call just to thank
opportunities (Stokes et al., 2013). them for their visit or ask them how
According to the finding of this study An- satisfied they are (Genesys, 2008).
nisa Hospital invest human resources with
giving training and guarantee of further Stakeholder’s Collaboration and Support
study to their staff. It is important because According to the confirmation from
proper management of human resources informants from both hospitals, they
is critical in providing a high quality of collaborate their hospital management
services (Kabene et al., 2006). When with several stakeholders such as owner,
hospital management can integrate administrators, and medical doctors. The
learning process with performance, it impact of collaboration with stakeholders
becomes much more related to employees is that the health system will improve the
who see how their training program quality of care (partly by rationalization
support their performance and positively and optimization) and improve integrated
impact patients (Sinha and Ojha, 2016). care by increasing patient flow through
Another important aspect is to ensure vertical integration (De Regge et al.,
employees’ welfare to keep them engaged 2018). Another study also concluded that
and happy, by developing strategies such hospital management requires
as hospital social responsibility collaboration from all stakeholders to
Glassdoor’s research showed that happy ensure that the strategy can be carried out
employees would create happy costumers without significant obstacles (Pandi-
(Zhao and Chamberlain, 2003). Perumal et al., 2015). District government
hospitals should cooperate with regional
Customer Relationship Management leaders and local institutions to get policy
Both of hospital in this study retain support.
the patients to willing visit back with giving Various studies have shown that
the best service and they do not doctors’ support is very important to shape
differentiate the health services between changes in values and quality of hospital
JKN and non-JKN patients. They also organization (Bradley et al., 2001).
implement the strategy of proactive word Management support can increase the
mouth from the patients related to the success of organizational change.
good health services in the hospital. Collaboration from doctors and
Research done by Blocker et al. (2011) management to understand the problems
revealed the impact of proactive costumer in hospital organizations is very important
service could create robust effect to to determine changes in hospitals to
superior value, statisfication and loyalty of improve efficiency (Nigam, Huising and
the costumers. Proactive approaches Golden, 2014).
could be done by asking costumers for Owners, management and staffs
feedback, paying attention to what must understand and be involved in the
costumers need, and offering rewards for process of organizational change to
regular costumers as both hospital have reduce concerns for negative
been implemented. For example, both expectations. Throughout the process of

Best Practice of... 19 Nugraheni, Zahroh, Hartono

 Jurnal Administrasi Kesehatan Indonesia Volume 9 No 1 Juni 2021
Published by Universitas Airlangga
doi: 10.20473/jaki.v9i1.2021.9-22

organizational change, such as rebuilding who gave the opportunity for taking data
hospitals, staffs need to be involved, for this research.
adequately informed, and trained as they
think the management and owners
CONFLICT OF INTEREST
supported them. Champions of varying
professions and leading departments can
The authors state that there is no
be used to increase a sense of
involvement among actors in hospital
conflict of interest for this article.
organization (Pomare et al., 2019).
This study has successfully REFERENCES
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