Get off the No. 7 train at the Seventy fourth Street-Broadway stop, in Queens, walk past La Abundancia Bakery, the Bollywood Beauty Salon, the New Hae Woon Dae Korean restaurant, the offices of Vishwanath Puttaswamygowda, M.D., and then past the New York Seventh-Day Adventist Chinese church (advertising free conversational-English classes), and you will find yourself at Elmhurst Hospital Center, in Elmhurst, the most diverse neighborhood in New York City and maybe in the world. The hospital serves 1.7 million patients a year, and offers translation services in a hundred and fifty-three languages. The Colombians, Bangladeshis, Koreans, Belarussians, Burmese, Chinese, Vietnamese, Croatians, Mexicans, and other immigrants who live nearby use Elmhurst for their care, and their communities back home often know about the hospital as well. It is not unusual for the exotically sick to fly to LaGuardia or J.F.K. from overseas to check in to Elmhurst. Diseases rare enough to merit special-case-study attention in The New England Journal of Medicine are, at Elmhurst, relatively common. If a young Southeast Asian is brought to the emergency room one morning because he is suddenly unable to move, even a junior physician knows to list familial periodic paralysis—an obscure disease that is considerably more common in the Philippines—as a possible diagnosis. An ambitious pedagogue of medicine couldn’t dream up a more diverse patient population for physicians-in-training.

The hospital was started on Roosevelt Island (then known as Blackwell’s Island), in the early nineteenth century, as a public institution that cared for prisoners and the poor; it went on to tend to soldiers in the Civil War and both World Wars. In 1950, the hospital, preparing for a postwar population boom in Queens, moved to Broadway between Seventy-seventh and Eightieth Streets, where it inhabits the kind of unremarkable complex of brick buildings in which filings for building-code exceptions might be processed. In the early nineteen-sixties, when the city could no longer afford to staff its public hospitals (of which Elmhurst is the second largest, after Bellevue), Elmhurst entered into an arrangement with Mount Sinai Hospital and School of Medicine, a private institution on the Upper East Side of Manhattan. Today, most physicians practicing at Elmhurst are interns, residents, and faculty professors at Mount Sinai. Elmhurst gets inexpensive staff; Sinai gets a unique training center. “It is pretty much universally residents’ favorite place to rotate,” Dr. David Muller, the dean for medical education at Mount Sinai, told me. If you want to learn not to be misled by the glittering chest X-ray of a Korean patient—in Korean acupuncture, the tips of the needles break off and remain lodged under the skin—go to Elmhurst.

Doctors also like to train at Elmhurst because of Dr. Joseph Lieber, a diagnostician and clinical educator who has been at Elmhurst, working from 4 A.M. until late at night, almost every day for the past twenty-five years. Practicing medicine at Elmhurst entails a daunting workload—at times, the hospital runs at a-hundred-and-forty-per-cent capacity—and the pay is not competitive with that of a private hospital or office. Yet an unusual number of doctors who train at Elmhurst choose to return to work there full time; they invariably cite Lieber as one of their main reasons for returning. His office is cluttered with tchotchkes from all over the world—a peaceful alpaca, a monkey in a toboggan, a miniature Taj Mahal—but, when I asked him about his travels, he said, “Maybe twice a month, I travel over to Sinai for teaching. Also, on Sundays, it’s true, I tend to go home earlier.”

Source: newyorker.com

The state Health Department has approved a major facelift of a western Queens hospital.

Mount Sinai Hospital Queens in Long Island City is moving forward with a sweeping $113 million expansion that would erect a state-of-the-art five-story medical building on its campus.

“We need a medical facility to accommodate the growing neighborhood,” Assemblywoman Aravella Simotas told the Daily News on Monday. “There are many young families moving in.”

The state issued a contingent approval letter last month, an important hurdle before construction can begin on the facility, agency officials said.

The operator, which is part of the larger Mount Sinai hospital network, will still have to submit legal documentation to the agency before final approval, Health Department spokesman Peter Constantakes said.

“The project will provide significant improvements to emergency and urgent services, imaging, endoscopy, ambulatory surgery, physician space, operating rooms and patient support spaces,” according to an executive summary prepared following an April hearing.

The hospital expects to break ground in September and complete construction in 2016.

A coalition of nine elected officials have been pushing for approval since 2012.

Mount Sinai spokeswoman Shelly Felder said in a statement that they were “delighted” the project is moving forward.

The 235-bed primary care center on 30th Ave. in Long Island City has seen an increase in visits in recent years, according to hospital figures provided to the state.

Between 2007 to 2011, emergency room visits have jumped by 6,000 more patients, or more than 13%. In that same period, surgeries spiked by 1,459, with Mount Sinai staff conducting 5,144 procedures in 2011, data shows.

“The emergency room is overflowing,” said Rose Marie Poveromo, president of the United Community Civic Association. “It is a long time coming.”

Under the current parameters, the expansion would add four more operating rooms and a new emergency department that would comprise 36 “treatment bays” and eight “observation beds,” according to the summary.

Queens Borough President Helen Marshall said the expansion is a vital lifeline for an area that has seen an influx of new residents in recent years.

“I have been a longtime advocate for Mt. Sinai’s expansion in western Queens where it remains today the only hospital in an area that has seen a dramatic growth in housing and new residents,” Marshall said in a statement.

Source: nydailynews.com

Jakarta, PKMK. Peserta lelang aset peralatan medis milik rumah sakit pemerintah di Kantor Pelayanan Kekayaan Negara dan Lelang (KPKNL) Jakarta cenderung terbatas. Umumnya, peserta merupakan kalangan yang benar-benar mengetahui fungsi peralatan medis tersebut. Setelah dibeli, peralatan medis itu mungkin dijual lagi ataupun diperbaiki. Melalui proses ini, mereka benar-benar mengetahui pihak yang berminat membeli, ungkap M. Subagyo, Pejabat KPKNL Jakarta V di Jakarta (6/5/2012).

Subagyo menjelaskan pihaknya sering berupaya ekstra mendatangkan peserta. Dalam hal ini, pihak rumah sakit selaku pemilik aset diminta membantu mendatangkan peserta lelang. “Kalau kami kan kurang tahu persis tentang siapa yang kira-kira meminati peralatan medis. Terlepas dari itu, lelang tersebut seperti biasa juga diumumkan melalui surat kabar beberapa hari sebelumnya. Peminat harus membayar uang jaminan,” kata Subagyo.

Peralatan medis yang dilelang, biasanya memang yang sudah tidak ataupun kurang berfungsi. Maka dari itu, manajemen rumah sakit lantas mengusulkan agar itu dimasukkan sebagai aset yang dihapuskan, lantas dilelang. Ia pun berkata, peralatan medis tersebut sering dijual per paket. Dengan demikian, peralatan medis yang bernilai sangat rendah dan tidak bisa berfungsi, terdongkrak oleh yang masih berfungsi. Berbeda dengan semua itu, lelang aset non-peralatan medis milik rumah sakit pemerintah ataupun Kementerian Kesehatan biasanya lebih ramai. Misalnya, lelang aset mobil milik Kementerian Kesehatan diikuti banyak peserta, jumlah peserta lelang tersebut bisa mencapai ratusan orang, ungkap Subagyo.

1. Ten Steps to a Result Based Monitoring and Evaluation System

Citing the real impact cutting the safety net would have on the most vulnerable residents, San Diego County Supervisors Greg Cox and Dianne Jacob joined with local hospital leaders today to call on the California Legislature and Governor Brown to spare hospital-based skilled-nursing facilities and other health care providers from devastating Medi-Cal cuts. Both Assembly Bill 900 by Assemblymember Luis Alejo (D-Salinas) and Senate Bill 640 by Senator Ricardo Lara (D-Long Beach) would reverse the Medi-Cal cuts that were enacted in 2011.

“As I’ve said before, what happens in Sacramento doesn’t stay in Sacramento,” said Cox, Chairman of the Board of Supervisors. “Unless the Legislature and Governor Brown take action, the health and safety of California’s most medically complex patients, frail seniors and disabled people will be at risk. Here in San Diego County, these cuts would come to $6.6 million moving forward and $10.4 million in retroactive repayments. We have a moral obligation to care for the most vulnerable. It’s time for Sacramento to assist local governments by restoring this critical funding.”

“If the state fails to stop its pending cuts to Medi-Cal, the most vulnerable members of our community will pay the biggest price,” said Supervisor Jacob. “These are courageous people who face challenges every day and need the intense level of care that comes at a place like the Edgemoor Skilled-Nursing Facility in my district. The cuts would be a travesty and we must not allow a special place like Edgemoor to become a victim of the state’s budget problems.”

Cox and Jacob spoke at a press conference at Edgemoor Hospital/DPSNF in Santee, where they were joined by Steve Escoboza , CEO of the Hospital Association of San Diego and Imperial Counties; Walter Hekimian , CEO of Edgemoor Hospital; Tony Guerra , CFO of Sharp Coronado; Pablo Velez , CEO of Sharp Chula Vista Medical Center and Marilyn Bailey , nursing director at Palomar’s Villa Pomerado. Together, they are dedicated to raising awareness of the issue as attention shifts to the Governor’s May Budget Revision and subsequent deliberations to enact the 2013-14 State Budget. They encouraged the public to learn more about the issue by going to www.CaringisourCalling.org, a website sponsored by the California Hospital Association. Visitors can watch a series of videos featuring patients and their families across California who rely on skilled-nursing facilities for their health care needs, and directly connect with their legislator to urge them to protect patients.

“The Medi-Cal cuts are not just bad for health care providers and patients, they also pose a risk to the state’s overall economy,” said Escoboza. “Although the state projects the cuts to hospital-based skilled-nursing units will result in a $58 million per year savings in the General Fund, that is only an educated guess. What we do know is that these cuts could translate into a loss of up to 36,000 jobs (16,000 direct caregiver jobs, plus the ripple effect in the broader economy) and a decline of up to $2 billion in statewide economic activity. These cuts are a classic example of the state being penny-wise and pound-foolish.”

Medi-Cal beneficiaries make up nearly 80 percent of the patients receiving hospital-based skilled- nursing care. These patients require specialized and medically complex care that freestanding nursing facilities and other health care providers will not or cannot provide. In the last five years, approximately 40 hospital-based skilled-nursing facilities in California (about one-third) have closed due to financial issues that further jeopardize California’s health care safety net.

Unless the Legislature approves AB 900 or SB 640 and Governor Brown signs it into law, hospital-based skilled- nursing facilities, already decimated by low Medi-Cal rates that don’t cover the cost of current care, will lose another 25-40 percent of their funding. That means millions of dollars in losses to acute care hospitals that provide essential care to the elderly and poor patients. The consequence would be cutbacks and closures that would tear a hole in California’s safety net, rip families apart, and punish the most vulnerable and sick among us. Families would be forced to relocate their loved ones to another facility, perhaps hundreds of miles away.

Other health care providers, including physicians, clinics, and emergency medical transport firms, also warn that the cuts jeopardize access to quality care.

Both AB 900 and SB 640 require a two-thirds vote in both the State Assembly and Senate before going to Governor Brown for action. AB 900 passed unanimously out of the Assembly Health Committee and now awaits consideration in the Assembly Appropriations Committee. SB 640 passed unanimously out of the Senate Health Committee and is pending in the Senate Appropriations Committee. It is likely that the two bills will be combined into one final bill during budget negotiations in June and considered an “urgency” bill, meaning that it will take effect immediately if the Governor signs it into law by July 1st.

Source: news-medical.net

TEMPO.CO , Yogyakarta:Penderita kelainan saraf otak, seperti tumor otak dan stroke di Indonesia bisa bernafas lega. Lantaran proses operasi tak lagi harus dengan cara membedah tempurung kepala. Melainkan cukup membuat sayatan pada alis mata sebesar lubang kunci atau yang dikenal dengan teknik operasi lubang kunci (keyhole surgery).

“Kenapa di alis mata? Karena bekas sayatan bisa disembunyikan di alis mata, sehingga tidak terlihat,” kata dokter spesialias bedah saraf Rumah Sakit Mitra Keluarga Surabaya Asra Al Fauzi saat dihubungi Tempo di sela acara Symposium on Cerebrovascular Disease; Enhancing Neuroendovascular Management in Indonesia di Sahid Rich Hotel di Jalan Magelang kabupaten Sleman, Ahad 5 Mei 2013.

Keuntungan lain dari teknik tersebut, sayatan akibat proses pembedahan minimalis, proses operasi berlangsung singkat, dan pasien tak membutuhkan waktu lama berada di rumah sakit. Jika pada operasi kepala secara konvensional membutuhkan waktu 4-5 jam, maka teknik bedah lubang jarum hanya berlangsung dua jam.

“Risiko perdarahannya sedikit. Sehingga banyak pasien yang memilih teknik ini. Pasien saya banyak yang usia tua, di atas 50 tahun,” kata Asra yang tergabung dalam Tim Brain and Spine Center (BSC) RS Mitra Keluarga Surabaya.

Pemahaman publik selama ini, penyakit akibat kelainan syaraf seperti tumor otak dan stroke dimaknai sebagai jenis penyakit yang sangat menakutkan dan fatal. Selain penanganannya sangat serius, tindakan operasi yang biasa dilakukan terhadap pasien berupa operasi besar dan menyeramkan. Inovasi pembedahan dengan resiko terkecil dan tingkat keberhasilan yang lebih baikmenjadi amat penting. Bedah lubang kunci, menurut Asra, merupakan salah satu inovasi dalam penanganan kasus minimally invasive neurosurgery.

“Prosedur tindakan dengan bedah lubang kunci ini lebih ringan dan lebih acceptable bagi pasien. Kami sarankan pasien untuk menggunakan metode ini,” kata Asra.

Teknik bedah lubang jarum adalah membuat satu lubang sebesar lubang kunci pada alis mata, tepatnya di antara bagian atas mata dan di bawah otak. Dari lubang tersebut kemudian dimasukkan alat mikro dan endoskopi untuk melihat sejumlah saraf yang mengalami kelainan. Proses operasi dilakukan dengan alat tersebut. Pasien harus menjalani bius total agar proses operasi berjalan tenang.

Hanya saja, teknik operasi tersebut tidak dapat diterapkan pada semua kelainan saraf. Hanya kelainan saraf pada stadium dini atau yang cepat terdeteksi yang bisa diterapkan metode tersebut.”Kalau tumornya sudah membesar atau stadium lanjut, jangan menggunakan cara ini,” kata Asra.

Kendala lainnya, metode bedah lubang kunci belum diterapkan di semua rumah sakit di Indonesia. Hingga saat ini, baru Rumah Sakit Mitra Keluarga Surabaya yang menerapkannya. Bahkan metode tersebut baru dikenal di Indonesia sejak tiga tahun lalu. Asra adalah dokter yang mempelopori penggunaan metode tersebut di Indonesia.

“Saya mempelajari teknik tersebut di Jepang. Semoga segera menyusul rumah sakit lain di Indonesia yang menggunakan teknik ini,” kata Asra.

Dia menjelaskan, teknik tersebut pertama kali diterapkan di Jerman sejak 10 tahun lalu. Beberapa negara di Asia yang sudah turut menerapkan adalah Cina, Korea Selatan, India, dan Jepang. Beberapa dokter di Filipina juga dikabarkan telah mempraktikkannya. Asra mempelajari teknik tersebut pada 2008 di rumah sakit Aizawa di Matsumoto, Jepang.

“Pertama kali saya kabarkan pada pasien saya soal metode ini, mereka terkejut. Tapi antusias dan ingin mencoba,” kata Asra.

Sumber: tempo.co

Citizen6, Klaten: Stroke yang tidak segera ditangani dengan tepat bisa menyebabkan kematian. Jika penderita segera dibawa ke rumah sakit dan terselamatkan, kadang-kadang penderita mengalami kelumpuhan pada anggota badannya atau hilangnya sebagian ingatan atau kemampuan bicaranya.

Untuk mencegah hal fatal tersebut, Rumah Sakit Islam Klaten membuat unit khusus stroke dan meresmikannya pada Selasa (30/04/2013). Peresmian dilakukan di Gedung Al Mabrur Kompleks Rumah Sakit.

“Penderita stroke makin tahun makin meningkat. Pada 2010 terdapat 424 penderita yang dirawat di rumah sakit ini. Sementara pada 2011 berjumlah 426 orang. Tahun 2012 meningkat menjadi 566 orang,” terang Agus Susanto, Sekretaris Humas & Pemasaran RS. Islam Klaten.

Dengan adanya unit khusus stroke tersebut bertujuan untuk memulihkan pemulihan fungsional penderita stroke sehingga akan menurunkan derajat kecacatan akibat stroke, membantu adaptasi keluarga penderita stroke, menurunkan mortalitas stroke.

Tim yang menangani unit Stroke terdiri dari tim inti dan tim konsultasi. Tim inti terdiri dari dokter spesialis saraf, perawat stroke, fisioterapist, ahli gizi dan psikolog. Sementara tim konsultasi terdiri dari penyakit dalam, kardiolog, pulmunolog, ahli Bedah Syaraf, dokter anestesi, rehabilitasi Medik, psikiater dll

Peresmian dilakukan oleh Ketua Yayasan Jamaah Haji Klaten, Drs. H. Soebiyanto didampingi oleh Jajaran Pengurus Yayasan serta Direksi dan Manajer RS. Islam Klaten di Unit Stroke RS. Islam Klaten yang lokasinya bersebelahan dengan ICU RS. Islam Klaten.

Sumber: news.liputan6.com

In a letter to affiliated physicians and staff, Hoag Hospital in Newport Beach has announced that elective abortions will no longer be performed at the hospital.

The letter said the decision is based of the low number of procedures done annually at the hospital and was made following a review of clinical services performed at the facility.

Hoag Chief Executive and President Robert Braithwaite said there is a direct correlation between quality of care and the number of procedures performed. Elective abortions, he said, are seldom performed in hospitals, partly because of the expense and the less private or intimate setting.

Hoag provided about 100 abortions a year, compared with 6,000 births and 10,000 mammograms, Braithwaite said.

“The bottom line is to provide high-quality healthcare to this community,” he said.

The decision does not affect the dispensing of emergency contraception following rape or sexual assault, emergency services for women who experience complications from pregnancy termination at other facilities, or management of ectopic or other pregnancy complications, according to the letter sent out to physicians dated May 1.

The review of services was prompted by the hospital’s partnership with St. Joseph Health, a Roman Catholic-affiliated institution, although Braithwaite said at no point did St. Joseph pressure the board to change its policy on elective abortions.

Braithwaite cited other procedures still performed at Hoag, including tubal ligation, which are typically not provided by Catholic healthcare providers.

Hospital officials emphasized that patient-physician relationships wouldn’t change and that Hoag-affiliated doctors could still perform abortions, just not at Hoag.

Physicians had mixed reactions to the announcement, according to Dr. Allyson Brooks, the executive medical director for Hoag’s Women’s Health Institute.

“We consider ourselves a center of excellence … and have provided great care, so it’s not unusual for our OB/GYN staff to feel like something went away,” Brooks said.

She said that on an individual basis, many physicians understood the change because so few elective abortions were performed at Hoag. Some doctors were worried that other factors played a part in the decision, Brooks said, but she denied this.

Brooks said there would not be a lack of access to the service since there are many other nearby academic and outpatient centers where elective abortions are performed, including UC Irvine, Planned Parenthood and Family Planning Associates Medical Group.

The elimination of elective abortions isn’t the first time the hospital has gotten rid of a program, Braithwaite said. About five years ago, the hospital decided to eliminate in-patient pediatric care because it felt those patients were best served by the Children’s Hospital of Orange County.

Source: latimes.com

As provincial government revenues stagnate with the sluggish economy, provinces are turning their eye to hospitals as a very obvious target for reductions in spending growth. Provinces spend more than $60 billion a year on hospitals — about $2.5 billion in Manitoba — which is more than they spend on many of their entire ministries.

Right now, most of this money flows to hospitals with few strings attached. Changes are underway to hospital funding pathways, however, to try and ensure that we get good value for that money.

The most recent data from the Canadian Institute for Health Information points to marked variation between hospitals in what this money buys. For example, a hospitalization for a hip replacement in one hospital can cost in excess of 50 per cent more than other hospitals in the same province.

The public should care about this, since large differences in spending between hospitals for the same type of care imply that there is potential for governments to cut spending. If hospital A can do hip replacements for $5,000 per patient why are we paying hospital B $8,000 per patient? If governments can find ways to bring hospital B’s costs closer to $5,000 the hospital has become more efficient and government spends less.

Every year provinces give hospitals a fixed percentage increase to their budget from the previous year. This across-the-board increase, similar to a cost-of-living increase, is intended to reflect increasing input costs, such as wage increases and new technologies and drugs. Over the past half-decade, these annual increases have been in the neighborhood of five per cent.

This type of budgeting and incentive structure rewards all hospitals with new funding equally. Perpetuating across-the-board increases provides little motivation for inefficient hospitals to change the way they operate.

Ontario and British Columbia are starting to change the way they fund hospitals. For the past few years, both provinces have directed hundreds of millions of dollars to hospitals as an incentive to perform more surgeries by tying funding to a fixed price per surgery. Hospitals that can perform surgeries at or below that price will generate free cash flow. Hospitals whose costs per surgery are higher quickly realize that they are receiving smaller increases than their more cost-efficient peers.

Some hospitals can’t compete on cost-efficiency alone. Hospital spending data shows that it costs more to operate hospitals in small and isolated communities than in urban centres.

Ontario and British Columbia are hoping their new hospital funding initiatives won’t close hospitals or undermine quality, but will instead put financial pressure on inefficient hospitals to change their management practices.

It’s not all about saving money.

Every opportunity to improve the safety and quality of hospital care should be seized. Government regulations can be vigilantly monitored to ensure hospitals are meeting acceptable standards of safety. Meeting such standards could also be tied to new hospital funding.

Another idea is to measure quality from the perspective of the patient. The experiences of patients at the hospital and changes in their quality-of-life after surgery should be tracked. Too often, provinces are choosing hip and knee replacements without considering other surgeries and procedures.

The value we get for the money we spend on hospital care can be improved by changing the way we spend that money. Perpetually distributing lump sums to hospitals with few strings attached can no longer be excused in the current economic climate. While change won’t be easy, it’s good that Ontario and British Columbia are leading the way. Other provinces will follow.

Jason M. Sutherland is an expert adviser with EvidenceNetwork.ca and assistant professor at the centre for health services and policy research, University of British Columbia. Nadya Repin is a research coordinator with the centre for health services and policy research, UBC. Their C.D. Howe Institute publication, Paying for Hospital Services: A Hard Look at the Options can be found at www.cdhowe.org

Source: winnipegfreepress.com

Sister Hospital dan Performance Management & Leadership di NTT

Kupang-PMPK. Kegiatan Sister Hospital sudah berlangsung selama lebih dari dua tahun dan PML lebih dari setahun. Selama proses tersebut banyak dinamika yang telah terjadi terkait dengan upaya penurunan angka kematian ibu dan bayi yang menjadi  tujuan utama kegiatan ini. Pertemuan yang dilaksanakan di Kupang pada 29 April 2013 lalu membuka pelaksanaan Monev Program SH-PML di 11 RSUD di NTT.

Berbeda dengan monev-monev sebelumnya, monev kali ini selain untuk mengevaluasi progress yang dicapai oleh RS Mitra A (Sembilan RS besar di Jawa-Bali-Sulawesi) dan RS Mitra B (11 RSUD di NTT), juga untuk mentransfer tanggung jawab dari PMPK FK UGM kepada mitra local di NTT yang telah ditunjuk, yaitu Undana, POGI dan IDAI Kupang serta Dinas Kesehatan Provinsi NTT. Monev dibuka dengan memberikan pelatihan pada para evaluator yang berasal dari keempat institusi tersebut. Hari berikutnyatim dibadi menjadi tiga kelompok, yaitu:

1. Kelompok A (melakukan Monev di RSUD Soe Kab. Timor Tengah Selatan, RSUD Kefamenanu Kab. Timor Tengah Utara dan RSUD Atambua Kab. Belu),
2. Kelompok B (melakukan monev di RSUD Larantuka Kab. Flores Timur, RSUD Lewoleba Kab. Lembata, RSUD Waikabubak Kab. Sumba Barat, dan RSUD Umbu Rara Meha Kab. Sumba Timur)
3. Kelompok C (melakukan monev di RSUD Ruteng Kab. Manggarai, RSUD Ende Kab. Ende, RSUD Bajawa Kab. Ngada dan RSUD TC Hillers Kab. Maumere)

Masing-masing kelompok terdiri dari: evaluator pelayanan maternal, evaluator pelayanan perinatal, evaluator SH, evaluator PML, serta peneliti kualitatif yang menggali pendapat stakeholder internal dan eksternal RSUD terhadap program SH dan PML ini. Tim dari UGM juga dibagi menjadi tiga kelompok dan bertugas mendampingi para evaluator tersebut.

Sampai saat tulisan ini diturunkan proses monev masih berlangsung. Hasil sementara yang didapat menunjukkan adanya variasi progress kegiatan dan pencapaian tujuannya. Sebagai contoh, beberapa RS menggunakan kontainer air kecil yang dilengkapi dengan keran sebagai pengganti wastafel untuk cuci tangan. Hal ini dilakukan untuk mengatasi kesulitan instalasi wastafel dan juga kekurangan air yang menjadi masalah umum di Provinsi NTT. Dengan inovasi ini, tidak ada alas an bagi petugas kesehatan di RS untuk tidak menjalankan prosedur hand hygiene untuk keselamatan pasien. Namun sayangnya fasiiltas pengering tangan masih menggunakan handung yang dipakai bersama dan berkali-kali, bukan handuk yang sekali pakai.

Pengelolaan sampah mulai dilakukan dengan baik. Tempat sampah untuk sampah medis dan non medis dipisahkan dan untuk memudahkan pengguna, kedua tempat sampah ini menggunakan kantong plastic dengan warna yang berbeda. Kantong plastik merah untuk sampah medis dan kantong plastik hitam untuk sampah non medis. Namun di beberapa lokasi masih ditemui kotak sampah yang tidak membedakan warna kantong plastik untuk sampah medis dan non medis.

Obat-obatan yang disediakan di ruang pelayanan sudah ditata menggunakan kontainer kecil dengan banyak laci dan setiap laci ditulisi nama obatnya. Namun masih ditemukan beberapa laci berisi obat yang tidak sesuai dengan label yang tertera di laci. Hal ini terkait dengan kedisiplinan petugas dalam mengembalikan sisa obat ke laci yang sesuai.

Beberapa RSUD mengalami pergantian direktur sehingga hal ini mempengaruhi tingkat kecepatan pelaksanaan program PML yang direncanakan di tahun 2013 ini. Proses hand over dari direktur lama ke direktur yang baru tampaknya kurnag berjalan dengan baik sehingga direktur baru tidak mengetahui detil kegiatan yang sudah terlaksana, hasil yang telah dicapai dan rencana yang akan dilaksanakan di tahun 2013. Pada akhirnya ini mempengaruhi pencapaian program PML secara keseluruhan. Sebagai contoh, beberapa RSUD merencanakan untuk mulai proses persiapan penerapan PPK BLUD dan mentargetkan untuk mencapai status ini pada pertengahan tahun 2013. Namun pada kenyataannya banyak yang belum memiliki rencana konkrit bagaimana untuk mencapai status tersebut.

Hasil dari monev ini akan disampaikan pada sebuah pertemuan yang rencananya akan diselenggarakan pada akhir Mei 2013 mendatang di Surabaya.