CHAPTER I INTRODUCTION RSIA Kemang Medical Care is Mother and Infant hospital located in Ampera Raya No. 34. The hospital provide health services for mother and infant that include counseling, promotion, prevention, diagnostic, therapeutic, operative, dietetic, outpatient, inpatient and other medical supportive services.
As a new business entity, RSIA Kemang Medical Care is preparing their readiness to begin their operation in October 2008. The vision and mission along with the strategy of RSIA Kemang Medical Care has just been established. The Group Field Project feels that RSIA Kemang Medical Care will need a tool to implement this new strategy and proposed to use Balanced Scorecard to assist the implementation of this vision and mission in RSIA Kemang Medical Care.
Balanced Scorecard is a management tool that has shown to help many companies succeed in executing and implementing their strategy. Numerous studies have shown that the ability to execute strategy was more important than the quality of the strategy itself.1 Currently there are many hospitals that have been also using Balanced Scorecard and they find it useful in improving their performance. The Group Field Project will use The Balanced Scorecard to translate the Vision and Mission of RSIA Kemang Medical Care into the Strategy Map, divide it into several Strategic Themes which are ready to be implemented in RSIA Kemang Medical Care.
Background of Indonesia & Jakarta Health Services:2
Various public health indicators show that health condition of mothers, babies and children in Indonesia have progressed in the last 25 years. However the condition is still worse compared to other South East Asia Countries. The World Health Report 2000 stated that the performance of Indonesian health system ranked 92 of 191 WHO’s member countries. This means, public health condition in Indonesia was still below Bangladesh (88), Brunei Darussalam (40), Malaysia (49), Philippine (60), Singapore (6), Sri Lanka (76), and Thailand (47).
A more depressing fact was clearly shown in the maternal and prenatal condition. In the situation analysis of Health Development Strategic Plan 2001 - 2004, The Ministry of Health, Republic of Indonesia, reported a 373 maternal mortality rate per 100,000 births. This high maternal mortality rate showed a low awareness of healthy living standard, behavior, nutrition, mother’s health, environmental health condition, as well as scope and quality of health service for pregnant, prenatal, and post natal mother.
About 20% of maternal mortality is caused by obstetric complications which happen during the labor. The major complication is bleeding (accounting for 40 – 60% maternal mortality) especially postpartum bleeding (accounting for 60% of all bleeding cases).The 2nd major complication is ecclampsia which is the cause of 20 –
30% mortality. This condition is actually could be treated and prevented during pregnancy.
The condition of neonatal and prenatal in Indonesia also has the same condition as the maternal condition. In 2001, The Ministry of Health, Republic of Indonesia, reported that around 45% of infant mortality happened during the prenatal period. Most of the prenatal mortality happens at home and around 70% of it could be prevented in the primary health care.
In line with the growth in the community social and economical level, the shifting pattern of death-caused illness and the advancement in medical knowledge and technology, there is also a growing need of a center in health care services. The development of Fetomaternal Medicine’s information and technology had opened up wider opportunity for doctors to improve health condition of mother, fetus, and children. The availability of state of the art technology, laboratory, and specialist doctors would potentially contribute to the effort to improve the wellbeing of mother, fetus and baby in Indonesia.
In DKI Jakarta there are 107 hospitals, including 7 Local Government Owned General Hospital and 4 Central Government Owned General Hospital2,3. The amount of available bed in those hospital are 7.087 units, meanwhile 96 private hospitals own 8.229 bed units. Thus, there are only 200 beds available for around 12,300,000 populations in DKI Jakarta. Until the end of 2004, in Jakarta, Bogor, Depok,
Tangerang, and Bekasi area, there are 120 hospital, (around 10%) both owned by government or private.
Based on data released in 2006 the number of Private Hospitals in Jakarta for both General and Maternity Care are 61 hospitals (53 General and 8 Maternity) with total number of beds are 7,641 unit (7,151 in General and 490 in Maternity). Number of beds in Obstetric Wards at General and Maternity Hospital in Jakarta in the year of 2006 are 1,704 beds (664 government/military/ state owned hospitals and 1,040 private hospitals) while number of beds in Pediatric wards are 1,606 beds (898 government/military/ state owned hospitals and 708 private hospitals).4
For South Jakarta in particular, the 2003 data shows that there are 25 hospitals with 2,992 units’ bed. For basic health service in South Jakarta, there are 77 units of primary health care (puskesmas), 30 hospitals specialized in obstetric & gynecology, 153 units of general health care (balai pengobatan umum), 4 units of community health care (balai kesehatan masyarakat) and 269 units of midwife practice houses. Various private health supporting facilities also scattered over South Jakarta, among other things are 20 units of laboratory, 249 units of pharmacy, 102 units of drug stores. The existences of traditional healer are also become inseparable part of health care service system in South Jakarta. At present there are 1,490 traditional healers offering alternative treatment.
Supply of health care service in DKI Jakarta, particularly in South Jakarta reflects a significant growth of basic health care facilities. Whereas South Jakarta is an urban
typical community settlement, with high density of middle-upper socio-economic status, especially in Buncit, Kemang, Pondok Indah, Pondok Pinang and Kebayoran Baru area. It could be assumed that this community needs secondary health care service (specialist) and tertiary (sub-specialist) which is currently still undersupply. Therefore market for secondary and tertiary healthcare provider in South Jakarta is still very promising. Induced by the rapid city growth, advancement of medical knowledge and technology, the growth of health care service industry is peaking up.
From business perspective, the ratio of Obstetric Bed to 100,000 of Female Population age between 15-49 years old in Jakarta on 2006 is 58.8 bed/100,000 Female, while The Ratio of Pediatric Bed to 100.000 of Children under 14 years old is higher which is 101.5 bed/100,000 children.5 This ratio shows that there is a shortage of healthcare service supply for women and children in Jakarta, and implies a huge potential market for Rumah Sakit Ibu & Anak Kemang Medical Care.
According to Feasibility Study Report of RSIA Kemang2, potential market of the hospital include South, Central and East Jakarta community amounted around 6 million people, with profile estimated as follows: 1) Amount of pregnant mother is 210,000 /year 2) Amount of pregnant mothers who are willing to and able to pay for service is 10,500 patients/year
3) The number of pregnant mothers who are willing to and able to pay for services are as follow: a. Antenatal visit around 42,000 visit/year b. USG around 21,000 USG/year c. Routine
examination/year d. Special
examination/year e. CVS and/or Amniocentesis around 105 examination/year f.
Genetic screening around 105 examination/year
g. Labor around 5,250 visit/year with estimate type of delivery as follows: 1. 2,625 normal/year 2. 2,625 sectio caesarian /year h. Amount of days spent in normal labor around 5,250 days/year i.
Amount of days spent in sectio caesarian around 7,875 days/year
Types of Hospitals and Accreditation
1.2.1 Types of Hospitals Hospitals in Indonesia could be categorized into 3 types of hospitals2,6: 1. General Hospitals
2. Mental Hospitals 3. Specialized hospitals including: •
Other specialized hospital
1.2.2 Hospital Accreditation
Accreditation is public acknowledgement through a national accreditation agency of a hospital’s degree of success in meeting accreditation standards that is established through an external, independent and expert peer review. 7
An accreditation assessment is conducted by an independent agency, the Hospital Accreditation Commission or KARS, which is made up of medical specialist with experience and who is acquainted with the intricacies of hospital services. In order to improve KARS’s performance, particularly in term of its surveyors, a KARS ethics and credentials team was also formed to asses, supervise and develop the performance of surveyors. Combining medical, nursing and administrative surveyors, there are now 120 surveyors in all. 7
The objectives of hospital accreditation are8: a. Creating a conducive environment so the health care provider in the hospitals aware that they have full accountability of the services provided to the patients b. Providing protection to patients (patient safety) and health care providers.
There are 3 types of accreditation according to the level of services provided by the hospital. There are 5, 12 and 16 standard of services. For a hospital providing only 5 standard of services, 112 parameters must be measured, while for those offering 12 there are 254 and, for 16 types of services, 319 parameters are used.7
Several hospitals in Jakarta that already have 16 standard of services are: RS Jantung Harapan Kita, RS MMC, RSU Fatmawati, RS Mitra Kelapa Gading, Siloam Gleneagles Hospital Lippo Karawaci, RSUP Persahabatan, RS Pusat Pertamina, RSPAD Gatot Subroto, RSUPN Dr Ciptomangunkusumo, RS Kanker Dharmais, RS Pertamina Jaya, RS Pelni Petamburan, RS Mitra International, RS Pondok Indah, RS Mitra Keluarga Bekasi Timur, RSAB Harapan Kita, RSIA Hermina Bekasi, RSIA Hermina Jatinegara, RSIA Hermina Podomoro, RS Islam Jakarta.7
1.3 Business Competition
Around South, Central, and East Jakarta, currently, there are some comprehensive, one stop healthcare service facilities for mother, infant and baby. In the near future, the competition could become more severe, even in fetomoternal service. Competitors had been/are developing fetomaternal supply chain through partnership at national, regional, and international level. The competitors also provide comprehensive, quality, efficient, and accessible service. It is also predicted that the competitor would offer substitute products of fetomaternal service such as specialist clinics, diagonal centers and therapy centers
From 25 units of hospital owned by both government or private in South Jakarta, performance of the following seven hospitals should be taken into consideration by RSIA KMC, i.e. (1) Rumah Sakit Metropolitan Medical center –Rasuna said; (2) Rumah Sakit Aini Rasuna said; (3) Rumah Sakit Siaga Raya –Buncit; (4) Rumah Sakit Pusat Pertamina –Kebayoran Baru; (5) Rumah Sakit Pondok Indah; (6) Rumah Sakit Umum Pusat Fatmawati, dan (7) Rumah Sakit Setia Mitra. Table 1. shows the performance of the above hospitals in terms of amount of patients treated in the hospitals, Length of Stays (LoS), Gross Death Rate (GDR) and Bed Occupancy Rate
Table 1: In-patient figures of Selected Hospital in South Jakarta in 2005: Hospital
Number of Patients 7,301
7.Setia Mitra 3,244 45,6 10,317 2,35 13 Source: Recap Report of Hospital – Dinas Kesehatan Provinsi DKI Jakarta 2005 From the table above we could see that Fatmawati General Hospital is the largest hospital with 536 units of bed with 116,873 number of treatment days, Bed Occupancy Rate of 59.7% and 20,146 patients. While Pertamina Pusat Hospital is hospital with the highest Bed Occupancy Rate of 67.2%, with 478 units of bed, number of treatment days of 115,119 days and 17,554 patients.
Until now, the government has not made any regulation regarding inpatient room rate of private hospitals. However the private hospitals are obliged to provide cheap services for poor patients (around 20 – 25%). Private hospitals usually put higher prices compare to general hospitals. The comparison of room prices in several private hospitals are shown in Table 2 below.
Table 2: Prices of several private hospitals in Jakarta on June 2004 Hospital Super VIP (Suit Rooms) 2,200,000 2,400,000 700,000 460,000 385,000 500,000
RS MMC RS Pondok Indah RS Mitra Keluarga RS Yadika RS Harum RS Harapan Bunda
825,000 750,000 625,000 360,000 300,000 400,000
In patient Room Rate 1st Class 2nd Class (2 beds) (2 – 4 beds) 500,000 225,000 400,000 250,000 325,000 200,000 255,000 155,000 200,000 125,000 225,000 185,000
3rd Class (4 – 6 Beds) 60,000 70,000 70,000 105,000 95,000 60,000
Source: Feasibility Study Report for the Development of Kemang Women and Children hospital of PT Sarana Mediktama Kemang
From outpatient perspective, the seven main hospitals reveal the performance such as shown in Table 3 below:
Table 3: Out-patient figures of Competitors in 2005 Hospital 1. MMC 2. Aini 3. Siaga Raya 4. Pertamina Pusat 5. Pondok Indah 6. Fatmawati 7. Setia Mitra
Number of Outpatients 180,177 51,720 17,889 497,395 251,427 523,067 26,548
Rate of outpatient/day 493 141 49 1,362 688 1,433 72
Source: Recap Report of Hospital – Dinas Kesehatan Provinsi DKI Jakarta 2005
In the Table above, once again we could see that Fatmawati general hospital and Pertamina Pusat Hospital are the main player in general hospital area. However, based on the number, quality of services provided to the patients, as well as Quality Management System, the Pondok Indah hospital (i.e. RSPI Obstetric and Gynecology and Pediatrics Unit) is the main competitor of RS Kemang Medical Care.
ICU/ ICCU 650,000 900,000 550,000 350,000 350,000
1.4. RSIA Kemang Medical Care
About RSIA Kemang Medical Care
RSIA Kemang Medical Care (KMC) is a hospital specialized in providing healthcare service for Women and Children. The hospital was built on around 6000 sqm land area in Ampera Raya, a street that is located around Kemang Area, South Jakarta. The building have colorful windows, contemporary design, and looks attractive compared to other buildings in Ampera street, a packed area with a mixture of Jakarta native residential houses, offices, commercial building; shops, restaurant, stalls in every corner, and street with a very heavy traffic. The area surrounded by Kemang, Pejaten, and Cilandak area, which have a substantial number of expatriate and foreign citizen population.
There are also some foreign and middle up private schools
KMC’s building is a six floor building. In the basement, there are kitchen for preparing in-patients food, canteen, and some commercial spaces. Located at the first floor, are lobby, admission/reception and waiting area, café, and polyclinics. At present there are 3 Obstetric and Gynecology clinics, 2 Pediatric Clinics, 1 General Clinics, and 1 Dental Clinics. The management plan to extend the polyclinic by building additional Pediatric, Lactation, and Dental Clinics in a near future. Laboratory, radiology and pharmacy are also located in this floor. The operating
theatre and delivery room are located at 2nd floor, as well as ICU and NICU. The 3rd and 4th floor are dedicated for in-patient ward, while administration office is at the 5th floor. KMC has 58 Beds that placed into 33 rooms: 5 VVIP rooms, 10 VIP rooms, 12 class 1 rooms, 4 class 2 rooms, 2 class 3 rooms. See Exhibit 1 for pictures of RSIA Kemang Medical Care
Vision and Mission of RSIA Kemang Medical Care
As a specialized hospital for women and children, KMC stated its vision, mission, motto and values as follows:
Vision Kemang Medical Care will become the premier health care provider for women and children in Indonesia Mission It is our mission at Kemang Medical Care to provide holistic quality health care services for women and children of Indonesia Values Forthcoming – Always servicing patients by exceeding their expectations Respect – Respecting individual differences and value Integrity – Fostering an environment of honesty, integrity and trust Excellence – Striving to continuously improve quality, competency and safety Nimble – Putting forward agile stance to better serve patients
Distinctive – Preparing to serve the unique needs of patients Loyal – Demonstrating reliability and truthfulness in patient’s treatment Youthful – Cultivating energetic and dynamic team to always advancing new technology and skill
1.4.3 Kemang Medical Care’s Business Strategy
RSIA KMC is a private healthcare service provider with medical specialist in mother, fetus and baby’s wellbeing. The market targeting, pricing along with the positioning of RSIA Kemang Medical Care are described below. Target markets of KMC are: 1. Upper-middle class community (more than Rp 5,000,000/month/person) in South, Central and East Jakarta, with proportion of 9.30% of 6 million total population or around 558,000. This number was quoted from National Socio-economic Survey in DKI Jakarta year 2001. 2. Existing patient of Doctors who are also shareholder of KMC 3. Foreign citizen population who lives nearby 4. Children who go to private school around South Jakarta, and their families
Pricing of RSIA Kemang Medical Care KMC decision on serving the upper class reflected in its in-patients room’s tariff. Table 4 shows the comparison of room rates at RSIA Kemang Medical Care with its head to head competitors.
Table 4: The Room rates of RSIA Kemang Medical Care compared with Competitors (Rp) Hospita l RSIA KMC RS PI* Inpatients Normal delivery
VVIP Gold/ Suite 2,750,000, -
Class 2 -
1,124,000, 1,044,000, 1,204,000, High1,493,000, care 2,247,000, Deliver y RS 2,750,000, 1,650,000, 1,100,000, 660,000,275,000,70,000,MMC* * * Buku Tarif tahun 2008, Rumah Sakit Pondok Indah, Pondok Indah Healthcare Group, Jakarta **Buku Tarif 1 Juli 2006, RS Metropolitan Medical Centre. Jl. H.R. Rasuna said Kav. C-21, Kuningan, Jakarta
Picture of the Rooms are shown in Exhibit 2.
Positioning of RSIA Kemang Medical Care: To achieve its vision and mission, while many other hospitals in Jakarta now competing in providing the use of high-end diagnostic facilities and state of the art medical technology as their distinctive value, RSIA Kemang Medical Care positioned itself as a hospital with a friendly touch, a hospital where people caring for people. The decision was supported from the survey questionnaire conducted by KMC’s Marketing Team, to gather opinion from market on what is the customer main consideration in choosing hospital. The result of the questionnaire shows that 64%
respondents choose a hospital based on who is the medical doctor in that hospital, and only 3% of respondents choose a hospital based on its high-end diagnostic facilities.
This survey showed that a hospital cannot easily gain trust just by investing in highend equipment and facilities. Hospital business is a caring business; you should show that you are trustable enough to make the customers choosing you as their healthcare partner for a long time. While equipment is just a supporting tools, the human resources in a hospital; including doctors, nurses, and other staff, play a critical role in building customers trust.
With motto of Safety, Quality, and Compassion; RSIA Kemang Medical Care use a lifecycle approach in developing its program and services; offering a healthcare system that cover the needs of customers of all stages of life; baby, infant, teenager, pre-wedding woman & man, mother to be, women hormones (endocrinology) issues. The life cycle is described in Figure 1 as follows:
Figure 1. The lifecyle approach of RSIA Kemang Medical Care
Based on the lifecycle approach, RSIA Kemang Medical Care Programs are: •
Women Wellness: Providing a holistic care for women wellness
Medical Check Up including Pre wed Health Screening
Antenatal Care and Pregnancy, including Pregnancy Exercise, and Yoga
Rooming In or let new-born baby sleep in the same room with its mother
Early Breastfeeding Initiation
Child Development Clinic
Healthy Children Program
Healthy Teenager Program
Holistic healthcare system usually follows the process of Promotive, Preventive, Early Diagnosis, Curative, and Rehabilitative. RSIA Kemang Medical Care also associates their program with this process as shown in Table 5 below: Table 5: Process and Program of RSIA Kemang Medical Care Holistic Healthcare System Process Promotive
Program Seminar/workshop for Women and Children Health
Life cycle approach programs
Table 6 shows how the design of RSIA Kemang Medical Care’s facilities was also developed based on the above process. Table 6: RSIA Kemang Medical Care Facilities Supporting the Holistic Healthcare System Process
Function Rooms, Children Play ground
Exercise Room/ Physiotherapy
Women/Children Clinic and Supporting Facilities In Patient Facilities Operating Room/Delivery Room UGD NICU