PENGARUH MOTIVASI TERHADAP KINERJA DOKTER DALAM PENGISIAN REKAM MEDIS DI RUMAH SAKIT UMUM TANJUNG PURA KABUPATEN LANGKAT TAHUN 2009
TESIS
OLEH
WIWIEK AGUSTHIN 077013028/IKM
PROGRAM STUDI S2 ILMU KESEHATAN MASYARAKAT FAKULTAS KESEHATAN MASYARAKAT UNIVERSITAS SUMATERA UTARA MEDAN 2009
Universitas Sumatera Utara
Judul Tesis
: PENGARUH MOTIVASI TERHADAP KINERJA DOKTER DALAM PENGISIAN REKAM MEDIS DI RUMAH SAKIT UMUM TANJUNG PURA KABUPATEN LANGKAT TAHUN 2009 Nama Mahasiswa : Wiwiek Agusthin Nomor Induk Mahasiswa : 077013028 Program Studi : S2 Ilmu Kesehatan Masyarakat Minat Studi : Administrasi Rumah Sakit
Menyetujui Komisi Pembimbing :
(Dr. Endang Sulistya Rini, SE, M.Si) Ketua
(dr. Fauzi, SKM) Anggota
Ketua Program Studi
Dekan
(Dr. Drs. Surya Utama, M.S)
(dr. Ria Masniari Lubis, M.Si)
Universitas Sumatera Utara
Telah diuji Pada tanggal :
2009
PANITIA PENGUJI TESIS Ketua
: Dr. Endang Sulistya Rini, SE, M.Si
Anggota
: 1. dr. Fauzi, SKM 2. Dr. Muslich Lufti, Drs, MBA, IDS 3. dr. Asmui Lubis, M.Kes
Universitas Sumatera Utara
PERNYATAAN
PENGARUH MOTIVASI TERHADAP KINERJA DOKTER DALAM PENGISIAN REKAM MEDIS DI RUMAH SAKIT UMUM TANJUNG PURA KABUPATEN LANGKAT TAHUN 2009
TESI S Dengan ini saya menyatakan bahwa dalam tesis ini tidak terdapat karya yang pernah diajukan untuk memperoleh gelar kesarjanaan di suatu perguruan tinggi, dan sepanjang pengetahuan saya juga tidak terdapat karya atau pendapat yang pernah ditulis atau diterbitkan oleh orang lain, kecuali yang secara tertulis diacu dalam naskah ini dan disebutkan dalam daftar pustaka.
Medan,
2009
(Wiwiek Agusthin)
Universitas Sumatera Utara
ABSTRAK Rekam medik merupakan bukti tertulis tentang proses pelayanan yang diberikan oleh dokter atau tenaga kesehatan lain kepada pasien. Mutu pelayanan kesehatan rumah sakit juga dilihat dari lengkap tidaknya pengobatan dan perawatan yang tercantum dalam rekam medik. Berdasarkan survei pendahuluan yg dilakukan penulis pada bulan April 2009, dari 100 status rekam medis di Rumah Sakit Tanjung Pura, ditemukan 60% ketidaklengkapan pengisian rekam medis, terutama pada lembar dokter jaga, resume, dan anamnesa yang seharusnya diisi oleh dokter yang melakukan tindakan medis. Penelitian ini bertujuan untuk menganalisis pengaruh motivasi intrinsik (prestasi, pengakuan orang lain, tanggung jawab, peluang untuk maju, kepuasan kerja), dan ekstrinsik (kompensasi, keamanan dan keselamatan kerja, kondisi kerja, prosedur kerja, mutu supervisi teknis, interpersonal) terhadap kinerja dokter dalam pengisian rekam medis. Populasi adalah dokter umum dan dokter spesialis di Rumah Sakit Umum Tanjung Pura yang berjumlah 30 orang, yang semuanya dijadikan sebagai sampel. Data dikumpulkan dengan kuesioner, dan dianalisis menggunakan uji regresi linier berganda. Hasil penelitian menunjukkan bahwa terdapat pengaruh variabel prestasi, peluang untuk maju, kompensasi, prosedur kerja dan mutu supervisi teknis terhadap kinerja dokter dalam pengisian rekam medis. Variabel yang tidak berpengaruh adalah pengakuan orang lain, tanggung jawab, kepuasan kerja, keamanan dan keselamatan kerja, kondisi kerja, serta interpersonal terhadap kinerja dokter dalam pengisian rekam medis. Kepada manajemen Rumah Sakit Tanjung Pura disarankan untuk membuat sebuah sistem reward dan punishment berdasarkan kinerja dokter dalam kelengkapan rekam medis; mengaktifkan komite medis guna meningkatkan standar pelayanan dan mengevaluasi pelaksanaan rekam medis; membuat kebijakan dalam proses pengembangan karir dan promosi yang mengacu pada kompetensi dokter dan sistem kepangkatan Kata kunci: Rekam Medis, Motivasi, Kinerja dokter.
Universitas Sumatera Utara
ABSTRACT
Medical Record is written proof about service processing that given by doctors or others health officer to the patient. The quality of health services in a hospital also can be showed by the completeness or incompleteness of medical and nurcing on the medical record. Based on preliminary survey that had been done on April 2009, from 100 medical records in Tanjung Pura Hospital, it had been found 60% incompleteness of filling out medical record, specially to guard’s doctor report sheet which is working on, resume and patient’s anamnese. The purpose of this research is to analyze the influence of intrinsic motivations (achievement, recognition, responsibility, advance opportunities, job satisfaction) and extrinsic motivations (reward, job security and safety, job condition, job procedure, technical supervise quality, interpersonal relationship) on doctor’s performance in filling out the medical record. The population of this study were 30 doctor’s in Tanjung Pura Hospital and all of them were selected to be samples in this study. The data were collected by using questionnaire and the data obtained were analyzed through multiple linier regression tests. The result of this research showed that achievement, advance opportunities, reward, job procedure, technical supervise quality and had an influence on doctor’s performance in filling out the medical record. The recognition, responsibility, job satisfaction, job security and safety, job condition, and interpersonal relationship did not have any influences on doctor’s performance in filling out the medical record The management of Tanjung Pura hospital is suggested to make the reward and punishment system based on doctor’s performance in filling out the medical record; to activate medical committee, include to increases service standard and evaluate medical record activities; make a policy in the process of career development and promotion referred to the doctor’s competency and the rank system. Keyword: Medical record, motivation, doctor’s performance
Universitas Sumatera Utara
KATA PENGANTAR
Segala puji dan syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa, atas segala berkat dan kasih-Nya sehingga penulis dapat menyelesaikan tesis ini dengan judul : “Pengaruh Motivasi terhadap Kinerja Dokter dalam Pengisian Rekam Medis di Rumah Sakit Umum Tanjung Pura Kabupaten Langkat Tahun 2009”. Penulisan
ini
merupakan
salah
satu
persyaratan
akademik
untuk
menyelesaikan pendidikan Program Studi S2 Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat Universitas Sumatera Utara Medan. Penulis menyadari bahwa dalam penyusunan tesis ini masih terdapat kekurangan-kekurangan, namun demikian penulis menyadari bahwa penulisan ini tidak dapat terselesaikan dengan baik tanpa bantuan dan kerja sama dari berbagai pihak. Oleh karena itu, pada kesempatan ini penulis ingin menyampaikan ucapan terima kasih yang tidak terhingga kepada : Dr. Endang Sulistya Rini, SE, M.Si, selaku ketua komisi pembimbing dan dr. Fauzi, SKM, selaku pembimbing kedua, yang penuh perhatian, kesabaran dan ketelitian dalam memberikan bimbingan, arahan, petunjuk sepenuhnya, sehingga sampai selesainya penulisan tesis ini. Tak lupa juga penulis mengucapkan terima kasih yang sebesar-besarnya kepada semua pihak yang turut membantu penyusunan tesis ini, terutama kepada : 1. Prof. dr. Chairuddin P. Lubis, DTM&H, Sp.A (K), Rektor Universitas Sumatera Utara.
Universitas Sumatera Utara
2. dr. Ria Masniari Lubis, M.Si, Dekan Fakultas Kesehatan Masyarakat Universitas Sumatera Utara Medan. 3. Dr. Drs. Surya Utama, M.S, Ketua Program Studi S2 Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat Universitas Sumatera Utara Medan. 4. Prof. Dr. Dra. Ida Yustina, M.Si, Sekretaris Program Studi S2 Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat Universitas Sumatera Utara Medan. 5. Dr. Muslich Lufti, Drs, MBA, IDS komisi penguji yang telah banyak memberikan arahan dan masukan demi kesempurnaan penulisan tesis ini. 6. dr. Asmui Lubis, M.Kes, selaku komisi penguji yang telah memberikan masukan dalam penyempurnaan tesis ini. 7. dr. Agus Nadi Talah, Sp.A, Direktur Rumah Sakit Umum Tanjung Pura beserta jajaran yang telah membantu dan memberikan izin penelitian. 8. Seluruh staff pengajar Program Studi S2 Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat Universitas Sumatera Utara yang telah memberikan ilmu pengetahuan yang sangat berarti selama penulis mengikuti pendidikan. 9. Ayahanda, ibunda, kakanda dan adinda yang tidak pernah berhenti memberikan dukungan kepada penulis, pada kesempatan istimewa ini penulis mengucapkan terima kasih tidak terhingga, karena berkat doa dan restu mereka penulis dapat menyelesaikan pendidikan ini. 10. Rekan-rekan satu angkatan yang telah memberikan masukan dan saran serta kritikan untuk kesempurnaan tesis ini.
Universitas Sumatera Utara
Akhirnya penulis menyadari atas segala keterbatasan, untuk itu saran dan kritik yang membangun sangat penulis harapkan demi kesempurnaan tesis ini dengan harapan, semoga tesis ini bermanfaat bagi pengambil kebijakan di bidang kesehatan, dan pengembangan ilmu pengetahuan bagi penelitian selanjutnya.
Medan, 2009 Penulis
(Wiwiek Agusthin)
Universitas Sumatera Utara
RIWAYAT HIDUP Wiwiek Agusthin, lahir pada tanggal 4 Agustus 1983 di Kabupaten Aceh Tamiang Provinsi Nanggroe Aceh Darussalam, berjenis kelamin perempuan, beragama Islam, bertempat tinggal di Jalan Tanjung No. 10 B KPR BTN Kecamatan Karang Baru Aceh Tamiang. Riwayat Pendidikan, SD Negeri 1 Kuala Simpang (1989-1995), Pesantren Al-Kausar Al-Akbar Medan (1995-1998), SMU Negeri I Kejuruan Muda (19982001), Fakultas Kedokteran Univesitas Islam Sumatera Utara (2002-2008), Pascasarjana USU Medan Program Studi Administrasi Kebijakan Administrasi (2007-2009).
Universitas Sumatera Utara
DAFTAR ISI Halaman ABSTRAK ······································································································ ABSTRACT ······································································································· KATA PENGANTAR ····················································································· RIWAYAT HIDUP ························································································· DAFTAR ISI ··································································································· DAFTAR TABEL ··························································································· DAFTAR GAMBAR ······················································································· DAFTAR LAMPIRAN ···················································································
i ii iii vi vii x xii xiii
BAB I
1 1 8 8 8 9
PENDAHULUAN ············································································· 1.1. Latar Belakang ··········································································· 1.2. Perumusan Masalah ··································································· 1.3. Tujuan Penelitian ······································································· 1.4. Hipotesis ···················································································· 1.5. Manfaat Penelitian ·····································································
BAB II TINJAUAN PUSTAKA ··································································· 2.1. Rekam Medis ············································································ 2.1.1. Pengertian Rekam Medis ·············································· 2.1.2. Kegunaan Rekam Medis ················································· 2.1.3. Peran Dokter Dalam Pengisian Rekam Medis ··············· 2.2. Motivasi ····················································································· 2.2.1. Pengertian Motivasi ························································ 2.2.2. Klasifikasi Motivasi ························································ 2.2.3. Usaha Pembangkitan Motif ············································ 2.2.4. Motivasi Merupakan Pola Prilaku ··································· 2.2.5. Prinsip dalam Memotivasi Kerja Pegawai ······················ 2.3. Kinerja ······················································································· 2.3.1. Faktor yang Mempengaruhi Kinerja ······························ 2.4. Landasan Teori ·········································································· 2.5. Kerangka Konsep Penelitian ······················································
10 10 10 10 13 17 17 19 22 23 24 25 25 28 29
BAB III METODE PENELITIAN ································································· 3.1. Jenis Penelitian ·········································································· 3.2. Lokasi dan Waktu Penelitian ······················································ 3.3. Populasi dan Sampel ·································································· 3.4. Metode Pengumpulan Data ························································
30 30 30 30 31
Universitas Sumatera Utara
3.4.1. Uji Validitas ··································································· 3.4.2. Uji Reliabilitas ································································ 3.5. Variabel dan Definisi Operasional ············································· 3.5.1. Variabel Independen ······················································· 3.5.2. Variabel Dependen ·························································· 3.6. Metode Pengukuran ···································································· 3.6.1. Pengukuran Variabel Motivasi ······································· 3.6.2. Pengukuran Variabel Kinerja ·········································· 3.7. Metode Analisis Data ·································································
31 33 33 33 35 36 36 37 38
BAB IV HASIL PENELITIAN ······································································ 4.1. Deskripsi Lokasi Penelitian ······················································ 4.2. Karakteristik Responden ··························································· 4.3. Karakteristik Motivasi ······························································ 4.4. Karakteristik Kinerja ································································· 4.5. Hasil Analisis Statistik ······························································
39 39 43 44 58 59
BAB V PEMBAHASAN ················································································· 5.1. Pengaruh Motivasi Berprestasi Terhadap Kinerja Dokter dalam Pengisiam Rekam Medis ··············································· 5.2. Pengaruh Motivasi Pengakuan Orang Lain terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.3. Pengaruh Motivasi Bertanggung Jawab terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.4. Pengaruh Motivasi akan Peluang untuk Maju terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.5. Pengaruh Motivasi akan Kepuasan Kerja terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.6. Pengaruh Motivasi mendapat Kompensasi terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.7. Pengaruh Motivasi akan Keamanan dan Keselamatan Kerja terhadap Kinerja Dokter dalam Pengisian Rekam Medis ········· 5.8. Pengaruh Motivasi akan Kondisi Kerja terhadap Kinerja Dokter dalam Pengisian Rekam Medis ····································· 5.9. Pengaruh Motivasi akan Prosedur Kerja terhadap Kinerja Dokter dalam Pengisian Rekam Medis ···································· 5.10. Pengaruh Motivasi Tentang Mutu Supervisi Teknis terhadap Kinerja Dokter dalam Pengisian Rekam Medis ························ 5.11. Pengaruh Motivasi akan Hubungan Interpersonal terhadap Kinerja Dokter dalam Pengisian Rekam Medis ························
62 62 63 65 67 68 70 72 74 75 76 78
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BAB VI KESIMPULAN DAN SARAN ·························································81 6.1. Kesimpulan ···················································································81 6.2. Saran ·····························································································82 DAFTAR PUSTAKA ······················································································83
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DAFTAR TABEL
No
Judul
Halaman
3.1.
Hasil Perhitungan Validitas ·····························································
29
3.2.
hasil perhitungan reliabilitas ·····························································
31
3.3.
Skala Pengukuran Variabel Motivasi ···············································
34
4.1.
Distribusi Pegawai Berdasarkan Fungsional di RSUD Tanjung Pura Kabupaten Langkat tahun 2007 ························································
38
Kinerja Rumah Sakit Umum daerah tanjung Pura Kabupaten Langkat tahun 2007 (90 TT) Berdasarkan Standar Baku Nasional ···
38
Distribusi Responden Berdasarkan Karaktersitik Umur, Jenis Kelamin, Lama Bekerja, Dan Status Perkawinan ·····························
41
4.4.
Distribusi Responden Berdasarkan Prestasi ······································
42
4.5.
Distribusi Responden Berdasarkan Kategori Prestasi ·······················
43
4.6.
Distribusi Responden Berdasarkan Pengakuan orang Lain ·············
43
4.7.
Distribusi Responden Berdasarkan Kategori pengakuan Orang Lain
44
4.8.
Distribusi Responden Berdasarkan Tanggung Jawab ·······················
45
4.9.
Distribusi Responden Berdasarkan Kategori Tanggung Jawab ········
46
4.10.
Distribusi Responden Berdasarkan Peluang Untuk Maju ·················
46
4.11.
Distribusi Responden Berdasarkan Kategori Peluang Untuk Maju ··
47
4.12.
Distribusi Responden Berdasarkan Kepuasan Kerja ·························
48
4.13.
Distribusi Responden Berdasarkan Kategori Kepuasan Kerja ··········
49
4.14.
Distribusi Responden Berdasarkan Kompensasi ······························
49
4.2. 4.3.
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DAFTAR GAMBAR
No
Judul
Halaman
1.
Kerangka Konsep Penelitian ··································································
29
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DAFTAR LAMPIRAN
No
Judul
Halaman
1. Kuesioner Penelitian ··················································································
86
2. Hasil Uji validitas dan reliabilitas ······························································
91
3. Hasil uji regresi berganda ··········································································
103
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