The Effect of Service Standards and Clinical Pathways Application on Commitments and Performance of Doctor in Charge in Dr. Loekmonohadi General Hospital, Kudus

Abstract

Abstract: Background: Accumulating evidence showed that the bad occupancy rate at the Dr. Loekmonohadi General Hospital, Kudus dropped to 75.06% in 2018. Interestingly, the value of the bad occupancy rate is much lower than in the previous two years. The elderly patient visitation data in 2018 also decreased (10,503 patients) compared to 2017. Importantly, the doctor in charge had the task to implement service standards, clinical pathways, commitments, and improving their performance optimally. This study aims to analyze the effect of the application of minimum service standards and clinical pathways to the commitment and performance of the doctor in charge of inpatient services at the Dr. Loekmonohadi General Hospital, Kudus. Methods: This research is explanatory research followed by survey methods. The population in this study were 198 nurses. Approximately 126 samples were taken based on existing inpatient rooms. Accordingly, the variables studied included the application of service standards, clinical pathways, commitment, and performance. Variable measurements are carried out through indicators developed based on the National Standards for Hospital Accreditation. The instrument of data collection is a questionnaire developed based on each exogenous and endogenous variable. Data collection is done by giving questionnaires to respondents. Data analysis was performed using the Structural Equation Modeling approach with Lisrel 8.80 software. Results: Based on our observation, the application of service standards, clinical pathways, commitments, and performance criteria of the doctor in charge at Dr. Loekmonohadi General Hospital, Kudus is good. However, there are still disadvantages in several aspects such as non-compliance with visiting hours (15.9%), not adhering to the diagnosis (11.1%), not adhering to providing education to patients during treatment and returning time (21-23%), length of stay still exist (11.1%), lack of commitment (11-19%), and poor performance (7-27%). The results of the analysis with Structural Equation Modeling show that clinical pathways significantly influence commitment with a coefficient value of 0.93; clinical pathways have a significant effect on performance with a coefficient of 0.45; commitment has a significant effect on performance with a coefficient of 0.49; and clinical pathways have an indirect and significant effect on performance through commitment with a coefficient of 0.49. Conclusion: This study concludes that clinical pathways influence the commitment and performance of the doctor in charge at the Dr. Loekmonohadi General Hospital, Kudus.