Barriers in Implementing Regulations of Physician Performance Assessment in Private General Hospital around Medan City Arfah Mardiana Lubis and Puteri Citra Cinta Asyura Nasution Public Health Faculty, University of North Sumatera, Indonesia

Medical Errors in healthcare industries USA = 44.000 to 98.000 deaths of medical errors every year. North Carolina hospitals =1.000 patients every day. Indonesia= 2006 to 2012  182 cases of medical errors caused by physicians.  Jakarta, Bandung, Tangerang, and Medan Indicates poor performance of physicians in practicing healthcare service Solved  Cinical Governance  implementing the clinical performance evaluation pillars = obligate healthcare service centers to arrange a performance indicator of assessment including physician performance assessment

Previous research on 20 private hospitals in Medan 10 private general hospitals around Medan city do not have sheet of physician performance assessment breaks the rules the Ministry of Health Regulation number 775 year 2011 obligates the medical commitees of hospitals to reverify the validity of their medical staff competence and the Hospital Accreditation Standard Version of 2012 hospitals have to evaluate the quality and security of clinical care which is given to their staffs continuously WHY ???

METHOD Survey research  Qualitative Interviewing medical committees of 10 private general hospitals around Medan city which do not have sheets of physician performance assessment. The data are analysed by using various theories and results of relevant researches.

RESULT AND DISCUSSION the physicians are not permanent employees (part time) (2 Hospital) There is no excuse  decision of the Minister of Health of the Republic of Indonesia number 631/MENKES/SK/IV/2005 about Medical Staff Bylaws in hospital  point 3.1.1. and 3.1.11 performance assessment must be conducted for physician who working in the hospital, whether working full-time or part time

RESULT AND DISCUSSION 2. yet Accreditation in 2012 and has not been cooperated with BPJS (2 hospital)  General Directorate of Health Efforts Development’s data recapitulation, there are 1.199 from 2.164 active hospitals which are accredited There is no excuse Law No. 44 of 2009 about hospital, clause 40 in an effort to improve the quality of hospital services must be performed regularly accreditation at least 3 years  If they have the medical committee or personalia  performance assessment for physician can be done

3. lack of time (2 hospital)  one period of performance assessment process takes a long time  many studies have found how to make performance assessment to be more effective and efficient  using technology 4. unwilling to create conflict with physicians ( 1 hospital)  performance assessment bring a negative response : unwillingness to change, refusal, and aggression to the result of the assessment There is no excuse decision of the Minister of Health of the Republic of Indonesia number 631/MENKES/SK/IV/2005 about Medical Staff Bylaws in hospital  point 3.1.11  organizing medical staff mean  "self-governing" in doing "self-control" and "self-discipline". Performance assessment that is conducted by the Director of administrative hospital. While the evaluation concerns the about professionally carried out by the Medical Committee

7. 2 hospital  plan to organize physician performance assessment. 5. being unaware of the benefits of performance assessment (1 hospital)  socialization benefits of performance assessment 6. 2 hospital  the assessment is not applied intensively; it is only daily surveillance  subjectivity since there are no reliable and valid standard of the assessment 7. 2 hospital  plan to organize physician performance assessment. The absence of the physician performance assessment brings the question of healthcare service quality that the patients get due to professional and procedural standard according to the regulation which causes its inability to reduce the number of medical errors by physicians.

Acknowledgment SUGGESTED The medical commitees in each private hospitals in Medan to reverify a valid proof of their functional medical staffs’ competence continuously according to the regulation Department of Health Medan  supervise Acknowledgment Thanks to University of North Sumatera that has funded this research (Bidang Keunggulan Akademik USU) through Non-PNBP fund for Fiscal Year 2016.

Thank you