"A Man can't make a mistake can't make anything"

Tuesday, 21 February 2012


(Library research)


Dr.Herry Setya Yudha Utama, SpB, MHKes, FInaCS




         The hospital is an organization that is very different and very unique compared to other institutions. Hospital organization is very complicated, because the set of all policies and activities which consist of different work units in the role, duties and responsibilities, but shall cooperate in conducting comprehensive health care in hospitals [1] . Doctors and hospitals play a role as provider of healthcare services, while patients act as recipients of healthcare services. Implementation of the relationship between doctors, patients and hospitals are always governed by certain rules to implement the harmony in the relationship occurred. These rules are set forth in rules established in a special hospital for the benefit of the hospital in question [2] .
The physician and patient, physician and hospital relationships and relationships with hospital patients, visits from his legal relationship is mutually agreed to bind themselves in carrying out the treatment which is known as the engagement (Verbentenis). Engagement generally used as the legal relationship on the engagement effort ( inspanning verbentenis ) which is an attempt to achieve optimum health care for the patients treated, not a result of the engagement ( resultaat verbentenis ).
To protect patients and the public in need of treatment and to avoid violations, negligence of duty of care by doctors and hospitals.
Hospitals should have rules to protect patients from that hospital practices are not feasible to operate, to protect health workers from the dangers posed by the hospital, to protect the public from the impact of the hospital environment, controlling the functions of the hospital in the right direction, improving the quality of hospital , harmonize services at the hospital with government programs in health and other - other.
Regulations hospitals must meet various criteria, among others, can answer all the challenges that arise in the practice of medicine in the era of globalization, can answer all the challenges that arise in the management of hospitals, forms a well-integrated setting, monitoring and built it clear shape and to optimize performance in empowering potential of the profession as well as related institutions [3] . 
Therefore, home-sick is the existence of a guideline as regulations to carry out the internal rules berlaku.di hospitals there are three functional units like the so-called three pillars representing the owner or owners, directors and medical staff, it must exist is set properly so that hospitals can have good governance between Corporate Governance and Clinical Governance [4] , the government issued a regulation of the Minister of Health 772/Menkes/SK/VI/2002 number of Hospital Internal Regulation Code (Statute of the House-Pain or the Hospital bylaws ). Also Minister of Health of the Republic of Indonesia Number 631/MENKES/SK/IV/2005 on Guidelines for Internal Regulations Medical Staff (Medical Staff bylaws ) in the hospital [5] .

         A decade back, confusion and sense of understanding of the term hospital bylaws in Indonesia is still much beloved, so let alone have all the hospitals in Indonesia have had a hospital bylaws, which really just do not understand much. At the hospital bylaws are very important in the life cycle weakly layperson.
            Now the layperson, sickly man had enough to understand the terminology hospital bylaws so they no longer understood as ambiguous as all forms of internal regulations that exist in or are made ​​by the hospital, but was limited to the basic rules or statutes alone.Therefore, the terminology of hospital bylaws need to be distinguished by the term rule and regulation in many ways, among others in terms of matter (substance) and body (authority) who has the authority to authenticate it.

If material hospital bylaws still contains principles that are common (general principles) then the rule and regulation has begun to load things that are more specific to the needs of the implementation of the general principles contained in the hospital bylaws .When the hospital bylaws must be approved by the g overning board [6] or an equivalent body (as the highest authority representing the owner) then the rules and regulations aresufficient by the executive (ie the hospital component which is responsible for daily management). Like the hospital bylaws that a law is the rule and regulation is an implementing regulation to the law (which is abstract, general and passive) become more operational in order to complete various tasks and real problems in the hospital.
Concretely, when in the hospital bylaws written provision which authorizes the executive to establish the right hospital clinic (clinical privileges) [7] to every member of staff who joined the clinic in the hospital coupled with other rules and code of ethics to fit a standard [ 8] , the provisions in the basic rule was to be followed up by the executive to make rules and regulations about the procedure of granting it to be used as operational guidelines. And of course, rule and regulation pertaining to the clinic staff must not conflict with the provisions of the hospital bylaws to remember the rules is the latter that will be won when there is conflict between the parties concerned.
In addition the material must not be contradictory, making management of rule and regulation itself must also not violate the existing guidelines for the manufacture of thehospital bylaws . Therefore, in the hospital bylaws should also be noted that the articles contain general principles that must be complied with by the executive in making rules and regulations; example of anyone who may submit a draft (draft) and who is authorized to authenticate it, when to take effect , for how long each is reviewed and revised as well as anyone who may propose amendments.
The question now is, how to formulate bylaws hospital is good and right so that the basic statutes or regulations from the point of formal juridical- effective? Of course, makinghospital bylaws not as easy as we want, a lot of "wound twists" it. [9]
            Health services in hospitals continue growing with the increasing variety of medical specialties. This is when it is not set correctly will lead to a sharp intersection between the owners, management, medical staff, other health professionals and patients that can degrade the image of health care in the hospital.
            Internal regulations of the medical staff, and other internal regulations in the hospital should be made ​​to avoid the problems that will arise from all aspects of the functional unit of the good relationship with the directors, the medical staff, other health professionals and patients, of course, must refer to the parent legislation the Hospital bylaws. In Indonesia developed a variety of hospitals with different ownership status. Broadly speaking hospitals in Indonesia can be divided by 2 is a hospital run by the Government and the hospital staff and are operated by private parties.  Of course there are differences between the Hospital bylaws in government hospitals [10] with private hospitals, not of the material in legeartis but the difference of the substance that is because:
A. Factors and hospital ownership status of the Agency statute.
2. Model Governing Board or the Governing Body [11] or the Board of supervisors / Trustees.
3. Vision and mission.
4. Differences in organizational structure and Corporate Culturnya.
5. Committee of Medical Model organization formed, role, duties and authority.
6. Employment Status of Medical staff (doctors).                                                  
7. House-type illness

A. Is there a difference between hospital Bylaws in government hospitals to private hospitals?
2. What are the factors causing the difference between the hospital Bylaws in government hospitals to private hospitals?
3. Why the difference between the hospital Bylaws in government hospitals to private hospitals?

To get an idea Hospital bylaws are good and right so as to be a reference to hospital-similar hospitals so as to improve the quality of layperson weakly in Indonesia.



[1] . White, The Hospital Medical Staff, Delmar Publishers,Albany New York, 1997.

[2] Sofwan Dahlan, " Health Law, beacons for the Profession Doctor ", ed. 3, the Agency Publisher Dipenogoro University, Semarang, 2005.

[3] C. Vincent et All, Medical Accidents,Oxford University Press,London, 1993.
[4] Samsi Jacobalis, Model Formulation Hospital Bylaws for the RS in Indonesia, Workshop on Hospital Bylaws I, PERSI cab. Central Java,Semarang , March 2002.
[5] See Regulation of the Minister of Health 772/Menkes/SK/VI/2002 number of Hospital Internal Regulation Code (Statute of the Home-Hospital or Hospital bylaws ). Also Minister of Health of the Republic of Indonesia Number 631/MENKES/SK/IV/2005 on Guidelines for Internal Regulations Medical Staff ( Medical Staff bylaws ) in the hospital.
[6] Cyril O. Houle, Governing Board, Jossey-Bass Publishers,San Francisco, 1997

[6] Herkutanto, workshop Hospital Bylaws II, Directorate General YanMed Ministry of Health, Jakarta, July 2002.

[7] Saint John's Hospital, Bylaws, rules and regulation of the medical staff,Santa Monica, 1985

[8] Yan Apul, Efficacy and Mechanism of the Code Enforcement Doctors and Medical Profession,Seminar on Hospital Management & Health Law Issues, Universitas Pelita Harapan in Siloam Gleneagles Hospital, Karawaci, juli1997
[9] Trisno Karmadji,Experience set Hospitalbylaws in health care ST. Carolus, DG Seminar bylaws Yan Med Hospital, Jakarta, 2001
[10] Aulia Sani, Medical Staff Bylaws in RS Government , Hospital Bylaws Seminar and Workshop II, Directorate General YanMed Ministry of Health,Jakarta, July 2002.

[11] The definition of the board, is an organized group of people with the authority to control and foster Collectively an institution is usually administered by That a qualified executive and staff.

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