Application of Total Quality Management in Health Care of hajj (Tasikmalaya County)


Authors: H. Syarhan, dr., MM. Dinkeskab Tasikmalaya

CHAPTER I

INTRODUCTION

In the midst of a global era characterized by the increasingly sharp competition and changing business environment is moving fast, pragmatic and tend to be unpredictable, requires each organization to increase its competitiveness. In addition, customers also increasingly strong demands on quality products and services, along with a number of alternative goods and services that are available and meningkatkanya knowledge and social status. (2)

The service sector are now growing rapidly is the health service, amid increasing public awareness of understanding of the word “healthy” as part of their investment in the future. Organizations engaged in health are scientifically almost have a similar working procedure. This means that technically the handling of patients in various conditions almost terstandarkan with the same procedure. Therefore, service quality improvement is now no longer solely on technical quality that is part of the “way to life” health care, but leads on how to manage health services that have competitive power in the eyes of users of its service by fulfilling wishes (Quality).

The concept of quality has been defined by experts from various points of view respectively. However there is an equation that essentially lead to efforts to comply with consumer expectations. Consumers’ expectations are not constant over time, but always changed dynamically, so what is the consumer expectation at this present moment may not be an option for the future and will also mean that the quality of products and services at this time may not be qualified again in the future.

Tjiptono (2001) explains that the quality is the dynamic conditions associated with products, services, people, processes that meet or exceed customer expectations. From this definition it is clear that the quality is not solely related to the final product, but the quality is also related to the quality of the process, even more so in the service industry that puts the quality of interaction between the service user with a front line officer who is the spearhead in the quality of the service industry. From the definition it is also clear that most users are entitled to claim jasalah quality by comparing what they expect with perceptions of receiving these services (perceived performance).

Such conditions will spur the development of health services in this health services for pilgrims (CJH). The intensity of interaction CJH as service users with lines of health organizations will illustrate the extent to which the government as a provider capable of providing adequate health services and satisfying CJH.

Hajj Operation aims to provide guidance, care and protection as well as possible through the implementation of an integrated management system and for the implementation of the Hajj to walk with a safe, orderly, smooth, and comfortable fit the demands of religion and pilgrims to perform Hajj on their own in order to obtain Mabrur pilgrimage. Health services for CJH in Tasikmalaya Regency is considered not optimal It is indicated there are still many complaints relating to health care for CJH.

Application of the principles of economic management in health services, have long occurred. How efficient health services and quality without reducing its portion as a social activity. CJH service capacity for transformation towards demand management changes, called ‘Total Quality Management’. The implementation of TQM means of quantitative methods and knowledge for humanity, 1. Improving the material and services which become inputs to the organization, 2. Fix all critical processes within the organization, 3. Improve efforts to meet the needs of the users of products and services at present and in the future. (4)

TQM is a management approach within an organization, focusing on quality and based on the participation of the entire human resources and aimed at long-term success through customer satisfaction and provide benefits to the members of the organization (human resources) and community TQM also be translated as a customer-oriented approach introduce a systematic change management and continuous improvement of processes, products, and services an organization. TQM process has specific inputs (wants, needs, and expectations of customers), transform (processing) input in the organization to produce goods or services that in turn give satisfaction to the customer (output).

The main objective of Total Quality Management is the improvement of service quality continuously. Thus, also own Quality Management should be carried out continuously. Since the 1950’s mindset about the integrated quality or TQM has appeared on the American mainland and Japan and finally Koji Kobayashi, one CEO of NEC, claimed to be the first to popularize TQM, which he did at the time of giving a speech at the Deming prize awards in 1974 (Deming prize, established in December 1950 in honor of W. Edwards Deming, was Originally Designed to reward Japanese companies for major advances in quality improvement. Over the years it has Grown, under the guidance of Japanese Union of Scientists and Engineers (JUSE) to Nowhere it is now Also available to non-Japanese companies, albeit usually operating in Japan, and Also to individuals recognised as having made major contributions to the advancement of quality.)

Many Japanese companies that obtain the global success due to a very high quality product to market. Companies / organizations that want to follow the race / compete to profit / benefit there is no other way but to apply the Total Quality Management. Philip Kolter (1994) says “Quality is our best assurance of customer allegiance, our strongest defense against foreign competition and the only path to sustained growth and earnings.”
In Japan, TQM are summarized into four steps, as follows.
– Kaizen: continuous process focused on improvisation (Continuous Improvement) so that the process that occurs in the organization become visible (visible), repeatable (can be done repeatedly), and measurable (measurable).
– Atarimae Hinshitsu: focus on the intangible effects on processes and optimization of the securities.
– Kansei: researching how to use products by consumers to improve the quality of the product itself.
– Miryokuteki Hinshitsu: tactical management that are used in products that are ready to be traded. Application of Total Quality Management facilitated by several tools, which
often called a “tool of TQM”. These tools help us analyze and understand the problems and help create a plan. Eight TQM tool described is as follows.
1. Brainstorm (brainstorm)-Brainstorming
Brainstorming is a planning tool that can be used to develop the creativity of the group. Brainstorming is used, among others, to determine possible causes of a problem or to plan the steps of a project.
2. The flow chart (process flow chart)
Process flow chart is one tool used in planning and analysis, among others, to compile a picture step by step process for the purpose of analysis, discussion, or communication and to find areas of improvement in the process.
3. SWOT Analysis
SWOT Analysis is an analytical tool used to analyze the problems with the framework Strengths (strength), Weaknesses (weakness), Opportunities (opportunities), and Threats (threats).
4. Ranking preferences
This tool is a tool of interpretation that can be used to select the ideas and problem solving among several alternatives.
5. Fishbone analysis
Analysis of fish bone (also known as cause-effect diagram) is an analysis tool, among others, to categorize the various potential causes of a problem and analyze what actually happens in a process.
6. Critical appraisal
Critical appraisal is a tool of analysis that can be used to check each process manufacturing, assembly, or services. This tool helps us to think about whether the process
that are necessary, appropriate, and whether there is a better alternative.
7. Benchmarking
Benchmarking is the process of data collection and analysis of our organization and compared to the situation in other organizations. The result of this process will be a benchmark to improve our organization on an ongoing basis. The purpose of benchmarking is how our organization can be expanded to become the best.
8. Diagram analysis power field (field strength)
Diagram of the power field is an analytical tool that can be used, among others, to identify the various obstacles in achieving a target and identify a variety. (3)

Thus, TQM is an approach that should be implemented by today’s organization to improve the quality of ‘output’. Discussion of this paper is how to implement (Application) TQM in the health services for CJH on Tasikamalaya District Health Office.

Reform of health development is marked by the launching of ‘Healthy Indonesia 2010’ as a vision of health development has established a new paradigm in health development in Indonesia. Development paradigm that prioritizes the health of health care that is curative and rehabilitative, turned into a health paradigm that more priority to health promotion and preventive efforts without ignoring curative and rehabilitative health efforts. Similarly, in terms of health development plan, which had more top-down with budgeting oriented and turned into a bottom-up planning with eviden basednya.

Granting local autonomy in accordance with Law No.32 of 2004 on Regional Government and Law No.25 of 1999 on financial balance between central and local governments are basically aimed to improve services and better community welfare, to develop a democracy that is fair and equitable and memlihara harmony and harmonious relationships between central and local as well as between regions in order to maintain the integrity of the unitary state of Indonesia.

The concept of autonomy must always be associated with the delegation of authority from central government to the regions to create or menperkuat Local Government so that all activities relating to the area to be organized and implemented with their own abilities.

To realize the above Tasikmalaya regency government has set its vision, namely: “Tasikmalaya the Islamic religious, as a developed and prosperous district as well as competitive in the field of agribusiness in West Java in 2010”.

To achieve the vision that has been established, the mission formulated Tasikmalaya regency government as follows:

1. Realising human resources as well as faithful and devoted berakhlakul karimah.
2. Achieve the quality of human resources and independent.
3. Realizing good governance and clean government.
4. Realize local development through community empowerment.
5. Achieve regional economic growth through agribusiness development, supported by other sectors.
6. Brought processing spatial and sustainable land and environmentally sound.

Linkage to health development, stated in the mission to-2 that is: “Creating an intelligent human resources and healthy” with the goal to be achieved are: Increasing the degree of public health and nutrition that is supported by the independence of the community. With the measures taken are “Improving the quality of health services through the following programs:

1. Program to improve health services management, formation and health resources.
2. PPM Program and kesling.
3. Service programs and health coaching family.
4. Development program and health promotion programs.

Department of Health as the regional body which was given trust and responsibility in the health sector, with reference to the vision and mission of the Health Department has set a vision of “healthy Tasikmalaya 2010″ means the year 2010 is expected every Tasikmalaya District residents have had affordability or accessibility to health services individuals and communities for healthy living through community self-reliance.

Tasikmalaya District Health Mission

To achieve this vision the Tasikmalaya District Health Department describe through 5 missions, namely:

1. Guarantee affordability of quality health care efforts and evenly on the community.
2. Creating opportunities for everyone to develop healthy living.
3. Encouraging self-reliance of individuals, families and communities to live healthy and productive.
4. Develop the ability of district governments to develop a healthy district.
5. Establish partnerships to achieve improved health status.

Tasikmalaya District Health Strategy

Meanwhile, to achieve the Vision and Mission are drafted several strategies, namely:

1. Tasikmalaya District Development with vision health.
2. Professional development of health personnel.
3. Development of Community Health Insurance (Managed Care)
4. Decentralization.

Tasikmalaya District Health Department Policy

The policy set associated with the instrument, its scope, objectives, goals and berpenetapan in the use of available resources. Tasikmalaya District Health Department policy is as follows:

1. Increase efforts to quality health services at all facilities / places where health services.
2. Improving environmental quality and hygiene and healthy.
3. Improving the effectiveness of efforts to eradicate infectious diseases.
4. Improving the quality of family health efforts to realize a healthy family, independent and qualified human resources.
5. Improving health management accountable health plan based on facts, strengthening health systems and health human resources.

Tasikmalaya District Health Service Program

The health programs are implemented, namely:

1. Program to improve the quality of health services include primary health care, specialized health services, health service referrals, health promotion and health financing systems (Managed Care).
2. Communicable disease eradication programs include animal sourced disease eradication, combating infectious diseases directly, disease prevention and disease observations.
3. Program to improve environmental health include environmental monitoring and water quality, environmental sanitation settlements, restructuring public places and industrial, food and beverage sanitation.
4. The program includes the development of family health and child health (MCH), adolescent health, geriatric health and community nutrition.
5. Drug surveillance program and hazardous materials.
6. Health care management quality improvement program includes the development of policies, health law and public relations, development and utilization of health facilities, health facilities and infrastructure development and development of health information systems.

3. Target Program Tasikmalaya District Health Office

The program targeted Tasikmalaya District Health Office, namely:

1. Increased access of population to basic health services and referral from government health facilities
2. The realization of the development of health care facilities according to needs and demands of society
3. The increase of clean and healthy living, health efforts and ensuring community berswadaya Managed Care
4. Implementation of rational drug use
5. Terksananya environmental health efforts throughout the neighborhoods, public places and industries that involve community participation and the potential for private sector
6. Realization decrease morbidity and mortality due to communicable diseases and outbreaks
7. Increased nutritional and health status of mothers, children, adolescents and elderly people

Special Health Section

One of the roles and responsibilities of special health section is to conduct health services for Hajj pilgrims Candidate (CJH). These activities through the stages that have been standardized nationally and internationally (OIC).

CHAPTER II

LITERATURE REVIEW

2.1. Health Care Policy for CJH

Health is the capital of the pilgrimage journey, without adequate health conditions undoubtedly the achievement of religious ritual to be not optimal. Therefore each CJH must have adequate physical ability (Isthito’ah in aspects of health). Implementation of health policy pilgrimage with risk management is an effort to be able to manage all the health problems of each of the stages CJH through screening efforts and health guidance that hosted early as possible. (2)

As the implementation of Law No.17 of 1999 on Implementation of Hajj, which states that the guidance and health services pilgrimage, either during preparation or execution of the implementation of the pilgrimage made by the Minister whose scope, duties and responsibilities include the areas of health. Health Department seeks to prepare CJH for optimal health status and maintain it for the pilgrims towards the realization of a healthy and independent. (2)

Prospective pilgrims will get a medical examination which serves as a tool to determine the health status and health coaching. The medical examination was conducted 2 (two) phase that is performed by the health center phase I and phase II, conducted in the County / City. (2)

For guidance and ongoing health monitoring on an ongoing basis, qualified in accordance with the standards or procedures, and sustainable, it is necessary to Jemaah Haji Health Books (BKJH) which contains data on the results of a complete medical examination and to describe the health status of CJH. (2)

2.2. Definitions and Significance Quality

In terms of linguistic quality comes from the Latin qualis, which means ‘as fact’. Definition of international quality (BS EN ISO 9000:2000) is the level that indicates a set of inherent characteristics and meet certain size (Dale, 2003:4). Meanwhile, according to the American Society for Quality Control of quality is the totality of the shape and characteristics of goods or services that demonstrate its ability to satisfy the needs of a visible or hidden (Render and Herizer, 1997:92). (4)

Some quality experts define quality with a variety of interpretations. Juran (1989:16-17), simply defines quality as ‘fitness for use’. This definition includes specialty products that meet customer needs and free from deficiencies. While Deming believes quality is the ‘bring together the needs and expectations of consumers in a sustainable manner over the price they have paid’. Deming philosophy of build quality as a system (Bhat and Cozzolino, 1993:106). (4)

Understanding the broader quality (Community Development Worker Productivity, 1998:24-25) are:

1. The perfect degree (degree of exelence): contains the comparative understanding of the level of product (grade) specific.
2. The level of quality (quality level): contains the sense of quality to evaluate

technical.

1. Suitability for use (fitness for purpose, user satisfaction): the ability of the product or service in providing satisfaction to customers.

While the eight dimensions of quality according to Philip Kotler (2000:329-333) are as follows: (1) Performance (performance): operating characteristics of a major product, (2) The characteristics or additional features (features), (3) Reliability ( reliability): probability that a product malfunction or failure, (4) Compliance with the specification (conformance to specifications), (5) Endurance (durability), (6) Ability to serve (serviceability) (7) Aesthetics (estethic): how a product is seen felt and heard, and (8) The accuracy of the perceived quality (perceived quality). (4)

In fact, quality is a concept that is quite difficult to be understood and agreed. Today the word quality has numerous interpretations, can not be defined in a single, and highly dependent on the context. Several definitions of quality based on the context needs to be distinguished on the basis of: the organization, events, products, services, processes, people, results, activities, and communication (Dale, 2003:4).

Further understanding of quality include: product quality (product), quality cost (cost), quality of presentation (delivery), quality of safety (safety), and moral qualities (morale) or often shortened to PCDSM (Community Development Worker Productivity, 1998)

Broadly speaking there are two effective arguments for the importance of quality for the company (Goodman et al, 2000:47): ‘First, quality and service improvements cans be directly linked to enhanced revenue Within one’s own company, and secondly, allows higher quality companies to obtain higher margins. ” 11 Dale (2003:12-20), concluded some survey results that focused on perceptions of the importance of quality products and services, including: public perception of the quality of products and services more widely, increasing the views and the role of top management, quality can not be negotiated ( quality is not negotiable), quality encompasses all things (quality is all-pervasive), the quality increases productivity, affecting the quality of better performance on the market, quality means improving business performance, non-quality costs are high, the consumer is king, quality is the view life (way of life).

2.2.1. Quality of service

Quality of care is one important thing that must be considered by the managers (the company). Especially with the era of globalization which has led to increasing competition, technological advances and the consumer is increasingly critical, requiring companies to pay attention to product quality as well as satisfaction. (1)

In an effort to improve the quality, the company should pay attention to and increase commitment and awareness and the ability of employees and staff, particularly those who will deal directly with consumers. This is because although the system and quality engineering is correct, but if those who implement and tools used are not the right way, then the quality is good and right that are expected will not materialize. (1)

Lethinen and Lethinen (1982) has the premise that the quality of services produced in the interaction between consumers and the elements in a service organization. They used three terms, namely the physical quality (phisical quality), quality of the company (corporate quality) that involve corporate image, and quality of interactive (interactive quality) with respect to personal contacts. (1)

Ovreveit (1992) has been defining quality in health services by distinguishing between the quality of the customer (if the waiter service is provided in accordance with the desired patient), a professional quality (whether the services meet the needs of patients as diagnosed by professionals), and quality management (whether services provided without extravagance and error, at low prices, and meet the official regulations and other rules) (1)

So the definition of service quality in general is that quality must be linked with customers’ expectations and satisfy their needs and requests. It should be understood here that although this definition of consumer-oriented, but not necessarily be interpreted as thinking that the company service providers (providers) must always obey or comply with consumers’ and wishes. In other words it is important to listen to the voice of consumers and then helped to formulate their needs. In many cases, consumers need help to explain their needs and permintaanya. This is where the importance of professional capabilities service providers (Edvardsson, 1990). (2)

2.2.2. Reviewing the Quality Service

In the case of service quality assessment, Bolton and drew (1991) memamarkan multistage model of customers assessments of service quality and value. This model states that consumers’ overall understanding of the services arranged by a series of steps that relate the understanding of service performance, service quality and value of services. This model is based on the concept of consumer satisfaction as a function of disconfirmation between consumer expectation with the perception of the perceived actual performance. (2)

Parasuraman, Zeithaml and Berry (1988) defines service quality as a global consideration or attitudes as global considerations relating to the superiority (superiority) of a service. They added that the service quality assessment is seen as a level difference of perception with expectations. This concept later became the basis for assessing the quality of service, known as SERVQUAL. (2)

2.2.3. Dimensions of Service Quality

In kaitannnya with service quality, Parasuraman, Zeithaml and Berry (1985) in their exploration of research describing the quality of services and the factors that determine this by defining quality of service as the degree of discrepancy between customers’ normative expectations in service and customer perceptions on the performance of services received. Parasuraman et al also presented a set of service attributes with full (comprehensive) in which customers may use them as criteria in evaluating service performance. The results of this study has identified 10 dimensions of service quality are reliability, responsiveness, competence, access, courtesy, communication, credibility, security, understanding / knowing the customer and tangible. (2)

Further empirical research is the year 1988, researchers developed a research exploration and producing SERVQUAL, namely a scale comprising five dimensions, namely:

a. Reliability is promised to provide immediate and satisfactory.

b. Responsiveness is the ability of the staff helps the patients and provide

service with a response.

c. Assurance, including guarantees the ability of services provided, courtesy and character

credible from the staff, the danger of risk or doubt – doubt.

d. Emphaty, including ease of communication, personal attention

given by staff to customers.

e. Tangibles, including physical evidence and the facilities available for customer service. (2)

Gronroos in Lamb (1993: 93) argues also that the quality perceived by the customer service has two dimensions. First, the dimensions of the process, namely the way customers receive services from the company in this case concerns what happens in a seller-buyer interaction. The two-dimensional result, ie the result of the transaction, involving what is perceived by buyers in their reactions to the company service providers. (1)

In a service industry whose product is intangible, quality is determined by the quality of interaction between companies and consumers. Therefore the quality of services provided mainly at the level of front line officers will determine the quality of interaction, which in turn will affect the company’s image. (1)

2.3. The measurement and Customer Satisfaction.

Satisfaction according to Tse and Wilton (1988) are as customer response to the evaluation of the perceived discrepancy between prior expectations with actual performance that is felt after wearing them. Engle (1990) defines customer satisfaction as a full evaluation and purchase where alternatives purchased at least equal or exceed customer expectations, while dissatisfaction arise if the results (outcomes) does not meet expectations. Kotler (1994) states that satisfaction is the level of state of one’s feelings which is the result of comparison between the performance of products or services related to those expectations. (1)

In the measurement of satisfaction, based on some definition above, it appears that the customer is most qualified or entitled to determine whether a service. This is because they are able to compare between previous expectations with actual performance it receives, thus fitting that the build quality of customer satisfaction should start from the perspective of customers. (1)

2.4. Total Quality Management

Total Quality Management is a management approach that develops from the United States, spearheaded by an expert quality: Deming, Juran, and Crosby from 1950 and more popular since the 1980s, widely implemented to improve the competitiveness of enterprises. There are several definitions of TQM. According to Hashmi (2004:1), TQM is a management philosophy that tries to integrate all functions of the organization (marketing, finance, design, engineering, production, customer service, etc..), Focused to meet consumer desires and goals of the organization. 15 Crosby argues TQM is a strategy and integrated management system to improve customer satisfaction, giving priority to the involvement of all managers and employees, and using quantitative methods (Bhat and Cozzolino, 1993: 106-107). (4)

Dale (2003: 26) defines TQM is a mutually beneficial cooperation of everyone in the organization and is associated with business processes to produce value products and services that exceed customer needs and expectations. According Tjiptono and Diana (2001: 4), TQM is an approach in running the business that tries to maximize the organization’s competitiveness through continuous improvement of products, services, people, processes danlingkungannya. Directorate of Productivity (1998: 3) define TQM as a management system to improve quality and productivity by using quality control in problem solving, involving all employees to give satisfaction to the customer. (4)

Understanding TQM in detail (Handoko, 1998) are:

1. Total: TQM is a comprehensive organizational strategy involving all levels and levels of management and employees, not just end users and external customers, but also the internal customers, suppliers, and even the supporting personnel.

2. Quality: TQM emphasizes quality service, not just a defect-free products. Quality is defined by the customer, individual customer expectations, depending on socio-economic background and demographic characteristics.

3. Management: TQM is a management approach, rather than technical approach to quality control is narrow.

TQM implementation can improve organizational productivity (quantitative performance), improve quality (reduce errors and the level of damage), increased effectiveness in all activities; improving efficiency (lowering of resources through increased productivity), and doing the right things the right way.

2.4.1. The principles of Total Quality Management

The principles of TQM by Krajewski, Lee and Ritzman (1999) is a philosophy that emphasizes on three principles: customer satisfaction, employee involvement and continuous improvement of quality. TQM also involves benchmarking, goods and services, product design, process design, purchasing, and things related to solving problems (problem solving).

Five concepts of effective TQM program are: continuous improvement, employee empowerment, performance comparison (benchmarking), the provision requirement in a timely manner, and knowledge of the tools of TQM (Render and Herizer, 2004).

While Juran (1995), developed the ‘Juran trilogy’ in the management of quality, made through the use of three management processes, namely:

1. Planning quality: product development activities and processes necessary to meet customer needs.

2. Control of quality: quality of performance evaluation activities, comparing the real with the goal of quality performance, and act on the difference.

3. Improved quality: ways to improve performance to a higher quality than previously. Chosby identifies fourteen stages of achieving zero defects involving the importance of the quality, the quality of existing measurements, estimating the cost of quality, eliminating errors and rework processes (Bhat and Cozzoline, 2003).

Broadly speaking Singh (1993: 10) create a framework that contains the essential elements of TQM are as follows:

Table 2.1. Important elements of TQM
ELEMENTS philosophical GENERIC TOOLS

EQUIPMENT QUALITY CONTROL DEPARTMENT
 The quality standards

Taking into account customer

 Relationships with customers

 Orientation prevention

 Quality of setiapsumber

 Improvements

continuous
 SPC Tools

(Statistical Process

Control):

1. Process flow chart

2. Check sheets

3. Pareto analysis and

histogram

4. Cause and effect /

fishbone diagrams)

5. Run charts

6. Scatter diagram

7. Control charts

 Quality function

deployment
Methods SQC (Statistical

Quality Contro):

1. Sampling plans

2. Process capability

3. Taguchi methods

Source: Singh (1993:10)

Key principles of TQM more fully described by Hashmi (2004: 2):

1. Management commitment: planning (encouragement, guidance), implementation (deployment, support, participation), examination (inspection), and measures (recognition, communication, revision).
2. Empowering employees: training, brainstorming, assessment and recognition, as well as a strong working group.
3. 3. Decision-making based on facts: stastistical process control, the seven statistical tools.
4. Continuous improvement: sistimetis measurement and focus on non-quality costs (cost of non-quality); a strong working group; cross-functional process management; achieve, maintain, and improve the standard.
5. Focus on customers: the relationship with suppliers, service relationships

with internal customers, quality without compromise, the standard by consumers.

In the development of TQM principles is not just a process approach and structure as explained earlier, TQM is an approach that also involves kesisteman human resource management activities. Therefore, according to Wilkinson (1992: 2-3), TQM is essentially a two-sided quality of the hard side of quality and soft side of quality. The hard side of quality includes all efforts to improve production processes ranging from product design to control the use of tools (QFD, JIT, and SPC, etc..), And other organizational change (organizational structure, organizational culture). While the soft side of quality focused on efforts to create employee awareness of the importance of customer satisfaction and foster employee commitment to always improve quality. These efforts can be done through education and training, wage systems approach that supports, and employment structure. These efforts include human resource management activities. (4)

Meanwhile, according to Setiawan (2003: 3), TQM is basically an integrated system that is open and consists of three sides: kesisteman, tools and human resources. From the kesisteman, among others, TQM consists of: Company standarts, Quality Assurance, Quality Qontrol Circle, Policy Management Deployment, Suggestion Systems. From the side of the device include: seven QC Tools 0.7-Management Tools, SPC. In terms of human resources is: work attitudes, work motivation, work culture (culture quality), competence, and leadership. (4)

2.4.2. Implementation of Total Quality Management

Some experts have suggested ways to implement quality of TQM based on different approaches. According to Bhat and Cozzalino (1993: 119), there are two fundamentally different approaches. The first is a radical approach

done to improve business methods and habits that do not need and make the company change drastically. Latest research results indicate that the approach was a waste of time and expense of unnecessary stuff. Another approach is incrementally performed by the company that builds quality gradually and incrementally. Most of today’s TQM implementation done incrementally as essentially a process approach to quality cultural change.

Broadly speaking TQM implementation process include:

1. Top management must make TQM as an organizational priority, a clear vision and achievable, set aggressive goals for the organization and each unit, and most importantly show commitment to TQM through their activities.

2. Organizational culture must be changed so that every person and every process to include the concept of TQM. The organization must be changed paradigm, focusing on consumers, all the things that are aligned to meet consumer expectations.

3. Small groups developed on the whole organization to understand the quality, the identification of consumer desires, and measure progress and quality. Each group is responsible for achieving their goals as part of overall organizational goals.

4. Change and continuous improvement must be implemented, monitored, and adjusted on the basis of the results of measurement analysis. While Goetsch and Davis (in Tjiptono and Diana, 2001: 350) describes the implementation of TQM, more detailed and systematic way, into three phases: preparation, planning phase and implementation phase. Each phase consists of several steps with time according to the needs of the organization.

The initial stage of TQM implementation is to assess the state of the existing organization. If the organization has proven effective sensitivity to the environment and able to succeed the previous change, TQM will be easy to implement. Conversely, if the fact that there is not support the required initial conditions, TQM implementation should be delayed and organisasasi ‘disehatkan’ before beginning TQM.

2.4.3. Characteristics and Principles of Total Quality Management

TQM is a concept that attempts to implement management systems

world-class quality. It required a major change in culture and value systems of an organization. According to (Nasution 2001:33) there are four main principles of Total Quality Management (TQM), namely:

1) customer satisfaction.

2) sespek against any person.

3) management by fact.

4) continuous improvement.

Next by Beckhard and Pritchard (in Hashmi 2003: 6-7), the basic steps in managing the transition to a new system of TQM are:

1. Identify tasks to be undertaken include the study of existing conditions, assessing readiness, determine the desired model, and assess the person in charge and resources. This stage is the responsibility of top management.

2. Develop the necessary management structure is also the responsibility of top management. Organization formed to oversee the implementation steering commite TQM.

3. Develop a strategy to build commitment, as has been discussed on the importance of leadership in TQM.

4. Designing a mechanism to communicate the changes. Meeting all of the special staff needs to be done by the executive, need to be designed when the dialogue and delivery of inputs, can use the declaration process (kick-off) and TQM newsletters may be an effective communication tool to maintain employee awareness of TQM implementation.

5. Managing resources for efforts to change are essential for TQM. Outside consultants were involved in determining kebutuhn training, staff and system designing TQM. Employees should be involved actively in the implementation TQM.Setelah trained to manage change, they can forward to other employees. Cortada (1993: 180) argues that there are five stages of transformation through which an organization since its start up to successful implementation of TQM into a superior company. (4)

CHAPTER III

APPLICATION OF TQM TO HEALTH SERVICES FOR CJH

Hajj Operation aims to provide guidance, services, and protection as well as possible through the system and implementation of integrated management for the implementation of the Hajj to walk with a safe, orderly, smooth and comfortable fit and the guidance of religious pilgrims to perform Hajj on their own in order to obtain Mabrur pilgrimage.

Tasikmalaya District Health Department seeks to prepare prospective pilgrims in order to have optimal health status and maintain it for the pilgrims towards the realization of a healthy and independent. This means that the health organization formed to service must be oriented to the quality and productivity based on in-depth knowledge (profound knowledge) in that field which is also the key to the organization’s ability to maintain a high level of readiness to fulfill its duties.

Health is the capital of the pilgrimage journey, without adequate health conditions, not necessarily achieving the maximum of ritual worship. Therefore, each congregation pilgrim must have sufficient physical ability. Policy implementation and risk management is an effort to be able to manage all the health problems of each candidate pilgrims through the stages of screening efforts and health guidance that was held as early as possible. Here we can see the implementation of TQM from quality aspects, not just a defect-free products. Quality is defined by the customer, individual customer expectations, depending on socio-economic background and demographic characteristics

Because every organization is a humanistic system, so there is always a tendency to resist cultural change. Usually, changes can not occur without a change in conduct. Change of conduct will not occur without the guidance of the organization about the conduct of the necessary organizational changes. So long before the start of the implementation of the stages of service for CJH, Kesus staff to approach and dissemination of information to the leader or chief and Sekdin Tasikmalaya regency health office, in an effort to the implementation or the implementation of TQM in these activities. Because according to Professor Shoji Shiba who is also from the MIT / Center for Quality Management believes that the first element and the most important for the successful implementation of TQM is the involvement of top management. Top management should lead to a significant way, and with a far-sighted vision and consistent.

The second element to the successful implementation of TQM implementation strategy is appropriate and prudent. The third element is the mobilization of organizational infrastructure that consists of seven parts, namely: objectives, organizational structure, education and training, promote the implementation of TQM, the dissemination of the success of the organization’s activities, incentives, monitoring and evaluation activities by top management.

These efforts require some changes in the system or ‘re-engineering’ which must be supported by all staff who are determined to make service improvements. In TQM, make a change as one of the technique, requires a holistic and humanistic approach, as follows:

First, the formation of the Committee of Medical Examination for CJH Phase I and II, which is “Cross-Functional Team”. The committee is composed by a central, functional, and bureaucratic organization composed combined with decentralized and results-oriented team, not the result of individual work. This will affect the soul and spirit of the members so that the resulting sense of ownership. (6)

As for the action to be undertaken by the leadership for ‘Cross-Functional Team’ is successful are:

1. Give adequate confidence to the Committee in accordance responsibilities.
2. Empowerment to the Committee according to its responsibilities.
3. Outline clear goals for the committee according to his intellectual level (SK).
4. Hold a feedback system to measure the work of the Committee.
5. Support the Committee with adequate resources.

Second, should be attempted to measure for the leadership and all members of the committee is always getting used to using language in communication with the organization. Languages organizations include the attitude patterns, thought patterns, and patterns of action in environmental organizations / committees. Effective communication depends on the means and methods to make the language of the organization flowing smoothly among members.

Third, we must have the methods, techniques and tools to measure the entire process taking place in the ministry. If do not have the means of measurement, we do not know whether the ministry has been headed in the right direction in an effort to make improvements. For that we need to use ‘benchmarking technique’ as a technique of TQM. Benchmarking is a continuous activity to measure the process, prouduk goods or services of a top flight organization or learning from the best “. For coaching and health monitoring progress continuously and sustainably, it is necessary pilgrimage Health Books (BKJH) which contains data on the results of medical examinations in accessories to describe the health status of prospective pilgrims. Furthermore, in order to get quality health examination results are valid and qualified CJH, required standards and inspection processes. The fulfillment of the standard and proper inspection is an early indication of the implementation process of the examination with the results as expected. This means that in these efforts and raised paradigm framework that describes the perspective of efforts to improve quality through Total Quality Management (TQM).

Conducting measurements of processes within the organization will provide important results as follows:

1. The committee always focused on things that are important.
2. Among the committee members can create an objective view.
3. In the work environment can be created confidence in what and where necessary improvements or repairs.
4. Motivation can be created by members of the organization to implement quality improvement work.
5. Cohesion and control within the organization can be maintained properly because of the motivation.
6. Member commitment can be maintained because of the empowerment and appreciation of the fair.

Fourth, leaders need to confound themselves periodically (immerse) with members of the committee. In this way, the leadership has a full understanding of the environment in which the committee worked, so it can provide guidance that is relevant and appropriate.

Fifth, the committee should be led and managed to have the awareness of the situation lingkungannnya (situation awareness), which has knowledge about itself and the atmosphere of competition, so it can be used as the basis for the planning process. Awareness of the environmental situation is a fundamental part rather than the ability of members of the committee. It plays an important role in directing and mobilize resources to control the situation and the correct destination space. (6)

Examination Objectives

General Purpose Examination, namely the realization of the implementation of inspection through approaches CJH ethical, moral, scientific, and professional qualifications by producing reliable data, accurate and complete to the implementation of coaching CJH on ground water and health management of pilgrims in Saudi Arabia.

Special Purpose Examination, namely:

1. The achievement of improved health status and quality of the identification of risk factors CJH.
2. Realization of data recording health status and risk factors CJH is true and complete in BKJH Indonesia.
3. Realized functions CJH BKJH as medical records to facilitate the development, monitoring, and follow-up in pengobatandan care on the trip, embarkation pilgrimage, while in Saudi Arabia and 14 days after returning from Saudi Arabia.
4. Realization of health requirements (Isthitho’ah) CJH is dispatched.
5. Achieving peingkatan vigilance against the potential spread of infectious disease outbreaks potentially on the international community / Indonesia from diseases carried by exit / entry by CJH Indonesia.
6. The realization of the health information system hajj fast, precise, and accurate. (2)

EXAMINATION PHASE CJH (2)

PREPARATION PHASE

Implementation meetings on 3 and 4 June 2009, at the meeting discussed the results of the implementation of health services previously CJH (evaluation), which contains the data show some achievement or success and also the shortcomings that still need to be improved constantly. Further discussion on the preparations in order to deal with the activities of health services for CJH and making a joint commitment to the success of the implementation of medical examinations for the year 2009/1430 H. CJH

Selanjunya in the meeting also dilaksakan coaching Team Inspection Phase I / PHC. Stabilization of general procedures and inspection procedures for phase I in the clinic. On that occasion presented the concept of service quality and quality improvement principles to be applied, both to members of the committee as well as for the whole process of inspection and management services.

Modification of the model Huarng and Yao (2002), Jabnoun and Sedrani (2005), and Srismith (2005) produced seven variables TQM implementation, namely: focus on customers, continuous improvement, management commitment, training, employee empowerment, performance comparisons, and use statistical tools.

From the theoretical and empirical studies have also found that among the seven variables of TQM implementation is generally the dominant influence on the successful implementation of TQM is a management commitment variable as the opinion of some expert quality, among others: Hashmi (2004:2), Curkovic and Landeros (2000: 67), and Paskard (1995:6-7), also supported the results of research conducted by: Dayton (2003), Baidoun (2003), Munizu (2003), and Metri (2005). This conclusion is placing top management commitment as the first factor that determines the success of TQM implementation. Baidoun (2003) Some of the key to successful implementation of TQM at the micro level that have been identified by the U.S. Federal Quality Institute (Paskard 1995: 6-7) are:

1. Top management support is needed and is represented as part of strategic planning of TQM.

2. Focus on customers is the most important preconditions, because TQM involves improving the quality of consumer demand.

3. Employee or group should be involved from the beginning, especially in terms of training and recognition of the existence of employees, and empowerment issues

employees and work groups. Attention to these issues is important in changing the organizational culture that lead to working groups, as well as focus on customers and quality.

4. Measurement and analysis of processes and products, and quality assurance is the last element that needs attention. Meanwhile, in the opinion Padhi (2004:1-3), for the success of TQM implementation, an organization must terkosentrasi on eight key elements. Elements are divided into four groups based on their function, namely: (1) Foundations: ethics, integrity and trust. (2) Walls: training, working groups, and leadership. (3) Binder and amplifier: communications, and (4) Roof: recognition.

Meeting with Providers of laboratory services in conducting evaluation, coordination, and cooperation in improving health services in the district CJH. Tasikmalaya

Meeting with KBIH in order to improve health services in particular pilgrim coordination and standardization of the implementation of laboratory examination. (Date May 25, 2009 & Date June 11, 2009). RTL further with related agencies.

EXAMINATION PHASE

Prospective pilgrims will get the guidance and health examinations are aimed as a tool to determine the health status of Hajj and coaching. The examination is done in 2 stages:

PHASE I

The medical examination is an effort to phase I assessment of health status and health coaching tools CJH as a requirement to follow the course of the pilgrimage. Delivery is scheduled to held from June 8 June to 31 July 2009 at the Health Center with the address of each CJH domiciled. Checking procedure using a standard protocol which includes examining the medical profession; Anamnesis, physical examination, functional testing, supporting examination, fitness test with the Harvard method.

At this stage diberlakuakan strict inspection standards, inspection standards, and standards of facilities, for purposes of guidance, medical examinations can be repeated as necessary. Head of Puskesmas responsible for implementing health checks for CJH, and reporting results to the District Health Office Tasikmalaya.

PHASE II

The medical examination phase II is an effort of health status assessment as a basis for continuation of the CJH and determining the feasibility of further development of CJH follow the pilgrimage journey. The medical examination conducted by a team of Health examination set by the District Health Office Tasikmalaya.

Establishment of committee / team CJH Health Services Phase II, beginning in July 2009. Committee or the Health Services Team CJH Phase II, including KBIH an ‘internal customer’ who in the organization who use the services or the results of which will be processed further. In this second stage of the process or activity produces more than one customer service internally, then the process is crucial in working in groups.

Implementation is scheduled on December 5 to 10 October 2009 at the health facility level as RS type C, which is appointed by the Regents of Tasikmalaya. Checking procedure using a standard protocol which includes examining the medical profession; Anamnesis, physical examination, functional testing, supporting examination, fitness test with the Harvard method, as in the examination phase I and plus Meningococci Meningitis immunization. (2)

At this stage strictly enforced on the standard examination, inspection standards, and standards of facilities, and determination of eligibility. For the sake of development and feasibility assessment of health at CJH, medical examinations can be repeated as necessary. Further Investigation Team set berdasrkanhasil airworthiness inspections and expert consultation in accordance with airworthiness qualifications specified. Results eligibility determination, the basic consideration to the Health Department reported the accumulation of Health Sub cq Hajj through provincial health office.

At each level of health services for CJH, namely the Inspection Phase I and Phase II service examination conducted by implementing the factors that determine the quality of service (Parasuranam, 1985) namely: Reliabilita, responsiveness, competence, access, kurtosis, communication, credibility, security , care and understanding the customer, and actually followed by the physical facts provided to the customer. (5)

One of the instruments to complement the achievement of TQM efforts in this activity is to manufacture and process flow of appearances (Flow Chart).

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